LEBANON, NH Trauma patients – with injuries ranging from those suffered in auto accidents to battlefield wounds – often seem, initially, to be stable, only to deteriorate without warning.  If not recognized early, this deterioration in condition can lead to shock or even death.

Doctors and researchers in the Emergency Department at Dartmouth-Hitchcock Medical Center (DHMC), as well as colleagues at Dartmouth College, the Thayer School of Engineering, and the Geisel School of Medicine, hope to improve care for seriously injured patients with a new $3 million Precision Trauma Care Research Award  from the Department of Defense’s Combat Casualty Care Research Program.

The three-year grant will develop an easy-to-use, noninvasive system for the detection of ongoing internal hemorrhaging in soldiers or other seriously injured patients initially classified as injured but stable. The Dartmouth-Hitchcock/Dartmouth College group will collaborate with the Mayo Clinic, the Ohio State University, and Maryland Shock Trauma.

“Emergency providers don’t currently have a good way to predict which patients will remain stable, and which will go into shock,” explains Norman A. Paradis, MD, an emergency physician at D-H and a professor of emergency medicine at Geisel, who serves as the project’s principal investigator.

“Our objective is to develop a non-invasive system that gives an accurate and early alarm that a patient has begun to deteriorate,” Paradis says.  “Individual patients will benefit from early intervention and medical systems will benefit because they can focus their attention and resources on patients who have been correctly identified as needing immediate care, while our system continuously monitors their other patients.”

Paradis says the grant was inspired by an email from Baghdad written in June 2007. Battlefield military physicians wrote:  “[T]here are three groups of casualties: 1) the ones who are really sick and (almost) everyone knows it; 2) the ones who have minimal injuries and will live almost regardless of what we do; and 3) those who look like they aren’t too bad but then deteriorate. (We are) most interested in identifying group three.”

The development team will include trauma specialists, engineers, computer programmers, and other experts to create a monitoring system that will gather signals continuously from multiple sites on the patient, using state-of-the-art sensors and computational technologies.

“The combination of machine learning and state-of-the-art sensing technology will allow us to better understand the early responses to hemorrhage,” Paradis says.  “We anticipate not only creating an innovative medical technology, but to also producing important new science.”

The U.S. Army Medical Research Acquisition Activity is the awarding and administering acquisition office. This work is supported by the Office of the Assistant Secretary of Defense for Health Affairs endorsed through the Department of Defense, through the Defense Medical Research and Development Program, Joint Program Committee 6, Combat Casualty Care Research Program – Precision Trauma Care Research Award under Award No. W81XWH-18-2-0076.