Effectiveness of Telemedicine in a Forward Combat Environment

Robert B Lim, MD LTC, Alberto H Abadia, MD MAJ, Juan L Martin, MD MAJ, Antonio D Colomo, MD CPT. Spanish Role IIe Hospital in Herat

Telemedicine has been touted as a way to augment a remote hospital’s capabilities, but little has been published on its effects in the combat environment. Small surgical teams have been deployed to remote areas of the battlefield in support of Operations Iraqi and Enduring Freedom since 2003. While they provide excellent trauma care, their abilities and expertise to effectively treat non-combat illness or specialized combat injuries is limited. We report our experience with the use of telemedicine in a forward combat environment in Herat, Afghanistan where a Role IIe hospital staffed by NATO forces was deployed from June to October 2010. Expert consultation was available 24 hours a day from a tertiary care center in Madrid, Spain. A satellite and terrestrial network using 512 kbps of shared bandwidth was used. 40 telemedicine consultations were performed in 9 different specialties. Additionally dermatology telemedicine consultants could perform real time examinations using a teledermatoscope. Radiology consultants could view digital images, see real time ultrasound examinations, and using robotics, even perform ultrasound examinations. In all 40 cases, the use of telemedicine favorably affected the outcome of patient care, prevented an unnecessary evacuation, or caused an evacuation to be more appropriately expedited. Telemedicine is a very effective force multiplier in the combat environment where availability of subspecialties is very limited.