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3D Printing Solutions for Contested Medical Logistics

 

Lt. Col. Michael Browning, DMD, MS, U.S. Army
Lt. Col. Michael Hoffman, DDS, MS, U.S. Army
Lt. Col. Michael Kroll, DMD, MS, U.S. Army
Lt. Col. Andres Mendoza, DDS, MS, U.S. Army*
Maj. Ross Cook, DMD, MS, U.S. Army
Maj. Martin Smallidge, DMD, MPH, MS, U.S. Army

 

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The Army Health System must reduce the size and weight of contemporary equipment to keep pace with the kinetic, dispersed nature of future conflicts. The Army Medical Modernization Strategy introduces the role of additive manufacturing, or 3D printing, in pharmacy and medications.¹ However, a growing body of literature suggests a wider range of uses in health care. Additive manufacturing can fabricate products such as bioactive bandages, orthopedic screws, surgical instruments, and medical simulation models.² The U.S. Navy 3D-printed teeth in 2021 to restore a young marine’s ability to eat, smile, and speak after reconstructive jaw surgery.³ The clinical and operational implications of this emerging technology are vast. Integrating additive manufacturing technology from Role of Care I to Role of Care III can reduce size and weight while improving mobility for forward medical units supporting maneuver elements. The Army Health System can employ 3D printing technology to enhance materiel sustainment by leveraging the U.S. Army Dental Corps’ training, knowledge, and experience.

Medical Mobility Is a Timeless Problem

Cumbersome medical equipment challenges mobile support. During World War II, the Mediterranean and North African campaigns revealed the recurring experience of dental, medical, and surgical units struggling to transport materiel. Medical containers were often mislabeled during landing operations and sometimes only partially filled with equipment. These units arrived either without any equipment or with a significant shortage of equipment, which reduced their capabilities. Patient litters, a basic item, were one of the most cited shortages.⁴ “Standard dental chests,” analogous to modern dental equipment sets, were often deemed too heavy and left behind.

During Operation Desert Storm, mobile Army surgical hospitals were significantly hindered by the weight of their medical and nonmedical equipment, such as surgical equipment, tentage, and portable generators. One mobile Army surgical hospital weighed 1,450 tons, equivalent to twenty-one M1A1 tanks.⁵ Exacerbating this problem, these medical units lacked adequate vehicles and competed with combat units for corps-level transportation assets. To maintain supporting distance with frontline movement, these hospitals advanced with only 40 percent bed capacity and 50 percent surgical capability.⁶ Medical units had to sacrifice their effectiveness to keep pace.

The materiel challenges of World War II and Desert Storm remain relevant. A brigade support medical company (BSMC) provides Role II care to an entire brigade combat team. In 2021, a BSMC commander for the 101st Airborne Division (Air Assault) determined their forty medical equipment sets and dental equipment sets take four hours to set up.⁷ This footprint impeded responsive support to air assault operations. The BSMC commander coordinated with the brigade support battalion’s distribution company to develop scalable, mobile support for a dynamic forward line. However, moving the equipment sets required an M1120 Load Handling System, a ten-ton vehicle; an M1077 flat-rack; and three Tricon shipping containers.⁸ Modernization demands reduced footprints of this size and weight to effectively support highly mobile units.

Conflict with near-peer adversaries demands agile support. The nature of large-scale conflict with a near-peer adversary will restrict evacuation, overwhelm treatment facilities, and exhaust medical logistics. Warfighter exercises estimate three thousand to four thousand casualties per day of large-scale combat.⁹ A U.S. Army corps-level wargame projected twenty-one thousand casualties in seven days, a loss of half the corps’ strength.¹⁰ Accurate reports from the Russian-Ukrainian conflict are unavailable since Moscow and Kyiv do not publish official figures. However, multiple sources estimate the Ukrainian military suffered 120,000 casualties, with killed in action ranging from seventeen thousand to seventy thousand.¹¹ Daily averages amount to fifty-four civilian casualties, 314 Ukrainian military casualties, and 502 Russian military casualties.¹² To offer perspective, the U.S. Army incurred 354 wounded in action and ninety-six killed in action over the entire duration of Operation Desert Storm.¹³ These numbers have overwhelmed Ukraine’s battered medical infrastructure.

Russian military tactics in Ukraine restrict movement and forward treatment. Long-range precision weapons and area-denial munitions, such as antitank and antipersonnel mines, along with trench warfare resemble World War I. Medics struggle to reach patients, and evacuation to hospitals can take up to ten hours.¹⁴ Civilian centers and medical infrastructure were targeted and attacked, with some medical facilities hit up to 400 km west of the Russian border.¹⁵ Since November 2022, Russia damaged or destroyed 1,100 health-care facilities, and at this point in the conflict, only ninety-five hospitals are fully restored.¹⁶ These conditions create a scarcity of medical equipment and medications. Implications for the U.S. Army are that medical evacuation platforms and larger hospitals may need to be positioned rearward to prevent being targeted, and forward medical teams may need to be positioned within hardened structures or even underground.¹⁷ Forward medical units must have the agility to relocate as quickly as one hour despite these constraints.¹⁸ Units with additive manufacturing capabilities could produce lightweight medical and surgical equipment in resource-scare environments like those observed in Ukraine. These same units can utilize this technology to produce repair and replacement parts to improve field-level maintenance.

Vulnerability of Medical Supply Chains

The globalization of medical supply chains represents another vulnerability in the American medical infrastructure. The United States relies on Asia, Europe, and India for its medical devices and medications. In 2019, the United States imported $20.7 billion in pharmaceuticals from China, accounting for 9.2 percent of all imports that year.¹⁹ Chinese companies provide America with more than 90 percent of its antibiotics, ibuprofen, and hydrocortisone.²⁰ During the COVID-19 pandemic, 85 percent of America’s personal protective equipment, such as the N-95 mask, came from China.²¹ The Hubei Province was ground zero for the pandemic, and when this production hub declined, it reduced China’s export of personal protective equipment by 75 percent.²²

A scarcity of medical equipment creates a market for low-quality, alternative products. Ukrainian military medical units are critically short of tactical medical kits, especially tourniquets. To distribute products at scale, Ukraine purchased Chinese-made tourniquets for approximately US$3 each, a cost-effective necessity since American-made tourniquets cost approximately US$40 each.²³ But this is a matter of quantity over quality. The cheaper tourniquets are failing, which is alarming given prolonged care and delayed evacuation.²⁴ A civilian medical company designed an open-source 3D-printable tourniquet, but the quality control is unclear, and they strongly caution its use and assembly.²⁵ Yet these products are used across multiple conflict zones, which speaks to the dire shortage of medical supplies. Employing additive manufacturing at echelon can enhance the capabilities of medical units by producing Class VIII armamentarium and replacement parts on demand, thereby decreasing supply chain dependence.

Fundamentals of 3D printing. Additive manufacturing technology converts digital data into physical objects from various base materials. Standard Tessellation Language is a printable file that represents a 3D physical object. Two common 3D printing techniques are stereolithography (SLA) and fused deposition modeling (FDM). Each technique has unique materials, processing, and post-processing requirements. SLA incrementally prints objects from a liquid resin.²⁶ The Formlabs Form3BL resin printer offers medical-grade resins for various uses, such as single-use instruments, anatomical models, and personal protective equipment.²⁷ The Formlabs BioMed Durable is an FDA-approved resin that offers accuracy and biocompatibility.²⁸ This material seems ideal for printing surgical equipment; however, this printing technique is demanding. It requires meticulous post-processing, including an isopropyl alcohol wash, post-curing, and polishing. The mechanical properties of a liquid resin may also degrade with the temperature and environmental extremes of field deployments; however, there is limited literature on this topic.

FDM printers extrude a spooled filament material through a heated nozzle.²⁹ Raise3D’s Pro2 Plus is a commercial FDM printer compatible with various filaments like polylactic acid (PLA).³⁰ These materials are more commonly used for prototyping, industrial models, and vehicle parts. The bulk of scientific literature discusses using PLA filaments to print surgical instruments. In terms of base materials, filament offers a significant advantage because the spools are lightweight and dimensionally stable, suggesting less transportability challenges. Additionally, the extrusion process reaches such a high temperature that the production can be considered a sterilization technique.³¹ Challenges may arise in humid climates. Filament materials can be hygroscopic, meaning they absorb moisture from air, which would reduce print quality. These are all vital considerations when selecting the appropriate material for surgical instruments or medical equipment in an austere environment.

Selective laser sintering is another manufacturing process that incrementally melts or “sinters” powder layers together. Selective laser sintering introduces the option of fabricating parts from metals like stainless steel and aluminum; however, these products have a grainy surface and require air blasters for post-processing and finishing.³² Historically, this printing technique was cost-prohibitive and limited to industrial use, but smaller, more affordable benchtop printers are now available.³³

Advantages of 3D printing. These 3D-printed instruments offer multiple advantages over traditional stainless-steel instruments, such as reduced weight and cost. PLA surgical retractors weigh twenty-five grams and cost only 5 percent of the online retail price.³⁴ A reduction in the volume and weight of this scale is significant for medical units when compared to traditional medical equipment sets. Basic surgical sets, such as hemostats, needle drivers, and forceps, can be printed on demand and customized as needed to serve the end user.³⁵ Printing can be conducted in hours as a surgical team establishes operations and prepares to receive patients.³⁶ Multiple instrument sets could be printed to expand surgical capacity to match the need, and 3D printing allows for scalable mission sets. When weight is critical, a small medical team could print instruments on demand in lieu of packing and bringing every equipment set they may need on deployment.

Single-use disposable items can now become a production option. These items could be safely discarded after use, reducing the risk of infection transmission between patients. Single-use items introduce flexibility for medical teams to rapidly relocate without the burdensome task of packing and transporting medical equipment sets. This would also significantly reduce the need for field sterilization, which often requires generators and imposes logistical challenges on small teams in remote settings.³⁷ The tabletop sterilizer used by a field hospital consumes 1400W and 12A of power and current, which can interfere with forward resuscitative surgical detachment split-team operations.³⁸ In comparison, the Formlabs 3L liquid-resin printer requires 650W and 8.5A, and the Raise3D Pro2 filament printer requires 600W and 3.3A.³⁹ Reduced power consumption would improve overall mission effectiveness.

Limitations of 3D printing. One known challenge is that high temperatures reached during traditional steam sterilization would weaken 3D-printed surgical equipment, especially the filament-based PLA.⁴⁰ Cold sterilization may be an effective alternative to achieve rapid disinfection in austere environments using commonly available materials.⁴¹ Another limitation is that 3D-printed surgical instruments often have reduced mechanical strength compared to traditional stainless-steel instruments. Policy and procedures would need to be developed to establish a standard for using surgical instruments and equipment printed in the expeditionary environment.

Additionally, 3D printing requires a stable, level, and clean workspace to fabricate products. The liquid resin is most susceptible to misprints or failures if the printer is not balanced and level. Filament printers can fail if the nozzle gets clogged during the printing process. Additionally, any high-quality manufacturing must avoid contaminants like dust from entering the machine. Solutions to minimize these limitations must be considered prior to fielding at scale. These printers must also be field tested in hot and cold climates to determine how weather affects performance.

Integrating 3D Printing across the Medical Roles of Care

The Army of 2040 must integrate additive manufacturing throughout the entire Army Health System, beginning at the Role I battalion aid station.⁴² A framework to meet this end state is achievable through commercially available printers and materials. Role I and Role II medical and surgical units should be fielded portable, ruggedized 3D printers along with a library of printable files. These units, such as the Role I battalion aid station and the Role II brigade support medical company and forward resuscitative surgical detachment, require agility to operate in austere, dispersed environments. Their additive manufacturing capability should include an FDM printer compatible with various filaments like nylon or carbon fiber. These materials are more dimensionally stable and lightweight. The lighter weight introduces the possibility for resupply with drones, as tested by special operations forces to deliver small packages of medical equipment and supplies.⁴³ Containers filled with liquid resin are heavier and could break during transportation, potentially leaking their contents. Additionally, a printer compatible with various materials could rapidly print replacement parts for biomedical equipment, bypassing supply chain constraints. To that end, these units should also be issued optical scanners to generate printable files in the field, effectively reverse engineering equipment as needed. For example, if a plastic attachment breaks on a surgical suction device, then a digital technician could scan and print a replacement part overnight.

Role III medical and surgical units such as field hospitals and hospital centers should field both SLA-liquid resin and FDM-filament-type printers. The more fixed nature of these units introduces the potential for robust utilization of this technology. The 673rd Dental Company Area Support (DCAS), a Role III dental unit, successfully employed liquid crystal display printers while deployed to the U.S Central Command area of operations in 2022.⁴⁴ Supply chain shortages and mobility limitations motivated the DCAS to innovate and improve processes within their forward treatment sections. These sections can be forward deployed to support both Role I and Role II units; however, the forward-treatment section only has 50 percent mobility based on its vehicles and equipment.⁴⁵

The DCAS forward treatment section adopted intraoral optical scanning and 3D printing to reduce the reliance on heavy dental equipment sets. Optical scanning and photography also allowed for asynchronous telemedicine consultations to support dispersed providers and units. The forward-deployed DCAS team practiced reaching back and leveraged continental U.S. support teams to design novel products and email those printable files to the end user. These efforts improved access to dental services while simultaneously reducing the weight of equipment for any forward missions. For example, the traditional prosthodontic equipment set weighs 1,200 lb. and contains over 350 line items, which makes its employment impractical forward of the corps support area. In comparison, the equipment required for a digital workflow weighed less than 100 lb. and could be transported on foot, nontactical vehicles, and vertical air lift.⁴⁶ This 92 percent reduction in overall weight offers promise to making the DCAS 100 percent mobile. The timely pivot to innovate dental services generated US$350,000 worth of expeditionary treatment and represents a proof of concept for integrating additive manufacturing.⁴⁷ This weight reduction, paired with increased capability, can make dental and medical support a more rapidly deployable asset to the warfighter. Lessons learned from this vignette could also be applied to medical companies across the Army Health System.

Dental officers assigned to the dental company or field hospital could serve as 3D printing subject-matter experts. Dental officers, especially comprehensive dentists and prosthodontists, receive extensive computer-aided design/computer-aided manufacturing (CAD/CAM) training during their residency programs, which includes printing and optical scanning. Dentists could serve in an adjunctive role as additive manufacturing officers for Role II and Role III units. This would enhance materiel sustainment without creating the need for additional training requirements or course development. This has precedent as additive manufacturing curriculum was added to the 91E (allied trade specialist) and 914A (allied trades warrant officer) advanced individual training courses. Dental officers’ skills and expertise can be leveraged to enhance capabilities across the Army Health System.

Developing a Digital Stockpile for Strategic Independence

A digital library of medical equipment and replacement parts must be developed to maximize the potential of additive manufacturing. The U.S. Department of Health and Human Services and the National Institutes of Health offer examples of medical stockpiles. The Health and Human Services Strategic National Stockpile stores supplies in the case of emergencies or natural disasters, but this is labor intensive and requires maintenance, inventory, and testing to extend the shelf-life of equipment and medications.⁴⁸ The National Institutes of Health 3D Print Exchange has a small library of digital products, mostly limited to masks and personal protective equipment.⁴⁹ A digital stockpile of printable files would provide greater strategic independence and operational flexibility in the case of escalating global competition. A digital stockpile (or library) could also tailor medical support to the demand signal. For example, a hospital unit could download and print more personal protective equipment if activated to support a pandemic or chemical incident. Ideally, medical and surgical units would download these printable files prior to deployment based on their operational demands. Forward medical units could also reach back to this digital stockpile to print products in theater. This stockpile could include commonly needed replacement parts for medical equipment.

Developing a library of printable digital files requires close collaboration among multidisciplinary working groups of clinicians, engineers, and industry. Successful reverse engineering, or digitizing, physical equipment requires communication and feedback from the end user, along with materials testing and analysis. Partnerships with industry could reduce the need for extensive reverse engineering. A systematic product development would eliminate a trial-and-error approach. These materials and printers should also be field tested in cold, hot, and humid climates to simulate environments found in the U.S. European Command and the U.S. Indo-Pacific Command.

In the future, a forward surgical team could deploy with one physical set of equipment and a 3D printer to then expand capacity as needed. As this technology becomes more robust, medical and surgical teams would only require a printer and a copy of digital files for deployment. A medical unit deploying with a stored library of printable files would eliminate concerns over network connectivity or generating digital signatures in theater. This reduction in size and weight would create space for expendable items or reduce the load entirely. It could also allow time for predeployment training and skills refresher versus the laborious task of equipment load.

Conclusion

Additive manufacturing imparts flexibility to expeditionary medical support. Robust 3D printing capabilities would provide a secondary logistics chain and allow rapid replacement of broken or nonserviceable items. Medical units would only need to maintain essential medical equipment and could print items on demand once in theater. Field-level maintenance can be expanded by enabling units to print items that traditionally require sustainment-level maintenance.

During conflict with a near-peer adversary, it will be critical that medical and surgical units reduce their size and weight without compromising capability and agility. These units must maximize mobility to maintain proximity to the maneuver forces. Additive manufacturing can provide capabilities to overcome contested logistics in large-scale conflict with a near peer. Army dental officers represent a preexisting cohort of 3D printing subject-matter experts with an established training and education pipeline. The Army Medical Modernization Strategy must open its aperture to also pursue solutions that streamline well-established challenges to medical logistics and equipment.

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Notes

1. Army Futures Command, Army Medical Modernization Strategy (Austin, TX: Army Futures Command, May 2022), https://www.army.mil/e2/downloads/rv7/about/2022_Army_Medical_Modernization_Strategy.pdf.
2. Jason Barnhill et al., “Additive Manufacturing for Fabrication of Point-of-Care Therapies in Austere Environments,” Military Medicine 188, no. 7-8 (July-August 2023): e1847–53, https://doi.org/10.1093/milmed/usad007; Shayne Kondor et al., “On Demand Additive Manufacturing of a Basic Surgical Kit,” Journal of Medical Devices 7, no. 3 (September 2013): Article 030916, https://doi.org/10.1115/1.4024490; Shayne Kondor et al., “Personalized Surgical Instruments,” Journal of Medical Devices 7, no. 3 (September 2013): Article 030934, https://doi.org/10.1115/1.4024487; Mitchell George et al., “3D Printed Surgical Instruments: The Design and Fabrication Process,” World Journal of Surgery 41, no. 1 (January 2017): 314–19, https://doi.org/10.1007/s00268-016-3814-5; Larry V. Duggan et al., “Front-of-Neck Airway Meets Front-of-Neck Simulation: Improving Cricothyroidotomy Skills Using a Novel Open-Access Three-Dimensional Model and the Airway App,” Canadian Journal of Anesthesia 64, no. 10 (October 2017): 1079–81, https://doi.org/10.1007/s12630-017-0926-9; Jeffrey Huang et al., “A Novel Approach to Emergency Airway Simulation Using a 3D-Printed Cricothyrotomy Task Trainer,” Journal of Education in Perioperative Medicine 23, no. 3 (July-September 2021): e670, https://doi.org/10.46374/volxxiii_issue3_sims; Matteo Parotto et al., “Evaluation of a Low-Cost, 3D-Printed Model for Bronchoscopy Training,” Anaesthesiology Intensive Therapy 49, no. 3 (2017): 189–97, https://doi.org/10.5603/ait.a2017.0035.
3. Jacob L. Greenberg, “Marine Receives DOD’s First Jaw Reconstruction Using 3D-Printed Teeth,” U.S. Department of Defense, 9 July 2021, https://www.defense.gov/News/Feature-Stories/Story/Article/2683418/marine-receives-dods-first-jaw-reconstruction-using-3d-printed-teeth/.
4. Charlie M. Wiltse, The Medical Department: Medical Service in the Mediterranean and Minor Theaters (Washington, DC: U.S. Government Printing Office, 1965; repr., Washington, DC: U.S. Army Center of Military History, 1987), xxvi, https://history.army.mil/html/books/010/10-8/CMH_Pub_10-8.pdf.
5. U.S. General Accounting Office (GAO), Operation Desert Storm: Full Army Medical Capability Not Achieved, GAO/NSIAD-92-175 (Washington, DC: U.S. GAO, August 1992), https://www.gao.gov/products/nsiad-92-175.
6. Ibid.
7. Robert G. Cockerham, “Improving Mobility, Survivability, and Modularity in a Brigade Support Medical Company,” Center for Army Lessons Learned, 1 June 2021, https://api.army.mil/e2/c/downloads/2023/01/31/e3ba64bd/improving-mobility-survivability-and-modularity-in-a-brigade-support-medical-company-jun-21-public.pdf.
8. Ibid.
9. Matthew Fandre, “Medical Changes Needed for Large-Scale Combat Operations: Observations from Mission Command Training Program Warfighter Exercises,” Military Review 100, no. 3 (May-June 2020): 36–45, https://www.armyupress.army.mil/Portals/7/military-review/Archives/English/MJ-20/Fandre-Medical-Changes.pdf; Mason H. Remondelli et al., “Casualty Care Implications of Large-Scale Combat Operations,” Journal of Trauma and Acute Care Surgery 95, no. 2S (August 2023): S180–84, https://doi.org/10.1097/ta.0000000000004063.
10. Todd South, “21,000 Casualties in Seven Days: The Push to Update Medic Training,” Army Times (website), 6 October 2023, https://www.armytimes.com/news/your-army/2023/10/06/21000-casualties-in-seven-days-the-push-to-update-medic-training/.
11. Remondelli et al., “Casualty Care Implications”; Svitlana Morenets, “Ukraine’s Real Killing Fields: An Investigation into the War’s First Aid Crisis,” The Spectator, 26 August 2023, https://www.spectator.co.uk/article/ukraines-real-killing-fields-an-investigation-into-the-wars-first-aid-crisis/; Helene Cooper et al., “Troop Deaths and Injuries in Ukraine War Near 500,000, U.S. Officials Say,” New York Times (website), 18 August 2023, https://www.nytimes.com/2023/08/18/us/politics/ukraine-russia-war-casualties.html.
12. Remondelli et al., “Casualty Care Implications.”
13. “U.S. Military Casualties: Persian Gulf War Casualty Summary, Desert Storm,” Defense Casualty Analysis System, last updated 9 February 2024, https://dcas.dmdc.osd.mil/dcas/app/conflictCasualties/gulf/stormsum.
14. Morenets, “Ukraine’s Real Killing Fields.”
15. “Russia Warns Kyiv Residents to Leave as Armored Convoy Nears Ukraine’s Capital,” Vanguard News Nigeria, 1 March 2022, https://www.vanguardngr.com/2022/03/russia-warns-kyiv-residents-to-leave-as-armored-convoy-nears-ukraines-capital/; Diane Cole, “Russia’s 226 Attacks on Health-Care Targets in Ukraine Are Part of a Larger Problem,” NPR, last updated 24 May 2022, https://www.npr.org/sections/goatsandsoda/2022/03/16/1086982186/russias-strike-on-ukraine-maternity-hospital-is-part-of-a-terrible-wartime-tradi; Aaron Epstein et al., “Putting Medical Boots on the Ground: Lessons from the War in Ukraine and Applications for Future Conflict with Near-Peer Adversaries,” Journal of the American College of Surgeons 237, no. 2 (August 2023): 364–73, https://doi.org/10.1097/xcs.0000000000000707.
16. “Russians Damaged 1,100 Medical Facilities in Ukraine,” Ukraine Crisis Media Center, 8 November 2022, https://uacrisis.org/en/rosiyany-poshkodyly-v-ukrayini-1100-medzakladiv.
17. Epstein et al., “Putting Medical Boots on the Ground.”
18. Ibid.
19. Committee on Security of America’s Medicial Supply Change, Building Resilience into the Nation’s Medical Product Supply Chains (Washington, DC: National Academies Press, 2022).
20. Tony Paquin and David Sanders, “To Protect the Medical Supply Chain, ‘Made in America’ Will Be Key,” STAT News, 14 December 2022, https://www.statnews.com/2022/12/14/made-in-america-protect-medical-supply-chain/.
21. Ibid.
22. Chad P. Bown, “How COVID‐19 Medical Supply Shortages Led to Extraordinary Trade and Industrial Policy,” Asian Economic Policy Review 17, no. 1 (January 2022): 114–35, https://doi.org/10.1111/aepr.12359.
23. Morenets, “Ukraine’s Real Killing Fields.”
24. Ibid.
25. “The Glia Tourniquet Project,” Glia, accessed 9 February 2024, https://glia.org/pages/the-glia-tourniquet-project; “GliaX/tourniquet,” GitHub, accessed 12 February 2024, https://github.com/GliaX/tourniquet.
26. George et al., “3D Printed Surgical Instruments.”
27. “3D Printing Materials for Healthcare,” Formlabs, accessed 9 February 2024, https://formlabs.com/materials/medical/.
28. “BioMed Durable Resin Manufacturing Guide” (Somerville, MA: Formlabs, 2023), https://media.formlabs.com/m/14cff42db244f816/original/-ENUS-BioMed-Durable-Manufacturing-Guide.pdf; “Technical Data Sheet: BioMed Durable Resin” (Somerville, MA: Formlabs, 2023), https://formlabs-media.formlabs.com/datasheets/2310772-TDS-ENUS-0.pdf.
29. George et al., “3D Printed Surgical Instruments.”
30. “Wide Range of Engineering Material Solutions,” Raise3D, accessed 9 February 2024, https://www.raise3d.com/filaments/.
31. Russell Y. Neches et al., “On the Intrinsic Sterility of 3D Printing,” PeerJ 4 (2016): e2661, https://doi.org/10.7717/peerj.2661.
32. George et al., “3D Printed Surgical Instruments.”
33. “Guide to Selective Laser Sintering (SLS) 3D Printing,” Formlabs, accessed 9 February 2024, https://formlabs.com/blog/what-is-selective-laser-sintering/.
34. Joshua V. Chen et al., “3D Printed PLA Army-Navy Retractors When Used as Linear Retractors Yield Clinically Acceptable Tolerances,” 3D Printing in Medicine 5, no. 16 (November 2019): 1–9, https://doi.org/10.1186/s41205-019-0053-z.
35. Kondor et al., “On Demand Additive Manufacturing of a Basic Surgical Kit”; Kondor et al., “Personalized Surgical Instruments.”
36. George et al., “3D Printed Surgical Instruments.”
37. Ross K. Cook et al., “Use of a Pressure Cooker to Achieve Sterilization for an Expeditionary Environment,” Journal of Special Operations Medicine 21, no, 1 (Spring 2021): 37–39, https://doi.org/10.55460/wpgc-a599.
38. “2540M Technical Specs,” Tuttnauer, accessed 12 February 2024, https://tuttnauer.com/us/medical-clinics/tabletop-sterilizers/manual/2540m#pane-technical-specs.
39. “Formlabs Stereolithography 3D Printer Tech Specs,” Formlabs, accessed 12 February 2024, https://formlabs.com/3d-printers/form-3/tech-specs/; “Raise3D Pro2 Series Technical Specifications,” Raise3D, accessed 12 February 2024, https://www.raise3d.com/pro2-series/.
40. Joshua V. Chen et al., “Identifying a Commercially-Available 3D Printing Process That Minimizes Model Distortion after Annealing and Autoclaving and the Effect of Steam Sterilization on Mechanical Strength,” 3D Printing in Medicine 6, no. 1 (2020): 9, https://doi.org/10.1186/s41205-020-00062-9.
41. Andrew Francis et al., “Rapid Cold Sterilization of 3D Printed Surgical Instruments for the Austere Environment,” American Journal of Surgery 225, no. 5 (May 2023): 909–14, https://doi.org/10.1016/j.amjsurg.2023.03.010.
42. Role I Tabletop Exercise, U.S. Army Medical Capability Development Integration Directorate, Fort Sam Houston–Joint Base San Antonio, Texas, 28 August 2023.
43. Tomaz Mesar, Aaron Lessig, and David R. King, “Use of Drone Technology for Delivery of Medical Supplies during Prolonged Field Care,” Journal of Special Operations Medicine 18, no. 4 (Winter 2018): 34–35, https://doi.org/10.55460/m63p-h7dm.
44. Michael Kroll, Digital Dentistry and Additive Manufacturing in CENTCOM, Executive Summary (Joint Base Lewis-McChord, WA: 673rd Dental Company Area Support, December 2022).
45. Army Techniques Publication 4-02.19, Dental Services (Washington, DC: U.S. Government Publishing Office, August 2020).
46. Kroll, Digital Dentistry and Additive Manufacturing in CENTCOM.
47. Ibid.
48. “Sustaining the Stockpile,” Administration for Strategic Preparedness and Response, accessed 12 February 2024, https://aspr.hhs.gov/SNS/Pages/Sustaining-the-Stockpile.aspx.
49. “NIH 3D,” National Istitutes of Health, accessed 12 February 2024, https://3d.nih.gov.

 

 

 

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