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 Table of Contents  
REVIEW ARTICLE
Year : 2019  |  Volume : 21  |  Issue : 2  |  Page : 108-111

Telemedicine: A force multiplier of combat medical care in the Indian Navy


1 O/o DGMS (Navy), IHQ MoD (Navy), New Delhi, India
2 School of Naval Health, INM, Mumbai, Maharashtra, India
3 Station Health Organization, Kochi, Kerala, India

Date of Submission07-Sep-2019
Date of Acceptance19-Sep-2019
Date of Web Publication07-Oct-2019

Correspondence Address:
Surg Cdr (Dr) Saurabh Bobdey
O/o DGMS (Navy), IHQ MoD (Navy), Sena Bhawan, New Delhi - 110 011
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmms.jmms_55_19

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  Abstract 


The tasking of the Indian Navy has increased manifolds in the recent past due to the country's growing economic importance, increasing energy requirements, and expanding trade routes. As operational elements of the blue water Navy, Indian Naval ships and submarines are deployed far and wide for prolonged durations. Therefore, for ships and submarines to be able to operate far away from our coasts, a comprehensive afloat medical care system needs to be developed with the capability to provide need-based secondary (specialist) and tertiary (superspecialist) care to men at sea. Telemedicine is envisaged to provide the solution to medical care needs of personnel onboard ships/submarines and in remote islands/locations and support unhindered Naval operations in peace and combat scenario. Telemedicine is a genuine force multiplier; it will not only complement the present medical support and extend expertise to areas bereft of the same but will also be helpful in prolonged operations and extended deployments by providing specialist/superspecialist consultation to the men at sea. In today's world of advanced telecommunication, telemedicine is a perfect amalgamation of communication technology and medical science, which is bound to revolutionize the field of Combat Medical Care by improving both clinical outcomes and operational efficiency of the Indian Navy. The article reviews telemedicine concept, its components, utility in the provision of specialized medical care to men at sea and its limitations.

Keywords: Combat Medical Care, medical emergency, telemedicine


How to cite this article:
Bobdey S, Narayan S, Ilankumaran M, Vishwanath G, Singh M V, Sinha A K, Anand N, Maramraj K. Telemedicine: A force multiplier of combat medical care in the Indian Navy. J Mar Med Soc 2019;21:108-11

How to cite this URL:
Bobdey S, Narayan S, Ilankumaran M, Vishwanath G, Singh M V, Sinha A K, Anand N, Maramraj K. Telemedicine: A force multiplier of combat medical care in the Indian Navy. J Mar Med Soc [serial online] 2019 [cited 2019 Nov 14];21:108-11. Available from: http://www.marinemedicalsociety.in/text.asp?2019/21/2/108/268626




  Introduction Top


Tele is a Greek word meaning “distance” and “mederi” is a Latin word meaning “to heal”. The term “Telemedicine” was coined only in the 1970s, which literally means “healing at a distance”,[1] and signifies the use of information and communication technologies (ICTs) to improve the patient outcomes by increasing the access to care and medical information. The World Health Organization in its 2010 Global Health Survey Report has described telemedicine as “The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities.”[2]


  Brief History of Telemedicine Top


In the recent past, due to technological advancement in telecommunication, there has been an explosion of interest in telemedicine; however, the history of telemedicine can be traced almost half a century back when the National Aeronautics and Space Administration (NASA) played an important part in the early development of telemedicine.[3] NASA's efforts in telemedicine began in the early 1960s when physiological parameters of humans flying in space were transmitted from both the spacecraft and the spacesuits during missions.[4],[5] Other examples of modern telemedicine in the early 1960s included two health-care projects incorporating the principles of telemedicine in health-care delivery in the United States.[5],[6],[7],[8] The first project involved a two-way audiovisual television system setup between the Nebraska Psychiatric Institute and a State Mental Hospital. This two-way communication process was utilized for medical consultation and educational purposes for patients and health-care professionals.[6],[7],[8] The second project involved Massachusetts General Hospital and Logan International Airport Medical Station in Boston. In this project, medical advice was given by audiovisual method from the hospital to the patients at the airport.[6],[7],[8]


  Utility of Telemedicine Top


Time magazine has called telemedicine “healing by wire”. Telemedicine a decade back was considered futuristic and experimental, but in today's era of high-end telecommunication network, telemedicine has become a reality and is here to stay and heal. Telemedicine has a variety of applications in patient care, education, research, administration, and public health, namely, it provides ease of access to remote areas, can significantly reduce the time and costs of patient transportation, help in monitoring home care, and ambulatory monitoring, critical care monitoring where it is not possible to transfer the patient, provides communications between health providers separated by distance, medium for continuing medical education, clinical research, disease surveillance, and program tracking, etc., the utility of telemedicine in medical panorama is endless and can be best left for the creative minds to explore.[9],[10],[11],[12],[13],[14]


  Mission Needs of the Indian Navy Top


The tasking of the Indian Navy has increased manifolds in the recent past due to the country's growing economic importance, increasing energy requirements, and expanding trade routes. As operational elements of blue water Navy, Indian Naval ships and submarines are deployed far and wide for prolonged durations. The men manning these naval vessels are provided with medical facilities commensurate to the size and displacement of the ship. However, unless accompanied by a large vessel bearing a specialist complement, personnel at sea are deprived of specialist/superspecialist opinion. In case of life- and/or limb-threatening medical emergencies at sea, it may not be possible for the limited medical staff available on board, a Naval Warship/Submarine to undertake the treatment by themselves. In such cases, the casualty is either evacuated from the vessel or the vessel abandons its mission and returns to the nearest port. During inclement weather conditions, casualty evacuation may not be possible, and valuable lives may be lost or the severity of the disease may increase. Therefore, for ships and submarines to be able to operate far away from our coasts, a comprehensive afloat medical care system needs to be developed with the capability to provide need-based secondary (specialist) and tertiary (superspecialist) level care to patients onboard. For this, while there is a need to enhance the medical facilities on board ships and submarines, workforce constraints and practicality prevent posting of specialists on board.


  Telemedicine as a Solution to Medical Needs of the Indian Navy Top


Telemedicine is envisaged to provide the solution to medical care needs of personnel on board ships/submarines and in remote islands/locations. It is a genuine force multiplier in the current circumstances of perpetual workforce and expertise shortage. Telemedicine system would be a boon for the ship's Medical Officer, as he/she would be able to contact specialists based in shore hospitals back home, to manage medical and surgical emergencies. This is even more relevant if the ships are deployed for naval operations and hence are not in a position to enter any port. Telemedicine consultation system will help the general duty medical officers, as well as specialists, posted to remote locations/hospitals and isolated island locations not connected to mainland/land with hospital services. The system will enable them to take expert opinion of specialists and superspecialists at tertiary care centers for real-time management of critically ill as well as seek advice on diagnostically challenging cases. Telemedicine also provides an opportunity for teleconsultation prior to the transfer of a patient from the periphery to higher centers for specialized treatment. The patients can be worked up in consultation with the concerned specialist, and then transferred for final treatment, this would ensure lesser time spent in the hospital away from duty station and would also reduce bed occupancy in overburdened specialized centers.

In midst of combat Naval operations, many a time casualty evacuation may not be feasible, because of the proximity to enemy forces, mission requirements or due to weather constraints, lack of aircraft, boats, and severe nature of casualty not permitting evacuation. Under such circumstances, secondary/tertiary level medical support on the high seas can be achieved by a comprehensive telemedicine consultation system on board. Further, telemedicine also provides an opportunity where the patient is seen by a specialist at the earliest and a firm decision whether to evacuate at all could be taken in consultation with him. Hence, telemedicine also has the potential to reduce the numbers of evacuations and ensuring unhindered naval operations.


  Components of Telemedicine in the Indian Navy Top


The main aim of telemedicine in IN is to provide quality specialist and superspecialist care to men at sea and at remote locations. This will only be feasible if the afloat platforms/remote locations are equipped with electromedical devices capable of capturing and forwarding various vital clinical parameters to specialist providing remote consultation and receiving clear communication back from the specialist. The following equipment will be installed at various levels for operationalization of telemedicine in IN.

Telemedicine consultation centers in Indian Navy

Teleconsultation centers (TCC) will be established on board all ships and submarines of the Indian Navy bearing a Medical Officer and in certain remote locations and island locations. In addition, mobile TCC will also be procured for teleconsultation while evacuation of patients in the ambulance. The heart of telemedicine consultation console will be rugged militarized laptop with optimized telemedicine software [Figure 1], that will acquire physiological parameters from the Biomedical Data Acquisition System, which when connected to patient will record the heart rate, respiratory rate, noninvasive blood pressure, SpO2, body temperature and, will acquire cardiac sounds through digital stethoscope and will also interface with third-party digital imaging devices such as ultrasound machine, dermatoscope, and otoscope to capture and transfer the images. The system will have the option for three modes of operation, namely real-time, store and forward and scheduling mode. In addition, it has the capability to support videoconferencing over low bandwidths (128 Kbps).
Figure 1: Components of telemedicine consultation center

Click here to view


Telemedicine specialist centers in Indian Navy

Telemedicine specialist centers (TSCs) will be established in selected hospitals of IN to provide specialist consultation on the receipt of communication from TCC (ships/submarines and remote locations/islands). The TSCs will have a computer, large wall-size screen along with videoconference equipment, printer, and scanner. The TSCs will be manned 24 × 7 by hospital staff.

Dual-mode centers (telemedicine specialist center + telemedicine consultation centers)

Some selected afloat platforms (with specialist onboard) and few peripheral hospitals will function in dual mode, i.e., they will provide consultation to remote afloat/remote units for basic specialties and will be able to seek consultation from tertiary care centers if the need arises.

Communication

Onboard afloat platforms the TCC will be located in sickbays/compartments easily accessible in case of an eventuality. The medical officer on board afloat platform/remote location on receipt of a patient requiring specialist care will communicate various biomedical parameters of the patient to the specialist/superspecialist at TSCs. The specialist after studying the reports will provide advice for management of the case in real time. All communications will be carried out on secure channels of communication, thus not comprising the location/operational capability of the warship.


  Challenges in the Provision of Health Care Through Telemedicine Top


There is little doubt that telemedicine has a valuable role in the case of emergencies in remote environments such as on ships, submarines, remote locations, and possibly on the battlefield because in all these situations, it may be difficult or even impossible to provide specialist care to the patient in time. However, telemedicine has certain limitations, telemedicine onboard afloat platforms is as good as or as bad as the user of the system and his capability to pick up and convey clinical findings to the specialist on the other end, for example, ability of the medical officer to perform ultrasonography, correct positioning of digital stethoscope/otoscope, etc., Further, any implementation of intervention suggested by the specialist depends on the capability of the medical officer present at the site and many a time he/she may not be competent or confident to carry out the intervention suggested by the specialist through teleconsultation.

During a teleconsultation, the images of both the health-care worker and the patient are projected onto a monitor and all interactions between the two parties are indirect. As our perceptions of what is seen on a monitor are very much influenced by our experience of watching TV, a teleconsultation might not be experienced as being real by either party and cloud the ability of the specialist to provide sound clinical advice.[15] Finally, the telemedicine system depends on technology, which can get interrupted by a number of factors such as bad weather, loss of power, software malfunction,[16] and especially in a combat scenario if the naval satellite is the target of enemy action the whole communication link would fall apart.


  Conclusion Top


Telemedicine is a genuine force multiplier; it will not only complement the present medical support and extend expertise to areas bereft of the same but will also be helpful in prolonged operations and extended deployments by providing specialist/superspecialist consultation to the men at sea. In today's world of advanced telecommunication, telemedicine is a perfect amalgamation of communication technology and medical science, which is bound to revolutionize the field of Combat Medical Care by improving both the clinical outcomes and operational efficiency of the Indian Navy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Strehle EM, Shabde N. One hundred years of telemedicine: Does this new technology have a place in paediatrics? Arch Dis Child 2006;91:956-9.  Back to cited text no. 1
    
2.
World Health Organization. A Health Telematics Policy in Support of WHO's Health-For-All Strategy for Global Health Development: Report of the WHO Group Consultation on Health Telematics, 11–16 December, Geneva, 1997. Geneva: World Health Organization; 1998.  Back to cited text no. 2
    
3.
Bashshur R. Technology Serves the People: The Story of a Cooperative Telemedicine Project by NASA, the Indian Health Service and the Papago People. Superintendent of Documents. Washington DC: US Government Printing Press; 1980.  Back to cited text no. 3
    
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Watson DS. Telemedicine. Med J Aust 1989;151:62-6, 68, 71.  Back to cited text no. 4
    
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Ryu S. History of telemedicine: Evolution, context, and transformation. Healthc Inform Res 2010;16:65-6.  Back to cited text no. 5
    
6.
Benschoter RA, Wittson CL, Ingham CG. Teaching and consultation by television. I. Closed-circuit collaboration. Ment Hosp 1965;16:99-100.  Back to cited text no. 6
    
7.
Murphy RL Jr. Bird KT. Telediagnosis: A new community health resource. Observations on the feasibility of telediagnosis based on 1000 patient transactions. Am J Public Health 1974;64:113-9.  Back to cited text no. 7
    
8.
Bashshur R, Shannon G, Sapci H. Telemedicine Evaluation. Telemed E Health 2005;11:296-316. [https://doi.org/10.1089/tmj. 2005.11.296].  Back to cited text no. 8
    
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Craig J, Patterson V. Introduction to the practice of telemedicine. J Telemed Telecare 2005;11:3-9.  Back to cited text no. 9
    
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Balas EA, Jaffery F, Pinciroli F. Patient care from a distance: Analysis of evidence. Annu Meet Int Soc Technol Assess Health Care 1996;12:17.  Back to cited text no. 10
    
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Grigsby J, Schlenker RE, Kaehny MM, Shaughnessy PW, Sandberg EJ. Analytic framework for evaluation of telemedicine. Telemed J 1995;1:31-9.  Back to cited text no. 11
    
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Singh M, Das RR. Utility of telemedicine for children in India. Indian J Pediatr 2010;77:73-5.  Back to cited text no. 12
    
13.
Asiri A, AlBishi S, AlMadani W, ElMetwally A, Househ M. The use of telemedicine in surgical care: A systematic review. Acta Inform Med 2018;26:201-6.  Back to cited text no. 13
    
14.
Vyas KS, Hambrick HR, Shakir A, Morrison SD, Tran DC, Pearson K, et al. A systematic review of the use of telemedicine in plastic and reconstructive surgery and dermatology. Ann Plast Surg 2017;78:736-68.  Back to cited text no. 14
    
15.
Hjelm NM. Benefits and drawbacks of telemedicine. J Telemed Telecare 2005;11:60-70.  Back to cited text no. 15
    
16.
Dasgupta A, Deb S. Telemedicine: A new horizon in public health in India. Indian J Community Med 2008;33:3-8.  Back to cited text no. 16
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Introduction
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