Mass casualty incidents refer to Large-scale events involving 20 or more people with minor injuries. Mass casualty events can be caused by many things, such as natural disasters, explosions, terrorist attacks and mass shootings. Nearly every event or situation that would see a huge influx of patients with major or fatal injuries, as well as numerous deaths, counts as an MCI.
Whether one is talking about large medical facilities or local support teams, mass casualty incidents (MCIs) are not only difficult to quantify, but they’re also incredibly challenging to deal with and mitigate.
In a mass casualty incident, minutes can often make the difference between life and death. The DARPA Triage Challenge (DTC) aims to drive breakthrough innovations that will enable medical personnel to respond effectively to mass casualty incidents (MCIs) in complex military and civilian settings, when medical resources are limited relative to the need.
The Defense Advanced Research Projects Agency launched a three-year competition in Nov 2022 focused on improving emergency medical response in military and civilian mass casualty incidents. The DARPA Triage Challenge aims to drive innovation that can aid medical personnel in the prioritization and acceleration of care in the case of MCI, the agency said.
The agency expects to see the use of technologies that can help identify casualties requiring the most urgent treatment and subsequently predict whether immediate lifesaving interventions are necessary. The competitors may use sensors, unmanned aircraft vehicles, algorithms and real-time data analytics.
During a catastrophe, disaster or major event that spans a huge area, it can be difficult for response teams to properly assess the situation and locate potential survivors. Major floods and other natural disasters, for example, often destroy entire communities.
Disaster recovery teams have begun using aerial surveillance technologies like drones to survey areas, find survivors and react. At the very least, the devices can be used to assess nearby surroundings and formulate an action plan. Perhaps one of the best features is that they can be controlled remotely through mobile devices and proprietary remotes.
Traumatic injuries suffered in diverse civilian and military settings such as combat, accidents, natural disasters, and attacks on gatherings may be fatal if not quickly identified and treated. Alongside monitoring patient vitals, it’s necessary to conduct triage. This is the process of deciding which injuries are more urgent and need immediate care, and which can wait — especially in the face of limited supplies.
Medical responders use triage procedures to rapidly prioritize casualties for immediate lifesaving interventions (LSIs), such as treatment of significant bleeding and management of airway threats. Triage is difficult in any circumstance, but MCIs in complex settings pose significant capability challenges. Overwhelmingly large numbers of casualties relative to medical resources on-hand; dangers to first-responders on the scene, such as unstable infrastructure, contaminants, or hostile fire; and environmental factors that make casualties harder to find and assess, such as rubble, flooding or darkness, may prolong the response. Further complicating triage is poor understanding of early physiological response to traumatic injury.
There are four different categories of triage labels, all denoted by a color system. Red tags are reserved for immediate medical care, yellow tags are severe yet capable of waiting, green tags indicate minimal injuries that are not life-threatening and black tags are used for patients who are already deceased or will be soon. Understanding the various classifications and properly identifying patients is vital to keeping many alive. Coupled with vital and smart health monitoring tools, an AI or automated system can help classify patients in a time of need. This would take some of the pressure off responders and healthcare providers, while also ensuring that patients receive the right amount of care.
“Primary triage requires hands-on evaluation, which may be appropriate for a small number of patients, but does not scale to mass casualty incidents. In secondary triage, the standard approach is to periodically check vital signs, such as heart and respiratory rate, blood oxygen saturation, and blood pressure. These approaches may miss early indications of life-threatening injuries,” noted CDR Jean-Paul Chretien, the DARPA program manager for the effort. “The DARPA Triage Challenge seeks to enable medical responders to save lives in mass casualty incidents by exploiting stand-off sensors to rapidly and autonomously provide information needed in primary triage, and providing continued monitoring to predict need for life-saving interventions in secondary triage.”
“Accurate triage is difficult in any setting, but particularly after a mass casualty incident that involves dozens, hundreds, or even thousands of patients. Humans alone struggle under the chaos and stress – research has found that in mass casualty settings recommended triage methods are often not used or inaccurately applied. DARPA’s work to bring technology to triage to improve the capacity and accuracy of triage in both the battlefield and civilian settings is critical to improve our Nation’s preparedness.”
The DARPA Triage Challenge is a three-year effort with three sequential 12-month phases for primary triage and secondary triage in parallel, each culminating in a challenge event.
The $7 million challenge will be divided into primary triage-real world, primary triage-virtual, and secondary triage segments, each with a duration of 12 months. Some of the participants will be self-funded, others will be financed by DARPA and all teams can join one or multiple competitions.
Prizes will be awarded to the top-performing teams in each challenge event based on eligibility, and competitors may participate in one or multiple competitions. Additionally, performers will collaborate with independent verification and validation teams and DARPA’s Research Infrastructure for Trauma with Medical Observations (RITMO) program, which provides data for use in the Secondary Triage competition.
The DTC’s long-term vision is:
- an initial, or primary stage of MCI triage supported by sensors on stand-off platforms, such as uncrewed aircraft vehicles or robots, and algorithms that analyze sensor data in real-time to allow medical personnel to identify casualties for urgent hands-on evaluation; followed by
- a secondary stage, after the most urgent casualties have been treated, supported by non-invasive contact sensors placed on casualties and algorithms that analyze sensor data in real-time to predict need for LSIs by medical personnel.
The notional DTC primary triage setting is the first few minutes of an MCI, with automated capture and processing of data from stand-off sensors to support medical responders in evaluating an overwhelming number of casualties. Competitors will be tested in physical or virtual simulations of MCIs. The notional DTC secondary triage setting is a casualty collection point, medical facility, or emergency department, after primary triage and immediate LSIs have been administered. In the secondary triage setting, patient status is further assessed and continuously monitored to identify changes requiring urgent intervention. Competitors will have access to de-identified clinical data from DARPA’s RITMO program for use during the competition.
In an eventual application, these sensors would provide injury information for integration with other data about the scene to enhance overall situational awareness, and focus further physiological interrogations, as evidence accumulates about injury mechanism and characteristics.
“The DARPA Triage Challenge will gather communities with expertise in triage and emergency medical response, tactical combat casualty care, trauma physiology, and a diverse array of physiological signatures and sensor and algorithm technologies that will continue to deliver innovative technologies that support medical responders beyond the Challenge,” added Chretien.
“The DARPA Triage Challenge will gather communities with expertise in triage and emergency medical response, tactical combat casualty care, trauma physiology and a diverse array of physiological signatures and sensor and algorithm technologies that will continue to deliver innovative technologies that support medical responders beyond the Challenge,” explained U.S. Navy Commander and DTC Program Manager Jean-Paul Chretien.