Month: January 2019

 

 

The highlight of Week 3 was our visit to Fort Bragg, where we experienced on-the-ground scenarios with casualties, had time to speak with numerous military personnel, and even got to ‘test’ the quality of MREs (Meals-Ready-to-Eat).

We then spent Week 4 synthesizing our new insights from Fort Bragg and continued our beneficiary interviews, where we learned more about the workflow of medical personnel during deployment as well as in-depth communication logistics.  A highlight of our week was also meeting with former Chairman of the Joint Chiefs, General(R) Martin Dempsey. His insight was invaluable to the big picture of our problem and is summarized, along with our other interviews, below.

Looking ahead, we will start to build our initial product based on the architecture outlined in our Week 4 presentation, which will allow us to test greater hypotheses with even more upcoming interviews.

Stay tuned, and God Bless.

– Duke Team 3

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Matt Runyan: Network Consulting Engineer, Cisco Systems
– Whatsapp constantly tries to make connections
– Other apps can have interrupted messages because of unstable connections

Josh Clark: 18E
– Commercial networking shares data faster but is less consistent; army is more consistent but has slower data sharing
– Heavier encryption worsens signal
– Would be ideal to have photos in app stored locally that can then be recalled separately from photos taken in other situations

Mike Thomas: Military Business Development Manager, GoTenna
– GoTenna is built based on line-of-sight, which makes it possible to relay information via drone (up to 52 miles)
– To get more range, need device offered by GoTenna for short distance mesh networking
– Funding of devices from the military operates on Life Cycle Analysis of 10, 20, or 30 year costs

Mike Fiocca: Former 18D
– Resources e.g. ebooks for non-trauma procedures to save time and resources
– Voices assistance that can operate without internet connection would be helpful
– Protocols and algorithms for all trauma procedures

Pat Butler: Former 18E
– Interconnected devices that would allow for smoother transmission of data
– Redundancies can be helpful to prevent loss of information, but lightening the load would be ideal
– MyVPN is helpful to tunnel through local internet

JA: Former 18D, current anesthesia resident, Duke University Medical Center
– Ultrasound is really useful for diagnosing volume loss
– One of the biggest problems is lack of basic knowledge understanding that then impairs communication between 18D and the support physician
– Notability or similar app has been helpful in the past

Martin Dempsey: 18th Chairman of the Joint Chiefs of Staff
– Product has to not only function with on-the-ground personnel, but also with higher ups
– How to potentially quantify success?

Kevin Iskra: Former 18D
– Doctrine of treatment: Medics treat on the ground, then evacuate to physician’s assistant
– Most time intensive tasks: pulse and blood pressure
– Documentation card or critical care card would be really helpful to transfer data to the next level

Zach Pearson: Team Sergeant
– Need to take vitals at regular intervals. Currently vitals are transferred by taking a photo
– SOFACC can be a beneficiary: closest thing to medic that’s not a medic
– Focus on TCCC: Tactical Combat Casualty Care

Phil K Bohan: General Surgery Resident, San Antonio Medical Center
– Organization of trauma care as they move from the field to hospitals in the U.S.
– Ideal would be more live way of transmitting vitals. Physicians use vitals to decide whether to continue to treat or not
– Blood transfusion, esp live blood banks, can knock the person out for several days from combat

James Horne: former 18A, SOFACC grad, current Fuqua student
– Communications should include the most reliable ones and other fancy modes of communication
– Operational Detachment groups usually consist of 3 people; Operational Detachment Alpha consist of 12 people
– Usually there’s only one chance per day to sync your record or get remote assistance
– Medics have autonomy to adopt telemedicine or not

PL: Prolonged Field Care Working Group
– 2 Types of challenging environments: austere env e.g. Africa, or mega cities like in China
– For vital records, prompts would be helpful, and voice dictation would be useful, but might be problematic in noisy environment esp in mega cities
– “Anything we do has to be layers to the overall solution.”

TO: Former 18E
– Mainly use iridium to connect satellite phones, often to connect with physicians
– PACE plan: mission dependent, necessity for high-threat operational environment, non-necessity for low threat via truck radio or satellite
– Data compressors used include NX powerlite (COTS)

Personnel Interviewed during visit to Fort Bragg:

Aaron Jefferson, Signals Officer
Chandler Merrell, 18D
Dr. Paul Tate, Battalion Surgeon
SFC Michael Goggin, 18D instructer, former 18D
MSG Kevin Schwartz, SOFACC Instructor
LTC David Lewis, SOFACC Instructor
Adam Russell, Instructor, Remote Medical Institute
LT Carl Ellison, 18E
SGT Tim Lanning, SIGDET Operations NCO
Alexi Kotchetov, 18E

We entered this week with a major realization already behind us: that telemedicine is not a new problem-of-interest for the Military. However, we verified that many groups are interested in this field and that work has been, and continues to be, driven by legitimate need from the Field.

For us though, we set out to find ‘how’ and ‘where’ our initial MVP of a mobile app would hold up with our beneficiaries. More importantly, we realized where both existing solutions and our hypothesis alike do not meet the prolonged field care needs of 3rd SFG operators working in austere environments.  The following interview highlights show the insights that led us to what we present as a revised MVP in tonight’s class: A simple, easy-to-use app for tracking only patient information and current medical resources with the aim of creating a more efficient conversation between medics and physicians during a telemedicine consultation. No bells, whistles, bluetooth, or bump-to-share. Just a simple tool for easy adoption and standardization.

Looking ahead, we will be bringing an initial schematic of our app to Fort Bragg  for further beneficiary review. There,  we plan to spend the day learning from 3rd Group members in a variety of settings. Among the exciting prospects, we will get direct interaction with our primary beneficiaries, the SF Medical Sergeants (18D) vernacularly referred to as “Deltas”.

Cheers to another week of progress, see you on the other side.

– Team 3

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Drew Hinnant: Assistant Operations Officer
– Need to categorize and list supplies to rely to hospital personnel
– Video not necessary for communication and rarely used
– Need for diagnosis from medical personnel

Doug Powell: Staff Intensivist at First Health Physicians Group
– Room for AI to alert changes in vitals for need to escalate or potential problems, especially during times when there aren’t medical personnel (wakeup criteria)
– Basic vitals: Blood Pressure, Heart Rate, pulse oximetry, temperature, respiratory rate, mental status exam, Glascow coma score
– Developed paper script for better communication
– App > device. 50% iOS/Android. Don’t need any more devices. Apps can integrate easily into iPhone and iPads that’s already on hand

Dan Taylor: Civilian Paramedic, former medical instructor for Special Operations Austere medical courses
– Austere communications have little bandwidth: voice call is great, good quality picture is better
– Ideal scenario for supply documentation: smart phone to take a picture of what supplies have been used, AI in app to assess what was used.
– People are less likely to use it if it add to their work
– There is rarely any standard to materials that are packed on deployments

Chris Turner: COO – Ragged Edge Solutions
– Difficulty with bandwidths often results in inconsistencies in system use: simple is better
– The best way to approach this might be to gather the pieces, because the pieces already exist, instead of reinventing the wheel
– Security is always going to be hard

Roger Dail: CEO –Ragged Edge Solutions, Former 18D
– Ragged Edge Solutions: Identified gap in concepts coming out of Prolonged Field Care and operations with teams, that there were no standards for training of TCCC
– Network security can be difficult to approach, given the size of the problem and security clearance
– During deployment, medics often only use Whatsapp

Sean Keenan: SOMA PFC Working Group¹ / Emergency Physician
– Telemed script + cell phone > asynchronous communication (relay patient data) > synchronous communication (video communication in real time)
– There are a few procedures that would be easy to do via telemedicine, e.g. fasciotomy
– Telemedicine often is low on tech, because that is what is most reliable and efficient

DE (name withheld): Senior 18D
– Trending vitals is an important piece that’s often done via hand, with instructions for a  “wake-up” criteria
– Hand-off to next level (often Germany) via SF-600 form, which populates electronically for injuries, meds, and vitals, often in combination with SOAP notes
– Most often used technologies are on phones, including WhatsApp and iMessage

Alex Wilson: Former 18D, current student at Fuqua
– Self-printed handoff cards are used often during handoffs instead of SF-600, because SF-600 are often used formally for record keeping
– Medics obtain supplies off of a formulary that’s often an excel sheet, up to 8-10 pages long, and have to order supplies one year in advance
– Monitoring vitals often require physical manpower 24/7. There is electronic monitoring, but it is a physically large and often old.

Brandon (Last name withheld): Lieutenant Commander Physician
– Military physicians also use telemedicine for communication with specialists when deployed that often telemedicine results in a written report returned in 24hrs (asynchronous communication)
– It is possible to get a phone call, but often unnecessary

GS (name withheld): Former Army Reserve, FBI Special Agent
– Communications have historically been an issue outside of the US, so working to solve that issue alone is not worth your time

PFC flowsheet:
https://prolongedfieldcare.files.wordpress.com/2018/05/handout-pfc-flowsheet-v21-1-16jan2018.pdf

¹Special Operations Medical Association (SOMA) – Prolonged Field Care (PFC) Working Group

 

 

 

 

Our first step as a team has been to further establish our working problem. In doing so, our first week was exclusively dedicated to Beneficiary discovery. Below, we list the people we’ve interviewed and the highlights of each conversation.

• Brian Smedick – Former 4th Battalion Surgeon
  • Provided high-level prolonged field care procedure and considerations
  • Described historical development of BATDOK and potential technical challenges
  • Explained security challenges to some current and proposed telemed solutions
• Russell Dallas – Medical Sergeant (18D)
  • Strong healthcare background specific to austere environments
  • Emphasized experience using communication devices purchased from local systems
  • Emphasized need to camouflage signatures that can tie communication to US sources
• Robert Collins – Operations Sergeant (Former 18D)
  • Some deployed soldiers and healthcare workers purchase and use civilian devices because difficulty with official devices
  • Communication with base doctors often require direct communication, but in subacute situations, can be okay with delay
  • Endorsement for BATDOK-like communication devices
• Phil Cotter – Captain, 3rd SFG
  • Elaborated on training program for non-medical operators that will need to be considered heavily in final product
  • Emphasized that ideal solution will not be 100% correct to everyone that we interview
  • Emphasized potential applications of this project to adventure sports and civilian medtech industries
• Dr. Richard Leidinger – Former Chief Medical Officer, Kirkuk Field Base, Iraq
  • Provided excellent insight to operations of field hospitals in war zones
  • Emphasized that insurgents are not the same as those portrayed in media – often, they are clever and seek to jam any communications between operators and base
• Brad Olsen – LifeFlight Pilot
  • Described process of civilian medical evacuation procedures
  • Directed us to future contact who is paramedic on civilian air rescue team
• Kal Rathnayaka Gunasingha – General surgery resident, Walter Reed Military Hospital
  • General military healthcare structure: 4 lines of healthcare deployment
  • Ethical considerations to treat or not to treat in resource-scarce situations
  • Resource allocation considerations
• Maddie Gervais – Navy military procurement
  • Procurement experience in Navy, familiar with mobile hospitals
  • Established connection point and contacts for next steps
• Greg Hauser – Statewide Interoperability Coordinator) for NC Emergency Management
  • Connections to more contacts in emergency personnel
  • US emergency procedures
  • Protocol  and current training of personnel in urgent situations
• Mohammad Noshad – Co-founder/ CEO VLNComm
  • Experience using innovative visible light communication and li-fi tech
  • Established time to reconnect when more specifics are known about telecommunications capabilities of team
  • Connection and knowledge of VLNComm’s most current tech offerings,

In addition to our interviews, we used the three following sources as primary reference to the problem at hand and work that has previously been done in the field of battlefield telemedicine:

Telemedicine to Reduce Medical Risk in Austere Environments

StratComm TATRC 

Teleconsultation in Prolonged Field Care Position Paper (JSOM Volume 17, Edition 3, Fall 2017)

From the collective input of our contacts and these sources, we’ve decided to focus on the key areas moving forward with the following guiding questions:

1. 1. What happened with BatDok? How does it deal with classified information? Bluetooth Security?
   2. Telecommunications industry specifics – how can one establish connections in remote areas?
   3. What body-monitoring tech do SF operators already wear?
   4. Continue to validate our Mission Model Canvas