Page 76 - JSOM Winter 2022

Expanding on the above description, the STEAM device is future high intensity conflicts will place tremendous logistical
comprised of five groups of components, all of which can be and operational burdens across the battlespace. One strategy
disassembled and reassembled in the prehospital environment to offset a unit’s dependence on higher echelons for medical
for cleaning and sterilization or repair by the end-user (Figure care is through the miniaturization of current technologies and
2). As such, the STEAM device can be reused. These groups in- making them easily portable. Additionally, developing new in-
clude the outside shell which houses the internal components novations that allow current capabilities previously delivered
the heating coil and furnace apparatus, the humidifier element, in-hospital to be employed close to the point of injury is an-
the electronic control circuit, and a rechargeable battery sys- other strategy. To enhance the performance of future medical
tem that is detachable to power the device. Furthermore, given devices and to serve as a framework to evaluate/develop inno-
the above-mentioned sensor technology STEAM can measure vative technologies, we propose that the principles of techno-
and display capnography, and barometric weather and altime- logical convergence and emergence enter the discussion.
ter functions. The device’s valve system also allows for positive
end-expiratory pressure (PEEP) control. In addition, the on- We define technological convergence as the combination of
board computer and sensor network can provide ventilatory multiple existing technologies into a single device in which
rate and volume control. the modern technology is more compact, portable, and lighter
than the sum of the existing technologies, thus likely offering
increased performance for the end user. STEAM adheres to
Discussion
the principle of convergence by design. STEAM integrates an
We proposed, designed, and digitally prototyped STEAM airway heater, humidifier, PEEP valve, capnography, a baro-
to begin the effort to meet the needs of our prehospital and metric weather station, and a barometric altimeter. STEAM is
austere medical professionals, allowing them control of in- estimated to weigh less than 100 grams, fully charged, signifi-
spiratory air at physiologic temperatures and humidity levels. cantly improving functionality based on size alone.
This innovation will bring the hospital standard, by medical
guideline, far forward. We recognize that revolutionary ad- Technological emergence is a term denoting the capabilities
vancements have been made to improve battlefield survival; that arise when multiple technologies work in conjunction
however, there remains a need for innovation surrounding with one another so that the overall capabilities and perfor-
hypothermia prevention and management. Furthermore, this mance are greater than the sum of the individual parts. Be-
issue is compounded by an increasing battlefield reliance on cause of its internal sensors and inherent design features,
PCC principals. STEAM is a novel solution that will integrate STEAM also adheres to the principle of emergence by enabling
with existing hypothermia management systems to help reduce the use of medical telemetry to assist the medic or other health
patient morbidity and mortality in the prehospital and austere professionals. STEAM is also able to utilize its internal tem-
environments. perature, humidity, and pressure sensors to sense the input air
volume, flowrate, and pressure entering the patient. By taking
The potential that STEAM holds for the future of battlefield. advantage of the internal rotating safety valve, STEAM has
Austere medicine should not be underestimated and the need the emergent properties of allowing the end-user to set a rate
for such a device is long overdue. By doctrine STEAM is com- limiting, volume, and pressure limiting function to prevent
patible with or incorporates all elements of the essential PCC barotrauma and volutrauma (Table 1). If manual ventilation
capabilities regarding airway ventilation and oxygenation, and is replaced by an external pressure source, STEAM can also
monitoring capability via capnography (Table 1). STEAM can serve as a ventilator by automatically controlling the respira-
operate to the maximum (“Best” rating) standards from ruck tory rate, flow, and pressure the patient receives as set by the
to plane (Role 1a–1d), and onward from Roles of Care 2–4. 22,24 end-user.

With near-peer threats rapidly developing and fielding ad- The major limitation to this work is that it is theoretical in
vanced anti-access/area-denial, or A2/AD, it is likely that nature. It is the proposed solution to an identified prehospital

FIGURE 2 Exploded view STEAM
(CAD) illustrating the devices’ ability
to be disassembled and re-assembled
in the pre-hospital environment for
cleaning or repair. 35

CAD = computer-aided design,
STEAM = System for Thermogenic
Emergency Airway Management.

74 | JSOM Volume 22, Edition 4 / Winter 2022