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Unmanned Systems in Support

of Future Medical Operations

in Dense Urban Environments

Nathan Fisher, MS
Project Manager/Robotics SME (CTR)
US Army Medical Research and Materiel Command (USAMRMC)
Telemedicine & Advance Technology Center (TATRC)
22 April 2016

"The views, opinions and findings contained in this research/presentation are

those of the author(s) and do not necessarily reflect the views of the Department
of Defense and should not be construed as an official DoD/Army policy unless
so designated by other documentation. No official endorsement should be

TATRC Parent Organizations


5 RMCs
5 RMCs
Health Readiness
MEDCOM – US Army Medical Command
MEDCEN – Medical Centers now called Health Readiness Platforms
AMEDDC&S – Army Medical Department Center and School
HR CoE -Health Readiness Center of Excellence
USAMRMC – US Army Medical Research and Materiel Command
PHC – Public Health Center
TATRC – Telemedicine & Advanced Technology Research Center

US Army Medical Research & Materiel Command (USAMRMC)
Telemedicine & Advanced Technologies Research Center (TATRC )
COL Daniel R. Kral, Director

Mission: Exploit technical innovations for the benefit of military medicine by developing,
demonstrating and integrating across a variety of technology portfolios including
teleHealth, medical simulation and training, health IT, medical intelligent systems &
robotics, command and control, computational biology, and mobile solutions. Sponsor
bottom-up innovation through limited technology demonstrations focused on readiness,
access to care, and healthcare delivery.

Biotechnology Medical Focus: Roles 1-3 AMEDD Health

High Modeling • Operational Advanced Technology
Performance Simulation Telemedicine Medical Innovation
Computing Innovation Technology Center
Applications Center • Robotics, UMS Initiative
Institute Autonomous

Planned Use of UMS in 2025B

• "Over the next 25 years, the Army aviation force mix shifts from being almost
entirely manned to consisting of mostly unmanned and [Optionally-Piloted
Vehicles].“ U.S. Army Roadmap for UAS 2010-2035
• “Unmanned systems will be critical to U.S. operations in all domains across a
range of conflicts, both because of the capability and performance advantages and
because of their ability to take greater risk than manned systems.”
DoD Unmanned Systems Integrated Roadmap FY2013-2038
• Unmanned Systems technology will continue to improve.
• Technological innovations rapidly evolving, to include data-intensive, multi-
sensor, and multi-mission capabilities.
• More autonomous/task level control
• More multipurpose
• More interoperable
• Less reliance on GPS
• Less reliance on persistent comms


Medical Evacuation (MEDEVAC): movement of any person who is wounded,

injured, or ill to and /or between medical treatment facilities while providing en route
medical care, performed by dedicated medical personnel onboard a dedicated
evacuation platform.

Casualty Evacuation (CASEVAC): movement of casualties onboard nonmedical

vehicles or aircraft without dedicated en route medical care.

En Route Care: The care required to maintain the phased treatment initiated prior to
evacuation and the sustainment of the patient’s medical condition during evacuation.

Roles of Care

Roles of Medical Care (NATO definition as applied to US Army Organization)

• Role 1: Self-aid, buddy aid, or combat lifesaver & Basic Primary Care.
• Point of Injury Care & Bn Aid Station
• Combat Medic trained in tactical combat casualty care (TCCC)
• Goal to stabilize and evacuate to Role 2-3
• Role 2: Stabilization & Forward Surgery
• lifesaving resuscitative surgery
• 100% Mobile
• Brigade Medical Company & Forward Surgical Team (FST)
• Stabilize and evacuate to Role 3
• Role 3: Combat Zone Hospitalization and outpatient services for all
categories of patients
• Combat Support Hospital
• Evacuate to Role 4 within Theater Evacuation Policy.
• Role 4 & above: Communications Zone or CONUS-based hospitals &
medical centers.

Constraints on Medical Resources –
Dense Urban Environments

Limited freedom of movement for conventional vehicle platforms (both air and ground)
to provide medical resupply and casualty evacuation
• Gridlocked transportation networks
• Predictable movement patterns (IED threats)
• 3-Dimensional threats (air, land, and subterranean)

Limited Medical Resources

• Mass Casualties/Natural Disasters
• Manned assets too high risk in A2/AD environments
• Increased evacuation time and distance to MTF
• Prolonged Field Care, Prolonged En Route Care

UMS could serve as a Force Multiplier,

providing increased access to Resources
• When conventional manned assets are denied
access: air superiority is not assured
• When medical resources are severely constrained
• Nonmedical vehicles will be increasingly unmanned
(less conventional “Vehicles of Opportunity” for
Future Medical Missions

From 2001 to 2011, nine out of ten Warfighters who died from injuries sustained in
combat did so before arriving at a medical care facility. Of these, almost 25 percent died
from injuries deemed potentially survivable (Eastridge, Mabry, Seguin et al., 2012).

Strategies to improve outcomes prior to Role 3:

1) Bring medical expertise, supplies, and equipment to the point of care (Roles 1-2)
2) Decrease evacuation times and improved En Route Care

Both strategies made more difficulty by likely mobility restrictions in Megacities.

UMS for Future Medical Missions

Dedicated Medical Evacuation (MEDEVAC) Platforms attended by experienced

medical processionals are ideal, BUT:
• What if no manned assets are immediately available
• Manned assets are denied access (risk of losing additional lives is too great)
• CBRNE exposure risk

Bottom-Line: Future UMS having a secondary capability to be reconfigurable to

support CASEVAC would be an enabler for the maneuver Commander. UMS for
CASEVAC should only be used under careful consideration, and only when acting in
the best interest of the wounded.

When CASEVAC (manned or unmanned) is too risky,

UMS could potentially be used to bring medicine,
supplies, and telemedicine/tele-consultation capabilities
forward in support of Prolonged Field Care situations

Suitably-sized future UMS could be developed to have a

secondary CASEVAC or medical resupply capability

UAS Size Categories

The Case for UMS CASEVAC

UMS Platforms have superior mobility in Dense Urban Environments

• Smaller, lighter, more agile
• Does not need to support weight of pilot and manual controls, displays, seats, etc.
• Potentially faster speeds/accelerations prior to loading casualty
• Smaller footprint means more potential Landing Zones (LZs)

Form Factor Comparison small UAS vs Conventional Platform

UH-60 (Sikorsky)

DP-14 (Dragonfly Pictures, Inc.)

UAS In-Development

Multi-Purpose UMS

DARPA ARES (Aerial Medium-size VTOL with

Reconfigurable Embedded mission-specific payloads

UGVs of various size with mission-specific payloads

Need to develop
secondary CASEVAC
capability for suitable
future UMS platforms
[Lockheed Martin SMSS]
The Case for UMS CASEVAC

Example Path of Adoption for Medical Missions:

• Near Term
• Scenario: UAS delivery of emergency medical supplies to support Prolonged
Field Care when manned-assets are denied access
• Enabling Capability: Mature autonomous navigation and C2
• Mid Term
• Scenario 1: Vehicle of Opportunity CASEVAC with attending medic
• Scenario 2: Unattended CASEVAC for stable patient (“walking wounded”)
• Enabling Capability: Ensured safety for limited UMS troop transport
• Far Term
• Scenario: Unattended CASEVAC/MEDEVAC
• Enabling Capability: Autonomous Enroute Care (closed-loop or remote
human control of patient management systems), Roll-on or man-transportable
En Route Care Kit
• Dedicated pilot-less MEDEVAC platforms (pilot SWaP vs. capability trade)

Challenges for Medical UMS

Safe Ride Standards for UMS CASEVAC

• NATO Task Group HFM-184 “…use of UAVs for CASEVAC will take place
as soon as Cargo UAVs or optionally-piloted conventional aircraft are
available on the battlefield – it is up to NATO and the Nations to ensure that
such use is carried out under the safest possible considerations”
• Considerations unique to UASs for casualty transport and medical resupply

Lack of VTOL UAS assets in the near/mid-term in Tactical/Persistent size classes for
agile/last-mile medical resupply.
• Larger VTOL UAS will likely be Optionally-Piloted Aircraft (OPA) in the
near/mid term
• Medical logistics prior to use as casualty transport
• Trust established for UMS troop transport in general
• Specific guidelines for UMS CASEVAC in terms of environmental exposure
(shock/vibe, temperature, noise, pressure)

**Need active development of CASEVAC as a secondary role for suitable UAS to

ensure safe implementation
Capabilities of UMS for Future Medical Missions

SOURCE: NATO STO Technical Report TR-HFM-184, December 2012
Future UMS Enroute Care Scenarios

Example En Route Care System onboard a UMS platform Example Interactions

Enroute Care with Care Providers
Control Unit
CASE 3: Autonomous
Care (closed-loop)

Increasing Levels of Autonomy

Patient Monitor provided by inflight
control unit with
BP human-in-the –loop in a
supervisory role

CASE 2. Remote control

of inflight control unit by
care provider at
destination MTF

Transport CASE 1: Remote

Ventilator monitoring of casualty
en route by provider at
Surgical Robots destination MTF
IV Pump

Future Therapeutic Medical Devices

Casualty (Simulated)
Novel Use of sUAS

sUAS – Tradeoffs: Size, Range, Payload

• Role for last-mile/agile resupply
Provide aid for Prolonged Field Care– driven by A2/AD
• Blood
• Supplies (devices, consumables, pharmaceuticals...)
• Expertise (telemonitoring, teleconsultation)
Considerable investment from industry
• FAA Aerospace Forecast FY2016-2036
• industrial inspection (42%)
• real estate/aerial photography (22%)
• agriculture (19%), insurance (15%)
• Delivery (Amazon, Google)

Enabling Technologies: Autonomy

Unmanned Systems technology will continue to improve

• Technological innovations rapidly evolving, to include data-intensive, multi-
sensor, and multi-mission capabilities.

State of the Science -> miniaturization and robustness, focus on autonomy

Synergy with emerging tech -> machine learning, cloud computing, augmented/virtual
reality, natural language processing, etc.

Example: LiDAR Evolution

Currently Available LiDAR Sensors

Integrated Solid State
LiDAR Sensor
Compact, lightweight,
2 lbs low cost


Enabling Technologies: Teaming

UMS Teaming with Soldiers for Operational Medicine:

• High Cognitive demands in TCCC scenarios
• Patient Care
• TCCC documentation
• Maintaining SA
• Cognitive burden of UMS C2
• Task-level Commands, Supervisory Role

Example Soldier – UMS Interactions during Medical Missions:

• UAS: Collaborative VTOL landing/takeoff at CCP (CASEVAC)
• UAS: “Last-Mile” emergency medical resupply request and coordinated drop-off
• UGV: Collaborative Casualty Extraction/Lift

Effective Manned-Unmanned Teaming (MUM-T) requires:

• Intuitive and efficient Human-Computer Interfaces
• Improved by implementation of hands free input (real-time natural language
processing, gesture control)
• Common controllers, interfaces, communications protocols for all devices and
actors in the system
MUM-T: Opportunity for

Cross Platform
(UMS-UMS, Human-UMS)
Cross Domain
(Air, Ground, Maritime)
Cross Service
(Army, Navy, Air Force)

Requires Joint

Human - Human
Human - UMS

UxS Control Segment (UCS) Architecture

Leveraging DOD initiated UCS cross-platform architecture framework to enable cross

service integration of our SBIR efforts for both ground and air UMS research projects.

UCS – An open architecture for the control systems of UxS

• Common basis for acquiring, integrating, and extending UxS capabilities
• Evolution of STANAG 4586 (standardized UAS comm protocols/data elements)
• OSD Open Business Model for future Ground Control Stations (GCS)

https://www.ucsarchitecture.org/ 22
On-going Research and Development

Kutta Technologies: Human-Computer Interface and Command and Control of

Unmanned Aerial Vehicles for Medical Missions
A Human-Computer Interface (HCI) and Command and Control (C2)
infrastructure needs to be developed for the combat medic to effectively
interface with unmanned VTOL platforms for future medical operations
(CASEVAC and emergency medical resupply)

Technical Approach: Two types of interfaces Soldier Radio or End User

Device (EUD)
Dial-A-Drone: Allows the soldier or medic in the field to send commands to the
UAS asset using currently-fielded tactical radios.

Field application for EUD (Nett Warrior): An application on a

handheld device that would provide the capability to a medic,
with little or no training in VTOL operation, to interact with
unmanned assets at the task/goal level in order to plan and
execute unmanned CASEVAC and resupply missions
Funding Source: Army SBIR Phase II

On-going Research and Development

Neya Systems: VTOL (Vertical Takeoff and Landing)

Evacuation and Resupply Tactical Interface (VERTI)

Technical Approach:
Android EUD compatible application for controlling
Vertical Takeoff and Landing Aircraft, along with software
for medical record exchange based on eTCCC card.

A telemedicine reference software architecture based on

UCS (Unmanned Systems Control Segment) for managing
and integrating multiple medical data streams, and
transmitting over a tactical network.

March 2015: Successful demonstration of collaborative

CASEVAC using an Unmanned Ground Vehicle and a K-

Summer 2016: Collaborative CASEVAC using UAS and

UGV in an operational relevant environment with transport
telemedicine integrated with HCI and C2.

Funding Source: Army SBIR Phase II

On-going Research and Development

SBIR TOPIC A14-053: Squad-Multipurpose Equipment

Transport Medical Module Payload for Casualty Extraction

Gap: TRADOC PAM 525-66, Future Operating Capability

09-06, Health Services Support:
“Future Soldiers will utilize unmanned vehicles, robotics and
standoff equipment to recover wounded and injured Soldiers
from high-risk areas, with minimal exposure:
- Recover wounded Soldiers
- Facilitate immediate evacuation & transport…
- The ability of performing networked medical information
interface support...”
Operational Concept:
Support secondary role of multi-mission UGV for expedited

Provide capability to secure a casualty onto the UGV as

quickly as possible, and to transmit medical information
during transport back to a Casualty Collection Point
Funding Source: Army SBIR Phase II
Potential R&D Opportunities

• Considerations unique to UMS in regard to medical applications need to be better understood in order
to inform doctrine development and the combat casualty care research and development community
• Inform trade-off decisions regarding the use of manned versus UMS for medical resupply and
patient transport in future OE
• Increase exposure to Warfighters of emerging UMS technology (use feedback to inform development)
• Integration of Patient Monitoring and emerging En Route Care capabilities with UMS C2
• Telemedicine interoperability standard based on UAS Control Segment (UCS) framework
• Utilization of emerging dexterous robotic manipulation technology for casualty extraction and en
route care applications (i.e. medical imaging, monitoring, limited intervention)

Questions / Discussion

“The enterprise that does not innovate ages and

declines. And in a period of rapid change such as the
present, the decline will be fast” - Peter Drucker

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Medical Robotics Project Manager: nathan.t.fisher3.ctr@mail.mil 301-619-7920

Government PM Medical Intelligent Systems : gary.r.gilbert.civ@mail.mil 301-619-4043

TATRC Director: daniel.r.kral.mil@mail.mil 301-619-7967 27