TRIAGE-X: Autonomous Casualty Triage and Treatment in Chemically Contaminated Mass Casualty Events

Develop and demonstrate capability with autonomous medical triage systems to recognize chemical toxidromes and physically deliver the corresponding antidote or life-saving intervention.

DARPA seeks innovative approaches to autonomous chemical, biological, radioactive, and nuclear (CBRN) triage that measurably improve casualty survival and increase the effective capacity of a medical response during CBRN disasters. Early situational awareness and timely treatment is a matter of life and death in battlefield and disaster medical triage. Responder vulnerability in hazardous environments caused by CBRN attacks adds significant difficulty to the medical response. When a mass casualty incident (MCI) occurs within a chemically contaminated area, the medical response is hindered by uncertainty while the threat is assessed and characterized. To ensure safety of the responders, they must don protective equipment before entry, delaying initial assessment, triage, and treatment with life-saving interventions (LSIs). Personal protective equipment (PPE) also imposes a physiological and functional penalty on responders resulting in slower movement, higher energy expenditure, heat stress, impaired respiration, and reduced manual dexterity; these penalties further impede responders’ ability to perform life-saving interventions. Effective stabilization occurs in the cold zone after casualties have been decontaminated [1,2], compounding the delay to evacuation and definitive care. The DARPA Triage Challenge (DTC) has demonstrated that autonomous air and ground systems, using standoff sensors, can locate casualties, characterize injury patterns, and support triage prioritization in realistic MCI conditions [3]. Using DTC triage support capabilities as a starting point, this solicitation aims to extend capabilities to operating in chemically hazardous environments where injury patterns have distinct signatures or toxidromes. Success here extends proven autonomous triage into the one of the most challenging settings where human entry is dangerous and delayed, and where early antidote delivery most directly determines casualty survival [4].Proposed systems should be able to locate and assess casualties for traumatic injuries and chemical toxidromes, generate triage recommendations, and deliver appropriate initial treatments to reverse, stabilize, or prevent the toxic effects of chemicals. Solutions should be designed for realistic operational use in difficult terrain under challenging environmental conditions. DARPA does not prescribe a specific platform, sensor suite, or level of autonomy. Offerors are encouraged to propose the human-machine teaming arrangement that best improves decision quality and casualty outcomes, and to define how their system fails safely when conditions exceed its competence. Approaches should be realistic in scope, repurposed within the period of performance, and grounded in how CBRN mass casualty response actually unfolds.At minimum, the effort shall deliver a demonstrated prototype that detects at least two representative chemical toxidromes and applies appropriate initial treatments for the assessed toxidrome following human-in-the-loop treatment approval.

Phase I work is expected to have been completed before award. Proposers must submit evidence that their existing prototype can:• Autonomously find and localize casualties and report their location to within 2m• Assess trauma patterns and assign a trauma triage category• Perform accurate standoff vital-signs assessment, including at minimum heart rate and respiratory rate • Operate at scale o At least 20 casualties in a single scenario o Perform assessment in <90 seconds for each casualtyo Survey a 30,000sqft area without battery change• Operate across diverse, realistic environments: indoor and outdoor, daytime and nighttime, ideally (but not required) in adverse weather conditions (rain, smoke)• Produce a human-interpretable output through a graphical interface that conveys casualty locations and priorities of care.• System must be portable. All components should be easily transported by a vehicle or drone.Capability demonstration:A written technical description or published report supported by data and video(s) demonstrating the prototype performing the capabilities above in the stated environments are required (provided via link).

Building on the feasibility demonstrated in the documentation above, the Phase II effort will extend their qualified baseline system to assess and treat chemical toxidromes. In this effort, performers will develop, integrate, and validate a prototype autonomous chemical casualty triage system and demonstrate it in a relevant environment. The system shall identify casualties, assess them for life threatening and other traumatic injuries, assess casualties for chemical toxidromes, and provide relevant physical treatments. Requirements: Performers shall develop the capability to assess and treat at least two chemical agent categories from Table 1. Agent detection is out of scope for this effort. Treatment recommendations and options for each casualty shall be presented through a graphical interface to responders. Treatment decisions will always be made by humans.

Table 1. Target toxidromes, symptoms, and interventions [1, 5, 6].

Toxidrome categoryRepresentative agentsPhysical presentationAnticipated treatment to demonstrate

Cholinergic (nerve-agent) syndrome

• Sarin

• VX

• Novichok

• Organo-phosphates

DUMBBELS – diarrhea, urination, miosis (constricted pupils), muscle weakness, bronchospasm, bronchorrhea, bradycardia (decreased heart rate), emesis, lacrimation, salivation and sweating.

• Intramuscular pharmaceutical delivery of simulated antidote (atropine and pralidoxime)

• Airway management*

Blood-agent syndrome (cyanide)

• Hydrogen cyanide,

• Cyanogen chloride

Rapid collapse; gasping, tachypnea (fast respiratory rate) progressing to apnea (no breathing); altered mental status, seizures; cardiovascular instability (low blood pressure, fast heart rate); skin flushing, central cyanosis; dilated pupils.

• IV/IO pharmaceutical delivery (i.e., cyanokit)**

• Airway management*

Pulmonary / choking-agent syndrome

• Chlorine

• Phosgene

Cough, dyspnea (difficulty breathing), wheezing, stridor; eye and airway irritation; respiratory distress; delayed pulmonary edema.

• Delivery of bronchodilators

• Airway management*

Vesicant / blister-agent syndrome

• Sulfur mustard

Blistering skin burns, airway irritation, pain

• Skin decontamination with removal of substance from exposed skin, clothing, and washing skin or using decontamination cloths.

• Airway management*

Opioid / respiratory-depressant syndrome

• Fentanyl-type incapacitants

Pinpoint pupils; respiratory depression progressing to apnea; decreased consciousness.

• Intranasal or intramuscular Naloxone

• Airway management*

* Airway management includes: providing supplemental oxygen by mask AND escalating to either non-invasive (bag-valve mask or mechanical) or invasive (endotracheal intubation or surgical airway) ventilation.

**Includes autonomous placement of intravenous (IV) or intraosseous (IO) catheter.

Performers will demonstrate their platform’s ability to recognize simulated toxidromes in silico (computer-based simulation) and on high-fidelity mannikins with the simulated toxidrome presentations outlined in Table 2.

Table 2. Simulated toxidromes for demonstration purposes.

Toxidrome categoryPhysical presentationSimulated presentation on a mannikin

Cholinergic (nerve-agent) syndromeDUMBBELS – diarrhea, urination, miosis (constricted pupils), muscle weakness, bronchospasm, bronchorrhea, bradycardia (decreased heart rate), emesis, lacrimation, salivation and sweating.

• Damp/wet clothing around the groin area and on the ground

• Constricted pupils (miosis)

• Coughing sounds

• Rapid breathing (rate > 30)

• Slow palpable pulses at the wrist and groin (rate < 40)

• Emesis from the mouth (head turned, vomit on side of face and on the ground)

• Damp “skin” (sprayed on liquid)

Blood-agent syndrome (cyanide)Rapid collapse; gasping, tachypnea (fast respiratory rate) progressing to apnea (no breathing); altered mental status, seizures; cardiovascular instability (low blood pressure, fast heart rate); skin flushing, central cyanosis; dilated pupils.

• Coughing sounds

• Rapid breathing (rate > 30)

• Altered mental status/confusion (mumbling words, does not respond verbally to instructions)

• Flushed (red appearing) skin

• Dilated pupils (mydriasis)

Pulmonary / choking-agent syndromeCough, dyspnea (difficulty breathing), wheezing, stridor; eye and airway irritation; respiratory distress; delayed pulmonary edema.

• Coughing sounds

• Rapid breathing (rate > 30)

• Red/irritated eyes (scleral injection)

• Wheezing on auscultation of lung sounds

• Cyanosis around lips

Vesicant / blister-agent syndromeBlistering skin burns, airway irritation, pain

• Gelatin on skin

• Skin blisters and burns

• Coughing sounds

• Rapid breathing (rate > 20)

Opioid / respiratory-depressant syndromePinpoint pupils; respiratory depression progressing to apnea; decreased consciousness.

• Constricted pupils (miosis)

• Slow breathing (rate < 10)

• Unconscious, non-responsive

Performers will demonstrate their platform’s ability to assess and deliver interventions on simulated casualties in both computer-based simulation or on physical manikins/in physical environments as outlined in Table 3. Some tasks that *must* be demonstrated on a physical manikin or in Table 3.

Table 3. Required technical capabilities for demonstration purposes.

Technical capability

Requirements

Casualty Assessment

• Locate casualty; report clinical signs (hemorrhage, respiratory distress, mental status, pain, emesis etc.), injuries and injury location.

• Evaluate casualties for chemical toxidromes and assign a probable target agent category from Table 1.

• Assign triage category (urgent, non-urgent).

• Identification of the specific chemical agent is out of scope. Chemical-specific sensors are also out of scope.

Intervention Delivery

• * The platform must physically administer treatment appropriate to the chosen toxidrome according to table 1 on a manikin.

• * Final demonstration requires the system payload and automation to administer treatment to at least 5 casualties in succession without battery changes or re-supply.

Platform, Environment, and Autonomy

• * Platform-agnostic: Autonomous UAV and UGVs. Performer may choose the sensor suite (excluding chemical-specific sensors). System must demonstrate safe physical interaction with casualties represented by high-fidelity manikins.

• † A single robust platform must operate across and transition between realistic environments — difficult terrain, inside and outside of buildings, and potentially subterranean settings. Dedicated single-environment platforms are not sought.

End of Program Demonstration

• Detection/assessment may be validated computationally through assessment of a test set of images and videos showing injuries and clinical signs. (e.g., respiratory distress, pupillary changes, salivation, sweating, skin changes/blisters.)

• * † Intervention delivery on multiple casualties must be validated by physical demonstration.

• The essential program output is a validated prototype.

* Required, on a manikin; † Required, over real terrain

Military: Autonomous triage and toxidrome-directed treatment in chemically contaminated, battlefield environments, protects medics from entry and prolongs casualty survival until human care is possible. Civilian: Similarly, autonomous systems capable of assessing and delivering life sustaining treatments during disaster responses, industrial chemical accidents, hazmat operations, and chemical terror attacks in which fire/EMS response will be delayed provides additional safety for responders and a survival advantage for casualties during public-health emergencies [2]. The autonomous system will perform initial triage and treatment in the hot zone so that responders either avoid entry entirely or gain time to don protective equipment.