Bring this to your J6, S6 to share what you need….

Using technology in a deployed environment may be a challenge to conduct in an area of operations (AO). Electricity and internet connection, while taken for granted in day-to-day life, are often limited resources in the AO and must be considered in the planning process for telemedical support. Technology should not limit teleconsultation but should augment it.

Ultimately, the type of technology you use should match the clinical question at hand and will be limited by the power, network, and equipment available.

- Use photographs and asynchronous technologies (e.g., e-mail, text) for routine problems or simple updates to a remote expert for their situational awareness. Slow internet connections will delay transmission of images especially ones of sufficient quality to be used. Dermatologic problems, for example, are well suited for using asynchronous technology to make diagnoses and care plans.
- Use synchronous technologies (i.e. phone) to discuss problems like diagnostic dilemmas, care plans with complex risk-benefit tradeoffs, problem solving for management of scarce resources, or timing of patient transport.
- Use video-teleconsultation for procedural telementoring or virtual direct patient care.
- Remote monitoring technology (i.e.telemetry) allows remote experts to help local caregivers identify trends in patient physiology. Using this technology, tele-critical care teams can help local caregivers by monitoring multiple casualties and facilitate better situational awareness. These services may also be utilized to help diminish task saturation (i.e., reduce documentation burden) and enable work-rest cycles.

Minimum: Voice telephone connection with/without asynchronous media to call ADVISOR hotline (1-833-238-7756 DSN: 314-429-9089) and read from the TCCC card or other form of documentation.

Better: Voice connection WITH concurrent email or photo exchange (i.e., send a photo of the call script, vital signs flowchart, the casualty/care environment, and available kit) closely followed by a phone call. Use a telemedicine report such as the Prolonged Casualty Care (PCC) flowsheet (Appendix B).

Best: Synchronous, real-time audio/video feeds with/without remote diagnostic equipment using the teleconsultation as a guide. If required use the Virtual Critical Care Consultation guide (Appendix B) and send a picture of casualty, capabilities, and vital sign trends to the consultant via email or text using operational security and protections of patient privacy.

SOFTWARE

At a minimum, if possible, the local caregiver (LC) and if required, the patient will need access to a secure platform to send messages (picture), make a call or conduct a VTC. There will be times that access to a secure platform is not possible. However, do not delay teleconsultation unless operational situations dictate otherwise (extremely rare). The LC should carefully balance the risk and benefits of waiting for a more secure platform.

HARDWARE

Many HCP/LCs can access TM through secured mobile devices.

- A computer (MC4/NIPR or any CPU) or mobile device
- An integrated or external microphone
- An integrated or external camera

INTERNET

Having a solid internet connection is a crucial piece of successfully accessing telemedicine, especially for telehealth visits conducted by the LC and the patient that require high definition (HD) pictures or a VTC. For Role I/II Access to NIPR with at least 512kb upload and download speed (1MB preferred), or ISP Wi-Fi connection w/same. Ideally, internet speeds should be at least 15Mbps download and 5Mbps upload. While video streaming can happen with slower connections and lower definitions (LD), these are the recommended speeds needed to have a clear video experience for the majority of platforms.