Reduction in Medical Evacuations from Iraq and Syria Following Introduction of an Asynchronous Telehealth System

Abstract

Introduction 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. Material and Methods 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. Results 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). Conclusions 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.

The Intersection of Telemedicine and Wilderness Care: Past, Present, and Future

“…Lastly, the utilization of telemedicine, including remote monitoring, has been shown to reduce evacuations in both civilian and military settings. 36,37 Early data suggest that similar results are possible in wilderness environments as well. 25,38…”

AT: Asynchronous Teleconsultation for Health Centers in Rural Areas of Peru

“…The iCanCloud platform has been utilized to simulate the management of asynchronous telecardiology services, demonstrating its ability to customize services for various healthcare facilities [21]. Additionally, the HELP system has been utilized in military settings in Iraq and Syria for teleconsultations [22], while other platforms facilitate collaborative image analysis [23]. In [24], neural networks, fuzzy logic, and neuro-fuzzy logic are used to analyze biomedical images in telemedicine, preserving a greater amount of information such as spectral representation and edges.…”

Asynchronous Teleconsultations: The US Military Experience in the Pacific

“…HELP was a sub-module built on the existing PATH platform and housed on the server at TAMC, but used to provide improved access to care, and to reduce the need for travel to a tertiary care center, for medical providers stationed in Atlantic Fleet and Europe [3]. By 2017, the HELP platform was expanded to medical providers who were deployed to the Middle East, making it the largest reaching teleconsultation platform in the DoD virtual healthcare system [4].…”

“…In 2017, a PATH/HELP pilot project brought the platform to military medical providers deployed to the Middle East. Comparing the window before introduction of the system to a window soon after the platform was introduced, there was an estimated 56% reduction in routine (non-emergency) medical evacuations from the Central Command area of operations [4]. Although there were many complexities comparing data of evacuations in a combat zone, the platform was widely accepted and is still utilized in the Middle East by deployed military providers over 3 years later.…”