SBIR-STTR Award

Prolonged Field Care (PFC) is utilized by the US Military to deliver field medical care beyond planned timelines of evacuation in order to decrease patient mortality and morbidity. PFC utilizes limited resources to sustain care until the patient arrives at the next level of care. Life-threatening medical conditions requiring evacuation, pose a significant risk of loss of life and mission for long duration exploration missions Astronaut crews evacuating to earth will deliver prolonged field care without real-time decision support. NASA will need to develop prolonged field care protocols that incorporate autonomous decision support. Nahlia Inc demonstrated an Autonomous Medical Response Agent (AMRA) in previous research efforts. AMRA is a multi-criteria feedback control Bayesian clinical decision support tool. Clinical history, physical exam, laboratory and imaging assessments, vehicle and environmental data are combined. Calculated post-test likelihood distributions of disease, clinical and mission outcomes (Med09) guide the sequence of evidence-based protocols. Inventory and astronaut personal preference (Med03) filter choices and just-in-time training provides point-of-care instruction to CMO's. Outcomes measures provide a multi-organ system state estimate of health and contributes to an estimated risk posture for crew and mission (Med08, Med09). Differences between current and goal health state, defined by NASA STD3001, sustain AMRAs guidance until a goal state is achieved. AMRA sends information to Mission Control, coordinating asynchronous care (HARI02). The proposal seeks to establish the benefits and feasibility of a systematic capability to develop, guide, and train PFC protocols for space. Tasks include (1)systematic approach to evidence-based autonomous PFC protocols (2) Clinical Case Simulator to test PFC protocols, (3) Mission Coordinator to facilitate collaboration with Mission control 4) Case-Based Trainer to prepare Astronauts for PFC in Space. Potential NASA Applications (Limit 1500 characters, approximately 150 words) High severity of illness, rapid decision making, where real-time telemedicine support is not available makes Prolonged Field Care scenarios the most likely lead to loss of crew and loss of life on long duration missions. For example: Acute respiratory distress, Undifferentiated Shock, MultiOrgan system Trauma Autonomous decision support, proposed here, will be required to support training and guiding Crew Medical Officers performing PFC in space. Potential Non-NASA Applications (Limit 1500 characters, approximately 150 words) Coordinated Bayesian Decision support can be used to automate the standard of care, decrease cognitive overload in other arenas. Military Prolonged Field Care, Disaster response, rural medical care, pandemic response,

In previous TRISH and NASA funded efforts, Nahlia has developed nested logic, Bayesian algorithms and software, to dynamically analyze and deliver evidence based clinical decision support to control evolving medical situations. This Autonomous Medical Response Agent (AMRA) was further advanced in phase I SBIR based on military Prolonged Field Care principles for autonomous field medical care. AMRA provides coordinated mission guidance for multiple caregivers, a clinical case simulator to systematically and verifiably improve AMRA’s decision structure, and an integrated clinical case-based training feature to maintain optimal human-machine performance for autonomous medical operations. Phase II work focuses on expanding AMRA’s probabilistic structure to include parallel feedback control, Bayesian nested hidden state networks capable of providing resource constrained clinical decision support to optimize the health state of Astronauts. Learning and path optimization algorithms in AMRA will extend longevity and usability of AMRA. The efficacy and validity of AMRA will be demonstrated with an experienced NASA Flight Surgeon and non-clinician astronaut-like users at the Naval Post Graduate School. Potential NASA Applications (Limit 1500 characters, approximately 150 words): Autonomous Medical Response Agent addresses multiple NASA HRP Gaps: Medical-101,201, 301, 401,601,701 Remote field applications to assist flight surgeons on HISEAS, or McMurdo Station Autonomous medical response system has the potential to aid astronauts on long duration missions to the Moon and Mars. Potential Non-NASA Applications (Limit 1500 characters, approximately 150 words): DoD: Prolonged field care practitioners, Undersea Submarine Medical Caregivers, Air Force pararescue Civilian: aeromedical evacuation, rural/indigenous peoples care, international disaster relief, prison health systems Commercial: Assist nurse practitioners and physician assistants, health insurance to predict costs of care Duration: 24