Page 77 - JSOM Winter 2022

TABLE 1 STEAM Capability Overlap and Integration With PCC Financial Disclosure
Guidelines The authors Pierce, Stevens, and Tilley are listed as inventors
Convergent Properties Emergent Properties for the STEAM device, patent pending. These authors are enti-
Ability to heat and humidify Inspiratory air temperature and tled to future royalties related to STEAM.
input air humidity control
ventilator and manual BVM Telemetry capability Funding
compatibility This work was supported by the Uniformed Services Uni-
intermediate and advanced Breath rate control function versity of the Health Sciences (USUHS) Medical Innovations
airway compatibility Interest Group, USU School of Medicine Capstone Program,
CO capnography Breath volume control function
2 The Henry M. Jackson Foundation for the Advancement of
Barometric weather station Output pressure limiting Military Medicine, Inc., and the US Army Medical Research
function and Development Command.
Barometric altimeter
PEEP capability
References
capability gap, which has just recently passed the digital pro- 1. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield
totype manufacturing and patenting phase of development. (2001–2011): Implications for the future of combat casualty
care. J Trauma Acute Care Surg. 2012;73(6 Suppl 5):431–437.
However, this milestone in itself should not be unacknowl- doi:10.1097/TA.0b013e3182755dcc
edged, considering we can now begin to have a profession-wide 2. Gerhardt RT, Strandenes G, Cap AP, et al. Remote damage con-
discussion regarding future advancements in this uncharted trol resuscitation and the Solstrand Conference: defining the need,
territory of medical technology. the language, and a way forward. Transfusion. 2013;53(Suppl 1).
doi:10.1111/trf.12030
Future planned works include physical device prototyping and 3. Mikhail J. The trauma triad of death: hypothermia, acidosis, and
development of the STEAM device’s ability to heat and humid- coagulopathy. AACN Clin Issues. 1999;10(1):85–94. http://www.
ncbi.nlm.nih.gov/pubmed/10347389
ify ambient air to physiologic levels, per industry standard. As 4. Simmons JW, Powell MF. Acute traumatic coagulopathy: patho-
research and development continues to device fabrication and physiology and resuscitation. Br J Anaesth. 2016;117:iii31–iii43.
testing, we will be able to standardize the STEAM for use in doi:10.1093/bja/aew328
future animal model studies. We estimate that the temperature 5. Balvers K, van der Horst M, Graumans M, et al. Hypothermia as
and humidity of ambient air will increase as it passes through a predictor for mortality in trauma patients at admittance to the
the STEAM device in proportion to the electrical power sup- intensive care unit. J Emerg Trauma Shock. 2016;9(3):97–102.
doi:10.4103/0974-2700.185276
plied to the heating and humidifier elements. A dose-response 6. Joint Trauma System. Hypothermia Prevention, Monitoring, and
curve and power draw can then be measured to determine if/ Management. Joint Trauma System Clinical Practice Guideline.
what improvements to the design are necessary to meet perfor- 2012;(September):1–11.
mance requirements. 7. Wang HE, Callaway CW, Peitzman AB, Tisherman SA. Admis-
sion hypothermia and outcome after major trauma. Crit Care
Med. 2005;33(6):1296–1301. doi:10.1097/01.CCM.0000165965.
Conclusion 31895.80
8. Dickey NW. Combat trauma lessons learned from military opera-
Although the future of battlefield medicine is unknown, it is tions of 2001-2013. Published online 2015.
predicted that PCC will become commonly practiced requir- 9. Howard JT, Kotwal RS, Turner CA, et al. Use of combat casu-
ing medical and technological innovation in prehospital care. alty care data to assess the US military trauma system during the
Currently there are medical capabilities that can only be de- Afghanistan and Iraq conflicts, 2001–2017. JAMA Surg. 2019;
livered in the hospital setting or in locations with more robust 78249(7):2001–2017. doi:10.1001/jamasurg.2019.0151
resources. We estimate that hypothermia management requires 10. Shackelford SA, del Junco DJ, Powell-Dunford N, et al. Associ-
ation of prehospital blood product transfusion during medical
innovation to better combat the lethal triad, especially in the evacuation of combat casualties in Afghanistan with acute and
PCC setting. We have identified such a capability gap – the 30-day survival. JAMA. 2017;318(16):1581–1591. doi:10.1001/
current inability to heat and humidify inspiratory air of venti- jama.2017.15097
lated patients in the prehospital setting. Through STEAM, we 11. Blackbourne LH, Baer DG, Eastridge BJ, et al. Military medi-
can bring the above capability far forward into the most aus- cal revolution: prehospital combat casualty care. J Trauma Acute
tere environments. Thus, it can bring the in-hospital standard Care Surg. 2012;73(6 Suppl 5):372–377. doi:10.1097/TA.0b013e
3182755662
of care into the pre-hospital setting, likely reducing morbidity 12. Kragh JF, Dubick MA, Aden JK, et al. U.S. military use of tourni-
and mortality of the injured. quets from 2001 to 2010. Prehosp Emerg Care. 2015;19(2):184–
190. doi:10.3109/10903127.2014.964892
Author Contributions 13. Morrison JJ, Ross JD, Poon H, Midwinter MJ, Jansen JO.
BP conceived the invention concept and design. All authors Intra-operative correction of acidosis, coagulopathy and hypo-
contributed to the evolution of the concept and design. BP re- thermia in combat casualties with severe haemorrhagic shock.
Anaesthesia. 2013;68(8):846–850. doi:10.1111/anae.12316
fined and created the design as filed. BP, RS, and LT obtained 14. Ditzel RM, Anderson JL, Eisenhart WJ, et al. A review of trans-
funding. RS wrote the first draft, and all authors contributed, fusion- and trauma-induced hypocalcemia: is it time to change
edited, and approved the final manuscript. the lethal triad to the lethal diamond? J Trauma Acute Care Surg.
2020;88(3):434–439. doi:10.1097/TA.0000000000002570
Disclosures 15. Wray JP, Bridwell RE, Schauer SG, et al. The diamond of death:
The views expressed are solely those of the authors and do hypocalcemia in trauma and resuscitation. Am J Emerg Med.
2021;41:104–109. doi:10.1016/j.ajem.2020.12.065
not reflect the official policy or position of the Uniformed Ser- 16. Friedman J, Ditzel RM, Fisher AD. Coagulopathy associated with
vices University, US Army, Department of Defense, or the US trauma: a rapid review for prehospital providers. J Spec Oper
Government. Med. 2022;22(2):110. doi:10.55460/ul89-sc0z

System for Thermogenic Emergency Airway Management | 75