AI, Battlefield Medicine, and Prisoner Rights

In these two lectures from the GSACEP 2025 Conference, we discuss AI and the future of battlefield medicine, as well as the subject of prisoner rights in the ED. 

Transcript

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Matt, hello. I'm Captain Matthew Turner, and welcome to another episode of the gsacep podcast. In this episode, we have two lectures from the government services conference in 2025 the first lecture deals with AI and Battlefield medicine, especially in an elsco environment. Our second lecture deals with prisoner rights and what we can do as physicians to address this in our practice. Good morning. What does a mass casualty incident look like in the lisco environment? The answer is complex and nuanced, and the truth is that no one truly knows. But if the recent wars in Ukraine and Gaza are any indication, it's becoming rapidly clear that our next war will be fought with drones and powered by machine learning. Our success and the survival of our patients will be determined not just by our clinical acumen, but by how well we're able to work with computers and machines in a low resource and dynamic environment. In this talk, we'll be discussing just a few of the emerging areas in which artificial intelligence is rapidly transforming emergency and Operational Medicine. My hope is that this talk will give just a few examples to help us think more critically about how battlefield medicine and our role as military physicians will change in the years ahead. One of the first areas we'll see this eMERGE is in the area of triage. So DARPA, which is the Defense Advanced Research Projects Agency, is currently in the second year of a three year challenge designed to integrate the fields of robotics, artificial intelligence, data analytics, to improve triage processes allowing for autonomous casualty assessment and remote patient monitoring in the case of a natural disaster or mass casualty incident, the focus of Phase One last year, was developing unmanned ground vehicles and unmanned aerial vehicles that can perform what's called stand off evaluation, geo locating casualties across three courses, a battlefield, a convoy ambush and an airplane crash, identifying their injuries, and outfitting these drones and robots with radar, Lidar and infrared capabilities to monitor patient vitals remotely is in no physical contact in order to triage them in order of severity. This initial phase allows for manual operations, so humans were controlling the drones and robots remotely as they navigated the field. However, phase two, which is actively underway right now, requires full autonomy of the drones and robots navigating the field independently, geo locating casualties, triaging and then re triaging. As these patients have dynamic vital sign changes, they've also added, in addition, additional challenges, such as patients that get up and walk around the field, as well as utilizing night operations, which cause severe degradation to the sensing capabilities of a lot of these tech, this technology, this technology is really important to talk about, because in a future conflict, the role of the medical director and us as physicians will be not just supervising human medics, but also analyzing and interpreting patient data that's derived from drones and other standoff monitoring technologies. So in the same way that we need to understand the difference between an idmt and a 68 whiskey. We'll have to understand that the capabilities and limitations of this technology as it's rolled out, which could possibly be quite rapidly in the case of a large scale conflict, this technology is changing every single day, and it's something that we need to be staying on the forefront from as it begins rolling out. Another area that AI is changing battlefield medicine and acting as a force multiplier is an emerging ultrasound technology. So automated identification of free fluid on a fast exam provides vital information to a role one medic trying to prioritize casualty evacuation. Some of this technology can even assist in obtaining higher quality images. So a less experienced medic who may not have much experience using ultrasounds will actually be getting real time feedback, helping them get better images, which can then be interpreted better to provide more accurate information and interpretation. This applies also to more advanced ultrasound modalities such as assessing cardiac output and fluid status using programs like auto VTi and auto ejection fraction, reducing the amount this reduces the amount of manual input and ultrasound experience that's required to obtain what could be vital management information. So technology like this provides allows us to develop more nuanced protocols. So a medic who's sitting on a patient for a prolonged field care scenario, trying to manage their fluid status and unable to contact a higher level provider will have more information at their fingertips, able to manage their fluid status during an actual communications blackout, which is a very real possibility in an operational environment in which communication can signal location and potentially endanger the entire operation itself. As combat and civilian medics are called upon to treat more casualties more extensively over more extended periods of time. Human Machine Teaming is rapidly becoming an important area of focus for its potential as a force multiplier. Research at the Johns Hopkins Applied Physics Lab. Laboratory in Maryland are currently exploring how teams of medics can utilize AI based virtual assistants and autonomous robots on the battlefield itself. If these robots look familiar, it may be that you saw that one super creepy Black Mirror episode where there's these robot dogs that run around and cut people up. This was actually based off of an actual Boston Dynamics robot. This episode aired back in 2017 so you can see that the actual robotics technology has been around for a while. The difference now is that with the rise of machine learning and natural language processing, we're suddenly able to give these robots the ability to be more human like in both their skill acquisition and communication. So whereas before, these robots would have had to be operated with remote controllers, an actual human seeing what they're seeing and telling the robot where to go and what to do. Natural language processing allows us to develop bots that can respond to verbal commands and analyze their surroundings. This allows them to be semi autonomous and have adapted teaming between medics and robots. So a medic could, for instance, tell a robot to go assess that patient's vital signs, go retrieve a medical equipment bag here, sit here and bag this patient at a particular rate. In this clip here, this robot was actually virtually verbally instructed to go retrieve what it called the injured goose. This robot was able to identify that one of the goose geese, geese had a bandage on its side and was able to identify that. That is the injured goose. As we develop this area, we're going to have to focus more and more on teaching robots to understand human concepts, like what is safety, what is injured? And if we don't think about these things ahead of time, then they're going to be developed by computer scientists who don't have the medical experience necessary to give a more nuanced understanding the overall this enhances the effectiveness of medics in a disaster and Battlefield scenario because it acts as a force multiplier in a list goes scenario where we're spread across multiple islands in the South Pacific and you only have a limited number of medics available, having additional non human assistance can be vital in the case of a large scale, complex operation. So all of this is just the tip of the iceberg, not even getting into any of the ethical ramifications of how warfare is going to fundamentally change as humans are replaced by robots. How will that affect our estimation of risk? What does it mean as more and more decisions can be made autonomously, without human input, regardless of that, what we do know is that any near peer conflict is going to entail casualty numbers far beyond anything we've seen in recent years. I would argue that as physicians, we have an ethical responsibility to try to use this technology as much as we can to balance the scales and try to save as many lives as possible. Thanks so much. Good morning. Hi everybody. My name is Joe Farrell, and I'm going to be talking about working with persons experiencing incarceration. Specifically, I'm going to be talking about that's I apologize specifically, we're going to be talking about special considerations for working with populations, additional diagnoses that we kind of need to consider, as well as practices for improving patient outcomes while respecting their autonomy. The motivation behind this talk comes from my working my first rotation at Seattle, at a state hospital. I remember feeling unsure of the procedure, unsure of where to start, and I just didn't have a good working model or approach. So through this lens, we're going to talk about a standard patient encounter. So history. When working with people experiencing incarceration, there are additional risk factors that you kind of need to consider. Several meta analyzes have shown that mental disorders among incarcerated individuals is substantial, nearly twice the incidence as compared to the general population. Alcohol Use Disorder is about 25% greater than the standard population, as well, as 45% have substance use disorder. Additionally, things that we need to consider are due to their diets. We need to think about hypertension, chronic things such as diabetes. And in addition, I apologize, we need to think about diseases as well, regarding things like HIV, STIs and hepatitis C. Hepatitis C, about one in six actually have or had hepatitis C. So moving on a physical exam, I know that it might just go without saying, but again, these are people with human rights, basic human rights, just like any other patient, they have the right to privacy. So if you can ask law enforcement to step out of ear shot or away for sensitive exams that said, there are going to be times that law enforcement can't step outside of your safety for your safety, but that does not mean that they cannot kind of turn around or step away just a couple steps back. If forensic restraints are limiting your exam, your exam, just ask the law enforcement if they can adjust them or have them switch to other restraints. Bottom line, be a patient advocate. You have the best idea of what is right for the patient, and just kind of do So next slide please. Lastly, disposition, lots of stakeholders that need to be addressed in this but the most. Important one is the one standing up in front of you. So just inform the patient of the kind of results and your concerns. Give clear oral discharge instructions to the patient, as well as including kind of what to come back for. Provide information to the patients regarding follow up in the form of kind of a range of times, so that they at least know that follow up is coming. Other than that. Workup is the same for any other patient. Just keep them informed of labs and and talk about kind of what your concerns are. Make sure to re evaluate them and discuss the plan. That said, if they are uncomfortable with the plan, they do have the right of refusal, and just make sure you kind of keep them informed of the potential consequences Next slide, please. That said, there are also other groups that need to be considered. Specifically communication with the family, keep legal next of kin and durable power of attorney informed as needed. Make sure you do not share the patient's locations though discharge times or specific appointments dates, just because that could be used to be as a way of trying to, kind of evade law enforcement, if a patient is in imminent danger, get them, kind of get this group involved as early as possible regarding patient status. The patient and Mexican still have complete control over this. This is not up to the prison system. Make sure also that you can communicate with the corrections facility. Provide them clear, detailed, explicit instructions. Just provide all Ed discharge summary in the form of just written into a manila folder that will then go to the healthcare staff at the facility. Remember, though that there are times where the prison Doc is going to be a PA or NP, some of whom might be extremely experienced, some might not be as experienced. So make sure to kind of lean into a little bit more of a holistic approach for these patients, providing more explicit instructions, more medications and things like that of kind of things like, for example, if you need to not remove sutures, signs of infections, etc, and just with regard to disposition, try to utilize common medications to ensure that they're within their formulary. When in doubt, you can call their formulary if you don't have this time or it's the weekend, you can also just fill those prescriptions prior to disposition. Remember that care at the prison is going to be very, very limited, and so kind of weigh that in and in kind of your dispo plan. If you do not think that you can provide a safe disposition for your patient, consider either kind of altering the plan and having them observed for an extra day, or kind of make contingency plans regarding medications to kind of ensure that safe. Dispo. Next slide, please. Oh, apologize. Can you go back one more time next? We also have to consider the the law enforcement itself as well. That said, HIPAA is obtained, and so you only need to provide what is kind of necessary. That said, sometimes we do need to, you need to do isolation precautions. That's something to consider if they're in charge of their disposition and getting them transport back. Think about things like brittle diabetes, pain management. Just kind of keep them informed. That said, there are exceptions that we need to inform law enforcement about. Specifically, if they if the wound or something that you're taking care of, it looks to be in the form of kind of something criminal, whether it's like a bullet wound, it's a stab wound, etc, they do need to be informed of that. Additionally, if they make a comment of somebody being in imminent danger or identifying or locating a subject, a fugitive or material witness, those all need to be relayed or just if they need notification of release of a patient, that's also something to pass along next slide, please. So in summary, when working with patients experiencing incarceration, just make sure to keep a broad differential ensuring closed loop communication with the prison is extremely important. And lastly, incarcerated individuals are just are the same as have the same rights as any other healthcare provider, when in doubt, do what's right for the patient, do.