The U.S. Army explored whether
real-time, electronic point-of-treatment care was possible or practical this
summer at its integrated capabilities testbed at Fort Dix, N.J.
Key medical and technical personnel from
the U.S. Army Medical Research & Materiel Command and the U.S. Army
Research, Development and Engineering Command combined prototype medical
military software with commercial hand-held technologies and tactical 4G
networks to send medical information from the point of injury on the
battlefield back to the doctor for real-time communication and decision making.
“It’s going to build confidence in the
medic on the field that’s isolated with a severely wounded soldier,” said Carl
Manemeit, Physiological Monitoring project lead for the MRMC’s Telemedicine
& Advanced Technology Research Center, or TATRC.
“If you’ve ever seen the movie, ‘Black
Hawk Down,’ the medic is trying to treat the guy with the artery issue in his
leg; the medic goes through all his resources, and once he exhausted all his
knowledge, he was stuck,” Manemeit said.
If he had been connected to the surgeons
back at the treatment facility, they could have given him more guidance on how
to save that soldier’s life. By injecting this expertise, we might be able to
do that one thing that could save some guy’s life; that’s what we’re looking to
do.”
Medics utilized man-portable
physiological monitoring devices with streaming video, voice and photo
capability, and sent electronic Tactical Casualty Care Cards, or TC3, over a
tactical network to the surgical facility so surgeons could see injuries and
what treatment had been performed prior to the patient’s arrival.
“There’s an information gap that lies
between the point of injury on the field and point of treatment back at a
medical facility,” said Dr. Gary R. Gilbert, TATRC Research, Development, Test
and Evaluation program manager for Secure Telemedicine. “We need to do a better
job of being able to record what the medic saw and did prior to the patient
being evacuated to the treatment facility, and we want this record to be
transmitted to the soldier’s permanent health records.”
“Now when the patient goes to a combat
support hospital, or gets back to Walter Reed for further care, the doctors can
see what happened in the field; and five years from now when the patient goes
into a VA hospital seeking treatment, the care providers can see everything
that’s been done,” Gilbert said.
Currently, medics fill out a paper TC3
that’s attached to the injured soldier before evacuation to the battalion aid
station or the combat support hospital. In some cases, the TC3 never makes it
back to the treatment facility, and the information never makes it to the
patient records.
“One of the issues I had with the card
is that it’s a piece of paper held on with a metal wire,” said Spc. Daniel
Vita, U.S. Army Medical Research Institute for Infectious Diseases, Fort
Detrick, Md. “Pretty much, you would have attached it to the patient through
his zipper or around his wrist, but you potentially had the problem of ripping
the paper from the metal loop.”
Vita, who was a medic with the 130th
Engineer Brigade Headquarters in Iraq, preferred using tape and a sharpie
because “it stayed.”
“I like the idea of an electronic TC3
because it’s simpler,” Vita said. “It’s a lot easier for the information to get
to where it needs to go and it makes it legible. When you filled out a TC3 card
and put it on the patient, they didn’t know what was happening until that
patient and card got to them. Now doing it electronically, you can send it
ahead to the level two or three so they have an idea of what kinds of patients
and casualties are coming in.”
The combination of secure tactical
communications and knowledge management may also help brigade surgeons
prioritize treatment and evacuation assets so the most critically injured can
be treated first.
“The Army uses medevac, but the bad news
is that it costs about $20,000 per patient flight,” said Dave Williams, Project
Manager for Theater Tele-Health Initiatives, TATRC. “And if you have six assets
and 12 patients, who should they get first? If we can determine which patients
can be held and which can be treated and stabilized on site, it might be a less
expensive way to save a patient’s life.”
The work was performed at the integrated
capabilities testbed operated by Product Director Command, Control,
Communications, Computers, Intelligence, Surveillance, Reconnaissance and
Network Modernization, an R&D program within U.S. Army RDECOM’s
communications-electronics RD&E center, CERDEC.
“This is a forgiving environment because
it’s designed for testing and solution proving,” Gilbert said. “If things don’t
work, that’s OK; you find out what doesn’t work and you fix it here. There are
a lot of technologies required to make this work, and we don’t have all of
these. CERDEC is helping to fill in those gaps by providing a variety of radio
capabilities that you wouldn’t get at a real brigade: SRW, WNW, ANW2,
deployable 4G, Airborne relay, connection to Army WIN-T. They provide the
infrastructure, and we just bring the application.”
PD C4ISR & Network Modernization
focuses on the future network, near-term and several years out, providing the
Army with a relevant venue to assess next-generation technologies and to
facilitate technology maturation. The program is also a key component in
CERDEC’s support of the agile acquisition process, utilizing its field lab
environment to perform risk mitigation and candidate assessment/selection for
future Network Integration Rehearsal/Exercise events.
“These guys are not only preparing the
current force to be successful, they’re closing the gaps for the future force
with each iteration of these integrated capabilities events,” Williams said.
“You don’t solve all the problems in one 12-month cycle. This venue is
providing the medics an opportunity to get inside the Program Objective
Memorandum cycle to come up with those solutions and iteratively solve them as
technologies emerge and grow with us. This has been a complete team effort to
develop a solution that did not exist six years ago.”
This is the third year that PD C4ISR
& Network Modernization has examined network capabilities that could
support the medic/first responder’s mission.
During 2011, PD C4ISR & Network
Modernization combined fielded tactical radios such as the Enhanced Position
Location Reporting System with the Soldier Radio Waveform to see if it was
possible and feasible to provide enhanced bandwidth and over-the-horizon
communications for hand-held medical data. This year, a 4G cellular mesh
network was implemented, using SRW to bridge back to the tactical network.
“We’re examining how best to combine the
future and current so we can enable the medical community to perform their
mission more efficiently,” said Jason Sypniewski, chief for PD C4ISR &
Network Modernization’s Integrated Event Design & Analysis branch. “We’re
looking at the Soldier Radio Waveform because it’s a self-healing waveform that
allows non-line-of-sight communication; that’s the vision for where the Army
wants to go. We’ve looked at EPLRS because it’s an existing asset on which the
medical community might could recapitalize.”
“Cellular technology could be the future
of tele-health on the modern battlefield, but we need to know if it can be
done, and if so, would it actually enhance the delivery of information?”
Sypniewski said. “As decision makers look at network modernization, this is the
type of information they will want in order to help them make informed
decisions regarding telemedicine capabilities and the networks on which they’re
going to ride. Our mission is to provide this.”
By Edric Thompson, CERDEC
From www.army.mil
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