Page 124 - Journal of Special Operations Medicine - Winter 2016

all SOCOM forces operating in austere environments is Conclusion
one of the most high-yield, immediately available meth- VC3 is an immediately available method to reduce med-
ods to reduce medical risk. The investment needed to ical risk in gray-zone operating environments. It meets
achieve such scaling is small: call-forwarding software the SOCOM requirement for telemedicine support of
to ensure that a medic’s call will be answered if the pri- decentralized operations. With minimal investment,
mary on-call provider is occupied or out of coverage VC3 can be sustained and scaled to all SOCOM forces.
range, a coordinator to manage a roster of critical care This is an essential first step before exploring additional
physicians who volunteer to take VC3 calls, and a re- capabilities or scaling to support conventional force
search coordinator to collect data from the calls, thus operations.
helping to further refine the system and enable future
enhancements in operational telemedicine. 4
Key points
All branches of the military employ physicians with the
required training and experience to be expert VC3 con- • The VC3 service is a direct link between medics in
sultants. Establishing a cadre of VC3 providers requires austere environments and critical care subject matter
selection, vetting, and training, as well as recognition of experts that enables best possible care of critically in-
activities in support of operational teleconsultation by jured and sick patients during PFC.
parent medical directorates. Regarding the former, the • VC3 provides effective consultation by telephone;
importance of a critical care provider (receiver) under- meeting a core requirement voiced by SOF medics
standing the operational context of the SOF provider that telemedicine be accessible in a wide variety of
(sender) cannot be overstated. Introducing providers to environments without specialized communications
VC3 via participation in training events ensures that phy- equipment. The addition of images transmitted by e-
sicians have a working knowledge of the equipment and mail can enhance communication but is not a require-
capabilities of the SOF medic and develop rapport, both ment.
of which will optimize real-world interactions. VC3 pro- • The VC3 service has demonstrated success in multiple
viders should be afforded the opportunity to train in the training and real-world scenarios.
field with the medics they may be supporting, to stay cur- • Access to this service is expanding and is available to
rent with training levels and equipment used. In this con- US SOF units for training and operational use via unit
text, traditional metrics of physician performance such as surgeon sections, Theater Special Operations Com-
productivity or revenue generating units may be difficult mand Surgeon sections, and the Special Operations
to extrapolate from VC3 encounters and training. Modi- Medical Association (SOMA) PFC Working Group.
fication of the VC3 service to fit current productivity
and reimbursement standards would be detrimental, and Acknowledgments
would likely discourage SOF medic use, and thus nega-
tively impact patient outcomes. Because the primary role We thank the following individuals for their efforts in
of military medicine is the support of combat operations, this project: the innumerable medics who offered advice
metrics that account for the value of physician partici- during the development and testing of this service. COL
pation in programs that support operations and reduce Daniel Kral, Telemedicine and Advanced Technology
operational risk, such as VC3, should be developed. Center (TATRC), for his leadership and mentorship with
getting this program started, as well as Gary Gilbert and
Future Directions James Beach, TATRC, for their continued support; Ni-
Current efforts are focused on expanding this pilot pro- cole Caldwell, US Army Institute of Surgical Research
gram to allow all deployed forces access to the consulta- (USAISR), for her support with maintaining research
tion service. Additional effort is underway to create a and regulatory files; LTC(P) Kevin Chung, COL Mi-
unified military program that includes immediate access chael Wirt, and LTC(P) Andre Cap, USAISR, for their
to multiple subspecialty services and guidelines regard- notable support of this effort; and LTC(P) Kevin Chung,
ing access to this system across the spectrum of illness USAISR, and MAJ James Lantry and LTC Philip Ma-
(i.e., routine, nonurgent consultation through immedi- son, San Antonio Military Medical Center, for provid-
ate/emergency consultation). Pursuit of technology must ing exceptional consultative advice during VC3 calls.
allow telemedicine services to remain flexible and scal-
able according to SOF mission needs and account for Funding
wide variation in technological capability at the point of
need. Research efforts are ongoing to determine when This effort was initiated in conjunction with funding by
or if more advanced technologies can provide better an Army Medical Department Advance Medical Tech-
consultation and improve patient outcomes than the nology Initiative grant from the Telemedicine and Ad-
voice and e-mail consultation solutions described here. vance Technology Center.

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