Page 145 - Journal of Special Operations Medicine - Fall 2017

Teleconsultation in
Prolonged Field Care Position Paper

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William Vasios, APA-C *; Jeremy C. Pamplin, MD ; Doug Powell, MD ;
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Paul Loos, 18D, ATP ; Jamie Riesberg, MD ; Sean Keenan, MD 6

Introduction
Teleconsultation is one of the 10 core prolonged field care Planning
(PFC) capabilities. Teleconsultation is commonly used across Providers should develop a teleconsultation PACE (Primary,
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all fields of medicine to improve patient care. The variability Alternate, Contingency, Emergency) plan before deploying.
of medical support across the spectrum of Special Operations The PACE plan should address both WHO to call and HOW
Force (SOF) mandates the need for teleconsultation during to communicate with them. The plan must remain flexible so
PFC. SOF Medics and providers must have a plan to obtain that units can tailor it to the available local, theater, and strate-
expert medical consultation when caring for complex patients. gic medical assets, and utilize organic commercial and tactical
Training is required for both local caregiver and consultant/ communications equipment.
expert to optimize effective teleconsultation. Additionally,
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teleconsultation must be flexible and adaptable to the opera- Consultant/experts of a teleconsultation PACE plan may in-
tional contexts of ruck, truck, house, plane. It is important clude, but are not limited to: surveyed and approved local
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to note: teleconsultation DOES NOT replace standard unit or hospitals, unit medical providers, Theater Special Operations
operational reporting requirements for medical incidents and Command (TSOC) medical providers, U.S. and coalition sur-
requests for evacuation. gical and critical care evacuation team assets, and specialty
consultants.
This PFC teleconsultation position paper addresses the follow-
ing topics using the minimum, better, best progression where Organic commercial and tactical communications equipment
applicable: definitions, planning, training, technology, secu- are covered in the technology section.
rity, and advice to industry.
Units should test and train both technology options and con-
Definitions sultant/experts included in their PACE plan before deploying
• Asynchronous communication – one-way (unidirec- and should conduct communications checks with all elements
tional, time delayed) communication. For example, a of the PACE plan once deployed.
text or an e-mail message.
• Synchronous communication – two-way (bi-directional, Training
real-time) communication. For example, a phone call or Local caregivers and consultant/experts must be trained to
VideoTeleConference (VTC). provide optimal care using various telemedicine technologies:
• Extended consultation – this concept reflects clinical phone, VTC, remote ultrasound guidance, etc. This should
engagement more than communication modality. This consist of classroom training and practical exercises:
refers to a consultant/expert who remains engaged with
the care of a local patient or local patients over time • Classroom training should incorporate a prepared tele-
by monitoring physiologic vital signs, audio channel(s), consultation script. Utilizing a script has proved to be a
video feed(s), or combinations of these technologies. highly efficient way to effectively communicate complex
• Local Caregiver – The person (not necessarily someone casualties to expert consultants. A field-tested example of
with medical training) who is taking care of a patient a teleconsultation script is available at https://prolonged
and who initiates teleconsultation. fieldcare.org.
• Consultant/Expert – The clinician who receives the con- • Practical exercises should utilize the consultants/experts
sult from the local caregiver. This may be a designated identified on the PACE plan and work with support-
consultant in a formal system, or a validated and/or ing documentation (e.g., flowsheets, scripts, capabilities
trusted expert provider chosen by the local caregiver. worksheets) in the field as they apply to their patient(s).

*Correspondence to william.n.vasios.mil@mail.mil
1 MAJ Vasios is the command physician assistant with Special Operations Command – Africa at Stuttgart, Germany. LTC Pamplin is the director
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of Virtual Critical Care at Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, and an assistant professor of medicine at
the Uniformed Services University, Bethesda, MD. MAJ Powell is the battalion surgeon with 4th Battalion 3rd Special Forces Group (Airborne)
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and staff intensivist with Womack Army Medical Center at Fort Bragg, NC. SFC Loos is the Special Forces medical sergeant course noncom-
missioned officer in charge for surgery, anesthesia, records and reports at Fort Bragg, NC. LTC Riesberg is the group surgeon with 10th Special
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Forces Group (Airborne) at Fort Carson, CO. COL Keenan is the command surgeon with Special Operations Command – Europe at Stuttgart,
Germany.
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