title: Technical innovations that may facilitate real-time telementoring of damage control surgery in austere environments: a proof of concept comparative evaluation of the importance of surgical experience, telepresence, gravity and mentoring in the conduct of damage control laparotomies.
abstract: Bleeding to death is the most preventable cause of posttraumatic death worldwide. Despite the fact that many of these deaths are anatomically salvageable with relatively basic surgical interventions, they remain lethal in actuality in prehospital environments when no facilities and skills exist to contemplate undertaking basic damage control surgery (DCS). With better attention to prehospital control of extremity hemorrhage, intracavitary bleeding (especially intraperitoneal) remains beyond the scope of prehospital providers. However, recent revolutions in the informatics and techniques of telementoring (TMT), DCS and highly realistic accelerated training of motivated first responders suggests that basic lifesaving DCS may have applicability to save bleeding patients in austere environments previously considered unsalvageable. Especially with informatic advances, any provider with Internet connectivity can potentially be supported by highly proficient specialists with content expertise in the index problem. This unprecedented TMT support may allow highly motivated but inexperienced personnel to provide advanced surgical interventions in extreme environments in many austere locations both on and above the planet.
authors.affiliation: The Regional Trauma Services, the Department of Surgery, University of Calgary, Calgary, Alta. and the Canadian Forces Health Services.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kirkpatrick
authors.affiliation: The Rocky Vista School of Osteopathic Medicine, Parker, Colo.
authors.forename: Anthony
authors.initials: A
authors.lastname: LaPorta
authors.affiliation: The Royal College of Physicians and Surgeons of Canada, Ottawa, Ont.
authors.forename: Susan
authors.initials: S
authors.lastname: Brien
authors.affiliation: NRC Aerospace Flight Research Laboratory, Ottawa, Ont.
authors.forename: Tim
authors.initials: T
authors.lastname: Leslie
authors.affiliation: The Trauma & Combat Medicine Branch, Surgeon General's HQ, Israel Defense Forces, Ramat Gan, Israel.
authors.forename: Elon
authors.initials: E
authors.lastname: Glassberg
authors.affiliation: The Innovative Trauma Care, Edmonton, Alta.
authors.forename: Jessica
authors.initials: J
authors.lastname: McKee
authors.affiliation: The Regional Trauma Services, and the Department of Surgery, University of Calgary, Calgary, Alta.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.affiliation: The NRC Aerospace Flight Research Laboratory, Ottawa, Ont.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Wright Beatty
authors.affiliation: The NRC Aerospace Flight Research Laboratory, Ottawa, Ont.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Keillor
authors.affiliation: The Regional Trauma Services and the Department of Surgery, University of Calgary, Calgary, Alta.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Roberts
authors.affiliation: The Canadian Forces Health Services, the 1 Canadian Field Hospital, Petawawa, Ont., the Trauma Services and the Department of Surgery, Sunnybrook Medical Centre, Toronto, Ont.
authors.forename: Homer
authors.initials: H
authors.lastname: Tien
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000601:surgery*; D000337:Aerospace Medicine; D002983:Clinical Competence; D004630:Emergencies; D004777:Environment; D006470:Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D020407:Internet; D007813:Laparotomy; D008611:Mentors; D017216:Telemedicine / Q000379:methods*