For the team at the U.S. Army Medical Research and Development Command’s Telemedicine and Advanced Technology Research Center, the effort to fight the ongoing novel coronavirus pandemic has been – as with the rest of the Command’s contributions – the product of both incredible urgency and focused creativity. Now, with the expanded launch of their next-generation National Emergency Tele-Critical Care Network, TATRC prepares to make its own sizable imprint within USAMRDC’s already sprawling response effort.
Launched in October and deployed just weeks later to a number of novel coronavirus hot spots across the globe, the NETCCN – a cloud-based, low-resource, stand-alone health information management system with the capability of creating innumerable “virtual critical care wards” via current handheld mobile devices – is already making a substantial impact.
“There is nothing more satisfying that receiving reports back from our performers that dozens of clinicians have downloaded a NETCCN [application] onto their phones and are actively using it for care within days of its introduction,” says TATRC Science Director Matthew Quinn.
To that end, TATRC has deployed NETCCN teams to COVID-19 hot spots in places such South Dakota, Minnesota, Puerto Rico, and beyond, with more than 235 local and distance clinicians downloading and using the NETCCN platform to manage nearly 100 patients in a number of different locales and situations.
Developed over the spring and summer months via a massive, accelerated mobilization effort involving a number prominent corporate and academic entities (an effort referred to as a “sprint” by Quinn), the NETCCN was born from the learned experience that, in short, there are simply never enough qualified clinicians to provide care during large scale emergencies. Far from operating as another standard telehealth tool, however, the NETCCN is designed to operate from point-to-point (“from anywhere to anywhere,” in TATRC parlance) as opposed to the traditional “hub and spoke” model, which is dependent on a single outlet broadcasting instruction to a series of single users.
“When we started the NETCCN project a few months ago, we challenged our performers to empower clinicians to deliver tele-critical care functionality by downloading a simple-to-use smartphone application,” says TATRC Director Col. Jeremy Pamplin, who helped develop the initial concept for the technology. “Our NETCCN teams have done just that, as evidenced by the rapid adoption, use and integration of NETCCN platforms into the COVID fight.”
So far, TATRC’s internal numbers show NETCCN users have conducted over 2,400 synchronous (live video) and asynchronous (messaging) exchanges through the platform; an effort which delivers on TATRC’s stated goal of being able to deliver (or “surge”) a large number of clinicians in times of crisis to almost any bedside in any location. Such efforts have led to any number of success stories from providers, including an anecdote from Guam, where the NETCCN – according to Quinn – likely saved its first life. In that instance, the bedside nurse for an unstable COVID-19 patient used NETCCN to call for assistance, eventually reaching a physician from Brooke Army Medical Center and a nurse from Naval Medical Center San Diego for an evaluation. According to Quinn, the U.S.-based team identified a pneumothorax – a deadly but treatable condition – in the unstable COVID-19 patient and quickly led the on-site nurse through an emergent tube thoracostomy, which eventually stabilized the patient.
“They’re making it part of the fabric of care in a disaster,” says Quinn, a former Army Engineer Officer turned Silicon Valley executive who only recently returned to federal service. “And that’s what we want.”
Quinn also notes that feedback has been positive in the aforementioned South Dakota and Minnesota, where NETCCN has excelled in supporting patients in their own homes; an effort which has greatly reduced the burden on hospitals and further allowed patients to remain in a more comfortable environment.
Beyond its various immediate uses, the NETCCN’s future remains bright. Outside of other practical applications on the home front, the technology has obvious applications to the future battlefield, particularly with regards to the current posture of the U.S. Department of Defense as it relates to multi-domain operations. To that end, the NETCCN team is currently working on a slew of models designed to project how, exactly, the network would be used in dense urban environments and on ships. As for now, however, the TATRC team remains focused on efforts to “scale-up” the NETCCN – or, more simply, figuring out how to allow a single tele-critical care clinician the capability to manage more patients, as well as developing the ability of the NETCCN to deliver care to a city, state, or region.
For the team at TATRC, the payoff for their visionary work is just beginning. For USAMRDC, it’s yet another example of the kind of tangible benefits a collective and focused effort can provide.
Says Quinn, “It is extremely heartening for TATRC and our performers to be able to contribute to the fight against COVID and to have tangible examples of how the [research and development] project that we put together a few months ago is having an impact.”
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