Technical Reports
A technical report is a technical document that records and disseminates methods and results from research studies and research, development, test, and evaluation (RDT&E) activities. Technical reports are USAARL's principal method of in-depth reporting on technical subjects that are of interest not only to the department, agency, or command sponsoring the work, but also to external groups and laboratories in government, academia, and industry. Technical reports may vary in type, to include technical reports that present the findings of research or analyses or that provide guidance or instruction on matters important to the DoD, journal articles (open access and embargoed text) that have been published under an open access agreement with the publisher or published under a Creative Commons license, conference proceedings that include whole collections of papers presented at a symposium or workshop, and conference papers that could include an individual paper, briefing charts, or a poster presented at a workshop or symposium. For inquiries related to USAARL's technical report(s), contact usarmy-usaarl-sic@health.mil.
Featured Reports
For more reports, please visit the technical reports archive page.
TITLE:A Systematic Literature Review of Operator State Detection using Physiological Measures
AUTHOR(s):Duffy, M. J., Feltman, K. A.
ABBREVIATED ABSTRACT:A systematic literature review was conducted to examine the literature (published between 2010 and 2021) surrounding the use of physiological measures to identify operator's cognitive state. operator states of interest were those that pose significant risks to Army aviators. Specifically, workload, fatigue, inattention, stress, and hypoxia. Additionally, studies that took place in applied and/or mobile contexts were sought in order to ensure the greatest likelihood of operationally relevant work. From this review, thirty-two eligible studies were identified. From these studies, it was determined that workload, fatigue, and inattention show the greatest promise for detection through physiological metrics. However, this is in part due to number of available studies. For instance, only one study was eligible where hypoxia was the cognitive state of interest. Additionally, based on the papers reviewed, EEG and eye metrics appear the most promising for identifying these various operator cognitive states. Further work is needed to validate some of these measures within true operational contexts. Specifically, based on the literature to-date, it is unknown how well some of these measures would hold up in a rotary-wing environment, where the sensors would be exposed to vibration and extreme temperatures. Further work is needed to determine whether the findings from these papers generalize to a larger population.
KEYWORDS:Operator state monitoring, aviation, rotary-wing
TITLE:Efficacy of Medical Device Alarm Integration into a Simulated H-60 Integrated Communication System
AUTHOR(s):Kroening, L. R., Kinsler, R. E., Molles, J. J., Lloyd, A. L.
ABBREVIATED ABSTRACT:The objective of this study was to evaluate the efficacy of incorporating audible medical device alarms into a simulated aircraft Intercommunication Set (ICS). The effect of integrating these alarms on care provided and time delegation was examined. Subjective data was also collected from the Subjects regarding the benefits, drawbacks, and improvements they recognized during participation.
Subjects performed patient care tasks for two 30-minute scenarios. Each scenario had two priority-level patients, which were preprogrammed to have four decompensation events each. During one configuration the audio alarms were integrated into the Subject's ICS, and the other was
non-integrated (the current standard). Testing took place in an HH-60 simulator with a Baseline Medical Interior (BMI) litter system. The Subjects were given all supplies in the current Medical Equipment Set (MES) and given time to configure the interior of the simulated aircraft as they normally would. The patients were simulated with SimMan3G manikins, which displayed vitals on Zoll Propaq MD patient monitors via a Dynasthetics VitalsBridge 300. Subjects wore an HGU-56P helmet with Communication Ear Plugs (CEPs). Medical device alarms were integrated into the subject's CEPs via a custom-built ICS system equivalent, and all audio levels were measured prior to testing.
KEYWORDS:Integrated alarms, Intercommunication Set, ICS, communication ear plugs, CEPs, U.S. Army, helicopter, HH-60, Baseline Medical Interior, BMI, Medical Evacuation, MEDEVAC, patient care, medical device, monitor, vital signs, simulator, alarms
TITLE:En Route Care in Confined Spaces: Medic Posture Assessment
AUTHOR(s):Lloyd, A. L., Kinsler, R. E., Caruso, K., Kroening, L. R., Dupuy, J., Molles, J.J.
ABBREVIATED ABSTRACT:The confined space of common medical evacuation (MEDEVAC) configurations requires strenuous positions and painful postures of Critical Care Flight Paramedics (CCFPs) during patient loading and unloading during en route care. The goal of this study was to identify areas for design improvements or loading techniques to limit awkward or painful postures experienced by the CCFP that may lead to injury or musculoskeletal disorders (MSD). A total of 17 human subjects participated in the study. The subjects were healthy members of the U.S. Army, Reserve, and/or National Guard. Subjects were be dressed in full gear and markered to track body movement. Markers were placed on the head, torso, left arm, and left leg. Before motion trials began, a static trial captured the subject's standing posture. Ten motion trials were be conducted. Six trials were recorded loading and unloading manikins onto the Basic Medical Interior (BMI) and four trials were recorded using the Interim MEDEVAC Mission Support System (IMMSS). Motion data was captured and analyzed to calculate the kinematics of the subject's major body segments. The simulated medic's posture was be investigated to identify potentially dangerous postures that are known to lead to injury or MSD. Force estimates were calculated on the data to estimate the force at the L5/S1 vertebral disk.
KEYWORDS:IMEDEVAC, helicopter, enroute care, compressive force, constrained environment, lifting, ergonomics
TITLE:Surgical Interventions for Cervical Intervertebral Disc Disease in U.S. Army Aviators: A Comprehensive Review and Identification of Knowledge Gaps
AUTHOR(s):Madison, A. M., Stewart, A. S., Robinette, A. M., Sous, S. N., Yoganandan, N., Chancey, V. C.
ABBREVIATED ABSTRACT:Two common cervical spine surgical intervention procedures (CSSIPs) for treating patients with severe cervical spine intervertebral disc disease (CIDD) are anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA). Most medical guidelines regarding ACDFs and CDAs are based on general population health, activities, and life expectancy. Presently, knowledge gaps exist related to CCSIPs in the context of operational activities of military personnel who are frequently exposed to more dynamic and physically demanding scenarios than the general population. Currently, military guidelines consider ACDF and CDA disqualifying conditions for military fitness. This work presents the results of a robust literature review updating the state of knowledge regarding CSSIPs used for the treatment of CIDD and their applicability to the U.S. military rotary-wing environment.
KEYWORDS:Cervical spine, cervical spine surgical intervention, cervical spine intervertebral disc disease, CIDD, Anterior cervical discectomy fusion, ACDF, cervical spine fusion, cervical disk arthroplasty, CDA, cervical spine surgical intervention procedures
TITLE:A Literature Review of Applied Cognitive Workload Assessment in the Aviation Domain
AUTHOR(s):Vogl, J., Delgado-Howard, C., Plummer, H., McAtee, A., Hayes, A., Aura, C., St. Onge, P.
ABBREVIATED ABSTRACT:Advancements in technology have pushed the standard unit of work from the joule to the byte, as operators are tasked with increasing cognitively demanding information processing in domains such as transportation, warfighting, and medicine. Due to these advancements, interest in the field of cognitive workload and its assessment in applied environments has grown exponentially over the last two decades. Operator state monitoring systems promise to use performance, physiological, and subjective cognitive workload assessment metrics to predict when operators are approaching or experiencing cognitive overload and the system will take remedial action. A systematic literature review was conducted to survey the last decade (2010-2020) of cognitive workload assessment literature in the aviation domain. The objective of the literature review was to identify cognitive workload assessment techniques that have seen success in the aviation domain and examine the usability of composite cognitive workload metrics in an operational use case. Articles were obtained from three databases using keywords that surveyed cognitive workload terminology, measures, and domains.
KEYWORDS:cognitive workload, mental workload, performance, subjective, physiological, workload assessment, aviation
TITLE:Preliminary Evaluation of an Osteopathic Manipulative Treatment (OMT) to Prevent Motion Sickness Symptoms
AUTHOR(s):Kelley A., Thomas, V., Lee, A. J., Fotopolous,T., Boggs, J., Campbell, J.
ABBREVIATED ABSTRACT:Motion sickness directly impacts the readiness of the Army's aviation units. Severe motion sickness results in the dismissal of pilot and aircrew candidates during initial training, while minor to moderate symptoms can be distracting during flight. The current medications on the market that target motion sickness symptoms are prohibited for use before flight. Osteopathic manipulative techniques are a low to no cost option, which lacks side effects, that allows Doctor of Osteopathic Medicine flight surgeons the opportunity to treat crew members without the use of pharmaceuticals. If effective, these techniques could be used along side current desensitization training in order to ensure more pilot and crew candidates are eligible for flight. Given the paucity of research on such a technique, we conducted a small pilot study to to evaluate the effectiveness of a novel osteopathic manipulative treatment to prevent motion sickness symptoms whilst controlling for motion sickness susceptibility. The results of this study suggest that OMT may be effective at preventing motion sickness symptoms, specifically gastrointestinal (e.g., nausea) and sopite-related (e.g., drowsiness) symptoms. The effects observed were moderated by motion sickness susceptibility but not to the extent to suggest limited utility. The limitations of the study, however, preclude firm recommendations for operational use at this time.
KEYWORDS:motion sickness, osteopathic manipulative treatment
TITLE:The Feasibility of Operator State Monitoring in Army Aviation: A Survey of
Subject Matter Experts
AUTHOR(s):Wilkins, J. C., Feltman, K. A., Aura, C.
ABBREVIATED ABSTRACT:The U.S. Army's Future Vertical Lift (FVL) program is developing a new fleet of aircraft that is set to replace the UH-60 Black Hawk and the
AH-64 Apache. These new aircraft will include autonomous systems and have increased capabilities of speed, maneuverability, and operational
range. With this increase in capability, there will be an increased overload in Aviators' cognitive state leading to mishaps and accident fatalities.
Operator state monitoring through psychophysiological indices and biomarkers are used to identify cognitive states. Subject matter experts
completed two rounds of a Delphi-style survey to determine the reliability of selected sensors and biomarkers when incorporated in aviator
operational environments.
KEYWORDS:Delphi, survey, future vertical lift, operator state monitoring
TITLE:Evaluation of Litter Carriage Performance and Post-Carry Fatigue Effects in Prolonged Combat Field Care Environments (Part 1): Preliminary Design Considerations, Specifications, and Recommendations for Exoskeleton Feasibility, Suitability, and Efficacy in Dismounted Military Casualty Transport Scenarios
AUTHOR(s):Madison, A. M., Chambers, T. T., Stewart, A. S., Chancey, V. C.
ABBREVIATED ABSTRACT:Litter transport is a standard procedure for initial military casualty evacuation and consists of two- or four-person teams transporting a casualty over a long distance or carrying multiple casualties over a short distance. The litter team may be required to provide critical care while also engaging in combat to protect themselves and the patient. Musculoskeletal disorders can develop over time due to frequent, repetitive, or extended litter transport scenarios. The use of an assistive device, such as an exoskeleton, has the potential to improve combat performance following litter carry and improve evacuation times of the injured. Currently, there are no assistive devices integrated into the standard Military Equipment Set or litter carriage procedures, and exoskeleton research for military patient transport scenarios is scarce. The U.S. Army Aeromedical Research Laboratory conducted a comprehensive review of the state of exoskeleton research to determine essential preliminary design considerations as well as provide preliminary recommendations for exoskeleton technology focused on improving or enhancing dismounted military casualty transport scenarios.
KEYWORDS:litter transport, litter carriage, military casualty evacuation and transport, assistive devices, exoskeleton, musculoskeletal disorders
TITLE:Forward Operating Base Expert Telemedicine Resource Utilizing Mobile Application for Trauma (FOXTROT)
AUTHOR(s):Chung, R., Legault, G., Stowe, J., Miller, K., Moccia, M., Cooper, M., Little, J., Gensheimer, W. G.
ABBREVIATED ABSTRACT:Introduction: During Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), 10-15% of combat-related trauma injuries involved the eye. During Operation Resolute Support (ORS) and Operation Freedom's Sentinel (OFS), 7% of patients presenting to the emergency department required ophthalmic surgical intervention, and 13% of trauma patients requiring surgical intervention underwent an ophthalmic surgical procedure. The military ophthalmologist's primary mission is to be prepared to manage ocular trauma, especially in an austere environment. However, with operations across the globe, military personnel are deployed across great distances often in remote locations with limited communication capabilities and no access to ophthalmic care. The primary purpose of our research was to develop an operationally secure, Health Insurance Portability and Accountability Act (HIPAA) compliant, mobile application (mApp) to provide ophthalmic care to any remote deployed location through teleophthalmology called Forward Operating Base Expert Telemedicine Resource Utilizing Mobile Application for Trauma
(FOXTROT).
KEYWORDS:Teleophthalmology, telemedicine, ophthalmology, emergency care, military telemedicine
TITLE:Behavioral Sound Localization for Video-Derived, Personalized Head-Related Transfer Functions (HRTFs)
AUTHOR(s):Connor, K., Davis, S., Jones, H., Smalt, C.
ABBREVIATED ABSTRACT:Three-dimensional (3D) audio is commonplace in augmented or virtual reality environments, and is used to simulate the direction of arrival for sounds presented over headphones. The Head-Related Transfer Function (HRTF) enables 3D audio by characterizing how sound is received from a sound source in every direction. Optimal sound localization performance with HRTF-based 3D audio is thought to require personalized HRTFs because the localization cues are dependent on the size and shape of the head and pinnae. In this work, we propose a pipeline to generate HRTFs from high-resolution smartphone videos of the head and ears, and we validate the localization performance of the resulting HRTFs through human-subject behavioral experiments. To create a personalized 3D HRTF, a video was taken of a subject's head and torso, left ear, and right ear using a smartphone camera. Simulations of the acoustic pressure waves at the ear canals were performed in COMSOL using the boundary element method, taking approximately one hour per ear to complete. Preliminary virtual sound localization results were obtained on nine subjects under three listening conditions: open ear, a gold-standard generic HRTF, and the personalized HRTF derived from a smartphone video. Results show that our pipeline-derived HRTFs result in increased localization accuracy in comparison to the generic HRTF for some subjects.
KEYWORDS:Personalized HRTFs, sound localization, spatial audio, 3D audio
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Last Modified Date: 2022-07-25