Augmented Reality Forward Surgical Care (ARFSC)

We’ve all seen it. We’re watching a sporting event on T.V. and after a key play we see a video replay. A commentator describes the play and augments it by drawing arrows, circles, and other freehand additions on the screen. That ability to do freehand markup over a video is called telestration. Telestration is currently used mostly for televised sporting events and weather forecasts. However, it also has great potential in telemedicine and surgical telementoring, where it can be used to provide guidance from a surgeon in a remote location from the patient and the patient’s on-the-ground caregivers. This capability is crucial in providing critical care in austere environments where trauma or combat surgeons are not available.

Research into the use of telestration and telementoring in remote casualty care is growing, and a number of capability studies are underway. The Augmented Reality Forward Surgical Care (ARFSC) demonstration project was funded by the U.S. Army AMEDD Advanced Medical Technology Initiative (AAMTI) program. The project aimed to show that telestration and telementoring using an augmented reality (AR) system is effective in remotely training and guiding non-surgical personnel through surgical procedures.

A student assigned to the U.S. Army Special Operations Command performs one of the medical tasks he learned as part of the battlefield emergent skills triad training at Fort Bragg, NC. (Photo credit U.S. Army. The appearance of U.S. Department of Defense (DoD) visual information does not imply or constitute DoD endorsement.)

This research effort presented an emerging capability to project damage control procedures far forward for situations where evacuation to a formal surgical team is delayed. Specifically, we demonstrated the plausibility of using a wearable augmented reality (AR) telestration device to guide a nonsurgeon through a damage control procedure


A stand-alone, low-profile, commercial-off-the-shelf wearable AR display was utilized by a remotely located surgeon to synchronously guide a nonsurgeon through proximal control of the distal external iliac artery on a surgical manikin. The manikin wound pattern was selected to simulate a rapidly exsanguinating junctional hemorrhage not controllable by nonsurgical means.


This capability demonstration displayed successful use of AR technology, telecommunication, and procedural training and guidance in a single test pilot. The assisted physician assistant was able to rapidly control the simulated external iliac artery injury on this model. The telestration system used was commercially available for use with available civilian cell phone, wireless and satellite networks, without the need for dedicated high-speed networks.


A nonsurgeon, using a wearable commercial on-visual-axis telestration system, successfully performed a damage control procedure, demonstrating the plausibility of this approach.