By Mr Jeffrey M Soares (Army Medicine)November 29, 2011
In an age of smart phones and high-tech gadgets galore, it may be surprising to hear that the next "big thing" coming out of the electronics arena is being spearheaded by the U.S. Army Medical Research and Materiel Command at Fort Detrick, Md. Since 2009, the USAMRMC has been directing several efforts to design, develop or refine handheld telemedicine devices that could help to save lives in theater.
And the culmination of this effort is drawing near for at least one of the candidate projects.
"The TEMPUS-Pro is an advanced compact telemedicine system intended to support combat casualties in forward areas near point-of-injury on the battlefield," says Dr. Gary Gilbert, chief of the Knowledge Engineering group for the USAMRMC's Telemedicine and Advanced Technology Research Center.
"The unit provides a capability for 'point-of-injury data capture' which is a critical gap we are trying to fill."
As a key resource for medics in the field, the TEMPUS-Pro combines three devices into one handheld module, allowing for (1) immediate communication with other units, (2) pre-hospital monitoring of patient vital signs and telemetry data, and (3) tele-mentoring instruction from more experienced medical providers to less experienced combat medics in theater.
The unit also provides real-time audio and video capability, which is extremely useful in transmitting images of the wounded patient immediately to physicians at distant locations, and a transcription feature for hands-free voice data input is on the horizon.
No, it doesn't fire lasers, and you can't use it to beam yourself to another planet -- it's simply meant to save lives.
But isn't that enough?
"An important aspect of the TEMPUS-Pro is that it can maintain patient data [i.e. vital statistics] from near POI through transport all the way into the hospital room," adds Gilbert. "The patient's medical data can stay with him wherever he goes -- which is very significant."
Along with Carl Manemeit, project manager for TATRC's Joint Combat Casualty Care division, Gilbert has headed up the TATRC branch of the large team tasked with making sure the TEMPUS-Pro was approved by the U.S. Food and Drug Administration as a medical device ready for use in the field.
Born from a British commercial product originally developed for use on aircraft, the TEMPUS-Pro is the result of a collaboration involving eight DoD organizations: TATRC, Medical Communications for Combat Casualty Care, or MC4, Defense Health Information Management Systems, U.S. Army Aeromedical Research Laboratory, U.S. Army Institute of Surgical Research, U.S. Army Medical Materiel Agency, Air Force Medical Evaluation Support Activity, and U.S. Joint Forces Command Surgeon's Office.
The command has implemented a new approach to its integrated product team model -- with one lead product manager being supported by other PMs from different critical areas -- and this new paradigm is showing much success.
In fact, it's award winning.
Out of 25 Joint Capability Technology Demonstrations reviewed in 2011, the "Joint Medical Distance Support & Evacuation" was recognized as "Best JCTD of the Year," and the TEMPUS-Pro system was a key component technology.
Designed to be lightweight, mobile, and rugged, the TEMPUS-Pro is intended to be used with tactical communication radio networks that support internet protocol-based transmission, so that signals can be sent out digitally over both classified and non-classified systems. This aspect of immediate digital transfer is what sets the TEMPUS-Pro apart from its predecessors. With this new unit, personnel can transfer data from one device to another -- from the ground to the helicopter to the hospital -- keeping the patient's medical information with him as he is transported out of the field; it can also be transmitted via radio or tactical internet in advance of the patient to the next stop in the medical evacuation chain.
Using either the standard military first responder medical data card called the Tactical Combat Casualty Care card, or a wireless "smart dog tag" that could be carried or worn by the warfighter, the patient's vital records can be exchanged wirelessly between various systems and eventually placed into a permanent medical record. Using this secure digital system, data is neither lost nor compromised.
Because of this feature, the TEMPUS-Pro is actually prompting an upgrade to the current limited capability of the military to transmit data digitally between air and ground units.
"The military's helicopters currently do not all have compatible high-tech radio systems necessary to transmit this information digitally from helicopter to ground," Gilbert says. "One of our biggest challenges is to get the TEMPUS-Pro integrated properly to be used in the medevac helicopters."
As the USAMRMC team works to overcome this obstacle, its focus remains on the welfare of the wounded, in an effort to save as many lives as possible.
"We want to be able to get pre-hospital data to the hospital before the patient gets there," says Gilbert.
While storage of patient data is important, the device's capabilities for transmitting both still photos and live video of injuries is essential for medics in the field.
Using the TEMPUS-Pro, medics can quickly assess severe injuries and send real-time images, as well as live telemetry data and the TCCC card to experienced surgeons offsite for instruction on how to proceed. Viewing the situation, the physician-mentor can immediately talk with medics over the built-in Voice-over-IP capability and guide them through life-saving techniques, instead of delaying effective treatment until the patient arrives at the hospital. The physician can even annotate an image with instructions and send it back to the medic.
And that's the reason the TEMPUS-Pro is creating such a buzz -- it doesn't just collect data.
With ultrasound and laryngoscope capabilities in the works, the effectiveness of the field medic will increase exponentially. Having the ability to capture and transmit internal images will afford a more complete assessment of patient trauma, leading to more accurate diagnoses and treatment.
Gilbert adds, "With this device, the U.S. military could realize much more of the hidden potential of its very capable medics, because it will make them better at what they're doing for the injured out in the field."
While the USAMRMC team researches some operational and logistics issues regarding the device, it anticipates the opportunity for the TEMPUS-Pro's widespread use in theater. Currently, the unit is awaiting approval under the Department of Defense Information Assurance Certification and Accreditation Process. However, about 25 units have been distributed to various Special Operations commands for trial use, and the results have been positive.
Regarding cost, Gilbert says that the estimated price per unit is "in the ballpark" of the Propaq® medical device currently used by the U.S. military, although the TEMPUS-Pro has additional capabilities that are potentially more useful to the field medic.
As for instructions on how to use the unit, the built-in tutorials are "well designed, easy to understand, and effective," says Gilbert.
"The medics from MRMC, the Special Operations Forces, the Air Combat Command, and the 1/25th Stryker Brigade Combat Team that have trained on this device said that they like the unit and believe it would help tremendously in the field."
Most recently, the TEMPUS-Pro has been selected as a candidate for the U.S. Army's Network Integration Evaluation exercise to be held at Fort Bliss, Texas beginning April 2012. The device will be field tested for two months to determine its operational effectiveness within Infantry Brigade Combat Teams. The TEMPUS-Pro has also been chosen for testing in a Marine Corps Warfighting Lab Limited Objective Experiment scheduled for Aug. 2012.
The USAMRMC team, including Gilbert, believes these two rigorous tests should help to validate the applicability and usefulness of the TEMPUS-Pro. The success of the device throughout these exercises should confirm its potential for treating wounded U.S. warfighters on the battlefield.
For the USAMRMC, it's all about saving lives.