Future Medical Operations in Urban Environments with Unmanned Systems

1. Unmanned Systems in Support of Future Medical Operations in Dense Urban Environments UNCLASSIFIED Nathan Fisher, MS Project Manager/Robotics SME (CTR) US Army Medical Research and Materiel Command (USAMRMC) Telemedicine & Advance Technology Center (TATRC) 22 April 2016

2. Disclaimer "The views, opinions and findings contained in this research/presentation are those of the author(s) and do not necessarily reflect the views of the Department of Defense and should not be construed as an official DoD/Army policy unless so designated by other documentation. No official endorsement should be made."

3. TATRC Parent OrganizationsUSAMEDCOM & USAMRMC MEDCOM 5 RMCs HR CoE (AMEDDC&S USAMRMC PHC 5 RMCs 5 RMCs 5 RMCs Health Readiness Platforms (MEDCEN) TATRC MEDCOM – US Army Medical Command MEDCEN– Medical Centers now called Health Readiness Platforms AMEDDC&S – Army Medical Department Center and School HR CoE -Health Readiness Center of Excellence USAMRMC – US Army Medical Research and Materiel Command PHC – Public Health Center TATRC – Telemedicine & Advanced Technology Research Center UNCLASSIFIED

4. US Army Medical Research & Materiel Command (USAMRMC) Telemedicine & Advanced Technologies Research Center (TATRC)COL Daniel R. Kral, Director Mission: Exploit technical innovations for the benefit of military medicine by developing, demonstrating and integrating across a variety of technology portfolios including teleHealth, medical simulation and training, health IT, medical intelligent systems & robotics, command and control, computational biology, and mobile solutions. Sponsor bottom-up innovation through limited technology demonstrations focused on readiness, access to care, and healthcare delivery. Medical Modeling Simulation Innovation Center Health Technology Innovation Center • Focus: Roles 1-3 • Operational Telemedicine • Robotics, UMS Autonomous • Devices Biotechnology High Performance Computing Applications Institute AMEDD Advanced Medical Technology Initiative Mobile Health Innovation Center UNCLASSIFIED

5. Planned Use of UMS in 2025B • "Over the next 25 years, the Army aviation force mix shifts from being almost entirely manned to consisting of mostly unmanned and [Optionally-Piloted Vehicles].“ U.S. Army Roadmap for UAS 2010-2035 • “Unmanned systems will be critical to U.S. operations in all domains across a range of conflicts, both because of the capability and performance advantages and because of their ability to take greater risk than manned systems.” • DoD Unmanned Systems Integrated Roadmap FY2013-2038 • Unmanned Systems technology will continue to improve. • Technological innovations rapidly evolving, to include data-intensive, multi-sensor, and multi-mission capabilities. • More autonomous/task level control • More multipurpose • More interoperable • Less reliance on GPS • Less reliance on persistent comms UNCLASSIFIED

6. Definitions • Medical Evacuation (MEDEVAC): movement of any person who is wounded, injured, or ill to and /or between medical treatment facilities while providing en route medical care, performed by dedicated medical personnel onboard a dedicated evacuation platform. • Casualty Evacuation (CASEVAC): movement of casualties onboard nonmedical vehicles or aircraft without dedicated en route medical care. • En Route Care: The care required to maintain the phased treatment initiated prior to evacuation and the sustainment of the patient’s medical condition during evacuation. UNCLASSIFIED

7. Roles of Care • Roles of Medical Care (NATO definition as applied to US Army Organization) • Role 1: Self-aid, buddy aid, or combat lifesaver & Basic Primary Care. • Point of Injury Care & Bn Aid Station • Combat Medic trained in tactical combat casualty care (TCCC) • Goal to stabilize and evacuate to Role 2-3 • Role 2: Stabilization & Forward Surgery • lifesaving resuscitative surgery • 100% Mobile • Brigade Medical Company & Forward Surgical Team (FST) • Stabilize and evacuate to Role 3 • Role 3: Combat Zone Hospitalization and outpatient services for all categories of patients • Combat Support Hospital • Evacuate to Role 4 within Theater Evacuation Policy. • Role 4 & above: Communications Zone or CONUS-based hospitals& medical centers. UNCLASSIFIED

8. Constraints on Medical Resources – Dense Urban Environments • Limited freedom of movement for conventional vehicle platforms (both air and ground) to provide medical resupply and casualty evacuation • Gridlocked transportation networks • Predictable movement patterns (IED threats) • 3-Dimensional threats (air, land, and subterranean) • Limited Medical Resources • Mass Casualties/Natural Disasters • Manned assets too high risk in A2/AD environments • Increased evacuation time and distance to MTF • Prolonged Field Care, Prolonged En Route Care • UMS could serve as a Force Multiplier, providing increased access to Resources • When conventional manned assets are denied access: air superiority is not assured • When medical resources are severely constrained • Nonmedical vehicles will be increasingly unmanned (less conventional “Vehicles of Opportunity” for CASEVAC) UNCLASSIFIED

9. Future Medical Missions From 2001 to 2011, nine out of ten Warfighters who died from injuries sustained in combat did so before arriving at a medical care facility. Of these, almost 25 percent died from injuries deemed potentially survivable (Eastridge, Mabry, Seguin et al., 2012). Strategies to improve outcomes prior to Role 3: Bring medical expertise, supplies, and equipment to the point of care (Roles 1-2) Decrease evacuation times and improved En Route Care Both strategies made more difficulty by likely mobility restrictions in Megacities. UNCLASSIFIED

10. UMS for Future Medical Missions • Dedicated Medical Evacuation (MEDEVAC) Platforms attended by experienced medical processionals are ideal, BUT: • What if no manned assets are immediately available • Manned assets are denied access (risk of losing additional lives is too great) • CBRNE exposure risk • Bottom-Line: Future UMS having a secondary capability to be reconfigurable to support CASEVAC would be an enabler for the maneuver Commander. UMS for CASEVAC should only be used under careful consideration, and only when acting in the best interest of the wounded. When CASEVAC (manned or unmanned) is too risky, UMS could potentially be used to bring medicine, supplies, and telemedicine/tele-consultation capabilities forward in support of Prolonged Field Care situations Suitably-sized future UMS could be developed to have a secondary CASEVAC or medical resupply capability UNCLASSIFIED

11. UAS Size Categories UNCLASSIFIED

12. The Case for UMS CASEVAC • UMS Platforms have superior mobility in Dense Urban Environments • Smaller, lighter, more agile • Does not need to support weight of pilot and manual controls, displays, seats, etc. • Potentially faster speeds/accelerations prior to loading casualty • Smaller footprint means more potential Landing Zones (LZs) Form Factor Comparison small UAS vs Conventional Platform UH-60 (Sikorsky) DP-14 (Dragonfly Pictures, Inc.) UAS In-Development UNCLASSIFIED

13. Multi-Purpose UMS DARPA ARES (Aerial Reconfigurable Embedded System) Medium-size VTOL with mission-specific payloads UGVs of various size with mission-specific payloads Need to develop secondary CASEVAC capability for suitable future UMS platforms [iRobot] UNCLASSIFIED [Lockheed Martin SMSS]

14. The Case for UMS CASEVAC • Example Path of Adoption for Medical Missions: • Near Term • Scenario: UAS delivery of emergency medical supplies to support Prolonged Field Care when manned-assets are denied access • Enabling Capability: Mature autonomous navigation and C2 • Mid Term • Scenario 1: Vehicle of Opportunity CASEVAC with attending medic • Scenario 2: Unattended CASEVAC for stable patient (“walking wounded”) • Enabling Capability: Ensured safety for limited UMS troop transport • Far Term • Scenario: Unattended CASEVAC/MEDEVAC • Enabling Capability: Autonomous Enroute Care (closed-loop or remote human control of patient management systems), Roll-on or man-transportable En Route Care Kit • Dedicated pilot-less MEDEVAC platforms (pilot SWaP vs. capability trade) UNCLASSIFIED

15. Challenges for Medical UMS • Safe Ride Standards for UMS CASEVAC • NATO Task Group HFM-184 “…use of UAVs for CASEVAC will take place as soon as Cargo UAVs or optionally-piloted conventional aircraft are available on the battlefield – it is up to NATO and the Nations to ensure that such use is carried out under the safest possible considerations” • Considerations unique to UASs for casualty transport and medical resupply • Lack of VTOL UAS assets in the near/mid-term in Tactical/Persistent size classes for agile/last-mile medical resupply. • Larger VTOL UAS will likely be Optionally-Piloted Aircraft (OPA) in the near/mid term • Trust • Medical logistics prior to use as casualty transport • Trust established for UMS troop transport in general • Specific guidelines for UMS CASEVAC in terms of environmental exposure (shock/vibe, temperature, noise, pressure) • **Need active development of CASEVAC as a secondary role for suitable UAS to ensure safe implementation UNCLASSIFIED

16. Capabilities of UMS for Future Medical Missions UNCLASSIFIED SOURCE: NATO STO Technical Report TR-HFM-184, December 2012

17. Future UMS Enroute Care Scenarios Example En Route Care System onboard a UMS platform Example Interactions with Care Providers Enroute Care Control Unit Tactical Radio Network CASE 3: Autonomous Care (closed-loop) provided by inflight control unit with human-in-the –loop in a supervisory role • CASE 2. Remote control of inflight control unit by care provider at destination MTF • CASE 1: Remote monitoring of casualty en route by provider at destination MTF ECG Patient Monitor SaO2 BP Increasing Levels of Autonomy Transport Ventilator Surgical Robots IV Pump Future Therapeutic Medical Devices Casualty (Simulated) UNCLASSIFIED

18. Novel Use of sUAS • sUAS – Tradeoffs: Size, Range, Payload • Role for last-mile/agile resupply • Provide aid for Prolonged Field Care– driven by A2/AD • Blood • Supplies (devices, consumables, pharmaceuticals...) • Expertise(telemonitoring, teleconsultation) • Considerable investment from industry • FAA Aerospace Forecast FY2016-2036 • industrial inspection (42%) • real estate/aerial photography (22%) • agriculture (19%), insurance (15%) • Delivery (Amazon, Google) UNCLASSIFIED

19. Enabling Technologies: Autonomy • Unmanned Systems technology will continue to improve • Technological innovations rapidly evolving, to include data-intensive, multi-sensor, and multi-mission capabilities. • State of the Science -> miniaturization and robustness, focus on autonomy • Synergy with emerging tech -> machine learning, cloud computing, augmented/virtual reality, natural language processing, etc. • Example: LiDAR Evolution Integrated Solid State LiDAR Sensor Compact, lightweight, low cost $8000 2 lbs Currently Available LiDAR Sensors [http://www.quanergy.com] UNCLASSIFIED

20. Enabling Technologies: Teaming • UMS Teaming with Soldiers for Operational Medicine: • High Cognitive demands in TCCC scenarios • Patient Care • TCCC documentation • Maintaining SA • Cognitive burden of UMS C2 • Task-level Commands, Supervisory Role • Example Soldier – UMS Interactions during Medical Missions: • UAS: Collaborative VTOL landing/takeoff at CCP (CASEVAC) • UAS: “Last-Mile” emergency medical resupply request and coordinated drop-off • UGV: Collaborative Casualty Extraction/Lift • Effective Manned-Unmanned Teaming (MUM-T) requires: • Intuitive and efficient Human-Computer Interfaces • Improved by implementation of hands free input (real-time natural language processing, gesture control) • Common controllers, interfaces, communications protocols for all devices and actors in the system UNCLASSIFIED

21. MUM-T: Opportunity for Overmatch Cross Platform (UMS-UMS, Human-UMS) Cross Domain (Air, Ground, Maritime) Cross Service (Army, Navy, Air Force) Requires Joint Interoperability Strategy Human - Human Human - UMS UMS - UMS UNCLASSIFIED

22. UxS Control Segment (UCS) Architecture Leveraging DOD initiated UCS cross-platform architecture framework to enable cross service integration of our SBIR efforts for both ground and air UMS research projects. • UCS – An open architecture for the control systems of UxS • Common basis for acquiring, integrating, and extending UxS capabilities • Evolution of STANAG 4586 (standardized UAS comm protocols/data elements) • OSD Open Business Model for future Ground Control Stations (GCS) https://www.ucsarchitecture.org/ UNCLASSIFIED

23. On-going Research and Development • Kutta Technologies: Human-Computer Interface and Command and Control of Unmanned Aerial Vehicles for Medical Missions • AHuman-Computer Interface (HCI) and Command and Control (C2) infrastructure needs to be developed for the combat medic to effectively interface with unmanned VTOL platforms for future medical operations (CASEVAC and emergency medical resupply) • Technical Approach: Two types of interfaces Soldier Radio or End User Device (EUD) • Dial-A-Drone: Allows the soldier or medic in the field to send commands to the UAS asset using currently-fielded tactical radios. • Field application for EUD (Nett Warrior): An application on a handheld device that would provide the capability to a medic, with little or no training in VTOL operation, to interact with unmanned assets at the task/goal level in order to plan and execute unmanned CASEVAC and resupply missions • Funding Source: Army SBIR Phase II UNCLASSIFIED

24. On-going Research and Development • Neya Systems: VTOL (Vertical Takeoff and Landing) Evacuation and Resupply Tactical Interface (VERTI) • Technical Approach: • Android EUD compatible application for controlling Vertical Takeoff and Landing Aircraft, along with software for medical record exchange based on eTCCC card. • A telemedicine reference software architecture based on UCS (Unmanned Systems Control Segment) for managing and integrating multiple medical data streams, and transmitting over a tactical network. • March 2015: Successful demonstration of collaborative CASEVAC using an Unmanned Ground Vehicle and a K-MAX UAS using VERTI • Summer 2016: Collaborative CASEVAC using UAS and UGV in an operational relevant environment with transport telemedicine integrated with HCI and C2. • Funding Source: Army SBIR Phase II UNCLASSIFIED

25. On-going Research and Development SBIR TOPIC A14-053: Squad-Multipurpose Equipment Transport Medical Module Payload for Casualty Extraction Gap: TRADOC PAM 525-66, Future Operating Capability 09-06, Health Services Support: “Future Soldiers will utilize unmanned vehicles, robotics and standoff equipment to recover wounded and injured Soldiers from high-risk areas, with minimal exposure: - Recover wounded Soldiers - Facilitate immediate evacuation & transport… - The ability of performing networked medical information interface support...” Operational Concept: Support secondary role of multi-mission UGV for expedited CASEVAC. Provide capability to secure a casualty onto the UGV as quickly as possible, and to transmit medical information during transport back to a Casualty Collection Point Funding Source: Army SBIR Phase II UNCLASSIFIED

26. Potential R&D Opportunities • Considerations unique to UMS in regard to medical applications need to be better understood in order to inform doctrine development and the combat casualty care research and development community • Inform trade-off decisions regarding the use of manned versus UMS for medical resupply and patient transport in future OE • Increase exposure to Warfighters of emerging UMS technology (use feedback to inform development) • Integration of Patient Monitoring and emerging En Route Care capabilities with UMS C2 infrastructure • Telemedicine interoperability standard based on UAS Control Segment (UCS) framework • Utilization of emerging dexterous robotic manipulation technology for casualty extraction and en route care applications (i.e. medical imaging, monitoring, limited intervention) UNCLASSIFIED

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