USU Student Hypothermia Management Invention Picks Up STEAM

Army 2nd Lt. Brad Pierce (left), Maj. (Dr.) Laura Tilley (center), and 2nd Lt.  Ryan Stevens (right) are co-inventors of the STEAM device for airway management.   (Credit: Maj. Laura Tilley, USU)

By Vivian Mason

Preventing and treating hypothermia in austere environments is a significant challenge for military medical professionals in the field, with 66% of trauma cases noted as hypothermic by the time they reach the emergency department. Hypothermic individuals have an increased risk of death nearly double that of patients who have already been treated for the condition. When then-fourth-year Uniformed Services University of the Health Sciences (USU) medical student Army 2nd Lt. Bradley Pierce heard about this issue, he decided to meet the challenge head on.

Alongside fellow class of 2022 student Army 2nd Lt. Ryan Stevens, as well as their faculty advisor and mentor Army Maj. (Dr.) Laura Tilley, assistant professor of Military and Emergency Medicine at USU, Pierce co-invented an innovative medical device called “System for Thermogenic Emergency Airway Management,” or STEAM for short. The device, which prevents and treats hypothermia by rewarming and humidifying airways in the body, has been successfully filed for patent protection with the support of the U.S. Army Medical Research and Development Command (USAMRDC), making it the first student-led project at USU to do so. 

Now, the STEAM team is working hard to get the device developed, and spread awareness about their remarkable project.

What does STEAM do?

It is extremely difficult to rewarm hypothermic patients in prehospital settings such as battlefields, austere wilderness environments, or mountainous terrains, which is a critical factor in improving survival following a traumatic injury. Traditional treatment or prevention of hypothermia in a prehospital setting includes removing wet clothing, moving the patient to an insulated surface, wrapping them in blankets or a heat-reflective shell (e.g., a blizzard survival blanket), and applying active heating elements to the torso or using body-to-body heat transfer. Even so, patients still are at risk of becoming hypothermic, and that’s where the STEAM device comes in. 

In this easy-to-use form, this portable innovation will save lives by enabling active airway rewarming and humidification during prolonged casualty care, assisting in the prevention of hypothermic conditions that commonly exacerbate injuries leading to deaths. Active airway rewarming can prevent hypothermia by taking advantage of the large internal surface area of the microscopic air sacs in the lungs, alveoli, that are responsible for taking in oxygen, as well as the microvasculature, which consists of various vessels throughout the body that maintain tissue health, to transfer heat to the patient in order to maintain adequate body temperature. 

The design for STEAM: System for Thermogenic Emergency Airway Management, patent pending. (Patent Cooperation Treaty No. PCT/US2021/061076).   (Credit: 2nd Lt. Ryan Stevens and 2nd Lt. Brad Pierce, USU)

The design for STEAM: System for Thermogenic Emergency Airway Management, patent pending. (Patent Cooperation Treaty No. PCT/US2021/061076). 

(Credit: 2nd Lt. Ryan Stevens and 2nd Lt. Brad Pierce, USU)

How Does STEAM Work?

“The STEAM device is essentially the miniaturization of multiple current technologies into a small, single, lightweight, hand-held device,” explains Pierce. “It is battery-powered and designed to attach to a positive pressure source, such as a bag valve mask, to enable users to heat and humidify ambient air to physiologic levels in austere environments.” 

The device contains an inline heater and humidifier that is able to control appropriately metered volumes of inhaled air to a patient and as close to physiologic conditions as possible. A digital user interface allows users (e.g., combat medics, emergency medical technicians, rescue personnel, field health care providers, etc.) to enter patient-specific parameters to control STEAM’s heat, humidity, and air volume. It will also have the ability to display patient data via sensors integrated into the device that could indicate hypothermia, hypercarbia—an increase in carbon dioxide in the bloodstream—among other possibilities. 

STEAM is designed to be used in patients requiring manual or mechanical ventilation. It is able to measure and adjust the temperature and humidity of ambient air for inspiration in patients requiring airway interventions. Considering that the airway is an underutilized means for managing body–environment heat exchange, STEAM will assist in keeping the trauma patient warm in austere and prehospital environments.

How was STEAM developed?

The STEAM device’s inception came while Pierce was attending the USU Summer Operational Elective at the Special Operations Combat Medic Course in Fort Bragg, North Carolina. During this elective, he spent time with Special Forces medics and questioned them about what they needed in terms of technology gaps. They talked to him about the challenges of preventing and treating hypothermia in austere environments. 

“My goal has always been to become an Army surgeon,” Pierce says. “I was always interested in medical technology and design in order to take care of our soldiers. If I saw a problem, it was always my intention to help where I could, be it now or in the future.” 

Pierce began by sketching out ideas and creating schematics of a device that could be held in the palm of the hand. His collaborator, Stevens, says that “the device was developed through making multiple design and engineering iterations, collecting information, talking to experts, etc.”

“With COVID,” Pierce elaborates, “we had three months of lockdown. For better or for worse, it was the perfect time to advance the design further.”

After a literature review and performing a capabilities gap analysis, Stevens reached out to Tilley to see if she would be willing to be their faculty mentor for the project. Stevens remembers her saying, “How can I support you?” These were very comforting words because Pierce and Stevens believed that it was her enthusiasm for their success and for the potential of their work to save lives that guided her mentorship. 

Army 2nd Lt. Ryan Stevens presents the STEAM concept and design at the Special Operations Medical Association Scientific Assembly in 2021.  (Credit: 2nd Lt. Ryan Stevens, USU)

Army 2nd Lt. Ryan Stevens presents the STEAM concept and design at the Special Operations Medical Association Scientific Assembly in 2021. 

(Credit: 2nd Lt. Ryan Stevens, USU)

“I saw two students with such passion for what they were doing,” Tilley recalls. “It has been a tremendous learning, yet exciting, experience to work with them.” For the past three years, Tilley made herself available to make sure that Pierce and Stevens were on track both academically and professionally. 

“Maj. Tilley is one of the most empathetic, supportive, and honest mentors I have ever had,” Stevens adds.

Pierce and Stevens filed a provisional patent application with the support of the Henry M. Jackson Foundation for the Advancement of Military Medicine in December 2020, and gained support from USAMRDC to successfully file the first medical student patent application for the STEAM device in December 2021, a fact that Pierce says the team is very proud of.

“I have a mechanical engineering background from West Point,” says Pierce. “[Stevens] has deployment experience as a combat medic in Afghanistan, and Maj. Tilley is an emergency medicine physician with deployment experience whose insights have been paramount to developing this device. We are a team.”

Additionally, Stevens presented their work at the Special Operations Medical Association (SOMA) Scientific Assembly in 2021 as well as several other national conferences, where it has been well-received in every instance.

Current Status?

Currently, the STEAM team has a manuscript under review with the Journal of Special Operations Medicine. USAMRDC is currently in talks with industry partners to further develop the technology. 

“With STEAM, this capability can save lives from Role 1 [battalion aid station] to Role 4 [large medical treatment facility],” Stevens notes. 

“We’re actually working with a licensing coach from USAMRDC who will help us take our concept and design, through other industry partners, and bring this technology to the soldier,” says Pierce. “It’ll be very exciting to see things develop because we worked really hard to get here.”