One of the many devastating blows that Hurricane Maria foisted upon Puerto Rico was the lasting damage to the island’s healthcare infrastructure.
Most of the island’s hospitals were knocked out of commission by the Category 4 hurricane’s early blows. Those that survived have had to make do with shortages of water, power, and supplies, all while dealing with the population’s intensifying healthcare needs from accidents and disease. A photograph posted on Twitter by former Governor Alejandro Garcia Padilla in late October showed doctors performing surgery by flashlight.
In the midst of this chaos, a team of medical specialists from the U.S. Army established a mobile medical response team equipped with the latest telemedicine technology to treat the local population in Humacao, one of Puerto Rico’s hardest hit areas. Their experience is proof that telemedicine can and should play a major role helping to treat victims of natural disasters in the field and during the recovery.
The team of military telemedicine professionals flew to Humacao on Oct. 12 and were embedded with the 14th Combat Support Hospital, a mobile hospital that’s based in Fort Benning, Ga. when not in use in the field. Sergeant Andrea Bloom, and Specialist Christian bark, both mobile medics, flew in from the Army’s first Virtual Medical Center at Brooke Army Medical Center (BAMC) at Fort Sam Houston, near San Antonio. Captain Becky Lux, RN, joined them from Dwight D. Eisenhower Army Medical Center (DDEAMC) in Augusta, Ga.
Upon arriving in Humacao, Lux, Bloom and Bark were confronted by hundreds of local patients, rescue workers and Army personnel crowding the Combat Support Hospital’s emergency room, seeking care. The high volume of patients, over 150 per day, was close to overwhelming the emergency room’s staff.
Working quickly, the mobile medics deployed a transportable telemedicine unit designed to enable remote communications via satellite with medical specialists as far away as the other side of the earth. The station’s multiple medical devices—including exam cameras, stethoscopes, otoscopes, EKGs, ultrasound probes and spirometers—and integrated video conferencing software let the medics communicate with internists and specialists at BAMC and DDEAMC to assess patients, determine diagnoses, and provide real-time treatment recommendations.
The telemedicine team provided badly-needed relief to the Combat Support Hospital staff and the mobile telemedicine unit quickly proved its ability to provide remote care for even those issues that normally required up-close in-person examination. On Oct. 20, the mobile medics were stymied by the case of a soldier who was experiencing right eye pain, loss of vision and a cloudy haze over his eye. The team launched a synchronous (real-time) virtual health encounter with Army Lt. Col. Jennifer Stowe, an optometrist located at the BAMC. Using the telemedicine station’s high-definition optical exam camera, the medics sent images of the soldier's eye to Stowe and consulted in real-time via teleconference. Based on her conversation with the patient and the physical exam, Stowe was able to establish a diagnosis, prescribe a recommend course of treatment, schedule a follow-up appointment, and keep the soldier from being evacuated to a higher level of care.
Stowe was extremely impressed with the audio and video quality.
"Without the ability to adequately evaluate the patient's eye and discuss the symptoms with the soldier, I would have likely recommended immediate evacuation to a higher level of care," she said. "Instead, he was able to continue fulfilling his mission in support of the efforts in Puerto Rico and I'm able to virtually follow-up on his progress."
As the mission has continued to expand and evolve, the mobile medics have moved beyond Humacao to provide virtual health support in remote and rural areas throughout Puerto Rico. The effort marks the first time that Army Virtual Health has used the full complement of available virtual health capabilities for disaster relief.
Using the Pacific Asynchronous TeleHealth portal and Health Experts On-Line Portsmouth, providers at the Combat Support Hospital can receive recorded (asynchronous) responses to non-urgent virtual heath consults. For urgent and emergency care, Army clinicians in Puerto Rico also have access to the Advanced Virtual Support to Operational Forces (ADVISOR) system, which provides 24x7 on-demand telephone and synchronous video consultations with on-call specialty services including critical care, emergency department, burn care, orthopedics, general/trauma surgery, pediatrics, toxicology, infectious disease and several other specialty providers coordinated though the BAMC Virtual Medical Center.
"The ADVISOR system is a truly tri-service capability that has the potential of shaping future operational healthcare delivery models across the Department of Defense," said Army Lt. Col. Sean Hipp, director of the BAMC Virtual Medical Center. "This is an exciting time to be a part of the virtual health community. We are looking forward to building a virtual health capability that will support operational forces anytime, anywhere around the world while bringing the full might of Army medicine to the greatest point of need."
Army Maj. Daniel Yourk is Deputy Director of Clinical Operations for the Virtual Medical Center at Brooke Army Medical Center, Fort Sam Houston, Texas.
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