Technical innovations that may facilitate real-time telementoring of damage control surgery in austere environments: a proof of concept comparative evaluation of the importance of surgical experience, telepresence, gravity and mentoring in the conduct of damage control laparotomies

Technical innovations that may facilitate real-time telementoring of damage control surgery in austere environments: a proof of concept comparative evaluation of the importance of surgical experience, telepresence, gravity and mentoring in the conduct of damage control laparotomies

Can J Surg 2015;58(3):S88-S90 | PDF

Maj Andrew W. Kirkpatrick, MD; Anthony LaPorta, MD; Susan Brien, MD, Med; Tim Leslie, MSc; Col Elon Glassberg, MD, MHA; Jessica McKee, MSc; Chad G. Ball, MD, MSc; Heather E. Wright Beatty, PhD; Jocelyn Keillor, PhD; Derek J. Roberts, MD, MSc; Col Homer Tien, MD

Summary

Bleeding to death is the most preventable cause of posttraumatic death worldwide. Despite the fact that many of these deaths are anatomically salvageable with relatively basic surgical interventions, they remain lethal in actuality in prehospital environments when no facilities and skills exist to contemplate undertaking basic damage control surgery (DCS). With better attention to prehospital control of extremity hemorrhage, intracavitary bleeding (especially intraperitoneal) remains beyond the scope of prehospital providers. However, recent revolutions in the informatics and techniques of telementoring (TMT), DCS and highly realistic accelerated training of motivated first responders suggests that basic lifesaving DCS may have applicability to save bleeding patients in austere environments previously considered unsalvageable. Especially with informatic advances, any provider with Internet connectivity can potentially be supported by highly proficient specialists with content expertise in the index problem. This unprecedented TMT support may allow highly motivated but inexperienced personnel to provide advanced surgical interventions in extreme environments in many austere locations both on and above the planet.


Accepted for publication Nov. 18, 2014

Acknowledgments: The research group is supported by the Canadian Forces Health Services.

Affiliations: From Regional Trauma Services, Calgary, Alta. (Kirkpatrick, Ball, Roberts); Department of Surgery, University of Calgary, Calgary, Alta. (Kirkpatrick, Ball, Roberts); Canadian Forces Health Services (Kirkpatrick, Tien); Rocky Vista School of Osteopathic Medicine, Parker, Colo. (LaPorta); Royal College of Physicians and Surgeons of Canada, Ottawa, Ont. (Brien); NRC Aerospace Flight Research Laboratory, Ottawa, Ont. (Leslie, Wright-Beatty, Keillor); The Trauma & Combat Medicine Branch, Surgeon General’s HQ, Israel Defense Forces, Ramat Gan, Israel (Glassberg); Innovative Trauma Care, Edmonton, Alta. (McKee); Trauma Services and the Department of Surgery, Sunnybrook Medical Centre, Toronto, Ont. (Tien).

Competing interests: J. McKee is affiliated with Innovative Trauma Care, who makes the iTClamp; but this product is not mentioned in any way in the manuscript. A.W. Kirkpatrick was the principal investigator of a randomized controlled trial on open abdomen management funded by Acelity, and he declares consulting with Acelity after completion of the trial.

Contributors: All authors contributed substantially to the conception, writing and revision of this commentary and approved the final version for publication.

DOI: 10.1503/cjs.014214

Correspondence to: A.W. Kirkpatrick, Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, AB, T2N 2T9; andrew.kirkpatrick@albertahealthservices.ca