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
