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By Paul Alongi<\/strong> Injured troops could receive better care and benefits with new research aimed at better documentation on the battlefield.<\/b><\/p>\n<\/div><\/section><\/div> GUNSHOTS CRACKLED as a man dressed in camouflage sat on the ground with a red stream trickling from his ear and a purple splotch marking the skin near his cheekbone. A medic asked what happened. The goal is to begin laying the groundwork for a hands-free system that would document battlefield injuries to improve medical care and ensure troops receive the benefits they are due.<\/b><\/p>\n<\/div><\/section><\/div> The system is in its early stages, but the idea is that medics would wear hands-free equipment that records audio and video during rescues. The audio would be automatically transcribed, separating words from battlefield sounds, and relevant information would be provided to doctors to help them decide on proper care for the injured. MAKING IT REAL<\/b> A LONG-STANDING NEED<\/b> Researchers Ron Gimbel (left) and K.C. Wang<\/p>\n<\/div><\/div><\/div> SIMULATING THE CHAOS OF BATTLE<\/b> “This is a collaborative effort aimed at advancing health informatics for the nation\u2019s military.”<\/b><\/p>\n<\/div><\/section><\/div> ONGOING RESEARCH FOR MAXIMUM CAPACITY<\/b>
\n<\/b>Photography by\u00a0Craig Mahaffey \u201998<\/b> |\u00a0Ashley Jones<\/b><\/p>\n<\/div><\/section><\/div>
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\n\u201cA clown ran up, balloon popped,\u201d the man replied incoherently.
\nIt sounds like a scene out of a war zone, but the man was an actor at a simulation center in Columbia, where researchers from Clemson University and Palmetto Health were recording the events as part\u00a0of a $1.6 million project funded by the Department of Defense.<\/p>\n<\/div><\/section><\/div>
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\nThe information would then become part of the permanent record, helping military personnel prove they were injured in battle, which is vital for claiming their entitled benefits.<\/p>\n<\/div><\/section><\/div>
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\nKuang-Ching \u201cK.C.\u201d Wang, a professor of electrical and computer engineering at Clemson, says the research is a two-year pilot project. Researchers don\u2019t expect to produce a completed product but will show how various components could work, he says.
\n\u201cWe envision in the long run the Department of Defense will have a big data center that will house all the recordings in one place,\u201d Wang says. \u201cSo, if they need to go in and take out any specific information about a soldier or a certain injury, they can do that.\u201d
\nRon Gimbel, chair of the Department of Public Health Sciences at Clemson, says that when troops seek disability benefits, lack of documentation makes it harder for assessment teams to determine whether injuries were sustained on the battlefield.
\nThere is often no documentation, he says, because battlefield medics are busy caring for their patients and don\u2019t have time to write notes.
\n\u201cI was approached about this disability challenge maybe 10 years ago,\u201d Gimbel says. \u201cNow we can actually try to solve it. That\u2019s really exciting. If we can reduce the hassle factor around disability claims, that would be great.\u201d
\nWang is the principal investigator on the project, and Gimbel, a former naval officer, is co-principal investigator. William Gerard, the lead for Palmetto Health, is the medical director for emergency services for Palmetto Health and the medical director for Richland County EMS.
\nOne of the key advantages that Palmetto Health brings to the project is deep experience with the Cerner hospital-documentation system, the same platform used by the Department of Defense.
\nGerard says that once a note is transcribed, it would be fed into the Cerner documentation system, which would also include other information, such as patient history, medications and immunizations. The Cerner system adds realism to the research, he says.
\n\u201cWe\u2019re trying to make this as real as it would be so when it all comes together it\u2019s going to be reproducible in the actual environment,\u201d he says.<\/p>\n<\/div><\/section><\/div>
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\nTHE DOCUMENTATION SYSTEM would come too late for World War II veteran Roy Thomas \u201cSmiley\u201d Pruitt, and no one will ever know if it could have helped him. But Pruitt\u2019s struggles illustrate the difficulties some veterans and their families face, even when the war is over.
\nPruitt suffered from dizzy spells, nausea and depression when he returned to Pendleton after finishing his military service in northern Africa and Europe, where he sometimes drove for Gen. George Patton, says his daughter, Nelwyn Landreth.
\nHis wife, Myrtis, tried to get his medical problems classified as service-connected but was unsuccessful, Landreth says. By the age of 48, Pruitt was totally disabled, she says. Medical tests later in his life showed shrapnel frgaments in his head, but by that point his medical records from the war had been destroyed in a fire in St. Louis in the early 1970s.
\nTo keep the family afloat, Myrtis worked at Gerrish-Milliken textile plant. Later, she took a job in the audit department at Sears.
\nOne Sunday, she collapsed in church from the stress of trying to keep her husband at home, Landreth says.
\nMyrtis retired at 60 because her husband had developed Alzheimer\u2019s disease and couldn\u2019t be left home alone. He died of a heart attack at 68 years old.
\n\u201cI feel so sorry for Daddy,\u201d Landreth says. \u201cJust think about what he would have been and what he could have done. To come out of the service and to be so broken and not to be able to get any help.\u201d<\/p>\n<\/div><\/section><\/div>
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\nTHE RESEARCH TEAM gathered in late November to record audio and video of simulated rescues at the Palmetto Health-University of South Carolina School of Medicine Simulation Center.
\nEach run-through began in a debriefing room outfitted to simulate a battlefield. The sound of bombs thudded in the background. A picture of black smoke rising from behind several vehicles was projected on the wall.
\nActors, including Rory Gilbert, played roles of wounded soldiers. As Gilbert sat on the ground, Simulation Center medical director Christopher Gainey called, \u201cOver here!\u201d
\nTwo medics wearing cameras on their helmets helped Gilbert to his feet and brought him into a stretcher in the hallway. They took him to another room that acted as the evac helicopter.
\nTwo other medics with cameras attached to their flight suits secured Gilbert and sat behind him, as he was \u201cflown\u201d away, the sound of rotors cutting the air.
\nThe medics then wheeled Gilbert\u2019s stretcher down the hall and out of the building to a mobile center in the parking lot for simulated surgery with Steve Shelton, medical director of Emergency\/Disaster Management at Palmetto Health.
\nShelton says that even in a controlled environment, it can be difficult to get true information from the scene. It would be even harder with the challenges that come from a battlefield and traveling long distances, he says.
\n\u201cSometimes it\u2019s important to know what\u2019s involved in that wound,\u201d Shelton says. \u201cWhat was the scenario that went into that? What was the other care that was provided before that may not necessarily be visible?\u201d
\nKelly Hawsey, who has worked as a critical-care air transport nurse, says that medics don\u2019t have much time for documentation as they assess patients and load and secure them on aircraft.
\n\u201cA lot of times we would have a piece of tape we would put on our flight-suit pant leg,\u201d says Hawsey, who is now telehealth lead at Palmetto Health. \u201cWe would write notes on that as we were going and pull that off later and use that to trigger our documentation. It can be chaotic. It\u2019s not as streamlined as it is in the hospital.\u201d
\nMelissa Smith, an associate professor of electrical and computer engineering at Clemson, watched the simulated rescues unfold on a video screen in a conference room. She is overseeing voice recognition and video detection tasks for the team.
\nHer job includes developing technology that separates words from battlefield sounds. Anyone who has used commercially available voice recognition, such as Siri, knows that words can be misunderstood even in the best of conditions.
\n\u201cJust in a normal environment, it\u2019s very difficult to recognize natural language,\u201d she says. \u201cThere are more advanced techniques we\u2019re going to be applying, including some specialized audio techniques, to try to reduce some of the background noise such that we can get that conversation out of the environment.\u201d<\/p>\n<\/div><\/section><\/div>
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\nTHE SIMULATION was the first of two. The team plans to have another in about 18 months. Simulation is a critical piece of the research, and the first went well, Gainey says.
\n\u201cYou could sit around a table and record the audio, or you could see what it\u2019s like to have the ambient noise, the background noise, the providers having to move from point A to point B, the multiple handoffs, other people\u2019s conversations,\u201d he says. \u201cThe only way to really, truly understand that is to run it through simulation.\u201d
\nResearchers are calling their system Complete and Resilient Documentation (CARD) for Operational Medical Environments.
\nBrett Wright, dean of the College of Behavioral, Social and Health Sciences, says the research positions the team for maximum effectiveness \u2014 and documentation.
\n\u201cOur college is proud to have a hand in taking some the guesswork out of documenting what occurs during military engagements,\u201d he says. \u201cWounded veterans deserve to receive care based on accurate information retrieved efficiently, and this research will be a game changer in that regard.\u201d
\nAnand Gramopadhye, dean of the College of Engineering, Computing and Applied Sciences at Clemson, points out the cross-disciplinary nature of the research.
\n\u201cThis is a collaborative effort aimed at advancing health informatics for the nation\u2019s military,\u201d says Gramopadhye. \u201cThe amount of funding is a testament to the team\u2019s hard work and relevance of the research.\u201d<\/p>\n<\/div><\/section><\/div>
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