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Unit Puts Telemedicine Technology Through Its Paces

By Karen Fleming-Michael
Special to American Forces Press Service

FORT DETRICK, Md., Sept. 24, 2003 – For many people, a summer road trip is a chance to exist on fast food, listen to nonstop radio programming and sightsee. But for 65 soldiers from the 48th Combat Support Hospital at Fort Meade, Md., a road trip in July was a chance to try out and evaluate medical equipment the Army may field in the future.

The soldiers went to Fort Indiantown Gap, Pa., for annual training and to see the Forward Deployable Digital Medical Treatment Facility, a medical technology testbed created in 2001 by the Telemedicine and Advanced Technology Research Center here.

"Our commander's primary (areas of emphasis) for annual training were hospital defense, defending ourselves in a combat scenario and NBC (nuclear, biological, chemical) training," said Capt. Russ Cote, patient administration officer for the 48th, "and in conjunction with that, to use the equipment to see a concept that may be coming down the pike and to provide feedback on it."

Housed in 20-by-30-foot tents, the testbed houses a lab, a two-bed emergency room, an intensive care unit, a patient ward, a pharmacy, a sterilizing area and a patient administration area. The equipment inside is leading-edge -- for example, a "ruggedized" portable X-ray machine, water purification and distribution systems, a portable ultrasound unit, and the SMEED, a platform that attaches to a standard patient litter to hold portable medical equipment.

A much-needed innovation the tent offers for a combat support hospital is the powerful Brigade Remote Subscriber System that allows wireless communications within the tent, said Curtis Callender, a team member for the Forward Deployable Digital Medical Treatment Facility.

Both the facility and the Brigade Remote Subscriber System are intended to meet modern Army needs for smaller deployable hospitals. Because of antiquated, switchboard-based communications systems, "doctors (in a combat support hospital) have a noose around their necks. You always have to know where they are, so they can't go far from the patients," he said.

With wireless technology, doctors can be kept posted on patient progress through cell phones and pagers, letting them move about the 17 acres of tents that make up a traditional combat support hospital. The equipment in the tent typically is three to four years ahead of the fielding process, but that's what the "forward thinkers" of the research center are chartered to find, Callender said.

"Even if the unit doesn't have a particular piece of equipment, if you can work one patient monitor, you can work any of them. A monitor is a monitor is a monitor," he said. "It may be a long time before they (the soldiers) see it again, but at least they'll be familiar with it."

Actually, Cote said, many of the 48th's soldiers participating in Operation Dragon Medic, the name given to the two-week training, have seen much of the technology before. "It's in the civilian hospitals," he said. "The majority of our nurses are already working with it."

Not all the equipment was familiar, though. Capt. Ed. McDonough from TATRC brought some of the center's emerging wireless technologies north for testing as well. The Patient Status Monitoring System lets providers monitor patients from one location, like an intensive care unit desk, or lets doctors see the vital signs far from the bedside.

Troops' reaction to the monitoring system, Cote said, was mixed.

"In my job as a patient admin officer whose job is to look at patients and keep track of them in the hospital, it's a wonderful tool because it allows information to flow instantaneously," he said. "Being able to monitor them, I think is wonderful. And in an ideal situation, it's what needs to happen."

The downside to the Patient Status Monitoring System, he said, was its high learning curve.

"They were installing parts of the system and providing training very close to, sometimes in conjunction with, the exercise occurring," Cote said. "I don't think it was fully used because we didn't have enough personnel or enough time to become familiar with it."

That's just the kind of feedback Tony Story, the project manager for the testbed, was looking for when he moved it in April to its temporary digs in Pennsylvania and invited the 48th to use it for training. Though the facility is used as a prototyping, integration and testing lab, "all the tent was doing at Detrick was sitting. It had become a static display," he said.

At the end of their time in the deployable hospital testbed, the 48th's soldiers completed a questionnaire addressing every aspect of the shelter.

"When you put the hospital in a new situation, you find out new things and see changes that need to be made," Callender said. "We try to find a better way of doing things and pass that on to the combat developer at the AMEDD (Army Medical Department) center and school."

Story characterizes the project's pace by saying it's at the "walk" stage of the "crawl, walk, run" progress phases, though he said he wishes it were at the sprint he first envisioned.

The original goals for the facility, in order, were to create it, put it in containers, have the package approved by an Air Force loadmaster and then fly it to the field for exercises, he said. Because of delays in working out mobility, though, the middle steps were skipped, and the facility went right to the exercise.

"We're behind on the containers, transportation and mobility," Story said. The team is trying to determine how many C-130s and 5-ton trucks it takes to move the whole facility, keeping in mind that it takes 17 airplanes and 33 trucks to move a 32-bed combat support hospital.

"Those are the numbers I keep in my head," Story said, adding that the obvious goal is to need fewer planes and trucks. He hopes to achieve full mobility by 2004.

One feature that helps keep the facility's weight down is its tents. In fact, the Alaska shelters used by the team since the project started were recently chosen by the AMEDD to be the interim replacement for TEMPER (tent extendable modular personnel) tents currently used for combat support hospitals.

"We're not in the market for finding a new shelter, just testing and developing the technology inside the tent," Story said, adding that he was pleased to be able to show the 48th's soldiers the interim tents and collect their reactions.

"It gave us a chance to look at the replacement tentage, which was a very, very, valuable learning experience for the unit because we received training at the ground level on how to put up and take down these tents even before they're in the Army system," Cote said.

If the unit chooses to use the Forward Deployable Digital Medical Treatment Facility in the future, its planners aim to be able to move the shelters and equipment easily.

Next year, the 48th will head to Fort Gordon, Ga., for annual training, but Cote said this summer's experience gave the unit a chance to "play with new equipment and give real feedback ... (on) equipment they may one day have."

"Technology is moving so fast, sometimes we get locked into doing things in a set fashion because it's always worked," he said. "The military is trying to address that and keep up with the times by buying the best equipment to take care of soldiers."

(Karen Fleming-Michael is a staff writer for the Standard.)

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Click photo for screen-resolution imageSoldiers from the 48th Combat Support Hospital use the Forward Deployable Digital Medical Treatment Facility for annual training at Fort Indiantown Gap, Pa., in July. The facility, a testbed for medical technology, was created in 2001 by the Telemedicine and Advanced Technology Research Center. Courtesy photo  
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