JSOM Summer Podcast

And Sydney is going to go ahead and lead us off.

Yeah, awesome.

So today I will be presenting Telemedicine Consultation, Lessons Learned from the Pararescue Experience.

This article is by Austin Gotchick, Jacob Oding, Mason Blacker, Eric DeSasi, and Stephen Rush.

So...

This article is a study where they reviewed 13 telemedicine consultations involving 28 patients over a 10-year period in an attempt to evaluate really how telemedicine supports military and medical operations in austere environments.

So a little bit of background on this is that obviously, as we all know, that based off different articles we've talked about and kind of just the trajectory that things are going, that modern military operations are increasingly incurring in remote locations where evacuations could take hours or even days.

This is creating a real need for prolonged casualty care where medics kind of have to manage critically ill or injured patients without immediate access to physicians or surgeons.

And so telemedicine has evolved into a tool that's kind of helping bridging that gap.

So as far as methods, the authors reviewed all pararescue telemedicine consultations from 2010 to 2020, and they analyzed mission reports, after-action reviews, and interviews with flight surgeons and pararescuemen to identify how telemedicine was used and then the challenges that they encountered.

So the results were, there were 13 consultations involving 28 patients, and cases like this included cave entrapment, trauma, burns, and medical illnesses.

Most consultations occurred between pararescuemen and flight surgeons, although specialists such as orthopedic surgeons, dermatologists, and burn physicians were also involved when needed.

What they found was that telemedicine was mostly used for medication recommendations, burn management, surgical decision making, and determining whether rescue missions should even be launched.

One notable example was the Thai cave rescue.

And I remember when this happened in 2018, I believe, where telemedicine was used to help guide pediatric sedation decisions during the extraction of 13 trapped individuals.

I actually remember watching a movie about this where they were discussing how they had to, divers went in to help rescue, I think it was a soccer team, and they had to sedate the patients in order to get them out safely.

So they mentioned that in this article as well, which I thought was interesting.

Some of the biggest challenges that were faced within telemedicine weren't technological, they were communication related.

One case, a provider reported that a patient was urinating okay, which led to confusion because urine output was not actually being measured.

Other issues included unfamiliarity between providers and occasional communication failures.

And the authors really identified three major lessons from this.

First was that teams need a shared communication framework.

The second was that simple communication such as voice calls often work best for And then third was that telemedicine should be rehearsed before deployment so providers know each other and communicate effectively.

So a lot of like themes around like effective communication.

So in conclusion, the authors concluded that telemedicine is a valuable force multiplier that provides remote access to expert medical guidance during complex cases and However, it can't really replace strong clinical training and experience and success really does depend on effective communication, standardization, and then just regular rehearsal.