Summary & Key Points

While Joint requirements documents for OVH continue to process, military medical providers have increasingly utilized formal and informal OVH capabilities to solve real-world problems. This is a natural evolution of casualty care secondary to continuous improvements in communications technologies, the process of healthcare delivery learnt during medical training, and the specialization and sub-specialization of the medical profession that occurs with the march of scientific discovery in medicine.

This guideline has focused on TC as a tool for increasing LC’s KSAs in real-time through care coordination with a RE, effectively increase scope of practice to manage complexities of casualty care created by operational constraints (like delayed evacuation). The CPG highlights the PREP mnemonic as a model for maximizing the benefit of TC and minimizing risks.

The following best practices for TC in resource limited, austere, and operational environments are summarized as follows:

1. PREPARE: Telemedicine is a skill that must be practiced by both local caregivers and remote experts to prepare for efficient and effective interactions. Ideally, this care team should train together using simulated patients to optimize their communication and ensure their technology choices match their clinical needs. Utilize PACE planning to harden your TC capabilities (Appendix A).

2. RECOGNIZE: Local caregivers must recognize when TC is necessary (i.e. “when to make the call”) and what process to use based on the acuity of casualty. Conceptually, the more “acute” a patient is, the earlier and more frequently the LC should engage with the remote expert. “Call early, call often” is a saying used often by REs when casualties are severely ill or injured. Routine, Urgent, and Emergent TC should be conducted using the resources outlines in Table 2.

3. EXECUTE: Effective and efficient teleconsultation takes practice, but can be improved by

- Using a script familiar to the both the local caregiver and remote consultant (Appendix B).
- Sending background information using asynchronous technology ahead of synchronous telemedicine encounters.
- Using closed loop communication that includes intentional pauses in communication for read-back and clarification.
- Having the remote expert document the telemedicine encounter and sending that documentation with a summary of recommendations to the local caregiver.

4. PROBLEM SOLVE: Understand the capabilities and limitations of available TC technologies and what types of TC can be performed using them. Be able and willing to switch between technologies when appropriate and have back-up communications solutions.

https://prolongedfieldcare.org/telemed-resources-for-us-mil/ offers some excellent information about operational TC form an experienced group of clinicians.

Additional information about the GTP and ADVISOR programs can be found at: https://info.health.mil/army/VMC/Pages/Home.aspx or by emailing dod.advisor-office@mail.mil

When utilized effectively, TC can improve casualty care, reduce evacuation costs, and optimize casualty outcomes in many challenging deployment contexts.

When in doubt, call early and call often.