Robotic, Semi-Autonomous and Autonomous Medical Systems: Where Will the Soldier-Medic Fit in the Future Fight?
Amber S. Linde and David M. Thompson
The following is presented as part of the TRADOC G2's "Soldier 2050" Call for Ideas. This material will form a compendium of thoughts and ideas that will support the exploration of future bio-convergence implications on the Army of 2050 at the Mad Scientist Conference 8-9 March 2018 at SRI International. The conference can be livestreamed at http://www.tradoc.army.mil/
Introduction
The Medical Simulation and Information Research Program (MSISRP) is actively investigating the state of the science and the state of the market regarding the use of medical robotic, semi-autonomous, and autonomous battlefield medical systems and technologies on the future front. In order for these future technologies to be useful, they must possess capabilities that can operate in real-time to either directly assist the medical provider or perform as the medical provider in order to deliver the correct medical interventions to the casualty at the time they are needed. Such a collaboration of human/machine interfacing will result in the success of the medical mission at the tactical, operational and strategic levels of war.
The ultimate priority for the medical provider is their patient(s). Treatment of the patient(s) without overextending the military health system (MHS) is a critical battlefield and military capability. A combat casualty is never a typical medical case, and unlike civilian injuries, many battlefield trauma injuries sustained are very complex in nature and usually involve multiple wounds and occur in unsanitary conditions. Further complicating medical treatment concerns the type of battlefield (dense urban, widely distributed, isolated, or no-communications) environment the injury occurs and the possibility of exposure from chemical or biological attacks. Such complexities can result in little to no resupply of medical supplies for an extended period of time; making the only available medical supplies being those which are already on-hand because they were carried into the battle. All of this drives a strong need for adaptive autonomous treatment and/or evacuation capabilities in an operational environment.
While near-future, semi-autonomous systems have the possibly of being attainable with today’s technology, a truly autonomous closed-loop system does not yet exist. Applying advancements in technology toward novel and innovative medical interventions in the areas of autonomous medical treatment and/or evacuation procedures in a high stress, hostile environment must be realized. Research will need to be addressed now so tomorrow’s technologies can be fielded to the Soldier of 2050.
The multifaceted nature of a battlefield is being magnified due to the dangers of the future fight occurring in a Multi-Domain Battlefield (MDB). For example, in the digital realm, the battlefield medical provider will not only be facing physical challenges (i.e. explosives, gun shots) but will also have to face the grim fact that attacks on equipment that can involve the disruption of a power source or attacks that block or hacks a signal to send or receive health data can render the field medical provider incapable of using advanced treatment tools. The future 2050 Soldier-Medic will have to have situational awareness of how the enemy can sabotage medical care in the MBD in order to better protect the health of their patient.
Background
Relevant capabilities include the capture of important medical data, semi and fully autonomous systems, and the seamless integration of technologies with the Warfighter.
Data collection using sensor technology is not a novel concept, and is in development in military laboratories, while commercial personal health data collectors are used by military personnel, just as they are used by the civilian population. Data from this technology could provide better insight and tracking of both known and unknown limitations of the human body. These technologies present the potential for the development of better personal protection equipment for the Warfighter; however enemy forces will continue trying to circumvent that protection.
This leads into concentrating semi-autonomous and autonomous systems with three main goals: 1) replace a human in the field with robotic systems; 2) assist a human in the field with specialized systems; 3) enabling the warfighter to be a remote operator of robotic, or a fleet of robotic, systems (eg: drone swarms) to assist or perform medical procedures. Underlying each of these goals is the use of real-time data, collected from the technologies described previously, to improve current systems and to enable future semi-autonomous and autonomous systems into theater settings. These systems would conduct point of care treatment and evacuation tasks, such as buddy aid and patient movement, which used to be a primary role of the medic or medical provider. As technologies improve, the Soldier-Medic of 2050 could see specialized semi-autonomous and autonomous technologies that can provide lifesaving surgical procedures.
The future battlefield consisting of medical support provided through these types of systems calls for today’s research to explore human/machine interfaces while addressing difficult questions:
The need to prepare the future soldier and combat medic to work with real-time data, operate with semi-autonomous and autonomous systems, and be capable of integrating tasks with machines, is expected to be an evolutionary process. As a part of that process, the MSISRP is developing platforms that include integrated military medical simulation systems while taking advantage of medical data collection and synthesis.
Soldier-Medic 2050
The Soldier and Combat Medic of 2050 will hone their medical skills, and prepare for the medical mission within an integrated and federated Defense Health Agency (DHA) Medical Simulation Enterprise (MSE). The MSE is a Family of Systems, comprised of six System of Systems (SoS). Each SoS exists within a planned and sustained Department of Defense (DoD) Program of Record, which has the required capability to support training at the individual, team and unit levels, and enable exercises across Joint, Inter-governmental and Coalition Partner organizations. Together, the six programs will replicate the complete Continuum of Care, enabling an effective “train as you fight” capability to the Military Health System (MHS). The MSE consists of the following programs:
JETS: Joint Evacuation & Transport Simulation
Provide DoD with standardized Joint Patient Movement simulation training capabilities, replicating the chain of evacuation.
POINTS: Point of Injury and Trauma Simulation
Develop Point of Injury training capabilities to sustain and improve first responder and combat medical (eg: medic & corpsman) skills for a disbursed and MDB.
THOR: Theater Hospital Operations Replication
Develop in-theater, Role 2 and Role 3 simulation training capabilities; enable more rapid deployment of prepared and skilled medical teams, task forces and hospitals.
SHOTS: Simulated Hospital Operations & Treatment Systems
Provides commonized Military Treatment Facility based simulation capabilities across the DoD, for the medical provider and clinician in fixed facilities.
WarPrep: Warfighter Performance, Resilience Effectiveness and Protection
Efforts translate to real-world medicine, with research and development efforts providing methodologies, techniques, and tools to deter skills degradation, enhance medical capabilities, increase patient protection and pre-intervention rehearsal.
ReST: Rehabilitation Simulation for Treatment
Works to provide simulation capabilities to train and improve healthcare provider skills in the area of rehabilitation and restoration of injured Warfighters within the Military and Veterans Health Systems.
The Soldier-Medic will not work in a silo of patient care. War is expected and is being prepared to be fought on a MDB front and thus the Soldier-Medic will treat causalities in a MDB focused MHS. The Soldier-Medic will serve in an operator role where pre-hospital care can be delivered remotely via drone/robot. Operators in this echelon of care are expected to have access to on-site medical providers to include but not limited to specialty care from doctors, nurses, radiologist etc. that the Soldier-Medic can quickly defer to if more advanced care is needed and/or PFC or mass casualty conditions prevent the timely evacuation of a patient from the field.
The Soldier-Medic of 2050 will be trained in simulated environments that will require many types of technology to be integrated into effective and interactive SoS to include simulation manikins, robotic field medics, virtual and augmented realities. Hybrid simulation training will be the norm and incorporate team learning with man-machine interfaces designed in the scenarios. Machine learning models will be implemented embedded in the learning environment to gauge the skill level of a learner and customize training to best fit the needs. Custom training will no longer be “just in time training”, customized training will be available in real-time at any time and will incorporate the appropriate scenarios that will fulfill the learning requirements of the particular mission before, during and after the Soldier-Medic is assigned to a medical field unit, remote operating unit, or a hospital.
As semi-autonomous and autonomous medical technologies are introduced into the battlefield, these technologies will be serving many roles for the Soldier-Medic. The traditional Medic roles and responsibilities are anticipated to be vastly different from today’s Medic. 2050 battlefield will see a medical team consisting of onsite (medic), and remote (medical operator) teams. Both the field medic and medical operator will use medical technologies that are specialized in the following areas: Proper use of medical devices, medical supply delivery, semi-autonomous systems, autonomous surgical closed-loop systems, and advanced telehealth support.
As the medical care in the pre-hospital setting integrates with technologies as a partnering smart tool, definitions of the roles and responsibilities of the medical providers have to be standardized and understood to ensure no patient is inadvertently harmed by the fielded technologies due to poor technology management and/or operation. For example, it cannot be expected for each robotic interface, regardless if it is semi-autonomous or autonomous, to have one operator to one technology. Technologies will be in constant communication with each other and the medical operator will need to be trained to understand their role in managing pre-hospital care remotely while also preparing medical care procedures if there is not an available field medic to perform or assist in certain procedures. Human-machine interfaces must be defined to prevent uncertainty in medical treatment delivery.
Human-machine handovers will need to be clearly defined. This is especially important in a field environment where the robotic tool being used may be damaged or destroyed in a hostile environment. In such a case the operator will need to operate the tool manually to aid the medical provider while sending an alert mechanism so another robotic tool can quickly take the place. Like handovers from human medical providers to the next role, machine interfaces will need to be designed to collect data from the damaged machine immediately so relatively little time is taken away from the care of the patient.
The importance of early hybrid training of robotic and human medical teams is crucial as the medical team will not necessarily be working in the same physical location of the patient. The behavior of the field medic will undoubtedly be based on a different perception than the medical operator or the telehealth advanced support provider. Early research now can determine steps to predict human behavior through hybrid training (human/machine interfaces) in order to circumvent the possibly that the late integration of medical technologies on the battlefield could negatively impact their use.
Conclusion
Technology is influencing how medicine is practiced. The Services have the opportunity to incorporate hybrid human machine interface simulated medical training using semi-autonomous and autonomous systems within the MSE platform. The military is deeply rooted in its traditions; the medical culture even more so. As we promote the use of machine systems to provide the needed medical support to our service members in the line of fire, early integration of human-machine team training will prepare the future soldier-medic for the next battle.
Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the U.S. Army or the U.S. Department of Defense.