Patient Movement, En-Route Care, and Decontamination in Arctic Conditions: Engineering the System for Safe Control...

Area of Science:

• Military Medicine
• Systems Engineering
• Risk Management

Background:

• Arctic operations require robust Cold Region Expeditionary Medical Operations (CREMO).
• En-Route Care and Patient Movement (ERC/PM) systems are vital for life-saving interventions.
• Chemical, Biological, Radiological, and Nuclear (CBRN) threats pose significant risks in the Arctic, with limited integration of current medical and decontamination systems.

Purpose of the Study:

• To apply a novel hazard analysis, System-Theoretic Process Analysis extended for Coordination (STPA-Coordination), to engineer safe ERC/PM and decontamination systems.
• To mitigate and remove identified risks in CREMO and CBRN scenarios.
• To develop a system-theoretic framework for safe control and coordination in military health systems.

Main Methods:

• Utilized STPA-Coordination, a 4-step process including hazard identification, system modeling, hazardous control action analysis, and loss scenario investigation.
• Incorporated STPA-Coordination's guidance for developing system models and identifying coordination-related loss scenarios.
• Validated results through expert feedback from medical and decontamination specialists.

Main Results:

• Analysis identified 16 unsafe control actions and 53 loss scenarios, leading to 49 unique safety recommendations.
• Developed a Triage Decision Matrix to prioritize recommendations based on triage category and trauma event size.
• Expert feedback provided validation for the study's findings.

Conclusions:

• The study provides 49 safety recommendations for ERC/PM and decontamination systems in CREMO and CBRN environments.
• A system-theoretic framework was established for engineering safe control and coordination in military health systems.
• This research addresses critical safety gaps in expeditionary medical operations.