Advanced Medical Technology Initiative (AMTI)

AMTI News

December 2020

Figure 1: The simulated lower leg used a part of the physical model-based curriculum to teach fasciotomy demonstrating a correct skin incision (upper image), but an incomplete fasciotomy (lower image)
31 December, 2020 AMTI Project Spotlight: Application of a Cognitive Mastery Learning Curriculum to Improve Fasciotomy Performance

Injuries to the lower leg are very common in combat casualties and one of the frequent consequences of such injuries is increased pressure within the envelope surrounding those muscle groups called Compartment Syndrome (CS).

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Screen of AMTI's Powerpoint presentation
31 December, 2020 TATRC’s AMTI Hosts First Virtual Town Hall Amid COVID-19 Pandemic

On 13 November, TATRC’s Advanced Medical Technology Initiative (AMTI) hosted a virtual town hall for the staff at Brooke Army Medical Center (BAMC). This virtual event was led by AMTI Program Manager, Ms. Holly Pavliscsak, who has managed the AMTI since 2016 and has 24 years’ experience in military medical research with an emphasis on medical technology projects and telemedicine.

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Figure 1: To begin a session, the subject will wear the multi-fit chest strap and apply the ECG electrodes. After powering on the mobile device, the subject will open the Zeriscope application, enter their subject ID, click enter and be prompted to power on the Hub device. Once a signal is received from the Hub device the application will prompt the subject to select ‘Start Session’. Recording will begin and continue to take place until the ‘Stop Session’ icon has been selected.
31 December, 2020 AMTI Project Spotlight: Novel Technology to Provide Real-Time Physiological Monitoring of Patients with TBI

Around 20% of combat casualties from Iraq and Afghanistan have sustained a traumatic brain injury (TBI). Furthermore, Service Members with blast-related injuries often sustain multiple co-occurring disorders, including Post-Traumatic Stress Disorder (PTSD) and other mood disorders, chronic pain, and cognitive dysfunctions.

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Many medical combat training scenarios incorporate theatrical makeup (moulage) to simulate wounds. The Val G. Hemming Simulation Center has developed a variety of temporary wound tattoos specifically for medical combat simulations. Custom medical illustrations were created from real-world injury references and printed on commercially available tattoo paper. Our detailed renderings ensures precise and detailed wounds that can stand alone or act as a base for further application of traditional moulage.
31 December, 2020 Advanced Medical Technology Initiative (AMTI) Update

As with most things in the DoD, change is a common occurrence. In the last year the AMEDD Advanced Medical Technology Initiative (AAMTI) has undergone some big changes of its own.

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September 2020

Figure 1: The Electric Cell-substrate Impedance Sensing (ECIS) system is comprised of an array station that holds a 96-well test plate. The ECIS software allows for real-time tracking of electrical resistance detected in the test plate. (Image: Applied BioPhysics, Inc. (Troy, NY), www.biophysics.com)
30 September, 2020 AMTI Project Spotlight: High-throughput Screening of Military-relevant Contaminants Using ECIS Technology

Soldiers encounter a wide range of potentially toxic chemicals throughout their military lifecycle; however, fast and inexpensive toxicity screening of chemicals found in and around military sites is not currently available.

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Training individuals with musculoskeletal injuries who use ankle-foot orthoses to shift from a heel strike pattern to a midfoot or forefoot strike pattern takes better advantage of the energy-storing-and-returning properties of the device.
30 September, 2020 AMTI Project Spotlight: Real Time Bio-Feedback During Running Rehabilitation

This project is the second in a line of AMTI-funded work using real-time bio-feedback to improve performance and rehabilitation outcomes for Service Members with severe lower extremity injuries. Ankle-foot orthoses are a type of bracing system often prescribed to support and stabilize the ankle and foot of individuals with lower extremity injuries.

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June 2020

Figure 1. The COMPASS® device from Centurion Medical Products. Compact, disposable, battery powered mean arterial pressure monitor.
30 June, 2020 AMTI Project Spotlight: Let the COMPASS® Guide the Way: Optimizing REBOA for the Austere Combat Environment

Resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhage control after severe traumatic injury is rapidly gaining use in both civilian trauma centers and in the deployed environment.

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An ectopic pregnancy can result in tubal rupture which accounts for the mortality associated with this condition. Gene expression profiling of the endometrium from women with ectopic compared with that of women with miscarriage, revealed a 5-gene classifier that reliably delineated pregnancy location.
30 June, 2020 AMTI Project Spotlight: An Endometrial Classifier for the Early Detection of Ectopic Pregnancy

Nearly 16% of active component U.S. military members are women, and the majority are reproductive age. As the number of military servicewomen and their operational scope increase, it is important to understand and mitigate the prevalent health issues that uniquely impact their readiness.

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March 2020

RAPTOR - Rapidly Tracking Outcomes in Rehabilitation
31 March, 2020 Use of the RAPTOR System in Outpatient Physical Therapy: A Multi-Site Demonstration Project

Physical therapists regularly evaluate and treat patients with musculoskeletal (MSK) injuries, which is the number one cause of medical non-deployability in military personnel. To effectively treat and manage injuries, physical therapists perform many tests and measures to assess a patient’s function, movement, and other factors that contribute to injury and recovery.

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FIGURE 3. MALDI-TOF MS spectra were acquired on a VITEK MS using routine FDA-approved IVD manufacturer recommended settings. Susceptible and non-susceptible interpretation was based on confidence value threshold.
31 March, 2020 AMTI Project Spotlight: Rapid Qualitative Antibiotic Resistance Characterization Using VITEK MS

The emergence of antibiotic resistant organisms pose a significant public health concern. The prevalence of antibiotic resistance especially in Gram-negative bacteria continues to increase globally. Since the beginning of Operation Iraqi Freedom and Operation Enduring Freedom, the U.S. military healthcare system has experienced a notable increase in the number of antibiotic-resistant organisms being isolated from wounded Service Members.

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December 2019

3D scan of Madigan trauma bay for VR build.
31 December, 2019 AMTI Project Spotlight: Virtual Reality Trauma Simulation: An Immersive Method to Enhance Military Medical Personal Training and Readiness

Two years ago, Madigan Army Medical Center’s (MAMC) Emergency Medicine Research Department initiated a project to create a realistic trauma simulator in immersive virtual reality (IVR). Similar to a pilot’s flight simulator, the Trauma Simulator is a free-play virtual reality training platform capable of training military medical personnel through dynamic physiologic responsive simulations that allow decision-training without an instructor. The primary focus was on decision training (i.e., cueing) when to initiate a blood transfusion, place a chest tube, or complete a cricothyrotomy.

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Cross-sectional view of how strike pattern data was captured in the study.
31 December, 2019 AMTI Project Spotlight: AMTI Shines A Spotlight on Warfighter Performance

Health care costs for running related musculoskeletal injury in the AMEDD exceed $560 million annually. The majority of these injuries are overuse in nature. TATRC’s AMTI program funded a project to further research these injuries called the “Feasibility of Wearable Devices to Measure and Monitor Changes in Gait Characteristics during Running”. Ms. Holly Pavliscsak, AMTI’s Program Manager stated, “This project highlights the AMTI programs’ continued support of projects that reinforce TATRC’s overall mission to fuse data, humans, and machines into solutions that optimize warfighter performance and casualty care.”

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September 2019

OCONUS Testing site in Bulgaria and Romania.
30 September, 2019 AAMTI Project Spotlight: The Agile Network Connectivity for Mobile Medics

The Agile Network Connectivity for Mobile Medics was an AMEDD Advanced Medical Technology Initiative (AAMTI) Rapid Innovation Fund (RIF) project that tested the use of a commercial off-the-shelf mobile broadband kit (MBK) by 4K Solutions to leverage both T-Mobile and AT&T cellular networks in the continental United States (CONUS) and four commercial “pay as you go” SIM cards in Europe and outside the continental U.S. to support synchronous virtual health and the mobile medic mission.

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news
30 September, 2019 AAMTI Project Spotlight: A Mobile Web-Based Application for Personalized Cancer Survivorship

According to military statistics, approximately 1,000 active duty service members are diagnosed with cancer on an annual basis with nearly $250 million per year spent on their treatment. After completion of initial cancer care, patients then transition to survivorship.

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The Team gathered for the annual photo at MHSRS 2019.
30 September, 2019 TATRC Research Shines at 2019 MHSRS

Team TATRC made their way to the sunshine state in Kissimmee, Florida from 19 – 23 August for the MHS Research Symposium (MHSRS). The Annual MHSRS, held at the Gaylord Palms Resort & Convention Center, is the Department of Defense’s premier scientific meeting that focuses on Combat Casualty Care (CCC).

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June 2019

The AMEDD Advanced Medical Technology Initiative identifies, explores, and demonstrates technologies to overcome barriers to healthcare that are militarily unique.
28 June, 2019 AAMTI FY20 Extended Innovation Funding (EIF) Updates

In FY99 (and each year thereafter), the Army Surgeon General, through the U.S. Army Medical Research and Development Command’s (USAMRDC) TATRC, provided a $5M special appropriation of DHP O&M funds to enable technology demonstrations throughout the AMEDD.

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March 2019

Sample “Actigraph” from single clinician/subject, showing 3, 24-hour periods including 3 nights of sleep data. Of interest, this subject has young children, leading to several periods of movement at night (black vertical lines within blue shaded periods). This illustrated to the subject, the sensitivity and validity of the Actiwatch data.
31 March, 2019 AAMTI Project Spotlight: Using Wearable Sleep Monitors to Improve Behavioral Health Care of Service Members’ Families: A Clinical Quality Improvement Project

Sleep dysregulation is a common symptom of numerous behavioral health conditions. Research suggests that treating sleep dysregulation can help improve not only the sleep of the patient, but improve the primary behavioral health condition of which the sleep dysregulation is a symptom.

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Figure 1. Special Operations Medical Sergeant caring for a simulated critically ill trauma patient during the Mountain Path prolonged field care training exercise. Using the Virtual Critical Care Consultation (VC3) call guide, the medic, if able, first sends images of the casualty, care documentation flow sheets, and available equipment via e-mail to the VC3 distribution list and then calls the VC3 phone number which forwards to the on call VC3 intensivist who provides consultation.
31 March, 2019 The ADvanced VIrtual Support for OpeRational Forces (ADVISOR) System

The project previously known as the ADvance VIrtual Support for Special OpeRations (ADVISSOR) is an AMEDD Advanced Medical Technology Initiative (AAMTI) funded effort that has just completed.

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Mobile sleep management platform delivers evidence-based sleep treatments that can be supported remotely, enabling a joint service solution. The system pictured has demonstrated utility in the Womack Army Medical Center Sleep Disorders Clinic. Future efforts seek to tailor and implement the system in non-specialty settings.
31 March, 2019 AAMTI Project Spotlight: Online Cognitive-Behavioral Treatment for Insomnia (OCBT-I) in the Primary Care Setting: An Efficacy and Feasibility Project

Insufficient and disturbed sleep are signature injuries of the Global War on Terror. The unrelenting operational tempo of military life, combined with non-traditional work schedules and high stress, all contribute to a culture of chronic sleep loss.

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A student assigned to the U.S. Army Special Operations Command performs one of the medical tasks he learned as part of the battlefield emergent skills triad training at Fort Bragg, N.C., Feb. 7, 2019. The training increases the ability of non-surgical medical personnel in remote locations to potentially save the lives of severely injured Soldiers. Eve Meinhardt / FORSCOM Public Affairs Office
29 March, 2019 Army developing training to expand medical capabilities

FORT BRAGG, N.C. — The Army is one step closer to increasing the ability of non-surgical medical personnel in remote locations to potentially save the lives of severely injured Soldiers thanks to continuing efforts by the U.S. Army Special Operations Command (USASOC), Womack Army Medical Center and the U.S. Army Medical Research and Materiel Command – Telemedicine and Advanced Technology Research Center (TATRC).

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December 2018

This image shows the location and number of projects the AAMTI program has funded through the Extended Innovation Fund (EIF) in the last five years.
31 December, 2018 A 5 Year Lookback at AAMTI

During the last five years at TATRC, the AMEDD Advanced Medical Technology Initiative (AAMTI) program has transformed into an ‘innovation incubator’ for enthusiastic clinicians across the AMEDD.

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NIRS Sensor (provided by BSX insight).
31 December, 2018 AAMTI Project Spotlight: Assessing the Feasibility of a Novel Non-Invasive Sensor for Guiding Wounded Warrior Rehabilitation

As a result of recent combat operations in Iraq and Afghanistan, the Military has been entrusted to care for over 1,700 Service Members and Veterans who have experienced traumatic limb loss, 82.7% of which have been of the lower limb.

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News Graphic
31 December, 2018 AAMTI Innovator Recognized at National Competition

Congratulations to an outstanding AAMTI Innovator, CPT Rowan Sheldon MD, Madigan Army Medical Center General Surgery resident, who was the winner of the 2019 American College of Surgeons (ACS) Committee on Trauma (COT) Resident Paper Competition for the all-DoD/VA/Canadian Military for Region 13.

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November 2018

Major Danielle Anderson is demonstrating a knee extension mobilization on a training partner. The loadpad® provides an unobtrusive interface that allows the treating physical therapist to feel the joint movement while providing real time feedback via a tablet device.
8 November, 2018 AAMTI Project Spotlight: The use of Real-Time Instrumented Feedback to Train Physical Therapists

Osteoarthritis (OA) of the knee is a common and debilitating condition for many active duty and retired Service Members and beneficiaries. Traditional medical approaches include medications and injections providing modest symptom benefit with associated risks.

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The assessment tool consists of a wearable IMU system, wireless headset and automated Dual-Task protocol. The desired end state is to package the assessment into universally available smart phone based application.
8 November, 2018 AAMTI Project Spotlight: Dual-Task Stability Assessment Utilizing a Wearable Motion Analysis System: Diagnosis and Management of mTBI

Despite the proliferation of state of the art traumatic brain injury (TBI) centers throughout the Department of Defense (DoD), the diagnosis and management of most mTBI cases occurs at the small unit level. Combat medics relying on the Military Acute Concussion Assessment (MACE) are often the first medical providers to assess injured Soldiers.

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Screenshot of profile/appointment information for patients’ future surgical visits
8 November, 2018 Summer Launch of the Peri-Operative Surgical Patient Education AAMTI Initiative

This summer the lab team at TATRC’s Mobile Health Innovation Center (mHIC) launched phase one of the “Development of a Mobile Web-Based Application for Pre and Post-Operative Patient Education of the Military Surgery Patient” pilot project.

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June 2018

An Evaluation of Novel Medical Devices and Other Interventions in the Treatment of Tension Pneumothorax in a Swine Model (Sus scrofa), presented by CPT Rowan Sheldon, Associate Investigator. ** Top presentation: Preclinical session
29 June, 2018 AAMTI PM Visits Madigan’s Annual Research Day

Ms. Holly Pavliscsak, TATRC’s Program Manager who oversees the AMEDD Advanced Medical Technology Initiative (AAMTI) was on the road again in May. This trip took her to Madigan Army Medical Center (MAMC) in Tacoma, Washington where she attended the Colonel Pat C. Kelly Madigan Research Day on 4 May. COL Richard Burney, Chief of the Department of Clinical Investigations hosted this impressive event.

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Medic utilizing the ADTMC manual at a Battalion Aid Station.
29 June, 2018 AAMTI Project Spotlight: Web-Based Medic Tool

Currently, U.S. Army medics in the field carry the 269 page, 2-4 lb paper Algorithm Directed Troop Medical Care Manual (ADTMC) with them to Battalion Aid Stations (BAS).

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Schematic of Motion-Scaling to counter excessive signal latency in tele-robotic operations
29 June, 2018 AAMTI Project Spotlight: T.R.O.N. Telesurgical Robotic Operative Network and Counter-measures to Excessive Signal Latency in Robotic Telesurgery

In early 2018, the U.S. Army Medical Department (AMEDD) defined its strategic vision on the role of medical robotics and man-machine interfaces for the future of Army medicine. In line with the Army’s Robotic and Autonomous Systems Strategy, AMEDD outlines mid and long-term goals for research and development of strategies to enable semi-autonomous tele-robotic surgery for combat casualty care in austere and combat environments.

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Physical Therapy Assistant and SPARTA Coach, Ashley Ricks, works with Soldier Athletes to correct functional movement, improving range of motion, strength, and power to maximize performance.
29 June, 2018 AAMTI Project Spotlight: Human Performance Optimization in a Non-SOF Unit

The XVIII Airborne Corps is aggressively working to reduce the impact and frequency of musculoskeletal injuries and have identified a gap in the traditional methods used to physically train our Soldiers prior to injury and following injury rehabilitation.

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April 2018

Photos courtesy of BrainMaster Technologies Inc. Pictures illustrate a mock neurofeedback treatment session utilizing BrainMaster Discovery 24E and BrainAvatar™.
13 April, 2018 Got a Bright Idea? AAMTI RIF Funding is Still Available for FY18!

In 2017, the AAMTI program introduced the Rapid Innovation Funding (RIF) program as an optional alternative program to the traditional AAMTI Extended Innovation Funding (EIF). Unlike the traditional AAMTI projects which are an average duration of eighteen months, AAMTI RIFs projects should be accomplished in 6 months or less.

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Photos courtesy of BrainMaster Technologies Inc. Pictures illustrate a mock neurofeedback treatment session utilizing BrainMaster Discovery 24E and BrainAvatar™.
13 April, 2018 AAMTI Project Spotlight: Feasibility Study of a Novel Neurofeedback Technology for Persistent Post-Concussive Symptoms in Soldiers

Lifetime history of traumatic brain injury (TBI) is present in over 60% of military personnel. While most of these events are mild and leave no complications, nearly 20% of individuals sustaining TBI experience persistent symptoms. The presence of somatic, cognitive and/or behavioral impairment may affect the service member’s capacity to return to duty.

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Electric Cell-substrate Impedance Sensing system from Applied Biophysics, Inc.
13 April, 2018 AAMTI Project Spotlight: Electric Cell-Substrate Impedance Sensing as a Means of Determining the Virulence Potential of Bacterial Isolates

The disruptive nature of war coupled with the degradation of barriers to infection resulting from combat and non-combat injuries predispose military personnel to bacterial infection. Bacterial infection is a significant cause of morbidity and mortality in the military healthcare setting.

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At BAMC’s Research Open House, Ms. Holly Pavliscsak educates attendees on the AAMTI Program, its processes and how to obtain funding.
13 April, 2018 AAMTI Program Manager Invited to Speak at BAMC

Ms. Holly Pavliscsak, Program Manager for the AMEDD Advanced Medical Technology Initiative (AAMTI), was honored to be invited by Department of Clinical Investigation and the Graduate Medical Education department at the Brooke Army Medical Center (BAMC) in Fort Sam Houston, Texas to be the featured speaker at their Research Open House event on 31 January.

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