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INTEGRATED AND ADAPTIVE RESPONSES TO TOXIC EMERGENCIES FOR RAPID TRIAGE: ENGINEERING THE ROADMAP FROM CASUALTY TO PATIENT TO SURVIVOR.

Periodic Reporting for period 3 - TOXI-triage (INTEGRATED AND ADAPTIVE RESPONSES TO TOXIC EMERGENCIES FOR RAPID TRIAGE: ENGINEERING THE ROADMAP FROM CASUALTY TO PATIENT TO SURVIVOR.)

Reporting period: 2018-09-01 to 2019-09-30

The TOXI-triage project addresses the operational; technological; ethical and societal dimensions of CBRN response and recovery, and importantly the economic base from which sustainable CBRN and multiuse systems are derived.

TOXI-triage was a project run by the consortium of 18 partners over 49 months with a budget of approximately €13 M of which €12 M were funded by the European Union under the Horizon 2020 programme. The focus of the project was the delivery of next-generation of tools, technologies and concepts to detect, trace, and triage casualties from a CBRN incident. The project approaches this challenge through the prioritization of 5 areas of activity which are: ICT; Situational awareness; The needs and activities of the end user; Casualty triage; and Clinical activity.

34 deliverables from the project address 7 Critical Objectives, which are focussed onto one or more of the 5 areas/categories above. Indeed of the deliverables represented progress beyond the state-of-the art in more than one of the 5 areas/categories . What arises is a comprehensive multidisciplinary record of accomplishment that spans a broad range of crises management challenges; ranging from mounting trace gas detectors onto remote piloted airborne systems (RPAS) to communicating with all casualties in a contextually, culturally and, most importantly, operationally effective manner.

An essential aspect of the project was the incorporation of two field technical exercises (FTX) that validated the operational concepts, along with the technological provenance and performance of the consortium's accomplishments. The direction and evaluation from the expert practitioners who participated and observed our FTXs was of significant value. Our FTXs acted as a driver for the project and the technology developers. The immovable, uncompromising challenges posed by each FTX catalysed innovation development and delivery across the whole project. The real and technologically difficult operational tests planned into the FTX scenarios also provided verifiable tests of our claims of Technology Readiness Levels (TRL) of 6 to 7 for our systems.

Our deliverables were deployed and demonstrated in challenging and credible scenarios from Hot Zone to Casualty Clearing and hospital admission under as close to operational conditions as could be accomplished. The complete record of accomplishment and innovation across the deliverables is difficult to fairly and completely summarise in only a few hundred characters. Each of the 34 technical deliverables is the culmination of collective endeavour that any researcher and developer would be thrilled and proud to be part of; the detailed reports and findings run to many thousands of pages. (Some of our deliverables are classified as a European Union restricted. Requests for copies of these deliverables may be made through the appropriate channels to the European Commission)

The reports, photographs and videos taken from the field technical exercises [ref D6.5] show how:
F. chemical simulants at trace concentrations were rapidly detected under 2 different operational scenarios;
G. casualties were assessed with a level of monitoring and data fidelity not previously accomplished; and,
H. how all of these data were integrated and combined providing opportunities, and challenges for the furture development of enhanced command and control competencies.
A quick look overview of the concepts and technology of TOXI-triage may be found in our deliverable “D2.4 Proceedings of meeting on verification of C-detection methods and procedures Restreint UE Restricted EU”
SO 1: Accelerated delivery of Situational Awareness
Rapid & integrated detection with remotely controlled platforms, hand held systems, stand off detectors & autonomous embedded micro-systems.
SO 2: Command & Control with secure, dynamic, & seamless communication & with Artificial Intelligence (AI) assisted tools for making decisions (The Integrator).
All data collected & processed across wireless networks automatically & dynamically mapped for the end user in contextually appropriate ways. Social media integrator provides real-time sentiment analysis enhancing significantly the situationbal awareness of the emergency services while providng focussed & effective information & messaging.
SO 3: Traceable point-of-care diagnostic tests with integrated casualty tracking.
Each “casualty’s” triage-state, triage-history, location, symptoms, treatment, image & associations with other casualties was captured & delivered from the operational site to the data integrator in real-time. We wee able to reconstruct over 1oo casualtys' journeys, as well as each end-user’s, activity throughout a whole crises reponse.
Field deployable breath analysis systems were developed & integrated into the TOXI-triage data hub & data integrator. The operational functionality & breath-based-triage concepts have been demonstrated successfully. Clinical studies produced a repository of 120,594 data sets relating to skin, saliva & breath profile; a significant research legacy.
SO 4: Comprehensive field toolbox of CBRN threats for end-users. Automated guidance to end user at point of need.
Best-in-class guidance & instructions for CBRN operations to anyone who needs them at any time & at any location, with easy-to-follow guidance to the end user on Protection; Decontamination; Sampling; Directions on detection technologies; Agents; & a field guide that maps observations to likely agent.
SO 5: Protocol for the registration of biomarkers of injury from CBRN poisoning
Biomarkers for radiation exposure, ethanol & organophosphorous under development.
SO 6: Establish a harmonized European framework for ethical & accountable CBRN operations
Guidelines for the care & triage of vulnerable groups in crisis management operations; Cross-cultural & social factors in planning for crises management; Messages for Clear & compelling communication during crises management
SO 7: Establish a Community of Commerce & deliver a commercial vision
Business plans & commercialisation outcomes; Data & publication repository; Promotional campaign trade exhibitions with press & media events; Multi-use capability for crises management technology; Market survey report; Revision of business plans & commercialisation outcomes; Standardisation & Harmonisation for detection systems on the semantic web; &,
Translation & coordination with governmental CBRN research laboratory.
The project’s most significant commercial contribution arises from the delivery of horizontal integration through the adoption of standards.
D1.2 Quantitative analysis of workshops to disclose development proprieties
D1.3 FTX functionalities for objective testing of new technologies and concepts
D2.2 Release of common standards for live agents testing of commercial CBRN systems
D3.2 and D4.4 Gas recirculation system for stand-alone operation with robust sampling systems for skin and breath.
D3.3 and D4.4 New breath, skin and saliva markers for R and OP exposure, comprehensive data base of biomarkers.
D4.1 RPAS IMS, GC-PID , HDI and R/N payloads
D5.2 Horizontal data integration across all detection systems with embedded privacy by design (D8.1 and D8.2)
D6.1 and D6.2 FTX plans with associated multiple hypothesis and objective test protocols for rigorous technology testing and evaluation.
D7.4 and D7.5 an entrepreneurial doctrine for all partners