Page 118 - Journal of Special Operations Medicine - Winter 2016

Telemedicine to Reduce Medical Risk
in Austere Medical Environments

The Virtual Critical Care Consultation (VC3) Service

Doug Powell, MD; Robert D. McLeroy, MD; Jamie Riesberg, MD; William Vasios, MPAS;
Ethan Miles, MD; Jeffrey Dellavolpe, MD; Sean Keenan, MD; Jeremy Pamplin, MD

ABSTRACT

One of the core capabilities of prolonged field care is tele- surgery, hemostatic (whole-blood or matched-component
medicine. We developed the Virtual Critical Care Consult therapy) blood-product resuscitation, Joint Trauma Sys-
(VC3) Service to provide Special Operations Forces (SOF) tem management guidelines, and critical care casualty
medics with on-demand, virtual consultation with expe- transportation, all require advanced medical capabilities
rienced critical care physicians to optimize management and significant logistical support. Constrained geography
and improve outcomes of complicated, critically injured and recognition that outcomes improved when casualties
or ill patients. Intensive-care doctors staff VC3 continu- received rapid, definitive, surgical resuscitative care led
ously. SOF medics access this service via phone or e-mail. to the development of increasingly more robust medical
A single phone call reaches an intensivist immediately. evacuation capabilities in OIF and OEF. As the military
8
An e-mail distribution list is used to share information transitions from operating environments with mature
such as casualty images, vital signs flowsheet data, and medical and evacuation resources to more resource-lim-
short video clips, and helps maintain situational aware- ited operations, a shift in medical capabilities is neces-
ness among the VC3 critical care providers and other sary because advanced trauma care from combat support
key SOF medical leaders. This real-time support enables hospitals (CSHs) and forward surgical teams (FSTs) is
direct communication between the remote provider and unlikely to be available within the “golden hour,” if at
the clinical subject matter expert, thus facilitating expert all (Figure 1). The concept of prolonged field care (PFC),
management from near the point of injury until defini- currently being trained and iteratively refined, addresses
tive care can be administered. The VC3 pilot program has this operational constraint. 9–11
been extensively tested in field training exercises and vali-
dated in several real-world encounters. It is an immedi- Figure 1 Comparison of time to critical care trained clinical
providers from OIF/OEF 2009–2014 to current operations in the
ately available capability that can reduce medical risk and AFRICOM area of responsibility. Time in red represents field care
is scalable to all Special Operations Command forces. without critical care trained providers. Maps with relative country
sizes are shown to to illustrate the scale of evacuation distances in
different operational theaters.
Keywords: critical care; telemedicine; military personnel;
emergency treatment; patient transfer; combat casualty care

Introduction

SOF Medicine in the Gray Zone Environment
Throughout history, armed conflict has led to substantial
medical innovation that improves outcomes for Combat ca-
sualties and civilians when innovations translate to civilian
healthcare. The case-fatality rates during Operation Iraqi
Freedom (OIF) and Operation Enduring Freedom (OEF)
are the lowest in recorded conflict. Multiple medical ad-
1
vances have contributed to this success, but only Tactical
1–4
Combat Casualty Care (TCCC) and, in many cases, pre-
5,6
hospital damage control resuscitation (DCR), can be reli- CASEVAC, casualty evacuation; CONUS, contiguous United
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States; FWD, forward; LRMC, Landstuhl Regional Medical Center;
ably implemented before casualties reach a surgical facility. MEDCOM, Medical Command; MERT, medical emergency response
Other important interventions, including damage control team; POI, point of injury; STRATEVAC, strategic evacuation.
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