Telemedicine Improves Performance of a Two-Incision Lower Leg Fasciotomy by Combat Medics: A Randomized Controlled Trial

Abstract

ABSTRACT Introduction The primary aim of this randomized controlled trial was to assess if a head-mounted display (HMD) providing telemedicine support improves performance of a two-incision lower leg fasciotomy by a NATO special operations combat medic (combat medic). Materials and Methods Thirty-six combat medics were randomized into two groups: One group performed a two-incision lower leg fasciotomy with the assistance of an HMD, while the control group completed the procedure without guidance. A Mann–Whitney U test was used to determine the possible differences in release of compartments and performance scores, as assessed by a supervising medical specialist. A Fisher’s exact test was used to compare the proportions of collateral damage between groups. An independent-samples t-test was used to interpret total procedure times. The usability and technical factors involving HMD utilization were also assessed. Results Combat medics in the HMD group released the anterior compartment (P ≤ .001) and deep posterior compartment (P = .008) significantly better. There was significantly more iatrogenic muscle (P ≤ .001) and venous damage (P ≤ .001) in the control group. The overall performance of combat medics in the HMD group was significantly better than that of the control group (P < .001). Combat medics in the control group were significantly faster (P = .012). The combat medics were very satisfied with the HMD. The HMD showed no major technical errors. Conclusions This randomized controlled trial shows that a HMD providing telemedicine support leads to significantly better performance of a two-incision lower leg fasciotomy by a combat medic with less iatrogenic muscle and venous damage.