TECHNOLOGY AREA(S): Bio Medical
OBJECTIVE: To create advanced medical moulage technologies that can simulate an injury or pathology by morphing through a series of clinical states to provide stimulation of different senses to the trainee during a training scenario to confirm progression of the injury / pathology and/or to understand if iatrogenic errors or pathologies occurred due to treatment provided. As an example of a potential use case, a military medical specialist training for point-of-injury care might perform a lifesaving intervention and see the long-term impacts of that intervention.
DESCRIPTION: Medical moulage is used in medical training to simulate injuries or pathologies to present trainees with a variety of training scenarios. Moulage can be relatively simple such as simulating bruising for blunt trauma, entry or exit wounds, or erythema applications. However, this effort is calling upon researchers to develop advanced moulage with the ability to morph, depending on the medical simulation scenario such as the progression of a burn, a wound that has become infected, ischemia depicting decreased blood flow, or even an iatrogenic error (mistreatment, misdiagnosis). Military caregivers involved in Tactical Combat Casualty Care (TCCC or TC3) are trained to provide live saving care under fire, but do not see the long-term impacts of that care. t is hypothesized that allowing the trainee to witness the injury or pathology morph while they are performing treatment will enhance learning and proficiency, ultimately leading to better outcomes in the patient treatment. These advanced morphing moulage technologies also need to be linked to the overall physiological state of the represented patient, and how that state changes over time. As a minimum when developing this morphing moulage technology, the following should be considered: The morphing moulage will be easy to apply/remove; The morphing moulage needs to be non-staining, hypoallergenic and nonirritating; Morphing moulage will display the gross characteristics of the injury with high accuracy along the entire course of the simulated pathology; The technology should be able to simulate progressive stages of injury based on treatment, which may include iatrogenic errors; Must be able to be used on manikins, part task trainers, wearable simulated proxy body parts, or standardized patients. It must be able to stay attached for long periods of time (the duration of the scenario which could last an entire day) and during times of movement (e.g. simulating a seizure, medevac); Must be usable in different environments such as heat, cold, humidity, direct sun, rain, etc.; Reusability Maintainability Cost effectiveness Ability to collect and assess performance data Ability to control the stages of the simulation Wireless communication Ability to be integrated/interoperable with a variety of simulation technologies Human safety Technology should engage different senses [touch (temperature), smell (burned skin/infection), and sight (oozing/blood), as examples]; If sensor technology is used or other technology that transmits energy (amperage / voltage), then system needs to be designed to not cause injury particularly to standardized patients; Traumatic wounds / injuries (e.g. burns, blast, penetrating, blunt, and/or crush injuries) as well as wounds that portray infection and skin disorders (e.g. burn progression).
PHASE I: The Phase I will develop a proof of concept of the morphing moulage education tool. A justification describing the accuracy of the wound type is required. The development of the moulage will need to prove to be highly accurate in wound progression. The proof of concept will need to demonstrate the morphing moulages ability to be used on, at a minimal at least two representative models such as a full body mannequin, physical / material-based part task trainer, a wearable simulated proxy body part, or a standardized patient. Any resulting solutions must integrate seamlessly with a broad range of simulations, including all major human patient simulators on the market today. It must also show the ability to integrate with multiple part-task trainers. Finally, it must demonstrate an ability to integrate with emerging augmented reality/mixed reality training systems. The intent of this phase is to produce an initial morphing moulage design, and proof of concept that demonstrates the feasibility of the concepts described in this topic. The performer will submit a final report and provide an initial demonstration (video) describing the stage of the development, along with details of what will be further developed in Phase II. REMINDER: No Human Use Studies should be included in the Phase I research.
PHASE II: Building upon the development and lessons learned of Phase I, Phase II will focus on expanding the moulages capabilities to include "smart" integration with the systems "physiology" and with additional stimuli / senses (i.e. touch, smell, sight, or auditory). Phase II will integrate the morphing complexity to the moulage and must provide initial studies proving protection to standardized patients (examples, hypo-allergenic, non-toxic, safety from energy (chemical, electrical, etc.) burns, etc.). In addition to prototypes that clearly demonstrate successful development per capabilities listed above, the performer will submit a final report that will include the current state of the development of the technology. The performer will provide analysis of the materials suggested vs. those compared or developed during research; provide analysis of synchronization of the moulage progressing through changes vs. that of the systemic physiologic status; and provide a detailed report and analysis of outcomes of use of these technologies particularly as they apply to standardized patients. The developer will provide a demonstration of the product along with details of what will be further developed in Phase III.
PHASE III: Concluding in Phase III the developer will have built a viable, commercially available morphing moulage product that can be used in a variety of simulation experiences that is easy to use and affordable, when compared to current static moulage technology. Optimization of material properties to address cost, effectiveness, and safety of the standardized patients should be pursued during Phase III. The product should include a variety of wounds that mimic wound transitions in such wounds as burns, blast, penetrating, blunt, and/or crush injuries but may also explore more chronic associated pathologies, especially within the realm of dermatology. Phase III should also consider paths to transition and commercialization. Such paths should explore various military medical training sites and acquisition programs, as well as the commercial marketplace. While point-of-injury care is a more likely candidate for both Department of Defense transition success and commercialization, higher echelons of care should be considered as well. The performer will demonstrate the product(s) at one or more potential customer sites, preferably military medical training sites.
1: Jouhari, Z., Haghani, F., & Changiz, T. (2015). Factors affecting self-regulated learning in medical students: a qualitative study. Medical Education Online, http://doi.org/10.3402/meo.v20.28694
2: Samur, S. I, (2016). Patient: performance practices in medical simulation at hospital Montfort. Vol 159. University of Toronto Press. DOI: http://dx.doi.org/10.3138/ctr.159.010
KEYWORDS: Medical Moulage, Morph, Simulation, Wound Progression, Wound Healing