On the battlefield, providing fast and efficient care for the wounded starts with a checklist meant to save lives.
In combat casualty care, it’s referred to as MARCH—Massive hemorrhage, Airway, Respirations, Circulation and Hypothermia/head injury—a mnemonic used to assess and prioritize treatment.
Now, a team of UT San Antonio clinicians, researchers and engineers has developed a new device aimed at improving one critical element of MARCH.
With more than 10% of combat fatalities resulting from a compromised airway, respiratory management has emerged as a top research priority in military trauma. In fact, more than half of all chances to secure the airway of wounded service members are missed during pre-hospital care.
“We all think that we save lives in the hospital, but the reality is, the people that save the lives are the ones closest to the point of injury,” said Robert De Lorenzo, MD, MSCI, MSM, FACEP, vice chair of research in the Department of Emergency Medicine at the Joe R. and Teresa Lozano Long School of Medicine.
For more than a decade, De Lorenzo has collaborated with R. Lyle Hood, PhD, associate professor of mechanical engineering in the Klesse College of Engineering and Integrated Design, to create devices to improve airway management, specifically in combat settings.
They recently worked with the university’s Medical Design Innovations Lab, and Post-Doctoral Research Fellow Connor Evans, PhD, to develop three devices that would offer combat medics a suction solution for any setting, from controlled to chaotic. Suction devices remove blood and vomit that can block a wounded patient’s airway and prevent breathing.
“We’re finding with a lot of these casualties there’s usually some airway trauma as well,” Evans said. “The patient’s airway needs to be stabilized right there on the battlefield and then the patient needs to be moved very quickly to a field hospital or to a higher echelon of care.”
Connor Evans with the devices the research team designed to help improve one critical element of MARCH.
The team came up with three distinct devices. The Suction Combat Ready Advance Multi-Functional Machine (SCRAMM) is the largest of the suction devices and offers three lines of suction that could be simultaneously used. It is lighter in weight compared to its predecessors but powerful enough to treat wounded soldiers in air evacuations.
Hood and De Lorenzo also collaborated in 2016 on the Battlefield Ready Innovative Suction Kit (BRISK), the first device they worked on together. A medium-sized device, it is lighter and more compact than SCRAMM and allows medics to suction without worry of contamination or inoperability if it is knocked over, a significant flaw in similar devices.
As the two continued to innovate and talk to first responders, user feedback demonstrated a need to “think big” and develop a device just as powerful as SCRAMM and BRISK, but smaller.
“We went out and talked to field medics,” De Lorenzo said. “They told us ‘We’re not carrying it, unless it works really well and is really, really small.’”
The team then participated in a National Science Foundation program that supports researchers in commercializing technologies, NSF-I-Corps, and came up with the idea for a pocket-sized version of the suction device.
“What if we made the most cut-down, slimmest version we could?” Hood said.
They challenged their students to work on the problem with two stipulations: size and functionality.
From this challenge, the first prototype of a device they called Suction Combat for Emergencies, Portable Technology for Responders (SCEPTRE) was born. It was a device the size of a flashlight, suitable for a combat medic’s hip pocket, and could be used at the immediate point of injury.
Former graduate research assistant Eric Wiatrek designed the first prototype for SCEPTRE. Wiatrek had past military experience and now serves as a Research Fellow for the U.S. Army Institute for Surgical Research. He understood what medics were looking for.
“No one believes that the current technology out there is worth the weight or size,” Wiatrek said. “If I gave [SCEPTRE] to anybody, they would figure out how to use it.”
Wiatrek said that what distinguishes SCEPTRE from other devices is its simplified mechanics, which reduce potential complications in a pre-hospital emergency.
Like its predecessors, SCEPTRE represents the ingenuity of a collective effort.
“Our line of suction units represents the work of five to 10 faculty and post-docs, 10-20 graduate students and 40+ undergraduate students over the last decade,” Hood said. “SCRAMM grew out of us showing BRISK to the U.S. Air Force, and SCEPTRE was our own idea. But these latter two benefitted incredibly from the expertise our group had built around BRISK.”
The goal now is to take all three devices to market and address a growing need in combat casualty care.
“We saw this error of omission as a critical gap that needed to be filled with our suite of advanced suction devices, but more work needs to be done,” De Lorenzo said. “Simply providing better equipment is only half the battle as field providers also need to be trained to have confidence in the new equipment. This will be our challenge as we field these innovative devices.”
The future impact of the airway management research conducted by Hood and De Lorenzo’s team has received local and state recognition. Hood recently received the Texas Innovation Award for translating academic research into real-world impact. The team also received the Innovation & Impact Award at UT San Antonio’s 2026 University Excellence Awards.
