Telemedicine Issues

Who should medics call for help while managing a critical patient for prolonged periods of time?  Different aspects of this have been discussed via different forums such as the SOMSA lunchtime working sessions and email chain.  We are posting it here in order to reach a wider knowledge base including those who it affects directly such as the medics on the ground.

(This is different than who should they call normally or for operational or logistical problems.)

Recent emails from the email chain to keep everyone on the same page:

-I was particularly impressed with the use and plan to incorporate telemedicine into the scenarios. While high-fidelity video may be the current “rage,” we should plan and rehearse multiple modes of remote consultation, from basic to high-fidelity. While there was discussion on the perceived value of a structured format to request a consult, I think we should also think about how we are going to train or manage the consultants.  Having a stable of available consultants who are familiar with PFC in a resource constrained environment will save time and confusion over limited bandwidth. Alternatively, we might develop a script that medics should read to a provider who is available but doesn’t really understand the tactical context.  Having and practicing this reach-back resource helps mitigate the challenge of preparing for every potential situation.  Just some initial thoughts.

Also, I am sure that I don’t have to remind everyone that the rest of the army will be looking at this, as well, since these issues come up with conventional forces, too (see attached).

Also, J mentioned that you guys have collected the data from the auto-transfusion training.  Have you guys thought or looked at publishing that data? I suspect that there will be some that will challenge it on ethical grounds and we might want to get ahead of that argument.

-R

-A couple of random comments as requested…

Technology is great when it works like it is supposed to, the batteries are charged, and when people on both ends are effectively communicating.  The PFC setting is a little more favorable for time allowances to set up whatever com linkage you might have (over typical battlefield/POI care).  However the remote nature of PFC often has the same limitations that put them in that situation.  There have been great advancements in the technology, and more to surely come.

I think having some practice with this technology is great and is the only way to see where it leads us.  However a big focus needs to continue on isolated PFC without outside help and providing the tools (education, protocols, etc) to help the provider in those remote, isolated cases.

 Not any clear answer here, but a couple of comments.

 -W

-In the same spirit of the PFC mantra of “Ruck, Truck, House, Plane” sequence of preparedness planning we should plan for the minimal and be prepared for better. Along the lines of R’s initial suggestion, we should have concise recommendations for the medic to consult higher medical advice.

Suggested layers could be:

Ruck: Relayed message (all patient information is communicated through a relay with delays in responses)

Truck: Phone call (verbal contact with consultant by provider that may/may not be near patient)

House: Combined verbal and data transfer (verbal contact with consultant with capability to transmit photos, reports, etc. but not in real-time)

Plane: Real time Telemedicine (direct two-way audiovisual contact with consultant)

I’m just throwing these metrics out there as a start. The PFC Telemedicine v4 provides a good PACE plan for who to call and what to say in your first few breaths.

A good tool does more than one thing. If we can design this correctly it could provide both a versatile guide and professional reminder on what is important under each subspecialty of Telemedicine. Giving the most relevant and concise patient presentation should be the goal for the consulter. Addressing W’s comments to be prepared when technology fails will also set the medic up for success when they are alone and unafraid. A list of the most relevant items to brief a consultant is an excellent reminder of what is important for the medic to know concerning their patient.

-B

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3 thoughts on “Telemedicine Issues

  1. We’ve now got a sub-group working on all aspects of telemedicine. It’s being run by SME’s at an operational HQ, with input from all over the community.

    Should be some good stuff coming out in the next few months, and maybe some cool research to follow.

    Stay tuned, Sean

  2. Telemed is ABSOLUTELY the long pole in the tent of Prolonged Field Care. Our most recent recommendations are to start with a short narrative video if possible. (if you’re using email or smart phone) This is something that will pass alot of information quickly and can be reviewed by the physician a number of times without interrupting the medic to ask questions. Text or email vital signs and drug doses, this way they can be reviewed and act as an aid in charting.

    1. Thanks Gabe, We absolutely agree with you on this. We are getting ready to post an update to this one with a new call script that the USAISR perfected to use with their new DOD Virtual Critical Care Consult (VC3) line. We have been testing the line as well which is staffed by the critical care docs in San Antonio. They are extremely dedicated to helping military medics and providers who may find themselves in over their heads. We all agree on your recommendation to send as much info as possible prior to the call, be it video or multiple pictures as bandwidth is available. Thanks again for the comment. I’m glad we are all on the same page. Now to convince the medics…

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