Podcast (video) Episode 34: Telemedicine to Reduce Medical Risk in Austere environments
Telemedicine is a crucial capability that must be planned and practiced. The base of knowledge that a SOF medic’s knowledge encompasses includes many areas of medicine but generally lacks
the depth of knowledge and experience of specialists available to consult. This depth of knowledge is almost universally available when making a simple telephone call to any number of docs willing to take a call at all times of the day and night. Don’t let pride or hubris prevent you from seeking advice from someone more experienced than you in taking care of critically injured, complex patients. Telemedical consult is one of the most important core capabilities in a prolonged field care situation.
BOTH the medic making the call as well as the Provider receiving the call must practice and rehearse a telemedical consult placed from a field environment. The medic will gain confidence and be able to relay vital information efficiently in a timely manner. The provider on the other end will have to anticipate problems that the medic may not have thought of and help create a prioritized treatment care plan from incomplete information.
Trust must be built prior to an actual call being made under stressful conditions; trust in the receiving physician and, more importantly, trust in the process. Medics may be apprehensive in calling a complete stranger if they haven’t made a test call or even better, a face to face meeting. If you build the rapport before the crisis, this won’t be an issue. You may even have the time to prep a draft email who you are and your equipment, training level and usually a region where you will be if you think it will be pertinent.
This is our latest PFC teleconsultation script. Updates have been made after many training scenarios and, very recently, after a real world case. It has evolved to its current state through a collaboration of Medics, ICU and EM Docs along with other providers and specialties and is continually tested and vetted by critical care docs across the world and all of us in the PFC working group.
Paul’s 10 Quick Telemed Tips
1. If possible text, email or IM pictures prior to calling.
- Flowsheet and other documentation like the telemed script
- Patient wounds
- Imaging – pictures or video
- Whole Patient
- Special Equipment
- Facility or aid station
2. Practice in a realistic training environment with a real provider with your actual comms. Practice while deployed. Practice with each piece of commo gear.
3. Prep your team that this is part of the plan so they expect you to do it in a real situation. You having to call someone else should not be a surprise for a few reasons.
4. Put the consult script in a document protector and put it in the back of your aid bag now. Show them where you keep it in case you are the casualty and attach a
5. Keep the script posted in the OPCEN or TOC next to the phone just like a 9-line on a radio. Make sure everyone knows the intricacies of dialing on each device.
6. Keep a script with each Sat Phone and in each truck with the first aid kit.
7. If you are going to use a green NIPR line with a cord or other land line, make sure you have one in your Aid Station. It will likely be you, the medic, making the call. Don’t turn this into a back-and-forth relay race where you have to run across the camp to make or receive a call.
8. Don’t be afraid to say no. If you are busy with patient care, don’t drop everything because someone way up in the chain of command needs a sit rep. Have your team leader take a message, explaining what he can and you can get back to them when you have a real free moment.
9. If your new-fangled telemonitoring device is taking more time than it’s worth, get your commo guy on it and get back to patient care. Make a regular phone call when you can.
10. While Telemedicine can help mitigate gaps in knowledge, don’t let it justify over extending your team. If your planning and risk assessment identifies that your mission needs a Surgical team forward deployed, a phone won’t take their place.
Telemonitoring and Technology
This is different than teleconsultation. Telemonitoring uses technology and bandwidth of some sort in order to send real time vital signs, audio/video and or other imaging such as live ultrasound. If this is part of a PACE plan it should be tested extensively prior to, but especially during a deployment, BEFORE you need it. Don’t get bogged down in technology. If it is taking more time than it’s worth, get your commo guy on it and get back to patient care.
Email Teleconsultation Services
If you are US DOD you can request both the new email consult service info and USAISR VC3 SAMMC number by emailing Dod.firstname.lastname@example.org
(Due to legal and logistical reasons our military providers cannot currently provide medical advice except to deployed(or training) US Military personnel. They may be able to participate during a training scenario with PRIOR coordination.)
Online SOF Medic Resources
Other Offline Protocols and References
TMEPs v.10, 2012 SOF Med Handbook, 2013 Ranger Med Handbook, ACLS Guidelines, Lexicomp, Sanford Guide