Page 122 - Journal of Special Operations Medicine - Winter 2016

Figure 3 The VC3 call script. Structured communication has been demonstrated to increase information transfer in both
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volume and content. The script is broken into five sections: Introductions & Call-Back, Clinical History and Problem, Vital
Signs/Exam/Previous Interventions, Recommendations, Follow-up. At the end of each section, a “pause point” is designed to
give the consultant or medic an opportunity to review information presented, via a read back, and to ask clarifying questions.
The section on capabilities is intended to be sent ahead of the voice consultation as a form of background information;
however, medics often send images of the entire script, which allows consultants to review the case before receiving the phone
call and often reduces talk time and may facilitate more concise recommendations.

in the intensive care unit (ICU) have been demonstrated
Discussion
to improve mortality in civilian and military ICUs. 17–21
Current Special Operations doctrine predicts prolonged Real-time teleconsultation can “bring the expert to the
gray-zone operations. 12,13 In this environment, smaller patient” in austere settings where the patient cannot be
elements will operate in more dispersed, austere envi- transported to the ICU for definitive care in a timely
ronments with little health-service support, often in manner. It is expected that the widespread availability
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failed states, with little to no organic medical infra- and use of critical care teleconsultation by SOF elements
structure. The nature of risk in these environments is conducting gray-zone operations will result in a reduc-
shifting from penetrating and blast trauma, to include tion of medical risk and an improvement in outcomes
significant rates of blunt trauma, burns, and infectious for critically injured and sick casualties. Ongoing re-
disease. Low-frequency, higher-risk resuscitations are search efforts are targeted to demonstrate this benefit.
predicted to become a normal experience in the next de-
cade’s operational environment. Although operational VC3 is a solution that provides synchronous teleconsul-
medical risk remains moderate to high, wide geographic tation to deployed SOF. It has been developed with the
dispersion of small elements operating in areas with close collaboration of SOF medics, SOF providers, and
limited country clearance who incur low casualty rates expert clinicians in the only military level 1 trauma and
make it difficult, if not impossible, to provide conven- burn center. VC3 has been tested and refined in dozens of
tional medical support through conventional echelons training exercises and validated in real-world scenarios.
of care and military medical evacuation.
The most important near-term challenges to SOF tele-
The use of critical care teleconsultation services and a consultation and VC3 are scalability, sustainability, and
multidisciplinary team approach to the care of patients physician participation. Scaling VC3 to be available to

106 Journal of Special Operations Medicine Volume 16, Edition 4/Winter 2016