A Deployable Telemedicine Capability in Support of Humanitarian Operations

Abstract

This paper describes how a military concept for telemedicine support in humanitarian crisis, the Medical Command, Control, Communication and Telemedicine Special Medical Augmentation Team (MC3T SMART TEAM), was transitioned from a theoretical concept into a functioning, operational entity. The European Regional Medical Command (ERMC) MC3T SMART TEAM successfully tested its capabilities during a military training exercise with the 212th mobile army surgical hospital (MASH). This was followed by successful real-life telemedicine support missions during a planned humanitarian support mission in Africa and then an emergency disaster support mission in Pakistan. While on these missions, the SMART team provided access to the Internet and e-mail by means of limited bandwidth mobile satellite equipment, established a working telemedicine process by introducing the staff to the United States Army's "Army Knowledge Online (AKO) Remote Consultation Program," and established a successful connection of the 212th's digital radiography system to the "Tri-Service Global Encrypted Picture Archiving and Communication System (PACS) and Teleradiology Network."

Implementing Telemedicine in Medical Emergency Response: Concept of Operation for a Regional Telemedicine Hub

“…Thus the satellite link NASA provided within 24 h of onset of the disaster was vital for the international rescue and relief efforts [7]. During multiple humanitarian support missions that the SMART Team, a United States military telemedicine team, carried out in Africa and Pakistan in 2005, they observed that sometimes the most critical tasks were focused on providing communications capabilities, while the amount of actual telemedicine activities may be small due to other limitations [14]. In the response stage of the 2008 Sichuan earthquake, mobile phones and telecommunications equipment were among the first batches of materiel air dropped to the most heavily impacted regions [19].…”

“…After the 1988 Armenian earthquake, telemedicine was employed to provide clinical consultation to several regional hospitals via the U.S.-U.S.S.R. Space Bridge project [2,27]. In this decade, telemedicine has been more widely used in various ways in response to disasters including earthquakes, tsunami and hurricanes [1,10,13,14,24]. In addition to response to real disasters, numerous telemedicine experiments, exercises and simulations of “staged” disasters have been carried out worldwide to evaluate the usefulness and performance of telemedicine systems [12,20].…”

The Clinical Application of Mobile Technology to Disaster Medicine

“…Most reports described early research or working prototypes; only two referred to systems that had been deployed in actual disasters. 7,8 All projects were based in high-income countries, although some had been tested in low-income countries. Six of the projects were run by the military; the remainder were civilian.…”

“…The final stage is to test the system with real patients, although only one system has been tested in this way. 7 Decision Support Applications-This category includes applications running on mobile devices to assist health care workers with decision-making in disasters. They are used in the areas of triage, monitoring and hazardous materials to assist rescuers in following predefined algorithms.…”

“…A telemedicine system used by the US military in the response to the 2005 earthquake in Pakistan allowed 44 remote consultations to be carried out with specialists in the US, including three radiology consultations. 7 A satellite link enabled communications to be set up immediately, although the cost (US $7.00 per minute) was a significant constraint. The satellite link was supplemented by other communication systems once they became available.…”