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Triage from a Distance

0712-dhs-triage-lead

Remember the days when the Star Trek medical tricorder, the fictional device that could read and diagnose patients instantly, seemed unrealistic? Well, the DHS Science & Technology Directorate (S&T) is working toward making this and other futuristic devices a reality.

In development by the DHS S&T, the Standoff Patient Triage Tool (SPTT) will allow emergency responders to rapidly triage victims from a safe distance, particularly in harsh, difficult to reach, high-hazard areas.

Created in partnership with the DHS S&T TechSolutions program, the Technical Support Working Group, the Boeing Company and Washington University’s School of Medicine, the SPTT will measure key patient vital signs including pulse, body temperature, and respirations in 30 seconds or less and from up to 40 feet away from the victim’s location.

The SPTT device is just one part of a larger suite of tools envisioned by DHS S&T leaders. “Our vision is to deliver technologies like the standoff patient triage device to the first responder community that aid them in doing their job faster, safer and more efficiently and effectively,” says Greg Price, director of the TechSolutions program.

With the SPTT, first responders can get patient information during such events as chemical spills or active shooter scenarios without risking their own safety. Price points out that, in hazardous conditions, “responders can’t always get directly to a victim and use traditional techniques where they would get up close to each individual to observe their respiratory rate and physically touch each individual to obtain a pulse and determine their body temperature.

“Responders at disaster scenes, terrorist incidents or other scenes where physical access to patients will be delayed will be able to get vitals in a clear format to see who needs to be treated immediately after the scene is secure and/or access can be gained,” he says.

Making the Measurement
To measure vital signs, the SPTT uses three key subsystems: a laser Doppler vibrometer, an infrared camera and an image stabilization system. The laser Doppler vibrometer measures the velocity and displacement of vibrating objects by monitoring how far light travels to and from the device. It’s a technology that has been used in aircraft and automotive components, acoustic speakers, radar technology and land-mine detection.

The slightest movement—chest muscles when a patient breathes or even the blood in a patient’s carotid arteries—causes a shift in the laser’s wavelength feedback. The device then uses an algorithm to convert the measurements into vital sign data.

The SPTT’s infrared camera measures the body’s surface temperatures and the system’s stabilization system compensates for the movement of the user’s hands while trying to keep the device perfectly still. Similar systems are already in use in digital camcorders to help users take better pictures.

“This technology will assist responders as they aim the SPTT while their adrenalin is pumping,” says Price. “That will be helpful when they are at a distance of up to 40 feet from a victim.”

Besides providing accurate data, the SPTT can help overcome common human biases at an accident scene. “Human nature is to pay attention to the person who is screaming and bleeding, but someone else with a less obvious internal injury may need to be the first priority,” says Price.

Researchers have found that best place to capture strong readings of vital signs is on the carotid artery, although strong signals have been obtained from the head, chest and abdomen—and even a foot. Researchers are also testing whether readings could be taken when someone is lying in an awkward position or wearing multiple layers of clothing. So far, the results are encouraging.

The current version of the SPTT is about the size of two reams of legal size printer paper stacked on top of each other (see diagrams above). Boeing is currently integrating the components into a preproduction prototype device for field testing. The company will then refine the device based on feedback from test users.

SPTT evaluation is expected to be completed by mid 2012. If field testing is successful, a commercial product could be available eight to 12 months later. As the technology evolves, the SPTT will likely become smaller and faster.

Price envisions that once first responders have a chance to use the device and gain trust in its accuracy, a time will come where the device becomes another tool in the first responder arsenal that allows for vital sign measurements in high-risk environments.

Improving Capability Gaps
If a technology can meet 80% of the stated requirements within a 12- to 15-month time period, DHS’s TechSolutions program can invest up to $1 million to help prototype that technology.

“It gives the boots-on-the-ground first responder a voice,” Price says. First responders can submit their own technology ideas via www.FirstResponder.gov, where users can also find articles and blog posts about emerging technologies and information on federal resources related to grants, equipment standards and testing.

DHS also sponsors First Responder Communities of Practice, which is the first cross-discipline social media platform designed specifically for emergency responders and homeland security professionals. In this secure Web environment, first responders can coordinate emergency planning and training development using online messaging and share files, as well as participate in wikis, threaded discussions and forums.

The site, which can be accessed from the www.FirstResponder.gov platform or directly via https://communities.firstresponder.gov, features an EMS community where members can discuss best practices and topics of interest to those who work in the discipline. Communities also exist for many other disciplines and specialty areas in the emergency response and emergency management areas of interest. For more information on these or other programs for emergency responders, visit www.FirstResponder.gov.

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