In the near future, U.S. warfighters might be wearing devices that automatically detect injuries and begin treatment well before they are evacuated to a field hospital.

Last fall, the Office of Naval Research awarded a $1.6 million grant to a team of researchers at the University of California, San Diego, and Clarkson University to develop such a device, called a field hospital on a chip.

The goal is to create an automated system that would continuously monitor a warfighter's sweat, tears and blood for biomarkers that signal common battlefield injuries, such as trauma, shock, brain injury and fatigue. Once the system detects a medical problem, it would automatically administer medication.

"The long-term goal is to develop and test autonomous devices that detect and respond to battlefield trauma or insult," said Linda Chrisey, a program officer at the Office of Naval Research's Biological and Biomedical Division. "The supporting research objectives are to identify and improve detection of robust biomarkers for battlefield injuries and stressors and to develop interfaces between the sensors and device-control systems that increase the reliability of the diagnosis."

Led by nano-engineering professor Joseph Wang, engineers at UC San Diego will build a minimally invasive system that monitors multiple biomarkers simultaneously and processes that information to diagnose conditions.

"Since the majority of battlefield deaths occur within the first 30 minutes after injury, rapid diagnosis and treatment are crucial for enhancing the survival rate of injured soldiers," Wang said.

He helped develop the first noninvasive system for treating diabetes by monitoring glucose levels in patients' sweat. However, that type of system is not advanced enough to function as a field hospital on a chip.

"Today's insulin and glucose management systems don't include smart sensors capable of performing complex logic operations," Wang said. "We are working on a system that will be different. It will monitor biomarkers and make decisions about the type of injury a person has sustained and then begin treating that person accordingly."

The project will build on Evgeny Katz's research into enzyme logic systems. Katz, a professor in Clarkson University's Department of Chemistry and Biomolecular Science and a member of Wang's research team, has shown that enzymes can be used to measure biomarkers and perform the logic necessary to make limited diagnoses.

One of the team's challenges and the expected focus of the first two years of research will be integrating enzyme logic with sensing devices people can wear. Researchers will work on developing electrodes with enzymes that serve as sensors and perform the logic necessary to convert biomarkers such as lactate, oxygen, norepinephrine and glucose into data that would trigger the release of appropriate medication.

"We just want the ones and zeros," Wang said. "The pattern of ones and zeros will reveal the type of injury and automatically trigger the proper treatment. This is biocomputing in action."

For example, if an injured warfighter goes into shock, enzymes on the electrode would sense rising levels of lactate, glucose and norepinephrine. Those, in turn, would cause changes in the concentrations of biochemicals generated by the enzymes and prompt the built-in logic structure to output a digital signal that indicates the patient is going into shock. That signal would trigger a predetermined treatment response.

The researchers expect to have a working prototype of the product in four years. "We are just at the beginning of this project," Wang said. "During the first two years, our primary focus will be on the sensor systems. Integrating enzyme logic onto electrodes that can read biomarker inputs from the body will be one of our first major challenges."

"Achieving the goal of the program is estimated to take nearly a decade," Chrisey said.

Developing an effective interface between complex physiological processes and wearable devices could have a broader impact, Wang said. If the researchers are successful, they could pave the way for "autonomous, individual, on-demand medical care, which is the goal of the new field of personalized medicine," he added.