Nguyen Charles, Mbuthia Jennifer, Dobson Craig P
Department of Pediatrics, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859.
Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814.
Mil Med. 2020 Sep 18;185(9-10):e1693-e1699. doi: 10.1093/milmed/usaa091.
While deployed, military medical personnel manage routine medical issues that fall under the category of Disease Non-Battle Injury (DNBI). The 86th Combat Support Hospital (CSH) partnered with Combined Joint Task Force-Operation Inherent Resolve (CJTF-OIR) Surgeon Cell, and Special Operations Joint Task Force-Operation Inherent Resolve (SOJTF-OIR) Surgeon Cell, to introduce the Health Experts onLine Portal (HELP) telemedicine system to medical personnel in Iraq and Syria. HELP is an asynchronous (store and forward) online system that provides secure provider-to-provider teleconsultation services for routine patient care and medical evacuation (MEDEVAC) coordination. The goal was to reduce the need for MEDEVAC by providing expert consultation to medical providers in farther-forward deployed units.
In June 2017, the 86th CSH launched HELP telemedicine services for Kuwait. Following the successful implementation of the telemedicine system in Kuwait, the 86th CSH leadership partnered with CJTF-OIR and SOJTF-OIR medical leadership in launching the system within Iraq and Syria as well as making the system available to all deployed locations in Central Command (CENTCOM). This was a prospective cohort study designed to determine if having convenient and secure access to remote subspecialty consultation would be associated with a reduction in routine MEDEVACs from far forward in the battle space. In August 2017, new-user training was completed and the program launched in Iraq and Syria. This study analyzes the baseline MEDEVAC rate in 3 months before the implementation of HELP telemedicine compared to 3 months following the implementation.
Iraq and Syria cases in the HELP telemedicine system accounted for 17.2% (76) of total CENTCOM telemedicine case volume over the 7-month study period. Comparing the 3-month period before and after implementation of HELP, use of asynchronous telemedicine in Iraq and Syria was associated with a reduction in total MEDEVACs from 157 to 68 (56.7% reduction, p < 0.001). DNBI represented the majority of the change, (65.0% reduction, p < 0.001). MEDEVAC for battle-related injuries decreased slightly from 13 to 6 per 3-month period (p = 0.03).
This is the first prospective study to demonstrate an association between the initiation of asynchronous telemedicine capabilities in a combat zone and decreased MEDEVACs. Annualized numbers would predict a reduction of 328 MEDEVACs/year for each 10,000 personnel by utilizing asynchronous telemedicine. This represents a significant potential cost savings of $1.2 million/year through avoidance of routine medical movement of personnel and supports unit readiness by retaining service members in areas of combat operations.
在部署期间，军事医务人员负责处理属于疾病非战斗损伤（DNBI）类别的常规医疗问题。第86战斗支援医院（CSH）与联合特遣部队-坚定决心行动（CJTF-OIR）外科小组以及特种作战联合特遣部队-坚定决心行动（SOJTF-OIR）外科小组合作，向伊拉克和叙利亚的医务人员引入了健康专家在线门户（HELP）远程医疗系统。HELP是一个异步（存储转发）在线系统，为常规患者护理和医疗后送（MEDEVAC）协调提供安全的提供者对提供者远程会诊服务。目标是通过向前线部署更远的医疗提供者提供专家咨询来减少医疗后送的需求。
2017年6月，第86 CSH为科威特启动了HELP远程医疗服务。在科威特成功实施远程医疗系统之后，第86 CSH领导层与CJTF-OIR和SOJTF-OIR医疗领导层合作，在伊拉克和叙利亚启动该系统，并使该系统可供中央司令部（CENTCOM）的所有部署地点使用。这是一项前瞻性队列研究，旨在确定方便且安全地获得远程专科会诊是否会与战区前线常规医疗后送的减少相关。2017年8月，新用户培训完成，该计划在伊拉克和叙利亚启动。本研究分析了实施HELP远程医疗前3个月与实施后3个月的基线医疗后送率。
在为期7个月的研究期内，HELP远程医疗系统中的伊拉克和叙利亚病例占CENTCOM远程医疗病例总数的17.2%（76例）。比较实施HELP前后的3个月期间，伊拉克和叙利亚异步远程医疗的使用与医疗后送总数从157例减少到68例相关（减少56.7%，p<0.001）。DNBI占变化的大部分（减少65.0%，p<0.001）。与战斗相关损伤的医疗后送每3个月从13例略有下降至6例（p=0.03）。
这是第一项前瞻性研究，证明了在战区启动异步远程医疗能力与减少医疗后送之间的关联。按年度计算，数字表明通过使用异步远程医疗，每10000人每年可减少328次医疗后送。这意味着通过避免人员的常规医疗转运，每年可节省120万美元，并通过将服役人员留在作战地区来支持部队的战备状态，具有显著的潜在成本节约。
