The Future of Front Line Medical Care

Military Vehicle Systems talks to Dr Abe Chandra, Founder of Sabrn Tech, about their innovative medical pod system

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Q: Would you give us a brief introduction to SABRN?

A: SABRN is a veteran-owned, family-run group of early-stage companies, founded in Australia with intentions to establish global footprints, especially in the AUKUS, QUAD and FiveEyes countries.

The initial motivator for SABRN was to improve the combat health support provided to our soldiers, sailors, aviators and marines. It started by understanding the capability gaps that have existed in previous conflicts. Several key statistics were critical in SABRN developing its 'system-of-systems' approach to combat health support to complement the current infrastructure of combat health care.

• 1) In the 20 years of conflict in Iraq and Afghanistan, of all the soldiers killed in action, 25% were potentially preventable deaths. This was despite overwhelming air superiority with the Allied Forces and almost all injured personnel reaching a surgical capability within the Golden Hour. This demonstrated that the infrastructure was too far away for this cohort of injured personnel. Therefore, to reduce the number of combat fatalities, the surgical and medical infrastructure needs to be brought further forward.
• 2) At least 25% of active duty service members have signs of a mental health condition. We need to ensure that all frontline troops have some type of access to mental health support.
• 3) Disease and non-battle injuries can account for 30-40% of the casualty population during active conflicts. These have significant adverse effects on the war fighting capability as well as morale.

Q: Tell us about SABRN LifePods?

A: Future operational environments will be Large Scale Combat Operations (LSCO) involving multiple domains over enormous distances. The ability of near-peer adversaries to target electromagnetic and heat signatures, and their use of drones and precision munitions increases vulnerability of traditional healthcare evacuation platforms (i.e. aeromedical evacuation). We anticipate significantly more combat casualties with overwhelming strain to be placed on current designs of Combat Health Support Capabilities.

SABRN's objective is to utilise a 'system-of-systems' approach to modernise the combat health support capability of the Allied Defence Forces to address this problem. It addresses the current capability gaps at three levels: 1) Scaling infrastructure; 2) Scaling specialists; and 3) Scaling frontline workers.

Scaling infrastructure that extends from the point-of-injury to the Role 3 Hospital is the first objective. SABRN's expeditionary medical, surgical and support LifePods are digitally interconnected with key stakeholders that would include military and civilian hospitals, as well as non-government organisations. Communications resilience for the LifePods is created by integrating terrestrial and satellite telecommunication systems.

The SABRN LifePods are designed to be compact, scalable, domain-agnostic as well as vehicle-agnostic. These features enable the LifePods to be interoperable across the land, air, maritime and littoral zones, and functional in remote, austere, hostile, overwhelmed and conflict environments.

There are three types of SABRN LifePods:

• 1) Emergency 'E-LifePods' (integrated ED-OT-ICU capabilities for life-saving and limb-saving presentations);
• 2) Non-Emergency 'N-LifePods' (for disease and non-battle injuries that depletes critical warfighting capabilities);
• 3) Support 'S-LifePods' that enable the E-LifePods and N-LifePods to function as decentralised geographically unconstrained mini-mobile field hospitals.

The E-LifePods are modular in design, with some variants containing advanced diagnostics (including on-board xray imaging), advanced treatment (including surgical capability and Extra-Corporeal Membrane Oxygenation [ECMO]) and advanced monitoring capabilities (including Intra-Cranial Pressure [ICP] monitoring). The E-LifePods are also installed with a plasma-based air decontamination system (that creates a surgically sterile environment within 12 minutes) and blue-light-technology surface decontamination system for eradicating surface micro-organisms. The E-LifePod also has the capacity to transport two additional patients on stretchers, or six additional seated patients.

These capabilities are necessary to ensure prolonged survival of combat casualties in the field where evacuation could be delayed for hours to days. Recent discussions with medics and medical officers in the Ukraine conflict confirms the need for this type of capability in current and future conflicts.

Q: Telemedicine at the scene and during transport

A: The second and third parts of SABRN's 'System-of-Systems' approach to optimising combat health support are: 1) scaling the frontline healthcare workers; and 2) scaling the accessible specialists. Both integrate technology and communications with the LifePods, with pre-deployment clinical training and telehealth/telementoring playing critical roles in the scalability process.

Medical personnel currently involved in the Russo-Ukraine conflict have emphasised the importance upskilling frontline personnel to perform critical lifesaving and limb-saving procedures likely to be encountered in current and future conflicts. The 'Stop-the-Bleed' education campaign to civilians in the USA and Ukraine enhances people without clinical qualifications to take up life-saving skills. Considering the future conflict being significantly more complex and complicated than ever before, with widely dispersed personnel in extremely challenging locations where expected casualty numbers are high and traditional combat health support infrastructure could easily be overwhelmed, upskilling people with these types of micro-qualifications is essential to save as many lives as possible. SABRN has been using combinations of Virtual Reality (VR), Augmented Reality (AR) and mannequin/3D printed cadaver technologies for initial training and skills maintenance. The combination of these training tools enables large numbers of individuals and teams to immerse into different artificial environments to learn and rehearse multiple life-saving skills. The deep-reinforcement-learning principles of VR and AR allow training to occur on specific types of injuries in specific types of environments within the E- and N-LifePods.

Three telehealth technologies are incorporated within the LifePods:

• 1) Electronic Medical Records (EMR);
• 2) Normal Telehealth; and
• 3) Augmented Reality Enhanced Telementoring.

The LifePods have their own EMR system that can facilitate a robust transfer of clinical information. The system allows for input of clinical data regarding the patient to be performed by the on-board healthcare worker as well as the support team at the Role 2/3 Hospital. Data collection, transfer, integration and analysis will help improve and optimise clinical performance. SABRN's EMR system meets international Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) global standards for exchanging healthcare information electronically, which allows uniform and consistent information transfer between different national and international healthcare systems.

Multiple telehealth systems could operate concurrently from each LifePod, depending on the tactical environment. The E-LifePods are equipped with strategically positioned cameras capable of providing clinical and non-clinical information to the Role 2/3 hospitals. This information transfer could be ceased temporarily in tactical environments to maintain operational security. AR-enhanced-telementoring headsets are also available within the LifePods that will enable remote specialists (emergency physicians, anaesthetists, surgeons etc.) to support the upskilled on-board healthcare workers to assess, monitor and treat patients. This would enable the on-board healthcare worker to perform at much higher levels.

Q: Supply chain solutions

A: The SABRN 'System-of-Systems' approach requires effective and efficient logistics between individual LifePods and the stakeholders. The key logistics issues include the transportation of each LifePod, the movement of clinical personnel (frontline healthworkers and or more advanced specialists) and relevant clinical equipment to and from LifePods.

GPS and non-GPS trackers located within each LifePod ensure personnel are aware of its exact geospatial location with respect to other assets. The S-LifePod variants play key roles in the logistics chain. Personnel within the C5 variants of the S-LifePod coordinate resupply of consumables and removal of clinical and non-clinical waste to-and-from each E-LifePod or N-LifePod using a variety of crewed or uncrewed systems.

A designated healthcare worker would remain in each E-LifePod to initiate pre-hospital care from the Casualty Collection Point. Clinical information gathered using the on-board telehealth systems will enable the commanders and clinicians at the Role 2/3 Hospitals to determine the best route of extraction via pre-determined rendezvous points. Caches of critical equipment (such as water and auxillary power) can be stored at these rendezvous points. Automating resupply of consumables using barcodes and RFID tags will help make logistics more efficient and effective. By using GeoJSON format for mapping geospatial data, delivery of precious resources (including skilled personnel) can be made in a 'just-in-time' manner to relatively safe locations within the remote, austere and hostile environments.

The LifePods are designed to have a small physical footprint, and therefore will only require a small vehicle for transportation. Other measures to reduce the LifePod thermal and electromagnetic (EM) signature, include incorporating a 'Faraday cage' to suppress leakage of EM signals when using energy intensive equipment on board the E-LifePods, and incorporation of EM protection devices that can spoof or act as towed decoys to protect against detection by adversaries.

For more information please visit:
https://sabrntech.com