The Revolutionary Technology Behind Israel's Game-Changing Casualty Card

The Israeli Defense Forces Medical Corps (IDF-MC) are actively working to reduce preventable deaths by improving pre-hospital battlefield care. High-quality records of injury and treatment help subsequent care and enhance future treatment capabilities. Currently, injuries and treatments are recorded on paper casualty cards, often leading to incomplete data collection and insufficient data transfer. To address these issues, the IDF-MC launched the BladeShield 101 project.

The BladeShield 101 system consists of three components paired with Near Field Communication (NFC) tags and synchronized via Bluetooth:

Portable vital sign sensors for continuous physiological monitoring. All data is transmitted to the Casualty Information Unit for storage and processing. Currently used commercial sensors include those from Nonin (Nonin Medical, Plymouth, MN, USA) and Masimo (Masimo Corporation, Irvine, CA, USA). These sensors provide readings for heart rate, respiratory rate, and oxygen saturation. In the future, the Casualty Information Unit can synchronize with any sensor equipped with a Bluetooth transmitter to read additional vital signs and related information, such as blood pressure, cardiac output, compensatory reserve measurement, shock level, and non-invasive blood tests.

A small box attached to the casualty with a quick-release strap, acting as a digital casualty card [see Fig. 1]. The box continuously records data collected from the sensors (every 30 seconds), logs all medical interventions, and stores operations and medical data entered by the care providers via a dedicated smartphone.

Installed on a rugged, dedicated smartphone, the application inputs all sensor-collected data via Bluetooth into the Casualty Information Unit, allowing for the collection of injury and medical operation data across different levels of care [see Fig. 2]. Alerts can be set for various indicators to better monitor the patient. The casualty’s condition and treatment data are processed and displayed in a visual interface, aiding care providers in making more efficient treatment decisions.

In practice, the first medical personnel to reach the casualty, whether a combat medic or an advanced life support provider, can collect casualty information at the injury site. The sensor pairs with the Casualty Information Unit using an NFC tag. Once paired, the unit begins recording vital signs. Field medics can use designated NFC tag kits to log necessary interventions (e.g., tourniquet application, analgesia) before advanced life support providers arrive. These providers carry a mobile device that pairs with the Casualty Information Unit via NFC, allowing them to retrieve previously recorded data and log all medical treatments performed. Additional information on injury mechanisms, injured body parts, initial assessments, evacuation tools, and related medical interventions can also be added.

In September 2019, the IDF began an evaluation of the BladeShield 101 system. All users received four hours of training and were required to conduct at least one practical training session weekly. Trauma registry data for all casualties from September 2019 to June 2020 were compared to evaluate the quality of data obtained with standard paper casualty cards versus BladeShield 101.

During the study, the BladeShield 101 system was used to monitor and record information for 24 casualties, whereas traditional paper casualty cards were employed for 197 casualties. All collected data were subsequently uploaded to the IDF Trauma Registry.

Notably, in the first eight months of deployment, the BladeShield 101 system was exclusively utilized in non-combat scenarios. A significant advantage of this system was the data transmission efficiency to the military trauma registry, which achieved a 100% transmission rate within a day. This was a considerable improvement compared to the 72% transmission rate observed with paper casualty cards.

The use of the BladeShield 101 system resulted in a remarkable increase in the number of recorded vital signs, soaring from 4 per hour to 120 per hour. This dramatic enhancement in data collection capacity was complemented by improvements in other areas as well. Information regarding the timing of treatments saw an increase from 43% to a perfect 100%, while the comprehensiveness of treatment information rose from 67% to 98%. Despite these improvements, the average treatment time before evacuation remained consistent at 14 minutes, indicating no additional time burden on medical teams.

Medical personnel utilizing the BladeShield 101 system reported several operational benefits. The system’s capability for continuous vital sign monitoring significantly aided in treatment decision-making processes. Moreover, the automated nature of data collection and transmission required less manpower, thereby optimizing resource allocation. Although the system had not yet been tested in combat scenarios, its use in non-combat situations demonstrated that it did not increase the pre-evacuation treatment time.

The BladeShield 101 system is designed for real-time, autonomous, and continuous recording and data transfer. Recognizing its potential, the IDF is now implementing a broad deployment strategy to minimize the reliance on paper casualty cards. Future plans include utilizing the BladeShield 101 system in combat scenarios, with integration into digital tactical control systems to provide real-time information to higher-level medical personnel and frontline commanders.

This integration is expected to enhance the situational awareness and decision-making capabilities of medical and tactical teams. Furthermore, the accumulated data from the BladeShield 101 system, when combined with advanced machine learning algorithms, is anticipated to facilitate the development of sophisticated decision support systems. These systems aim to significantly improve battlefield casualty care, particularly in the challenging conditions of combat scenarios.