Poster W5 - Enhancing Combat Airway Management: Evaluation of an Innovative Parallel Line Portable Suction System Through Structured End-User Testing in Military Medical Contexts.

Introduction: Airway management is essential in combat and emergency scenarios, directly influencing over 10% of preventable battlefield deaths [1]. Despite the critical role of suction devices in clearing life-threatening obstructions such as blood, vomit, and debris [2], their adoption is limited among combat medics and first responders due to their considerable weight (for battery-powered devices) or often inadequate suction power (for those manually powered) [1, 3-5]. The novel Suction Combat Ready Advanced Multifunctional Machine (SCRAMM) addresses this challenge by offering a lightweight, multifunction alternative, designed to enhance portability without compromising effectiveness. This solution aims to meet the demands of both military and civilian medical operations, facilitating rapid and efficient airway clearance under diverse field conditions.
Building on this need, the objective of this work was to evaluate SCRAMM’s performance through structured end-user testing involving military medical personnel. We hypothesized that the novel solution would be preferred by end-users due to its high level of usability and portability compared to market leaders Zoll 330 and Impact 326M. The comprehensive evaluation methodology combined both qualitative and quantitative measures, including the System Usability Scale (SUS) score. This testing, conducted under simulated scenarios, aimed to verify SCRAMM’s integration capabilities in military medical setups as well as its overall usability level. By directly engaging the end-users in the testing process, the study sought to gather actionable feedback to refine the device’s design, to ensure it meets the specific requirements of combat medics and enhances their capability to manage airway emergencies effectively.

Materials and

Methods: The end-user testing methodology for the SCRAMM prototype integrated both qualitative and quantitative research techniques to evaluate the device thoroughly. Using affinity mapping, user feedback was organized into themes based on Heuristic Principles and critical tasks, which guided the development of the testing protocol. Military medical personnel with experience in using suction devices, including active duty and reservist physicians from the US Air Force and Army, participated in the study. Tests were conducted at the University of Texas Health Science Center’s Simulation Laboratory to simulate actual field conditions.
Participants were grouped based on availability and instructed to independently operate three suction devices: SCRAMM, Zoll 330, and Impact 326M, performing suction on an airway mannequin, focusing on high-vacuum suction capabilities. Participants cycled through stations, to assess and compare the weight, usability, and additional features of each device. Feedback was captured through a structured post-test questionnaire, which was divided into two parts. The first part included Likert scale questions, binary yes/no questions, and open-ended questions to gather comprehensive user feedback and suggestions for enhancements. The second part of the questionnaire utilized the SUS to provide a quantitative measure of usability.
All quantitative data was analyzed using Microsoft Excel, while qualitative feedback was visualized using word clouds to highlight prominent themes and feedback patterns. Additionally, the SUS Analysis Toolkit was employed as a visualization tool to facilitate the representation and interpretation of SUS data. This approach ensured an evaluation of SCRAMM’s performance and user satisfaction in a military medical context.

Results, Conclusions, and Discussions:

Results: Quantitative analysis from the structured posttest questionnaire showed that 71.4% of participants (5 out of 7) perceived SCRAMM’s weight as “somewhat light,” underscoring a good balance between durability and portability essential for field use. About 42.9% (3 out of 7) found the on-screen information “somewhat useful,” pointing to opportunities for enhancing data presentation. Notably, SCRAMM’s integration into field equipment and its portability were unanimously praised, confirming the hypothesis and its design efficiency for field hospital applications.
Qualitative feedback highlighted SCRAMM’s intuitive operation and efficient default settings, with suggestions to boost suction power and modify the interface for easier use with gloves. Participants also recommended improvements in suction feedback mechanisms and called for features like larger dials and buttons and night vision compatibility to enhance usability in diverse operational conditions.
The SUS for SCRAMM yielded a “Good” usability score of 74.29/100, illustrating strong design and functionality, and directing future enhancements based on detailed user insights.

Discussion: Feedback from SCRAMM’s end-user validation highlighted its practicality and potential for integration into military settings, affirming its design effectiveness for field use and supporting the primary hypothesis. Despite its advantages, the need for enhanced suction power, nigh vision compatibility, and improved interface for glove use were noted. These insights direct specific areas for development to fully meet the exigencies of combat medical scenarios and optimize user interaction.

Conclusion: The SCRAMM device has demonstrated significant potential in enhancing airway management in military contexts. With its strong design and good usability score, SCRAMM aligns with operational military medical needs. Continuing refinement based on detailed feedback will ensure the device meets stringent field requirements, paving the way for broader deployment and improved emergency response effectiveness.

Acknowledgements (Optional): This work was supported by the AFWERX Direct to Phase II SBIR contract number FA864922P0928.
Disclosure: Research was supported in part by EmergenceMed, LLC, San Antonio, TX, a university startup, and RAD and RLH are principals in the company.

References:
1. Lairet, J.R., et al., Prehospital interventions performed in a combat zone: a prospective multicenter study of 1,003 combat wounded. Journal of Trauma and Acute Care Surgery, 2012. 73(2): p. S38-S42.
2. Vandenberg, J.T. and D.R. Vinson, The inadequacies of contemporary oropharyngeal suction. The American journal of emergency medicine, 1999. 17(6): p. 611-613.
3. Army, U., Tactical Combat Casualty Care: Lessons and Best Practices. 2012: Ravenio Books.
4. De Lorenzo, R.A. and R.S. Porter, Tactical emergency care: Military and operational out-of-hospital medicine. Vol. 10. 1999: Prentice Hall.
5. Schauer, S.G., et al., An Inventory of the Combat Medics' Aid Bag. Journal of special operations medicine: a peer reviewed journal for SOF medical professionals, 2020. 20(1): p. 61-64.