One thing we can surely all agree upon in this era of divisive wartime politics: We want our fighting men and women who are wounded in battle to be treated with the utmost speed and skill, and ideally without endangering the lives of highly trained medical personnel. If this sounds like a fantasy, it isn’t. Scientific advances and out-of-the-box thinking have already revolutionized battlefield rescue, triage, and surgery.

Under battle conditions, medics have put their own lives at risk to treat and move wounded soldiers while fighting was often still fierce. But cutting-edge, 21st-century military medicine is on the cusp of an enormous change, where medicine meets virtual reality. The operating room of the future will have no humans; robots will operate under remote direction from surgeons and other experts who are far from the battlefield.

Why should this matter to you? Military medical advances have historically transformed “civilian” medical treatment, so what is available and possible in the battlefield is coming soon to a hospital near you.

How soon? According to Dr. Richard M. Satava, program manager for DARPA (Defense Advanced Research Projects Agency of the U.S. Army Medical Research and Material Command) and a professor in the Department of Surgery at the University of Washington, by late 2006 there will be a functioning operating room with no humans. Under DARPA’s supervision and funding (built with your tax dollars and mine) in collaboration with SRI International in Palo Alto, Calif., the operating room will feature a “DaVinci robot” surgeon, a robotic “tool changer” in place of a scrub nurse, and a robotic “supply dispenser” in place of a circulating nurse.

How are designers involved? As with much technology, form follows function. “Once we get the technology down,” Satava says, “we need input from industrial designers: how to get it right, how to minimize size and weight and maximize power.” According to Satava, several design schools have been involved in cutting-edge design collaboration on military medical advances with SRI and DARPA, including Rhode Island School of Design and Art Center College of Design.

David A. Muyres, vice president of Educational Initiatives at Art Center, says “Dr. Satava sees the benefits of bringing design, business, and science/engineering together. He sees how designers bring a human value and understanding to technological advances.” Satava says, “No one else is doing anything like this. DARPA has pioneered many new technologies, including advanced body armor to minimize injury, hemostatic agents such as fibrin glue to stop bleeding, and new diagnostic devices like handheld ultrasound, which can now be readily available on site.” Satava and DARPA are developing a robotic trauma pod which will allow lifesaving initial surgery to take place in remote locations. “Our purpose is to bring surgical expertise as far forward into the battlefield as possible, no matter how small the unit.”

Once considered the stuff of science fiction, these advances have saved lives and limbs. “The Medical Frontlines of War,” a recent segment on CBS News, explored the groundbreaking advances on the medical battlefront.

Dr. Atul Gawande, a researcher at the Harvard School of Public Health, explains that today America’s wartime wounded have an extraordinarily high chance of survival. “This is a historic achievement. We’ve now saved more than 90 percent of the soldiers who were hit in the battlefield ... you go back to the Revolutionary War and 42 percent of those soldiers who were hit in battle died,” Gawande says. “By World War II, it was under 30 percent who died from their wounds. And, yet, by the Korean War, Vietnam War, and even the Persian Gulf War, it was around 25 percent who died.”

The dramatic difference in today’s survival rate arose from a new way of thinking in surgical protocol described as “damage control surgery.” Instead of a surgeon who takes care of a person from beginning to end, the goal is to save lives by doing only what is absolutely necessary, then sending the patient on to the next link in the military’s medical care network: from the medic on site to surgical units to combat field hospitals to “critical care” aircraft to a military medical facility in Germany and then home.

As recently as the Vietnam War, it typically took 45 days for the wounded to go from battlefield to stateside. Today, it takes less than four days. And medical help routinely arrives more quickly, often within 15 minutes. The new approach made headlines a few months ago when ABC correspondent Bob Woodruff received serious head injuries in a roadside blast in Iraq. His head wound was treated and left unclosed (to minimize brain swelling) with a sign indicating that his skull was still open. Then he was transported to a military hospital in Landstuhl, Germany, for additional surgery. Two days after the incident he was moved to the Bethesda Naval Hospital near Washington for treatment at its brain injury center.

The innovative technique—leaving wounds open and often sealing them temporarily with Goretex™—is now being used in civilian hospitals—just the latest example of medical advances on the front lines making their way to the home front and the general public.

On “The Medical Frontlines of War,” Colonel Craig Shriver, who teaches battlefield surgery at the Walter Reed Army Medical Center, explains that improvements in transporting patients by air have led to the quick turnaround. But, Shriver says, innovation isn’t just happening out in the field. Doctors from Baghdad to Landstuhl to stateside are constantly communicating and collaborating like never before. The correlation between advances in emergency care and war stems from the fact that war is “an intense American experience where really the best minds of healthcare are all coming together for a cause.”

Satava agrees. The next great advances are only small steps away. “DARPA has funded nearly all of the medical robots since 1992.” Soon his vision of the operating room of the future will become a reality. Remotely operated robotic modules will scoop up the wounded and take them to nearby “trauma pods” where tele-operated surgical robots will perform lifesaving procedures and then transport the wounded to more secure medical facilities elsewhere.

Medicine meets virtual reality...we are almost there.

DARPA | http://www.darpa.mil/

TOP: In the operating room of the future, a patient will receive a total body scan before being anesthetized, and then will be taken to the operating room where the surgeon will remotely perform surgery.