Problem Solve

A general understanding of the capabilities and limitations of the various TM and TC technologies available is important. Intentionally using different technologies during training, especially switching between them, and limiting network resources during an encounter, helps LCs and REs become flexible in their use of technology and its limitations for delivering casualty care with TC support. Not all questions can be answered with TC; sometimes the best recommendation is simply to evacuate the casualty or experience the consequences. Still, TC may help mitigate risks if/when evacuation is no possible or available quickly.

Synchronous video helps make TC more efficient because REs can see what is happening in real time, but it is rarely required if TC does not involve tele-mentoring a procedure. Preliminary data from a small study presented in abstract10 demonstrates that key aspects of procedural quality may suffer when voice only TC is utilized for procedural tele-mentoring compared to video. When not performing a procedure, sending image asynchronously and/or providing detailed description by text or during synchronous audio TC can convey the same information as real-time video with significantly less network consumption. Indeed, some procedures can be completed with frequent asynchronous “chats” that include images (often with the RE sharing annotations on the image).

Because the telemedicine capability is a function of network resources matched to the number of casualties or encounters (Figure 2), understanding this relationship is important for mission planning.

Always use the most appropriate technology to optimize the consultation. Do not waste time establishing a network heavy video TC if lesser or more available technology (i.e. a radio or phone call) is sufficient. Also, it may be possible to increase the technology (i.e. go from an asynchronous consultation to a video consultation) if resources (hardware, software, and network) are available and the TC would benefit.

Understand the limitations of your technology and how to maximize its utility. It is difficult to complete a physical exam or part of a physical exam virtually without the correct digital equipment (e.g., stethoscope, ophthalmoscope, otoscope, etc.). Similarly, if bandwidth is limited, but video is needed by the RE for understanding, consider turning off the RE’s video (thus decreasing bandwidth needs by approximately half).

If utilizing TC for casualty care, always have a back-up means of communication – a second radio/frequency, a second phone-line/cellphone (on both ends of the encounter – LC and RE), an alternate computer – whatever your pace plan states. At the beginning of an encounter, always ensure that call back numbers and second options are discussed at the beginning of the consultation (this is included in the example call scripts in Appendix B). Train to use back-up options.