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have committed to using this modality to diversify the deliv- play an important role in the sustainability of procedural skills
ery of our healthcare system, extend the reach of specialty in our forward-deployed providers.
expertise, and support continued healthcare delivery despite
requirements for physical distancing during the COVID-19 Disclosure
pandemic. The authors have indicated they have no financial relation-
ships relevant to this article to disclose.
We sought to investigate the feasibility of using synchronous
bidirectional VH to enhance training and procedural telemen- Disclaimer
torship to remotely located first-responders. Our data indicate The views and opinions expressed are solely those of the au-
that novice providers did benefit from surgeon teleconsulta- thors and not the official position of the United States Navy,
tion during simulated adult and pediatric trauma scenarios. All Department of Defense, or the United States Government.
responders were able to successfully complete all procedures
required during the scenarios, including advanced, multi-step Copyright Statement
procedures such as tube thoracostomy and cricothyroidotomy, The authors are military Servicemembers or employees of the
which they had not previously performed in either a live or US Government. This work was prepared as part of their of-
simulated environment. ficial duties. Title 17, USC. §105 provides that copyright pro-
tection under this title is not available for any work of the US
Synchronous audiovisual communication during telementor- Government. Title 17, USC, §101 defines a US Government
ship has significant potential to support the deployed provider. work as a work prepared by a military Servicemember or em-
Procedures such as surgical cricothyroidotomy are recognized ployee of the US Government as part of that person’s official
as life-saving in the prehospital setting, but their relative infre- duties.
quency makes maintaining proficiency difficult. 10,11 Addition-
ally, performing such procedures in the field setting frequently References
occurs in suboptimal conditions, with a critically ill patient, 1. Risk G, Hetzler M. Damage control resuscitation for the Special
the potential for multiple casualties, injured medical provid- Forces medic: Simplifying and improving prolonged trauma care:
12
ers, and overextended resources. Given these challenges, it part one. J Spec Oper Med. 2009;9(4):14–21.
is prudent we continue to explore and invest in ways of pro- 2. Tieng HC, Jung V, Rizoli SB, Acharya SV, MacDonald JC. An
evaluation of tactical combat casualty care interventions in a
viding training support to those who may be in the position of combat environment. J Am Coll Surg. 2008;207(2):174–178.
providing prolonged field care. 3. Hetzler MR, Risk G. Damage control resuscitation for the Spe-
cial Forces medic—simplifying and improving prolonged trauma
Limitations at this juncture include proficiency training with care: part two. J Spec Oper Med. 2009;9(4):53–62.
available VH equipment with scenario-based medical response 4. US Combat Casualty Care Research Program (CCCRP). Capa-
drills, as well as virtual encounter etiquette (e.g., audio and bility Gap Closure Analysis. June 26, 2015. https://ccc.amedd
.army.mil/ScientificPapers/2015%20Combat%20Casualty%20
visual closed-loop communication checks, optimal camera Care%20Research%20Program%20Capability%20Gap%20
positioning for the telementor), which would reduce loss of Closure%20Analysis.pdf.
critical seconds in a clinical emergency. Given that the goal of 5. Vasios WN 3rd, Pamplin JC, Powell D, Loos PE, Reisberg J,
our study was exclusively to determine the feasibility for VH Keenan S. Teleconsultation in prolonged field care position paper.
to provide mentorship, demographics of the target population J Spec Oper Med. 2017;17(3):141–144.
were not measured. Our small sample size would not have 6. Hwang JS, Lappam CM, Sperling LC, Meyerle JH. Utilization of
telemedicine in the US military in a deployed setting. Mil Med.
yielded meaningful statistical analyses and therefore was not 2014;179(11):1347–1353.
included in this pilot study. However, when performed on a 7. Poropatich R, Lappan C, Gilbert G. Telehealth in the Depart-
larger scale, it would be prudent to collect demographic in- ment of Defense. In: Rheuban K, Krupinski E, eds. Understanding
formation of the participants to include rank, years in service, Telehealth. New York, NY: McGraw-Hill; 2017. https://access
and number of prior deployments. Future studies should look medicine.mhmedical.com/content.aspx?bookid=2217&
to implement this technology using a larger target population sectionid=187795495.
and testing it among a variety of simulated clinical vignettes, 8. Davis K, Perry-Moseanko A, Tadlock MD, Henry N, Pamplin J.
Successful implementation of low-cost tele-critical care solution
as well as across many different environments in which the by the US Navy: initial experience and recommendations. Mil
deployed first responder might find himself or herself. Med. 2017;182(5):e1702–e1707.
9. Van Gent J-M, Davis KL, Henry N, et al. The initial impact of
tele-critical care on the surgical services of a community military
Conclusion hospital. Mil Med. 2018;183(11–12):e494–e499.
10. Adams BD, Cuniowski PA, Muck A, De Lorenzo RA. Registry of
The DoD maintains a high-priority focus on training and read- emergency airways arriving at combat hospitals. J Trauma. 2008;
iness for combat troops at all times. We must also maintain a 64(6):1548–1554.
high resolve for the same within our medical community. Our 11. Barnard EBG, Ervin AT, Mabry RL, Bebarta VS. Prehospital
study demonstrates the feasibility of telementorship for novice and en route cricothyrotomy performed in the combat setting: a
first responders on a deployed Naval Ship, but we must con- prospective, multicenter, observational study. J Spec Oper Med.
tinue to study this technology to ultimately determine its pos- 2014;14(4):35–39.
sible scope and impact. Telementorship is scalable and could 12. Mabry RL. An analysis of battlefield cricothyrotomy in Iraq and
Afghanistan. J Spec Oper Med. 2012;12(1):17–23.

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