Page 16 - JSOM Spring 2026

TABLE 2 A Tabulation of Likert Ratings (LR) of Each Device in of qualitative factors in end-user experience in equipment
the Three Domains Tested: Ease of Use, Perceived Efficacy, and selection.
Perceived Reliability
LR, median P value The current Joint Trauma System (JTS) Clinical Practice Guide-
Domain (IQR) (vs. M-Warmer) line on hypothermia management emphasizes the importance
Ease of use of maintaining normothermia during damage control resusci-
M Warmer 2.00 (1.00–2.00) — tation, citing clear links between hypothermia, coagulopathy,
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Buddy Lite 1.00 (0.00–1.50) 0.0005 acidosis, and mortality. Trauma-induced hypothermia, is as-
NAR Quantum 1.00 (–1.00 to 2.00) 0.0003 sociated with higher mortality compared to non-traumatic or
QinFlow 0.00 (1.00–2.00) <0.0001 environmental hypothermia. Some of the key desirable char-
acteristics of a resuscitative blood warming device were to be
Thermal Angel 1.00 (1.00–2.00) 0.1340 portable, lightweight, rugged, to have operating conditions of
Perceived efficacy –10 to 45°C, output temperature of at least 38°C at ≥100 to
M Warmer 2.00 (1.00, 2.00) — 150mL/min (4°C starting temperature), and battery duration
Buddy Lite 1.00 (0.00–2.00) 0.0002 for four units of blood >100mL to 150mL/min. These charac-
NAR Quantum 1.00 (0.00–2.00) 0.1300 teristics are critical to corpsmen and medics that are operating
QinFlow 1.00 (0.00–2.00) 0.1327 in prehospital environments. Additionally, with more remote
Thermal Angel 1.00 (1.00–2.00) >0.999 battlefields and in harsh operating environments, from island
Perceived reliability chains to arctic climates; the devices should be able to operate
M Warmer 2.00 (1.00–2.00) — in all theaters.
Buddy Lite 0.00 (–1.00 to 1.00) <0.0001 Current military equipment sets (AMALs) still widely field
NAR Quantum 1.00 (–1.00 to 2.00) 0.1785 devices like the Buddy Lite, despite documented limitations
QinFlow 0.00 (–1.00 to 1.00) 0.0001 in both performance and perceived reliability. While histor-
Thermal Angel 1.00 (–1.00 to 2.00) 0.1399 ical data and acquisition cycles may explain the persistence
of legacy devices, the present work offers an updated, user-
centered lens that may inform modernization efforts. As the
be less favored when compared to the M Warmer and NAR DoD continues to refine Prolonged Casualty Care doctrine
Quantum. and gear standardization across services, integrating user feed-
back into device selection will be critical.
Overall, the qualitative data converged into a core theme of
“Optimized Operational Efficiency.” These findings suggest Limitations
that design features emphasizing a compact form, intuitive as- This study has several limitations. Although all survey re-
sembly, and seamless functionality play a pivotal role in shap- sponses were analyzed, the sample size was relatively small
ing end-user preferences. These qualitative data align with the (n=35) and concentrated in East Coast NSW teams, which
quantitative results, as the majority of NSW medics (n=16, may limit generalizability to other medic populations or con-
45%) selected the M Warmer as their preferred device over ventional forces. Additionally, Likert scale-based surveys in-
all others (χ =14.2, P=.0067), highlighting user preferences herently capture perception rather than performance and are
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for portability, user-friendly operation, and dependable perfor- subject to intrinsic bias. As with all small survey-based studies,
mance in austere forward-deployed environments. the limited sample size and self-reported nature of the data
restrict the ability to draw broad generalizations or establish
causal relationships.
Discussion
Delivering trauma resuscitation in forward-deployed environ- Future studies should explore actual in-theater performance
ments necessitates equipment that is effective and operationally that integrates objective thermal and flow metrics with user
feasible in logistically limited settings. This study represents the satisfaction scores to build a more comprehensive assessment
first known effort to directly assess NSW medics’ subjective of device effectiveness.
evaluations of currently available blood-warming devices. The
results revealed significant differences in perceived use among Conclusion
warming devices, with the M Warmer ranking the highest in
all categories. The present findings suggest that medic pref- In summary, this study highlights the user preferences of NSW
erence is influenced by operational design and intuitive use, medics in selecting small portable blood warming devices. This
which may be equally or more important in determining a de- sample size of medics emphasized the need for devices that
vice’s suitability for far forward environments. balance speed, durability, and simplicity in high-stress environ-
ments, ultimately selecting the M Warmer as their preferred
The core theme of Optimized Operational Efficiency encap- device. User feedback underscored the critical role of intuitive
sulates the notion that not only performance, but also adapt- design and minimal logistical burden in device selection. These
ability and device simplicity, are essential in dynamic and findings should inform both procurement decisions and the
resource-constrained environments. This thematic conver- design of next-generation resuscitative technologies.
gence between qualitative and quantitative data reinforces the
finding that device choice is shaped not only by clinical perfor- Author Contributions
mance but also by applicability to real-world mission profiles. WP conceived this study and wrote the protocol with EF. WP,
Nearly half of surveyed NSW medics (45%) selected the M LG, EF, and BD orchestrated all approvals for observations.
Warmer as their preferred device, validating the importance WP, LG, EF, and BD recruited participants and collected data.

14 | JSOM Volume 26, Edition 1 / Spring 2026