Conversational AI in Tactical Casualty Care: Baseline GPT-4o Improves Combat Medic Decision-Making

This study investigates the potential of conversational artificial intelligence (AI), specifically GPT-4, to enhance clinical decision-making in Tactical Combat Casualty Care (TCCC) scenarios. The primary objective is to evaluate whether AI support improves the accuracy and efficiency of ventilator management decisions for combat medics in high-pressure environments without compromising their autonomy.

A prospective, randomized, within-subject study design will be employed. Thirty combat medics from the Czech Armed Forces will participate. Each participant will complete 10 simulated TCCC scenarios: five with AI assistance and five without. Scenarios will be matched for complexity and randomized to control for order effects. Participants will use ChatGPT on handheld devices to simulate real-time AI-assisted decision-making.

In scenarios involving AI assistance, medics will query GPT-4 for support in optimizing mechanical ventilator settings based on patient data, including blood gas results, vital signs, and ventilator parameters.

The primary outcome is the accuracy of ventilator settings as categorized into "excellent," "acceptable," or "failing" based on predefined TCCC standards. Secondary outcomes include decision-making speed and participants' perception of AI's utility, measured through post-scenario surveys.

The findings aim to determine the feasibility of integrating large language models (LLMs) into combat medical care to optimize patient outcomes and support medics under combat conditions. The study seeks to advance the understanding of AI's role in military medicine, providing a foundation for future deployment of fine-tuned AI solutions in TCCC and other critical care scenarios.

This study offers a proof-of-concept evaluation of LLM applications in combat casualty care, with the potential to improve decision-making and inform the development of specialized AI tools for military use.

Inclusion criteria

• Combat medics actively serving in the Czech Armed Forces
• Completion of standardized Tactical Combat Casualty Care training modules and e-learning on ventilator settings and blood gas interpretation
• Successful passing of pre-tests to ensure a uniform baseline knowledge level.
• Willingness to participate and provide informed consent.
• Availability to complete the full study protocol, including 10 simulated scenarios.

Exclusion criteria

• Failure to pass the pre-tests or complete TCCC and ventilator management training
• Prior advanced training or professional certification in critical care or mechanical ventilation that could bias results
• Refusal to provide informed consent or inability to commit to the study schedule