Telemedicine gains ground on the battlefield

In the event of a war against Iraq, the U.S. military might get its inspiration for advanced telemedicine systems already in use in Afghanistan.Military personnel say they don't want to speculate on systems they would use in Iraq. Instead, they cite a full telemedicine theater'from digital images to satellite links'being used in the city of Bagran in southern Afghanistan.Since Nov. 1, a command support hospital there has been stretching a high-bandwidth satellite link to a U.S. Army hospital in Germany, sending high-resolution pictures of soldiers' injuries and X-rays back and forth for consultations and second opinions.Telemedicine's single-day turnaround means military hospitals abroad don't have to transfer every soldier whose injuries might need a second look. That saves money in Air Force transport and hospital fees.'When they're in doubt, clinically, obviously they evacuate the patient,' said Maj. Timothy Rapp, chief of the IT Engineering Division of the Defense Department's Telemedicine and Advanced Technology Research Center.The backbone of the network in Afghanistan is the Brigade Remote Subscriber System, a complex name for a switch device that looks like two briefcases glued together. It was developed in-house by several Army commands.BRSS plugs into a satellite connection from Landstuhl Regional Medical Center in Germany, linking all of the notebook PCs scattered across the Bagran hospital's roughly dozen tents, including those for pharmacy, emergency, logistics and labs. Server and router equipment in Landstuhl and the remote locations transmit at 768 Kbps.The connections allow simultaneous two-way voice, data and high-res video transmissions. Military doctors in Bagran have at their disposal 25 phone lines using voice over IP. As of December, they were using only four and projected they would tap into another eight by the middle of January. The system carries anything from large e-mail attachments to interactive examinations.The military bought the additional bandwidth, normally costing an estimated $25,000, from a third-party vendor, said Col. Ron Poropatich, a physician and consultant to the U.S. Army Surgeon General, and president of the nonprofit American Telemedicine Association.It boosted the hospital's ability to send digital medical images considerably compared with the first time such telemedicine techniques were used in Somalia in February 1993, Poropatich said. Then, doctors had a mere 56 Kbps of bandwidth to work with'less than 14 percent of today's speed.Previously, most of the medical field connections couldn't handle heavy transmissions. 'Or even if they did,' Rapp said, 'you could just go get a cup of coffee while you were waiting for them.'The combat support hospital in Bagran has set up telemedicine systems for radiology, dermatology, ophthalmology and psychiatry. Scanned X-rays, ultrasounds and CAT scans requiring second opinions are the most frequently transmitted items, Poropatich said.Using digital cameras embedded in medical equipment, field personnel can take pictures formatted to Digital Imaging and Communications in Medicine standards. The doctors and medical staff in Bagran also can tap Army medical reference libraries online to look up symptoms. And they can send soldiers to videoconferencing rooms, where patients discuss emotional issues with psychiatrists sitting hundreds of miles away.Since deployment in Afghanistan, the combat support hospital has run two-day webcasts on bioterrorism and archived more than 2,000 radiological digital images. That's a big improvement from earlier deployments in Somalia, Bosnia, Kosovo and Haiti, when such transmissions were still a stretch, Poropatich said. 'It's not a foreign concept anymore,' he said. 'We've got a more accepting audience.'The next step, Rapp said, is to go wireless. Hospitals are still resolving wireless' security gaps, but he said they hope doctors will be able to move from tent to tent with a notebook PC and an IEEE 802.11b card connecting them to the switching backbone.In fact, a few years from now, wireless could have a much meatier role in military telemedicine.The more than 200 projects being developed in the Telemedicine and Advanced Technology Research Center labs include prototypes for the Battlefield Medical Information Systems-Telemedicine. That would let medics rush to a survivor on the battlefield with a handheld PC equipped with a digital camera to take pictures of injuries, save diagnostics and medical treatment information, and wirelessly transfer that information to the downed soldier's electronic dog tags via Bluetooth or another wireless technology.Military telemedicine experts also plan even more ambitious projects. In five to 10 years, Poropatich said, robotics will administer medical aid to soldiers on the field'dragging them into safe zones or climbing atop them to give injections.'It isn't just a pipe dream,' he said. 'It's what we're actually working on.'