Allow me to paint you a putative vision of trauma care in the year 2050 (assuming civilisation hasn’t been eradicated by climate change by then).
The predicted widespread use of driverless cars may significantly reduce the trauma burden from road traffic incidents (see June’s article below). But with the pressures of growing populations, stretched public services and rising social deprivation we can expect interpersonal violence to continue to provide a steady if not increasing flow of trauma cases.
In the immediate aftermath of a violent or traumatic incident EMS dispatch is automatically triggered by distress signals from the victim’s smart watch-like device. This intelligent wearable tech will detect changes in stress hormones, nociception, significant force vectors and vital signs and relay these along with precise geographical data to the EMS dispatch HQ. Existing smart devices such as the Apple Watch Series 4 are already incorporating elements of this with their fall detection technology. First responders will receive all the relevant baseline vital signs and medical history such as anticoagulation status and allergies whilst en-route. Corroborating information garnered from bystander 911 calls will also add to the picture. Upon arrival at the patient’s side the EMS teams will already have an in-depth knowledge of patient physiology, injury pattern and mechanism, thus facilitating rapid triage to an appropriate level of trauma centre.
Point-of-care genomic testing could feed into predictive models of coagulopathy, transfusion requirement and subsequent multi-organ dysfunction, further informing the triage decision. Professor Tim Billiar’s group from Pittsburgh are one of several groups looking into the multitude of inflammatory mediators and their underlying gene expressions that predispose different patients to develop multi-organ dysfunction following trauma. Real-time and predicted physiological data could be fed back to the receiving emergency department allowing them to fine-tune the make-up of the trauma team, prepare blood products and begin the process of creating bed capacity and readying the operating room. On-scene audio-visual feeds from EMS bodycams or overhead drone footage could provide vital information not easily communicated in a standard verbal handover. Police forces around the UK and elsewhere have been using real-time drone footage for a number of years to assist in searches and crowd management operations and we further highlighted the current and future capabilities of medical drones in the March edition of this blog. Larger drones may even be used to expedite patient transport, especially from remote areas or when road transport would lead to delays.
With significant life-threatening injuries identified prior to arrival, a targeted primary survey will facilitate rapid transfer of the patient to the imaging suite where static anatomical displays will be augmented with dynamic organ functional imaging to provide unprecedented cellular-level detail of organ dysfunction and hone in on specific bleeding points and the best surgical targets for haemostasis. Ultra-high-resolution 3D images of the scan will quickly be distributed amongst the surgical team to start planning their approach as well as providing a basic blueprint for the dimensions of any replacement organs that may need to be bioprinted at a later date. Recent breakthroughs in bioengineering allowing the printing of intricate vascular tissue beds herald the way for the rapid mass production of organs on-demand and without the often-tricky issue of having to approach recently bereaved relatives to seek permission to harvest the organs of their loved one.
In the next article we look at the crossover of advanced imaging into the operating room of 2050 where nanotechnology complements surgical hands and the continuum of care through ICU to rehabilitation is tailored to specific patient needs.
Obi Nnajiuba is a British surgical resident and current PhD student with a specialist interest in trauma, acute care, prehospital care, triage, mass casualty events and trauma systems. His postgraduate qualifications include an MSc in Trauma Sciences and membership of the Royal College of Surgeons of England. He is also a registered Motorsport UK physician, providing trackside advanced trauma care to competitors at world famous motor-racing circuits such as Brands Hatch, Goodwood and Silverstone.