Schulich School of Medicine & Dentistry professor Vivian McAlister, along with a team of Canadian Armed Forces (CAF)-led trauma surgeons, recently took a hefty research agenda into a semi-weightless environment. And what that team discovered may have dramatic implications on the ground – and beyond.
Earlier this month, McAlister was aboard a specially equipped Falcon 20 jet from the Flight Research Laboratory at the National Research Council as surgeons and technicians experienced up to 27 parabolic flight maneuvers, each producing 20-25 seconds of weightlessness, while 14 separate surgeries were performed on a simulated human torso.
The first-of-its-kind experiment focused on massive torso hemorrhage control in extreme locations. And what is more extreme than space?
“We’re extending our capability of caring for people in extreme environments, and the military are good at that,” said McAlister, who joined the Canadian Forces in 2007 and has served Canadian deployments in Afghanistan and Haiti. “Space is an extreme environment – and it’s a very unlikely one – but it helped us understand a whole pile of the issues that we face.
“There are lessons we learn that we can apply and send out to others in civilian situations. You could apply it to submarines, to navy ships, to the Arctic, to forward-surgical care in combat, to extreme environments such as heat. There are actually things you can learn about yourself that you can apply in regular situations.”
While weightless – or in microgravity – the surgeons either performed a laparotomy – a large incision through the abdominal wall to gain access into the abdominal cavity – or accessed the organs via a needle-puncture in the skin. Because these procedures take longer than each weightless episode, they were broken up into multiple steps.
McAlister, a member of the General Surgery Group within Canadian Forces, wore sensors monitoring his physiology, while cameras inside the aircraft recorded the procedures, and various electronics recorded everything from G forces, acceleration and flight data to blood loss and time to complete the task. Each step was assembled into a complete surgery and compared to the same procedure McAlister performed on the aircraft in the hangar prior to flight.
“In this case, I was the experiment, not the experimenter,” McAlister said. “It’s really part of a bigger program we (Canadian Forces) have to provide surgical care in extreme environments.”
Bleeding to death is the most preventable cause of posttraumatic death worldwide. Yet, they remain lethal when no facilities or skills exist to perform basic damage control surgery.
These experiments in parabolic flight have wide-ranging implications for terrestrial applications from battlefield to rural to wilderness areas said.
“In our extreme environments in the military, we have three elements to look at,” McAlister said. “One is the environment itself – is it hot/cold? The second is equipment will be austere – you won’t have all the equipment you normally have. And third is you may not have a surgeon doing it – you may have a medic or another crew member undertaking the procedure.”
While McAlister doesn’t seek out such unique training exercises – “(I’ve been asked) to do a whole pile of things in the military that I would normally not do” – he realizes the importance that can come from such extreme testing.
“I’m not an adventure seeker sort of person. That’s not my want. I take it easy if I can. I’m a coward basically,” he laughed. “But, if we learn about the physiology of the person who performs the best, can we mimic that and then all perform better? Slowing down their heart rate and breathing. There is stuff you learn that is not directly the mandate of the exercise, but there are a lot of things that come from that which can apply in other situations.”
McAlister, a lieutenant colonel, recalled providing surgical care in Kandahar in an unusual environment.
“But we were well supplied and well protected. We weren’t at risk like the soldiers were,” he said. “The supply chain was good. We were stable. Although we were working in a plywood-type shack, you still had everything you needed; it was relatively easy to adapt.
“Going forward, can we reproduce the quality of care as we make it harder and harder? We have to do damage-control surgery. It is stop the bleeding, keep them alive and get them to the next stage. It’s about adaptation”
Even McAlister had a bit of adapting to do during the experiment.
“I use both hands, but prefer to stand on the left side of the patient, and in this instance I had to be on right side. I had to do things upside down,” he said.
The principal investigator on the project was Maj. Dr. Andrew W Kirkpatrick, a professor in the departments of surgery and critical care medicine at the University of Calgary.
Funding was provided by the Canadian Forces Medical Services, the Regional Trauma Service of Foothills Medical Centre at the University of Calgary, the College of Physicians and Surgeons of Canada, the Flight Research Laboratory of the National Research Council, Innovative Trauma Care Corporation and Strategic Operations Inc., developer of the cut suit.