Stringent Requirements have produced an array of innovative solutions.
Tripler's scenic view includes glimpse of military medicine's future, outreach.
by Tripler Army Medical Center Public Affairs Office
Tripler Army Medical Center, home of the Pacific Regional Medical Command, is the largest Army medical treatment center in the entire Pacific Basin with an area of responsibility spanning more than 52 percent of the entire earth’s surface. Tripler’s service region includes Hawaii, Japan, Johnston Atoll, Guam, Eniwetok, Kwajalein, various Pacific Island Nations, American Samoa, and in October 2008 Korea will be a new addition to the service region. In support of the theater security cooperation plan as well as develop and promote international linkages through medical operations, Tripler deploys medical personnel to Thailand, Malaysia, Australia, Philippines, India, Nepal and Indonesia. More than 400,000 people are eligible to receive care at the Pacific Regional Medical Command’s premier teaching medical center. This includes active duty servicemembers of all branches of service, their eligible families; military-eligible retirees and their families, eligible veterans and many Pacific Island Nation residents.
TRIPLER’S EICU REACHES THOUSANDS OF MILES ACROSS PACIFIC
High above the shimmering Honolulu skyline flanked by Diamond Head crater in clear sight to the east, perhaps a more impressive view from the hospital atop Moanalua Ridge is inside an unassuming office on the sixth floor and offers a glimpse into the future of military medicine.
Doctors in the intensive care unit here are using telemedicine technology called “electronic ICU,” or eICU, to care for critically ill patients at U.S. military bases thousands of miles across the Pacific, helping save lives and reduce medical evacuation costs in the process.
With high-resolution cameras fed into a bank of computers with real-time transmissions, critical care specialists here can examine, diagnose and monitor intensive-care unit patients in conjunction with bed-side local doctors at U.S. military installations in Guam and Korea, where the program is installed.
“We are able to provide an enhanced level of care to deployed active-duty military members, their families, and other beneficiaries with this program, allowing remote hospital intensive care units access to our medical specialists,” said Lieutenant Colonel (Dr.) Eric Crawley, the eICU program director here.
Tripler is the first military medical center to use this telemedicine technology for longdistance ICU care.
“We have the expertise and the capacity to participate in the care of those patients, and I think this system is a great way of projecting that expertise to those smaller facilities,” said Dr. Benjamin Berg, an intensivist at the University of Hawaii’s Telehealth Research Institute. Berg, a retired Army colonel who was instrumental in bringing the electronic ICU program to Tripler in 2003 while on active duty here, is now an eICU program consultant in a partnership between the University of Hawaii and Tripler.
Critical patients at either U.S. Naval Hospital Guam or U.S. Army Hospital Yongsan in Korea can be stabilized under the direction of intensivists at Tripler using this system, Berg said, possibly eliminating or delaying the need for air evacuation at a cost of more than $100,000. If need be, stabilized patients can be brought to Tripler on a regularly scheduled medical flight mission when they are in better condition to fly, saving money and resources.
The fiber-optic, internet-based technology was used during a boiler room explosion on the Guam-based submarine tender USS Frank Cable in December 2006. The ability of surgical and critical care specialists to remotely examine and triage the sailors helped with the initial stabilization and evacuation of the severely burned sailors from the hospital in Guam to Brooke Army Medical Center in San Antonio, Texas.
“This program has provided the hospital’s physicians, particularly in the intensive care unit, immediate access to critical care specialists, such as cardiologists and pulmonologists, at Tripler,” said Lieutenant Robert Krejci, U.S. Naval Hospital Guam’s eICU program manager. “It’s available to physicians on a 24-hour basis and has improved our ability to provide patients here with a higher standard of care.
The consulting doctors at Tripler are able to quickly view a patient’s chart, labs and other data, as well as directly see the patient using a video camera, simulating a near hands-on practice of medicine, he said. In the future, the telemedicine technology may be used to bring the expertise of Tripler’s specialists to patients aboard ships at sea, or in forward deployed locations such as field hospitals, Crawley said.
NEVER DONE BEFORE: EXCESS DOD FLU SHOTS TO PACIFIC ISLANDS
Another way Tripler reaches out is through an on-going partnership between the U.S. Army, local airlines and other federal and non-governmental agencies yielded the Defense Department’s entire stock of excess seasonal influenza vaccinations to benefit U.S.-affiliated islands in the Pacific.
This collaborative effort will benefit tens of thousands of Pacific Islanders over millions of square miles, according to Colonel Mike Brumage, Tripler Army Medical Center’s chief of preventive medicine.
“The shipment represents a year’s worth of collaboration between a number of agencies to deliver excess Department of Defense influenza vaccines to different jurisdictions in the Pacific,” Brumage said. “This enables Pacific Islanders to be immunized against influenza, which is a year-round disease in the tropics.
Receiving the flu shot protects not only the recipient, but also all those people who work closely or live with the vaccine recipient, Brumage said, extending the benefit of the vaccines beyond the actual number of doses shipped.
In total, the team has shipped nearly 30,000 doses of the vaccine to American Samoa, Northern Marianas Islands, Palau, Micronesia, Guam and the Marshall Islands, with a value of almost $260,000. The vaccines are provided at no cost to the islands.
Each year, the Defense Department uses influenza vaccine in order to protect beneficiaries against the virus. The vaccination is mandatory for active duty and recommended for all beneficiaries who are eligible to receive it, such as family members and certain civilians. “Invariably, the department ends up with excess doses that are destroyed at the end of the influenza season or when the vaccine expires,” Brumage said. “The resources of our collective inter-agency partnership enable us to benefit large populations of our neighbors in the Pacific.
In a trial run of this partnership program during the 2006-2007 flu season, 7,800 doses of excess influenza vaccine on Oahu were shipped to the Northern Mariana Islands. Based on the success of last year’s program, the collaboration of governmental and non-governmental agencies along with local airlines expanded the scope of their efforts to include the entire Defense Department’s excess vaccinations, which has never been done before.
“Often times these islands only have a small amount of doses to give out to the local population each year, so these extra vaccinations from the U.S. military will afford more people with protection against this particular virus,” said Ron Ballajadia, Pacific Islands Health Officers Association.
Tripler medical and supply specialists collected the excess vaccines throughout the entire Army, with help from Fort Dietrick, Md.-based U.S. Army Medical Materiel Agency.
Military Vaccine Agency Hawaii coordinated receipt of the shipment at Tripler’s warehouses and maintained quality control. Each nation’s embassy, in conjunction with their Ministry of Health, requested and arranged receipt of the shipment to their respective islands.
The local non-governmental agency Pacific Island Health Officers Association worked with health officials from the island nations to identify their needs for the vaccine.
Continental Airlines Micronesia and Hawaiian Airlines are shipping the vaccine at no cost to each island.
“Our network throughout the Pacific allows us to do this,” said Jeff Moken, general manager of Continental Airlines. “We feel this is a very important initiative we have to take. Many of the recipients of the vaccines are not only customers, but also are our coworkers and family members.
In the U.S., seasonal influenza kills approximately 36,000 Americans on average each year. The victims are primarily infants and the elderly. ♦