Page 146 - Journal of Special Operations Medicine - Fall 2017

• Utilize the “PREP” mnemonic to optimize teleconsultation: enhance security or protect patient information but is not a
➤ o PREPARE: Optimal teleconsultation occurs when requirement at this time.
caregivers are prepared. Develop a PACE plan to
utilize and refine during training events. Document Minimum: Voice telephone connection with/without asynchro-
patient care using flow sheets and call scripts familiar nous media.
to both the local caregiver and consultants. Better: Voice connection WITH concurrent email or photo
➤ o RECOGNIZE: Caregivers should be trained to make exchange (i.e., send a photo of the call script, vital signs
the call when they have a clinical question concern- flowchart, the casualty/care environment, and available
ing a serious or critical patient beyond their training. kit) closely followed by a phone call.
Optimal treatment requires caregivers to recognize Best: Synchronous, real-time audio/video feeds with/without
their limitations early on and call before treatable remote diagnostic equipment using the teleconsultation
conditions become problematic. script as a guide.
➤ o EXECUTE: Send available patient information (im-
ages, flow sheets, call scripts) by email or text ap- Security
proximately 10 to 15 minutes ahead of the call when DO NOT DELAY teleconsultation due to an unsecure connec-
possible. Make the call using a script. tion unless operational situations dictate otherwise. Traditional
➤ o PERFORM: Understand the capabilities and limita- teleconsultation is UNCLASSIFIED and the local caregiver
tions of the technology available. Perform training should maintain normal rules of operational security when uti-
calls to the consultant(s) on the PACE plan devel- lizing unclassified networks. Consultants in standard medical
oped for the mission, using communications equip- systems typically DO NOT have means of secure communi-
ment identical or similar to what will be used when cations. Maintaining patient privacy should be a priority, and
deployed. Intentionally train with full and degraded many simple or available tools for communication meet patient
communications. Perform after-action report (AAR) privacy requirements. When sending patient information or im-
on these training calls to identify and fix any prob- ages by open communication methods, patient identification
lems encountered in training. should be limited to gender and age. Location can be generic
addressing temperature (hot/warm/cold), surroundings (urban/
Training scenarios should involve varying levels of patient rural), or environments (desert/tropical). Location to the level
complexity utilizing basic critical care methodology (sick/not of continent or region can be useful for the consultant/expert
sick and stable/unstable). Incorporating critically injured and to better identify diseases specific to certain areas (e.g., hemor-
complex patients into exercises before deploying has the high- rhagic fevers, malaria, etc.). Photographs should not include the
est operational payoff. Engaging the consultants during these face or identifiable scars or tattoos unless unavoidable due to
exercises tests and validates resources, increases medical capa- location of injury. A full description for optimizing e-mail mes-
bilities and confidence while building trust between all elements sages/consults is available at https://prolongedfieldcare.org.
in the PACE plan. Time to prepare and conduct this training is
limited and can be scaled using the following progression: Advice to Industry
Every effort should be made to incorporate existing technol-
Minimum: Local caregiver prepares the MIST (Mechanism of ogy. For example, new solutions should take advantage of
injury, Injuries/Illness, Signs/Symptoms, and Treatments cellphone-, tablet-, or computer-based technologies. This will
rendered and/or needed) and the teleconsultation script. reduce the need to purchase new or unique equipment. Power
Better: Local caregiver trends the patient’s vital signs, exami- and weight limitations must be understood. New technology
nation, and interventions on a flowchart that can be sent should be intuitive and scalable using the guidelines above.
to the consultant/expert and prepares a teleconsultation Data and information produced by any program or device
script complete with their capabilities and equipment should be exportable in existing and common formats avail-
available. able to all (e.g., PDF, MS Office, .CSV, etc.).
Best: Local caregiver and consultant/expert have a pre-existing
teleconsultation training relationship and have an estab- Disclaimer
The views expressed are those of the author(s) and do not re-
lished protocol for scripted information exchange.
flect the official policy or position of the U.S. Army Medical
Department, Department of the Army, Department of De-
Technology fense, or the U.S. Government.
Technology is a tool used for teleconsultation. Use the best
technology available that optimizes the consultation; however, Disclosures
do not waste precious time or resources establishing a VTC if The authors have nothing to disclose.
lesser or more available technology is sufficient. For most rou-
tine cases, asynchronous consultation (e.g. e-mail) is often suf- References
ficient. For urgent and emergent cases, voice communications 1. Ball JA, Keenan S. Prolonged Field Care Working Group posi-
plus/minus images sent via e-mail or text is recommended. tion paper: prolonged field care capabilities. J Spec Oper Med.
Videoteleconsultation is likely needed for procedural telemen- 2015;15(3):76–77.
toring and, if needed, interactions between the consultant/ 2. Powell D, McLeroy RD, Riesberg J, et al. Telemedicine to reduce med-
expert and the patient (i.e., “direct-to-patient” virtual care). ical risk in austere medical environments: the Virtual Critical Care
Consultation (VC3) service. J Spec Oper Med. 2016;16(4):102–109.
Teleconsultation is widely accessible and used daily in all en- 3. Mohr CJ, Keenan S. Prolonged Field Care Working Group position
vironments without specialized communications equipment. paper: operational context for prolonged field care. J Spec Oper
2
Use technology that is already available and used by SOF Med. 2015;15(3):78–80.
Medics: cell, radio, satellite phone or computer via voice, text,
smartphone/tablet app, photo or video media. Encryption may Keywords: teleconsultation; prolonged field care

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