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ADVISOR brings support to medical personnel in austere environments

Photo of Michael Kile, LPN, the operational readiness program manger ADVISOR provides support to medical personnel in remote operating locations (Courtesy of DHA Connected Health).

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U.S. military medical personnel often serve in remote operating locations with limited external communications and often a sparse health care infrastructure. Traditional land-line phones remain their primary connection to the outside world.

When these highly trained clinicians encounter medical emergencies beyond their considerable skills and local resources, having experts on the other end of the line to guide them can vastly improve outcomes for forward-deployed patients. Providing a single point of contact makes it easier for those frontline personnel to get the immediate assistance they need, which is why the Military Health System offers the Advanced Virtual Support for Operational Forces program, or ADVISOR.

The only program of its type across the Department of Defense, ADVISOR provides global on-demand access to a full spectrum of medical tele-consultation services for emergent and urgent care. ADVISOR also delivers those services 24/7/365 in austere environments that have limited to no local specialty support.

Field medical personnel anywhere in the world can call one phone number – 1-833-ADVSRLN (1-833-238-7756 or DSN 312-429-9089) – and get immediate live help in 13 different medical specialties, from emergency care and critical care, to infectious diseases and toxicology.

Think of ADVISOR as a "phone-a-friend" capability that connects field medical personnel with the MHS' best experts for when medical situations require assistance far from home – similar in spirit to NASA's Mission Control. Field personnel are not on the Moon, but handling a medical crisis in faraway, resource-constrained locations can feel that way.

Imagine being hundreds of miles from the nearest medical facility and having to answer the question, "I have two intravenous saline bags, three bandages, and a lollipop stick from last night's Meals Ready to Eat – how do I keep this patient alive until the chopper comes?"

With ADVISOR, field medics get real-time access to capabilities they otherwise lack and guidance on improvising care using whatever resources are at hand – huge confidence and capability boosters that can make a life-or-death difference for patients.

Goal: 100 percent survival

ADVISOR aims to provide the same level of clinical accuracy as in-facility care and achieve a 100% survivability rate of casualties with potentially survivable wounds. The program enables virtual access to advanced monitoring and decision support systems to improve remote casualty location, triage, and treatment for:

  • Emergent care, including combat casualty care, advanced critical care, and prolonged care when evacuation is delayed
  • Urgent care, including specialty and emergency care consults and remote medical and behavioral health diagnosis and treatment
  • Routine care by connecting field medics to the MHS' Global Teleconsultation Portal system

ADVISOR's integrated, interoperable system works across all DOD platforms and networks and flexibly scales to whatever technology resources field clinicians have available, from text message to video. At all times, callers can reach two staff providers for each specialty, who have both operational and virtual health experience.

ADVISOR currently has 127 volunteer providers from all three services, many of whom are chiefs of departments at their respective medical institutions. Providers commit to helping service members solve problems in the field based on real-time conditions, resources, and challenges on the ground.

Hundreds of Consultations

ADVISOR started in June 2017 as a pilot program for Special Operations Forces. Since then, it has supported clinicians throughout all combatant commands, as well as from NATO and other partners in multi-national operations.

To date, ADVISOR has provided 322 real-world emergent care or urgent care consultations, mostly in emergency care and infectious disease cases. Additionally, ADVISOR has been a valuable resource for garrison care as a centralized consultation line, supporting smaller military hospitals and clinics lacking onsite specialty capabilities.

ADVISOR has also aided pre-deployment training to help increase field clinicians' skills in prolonged field care and delayed evacuation care. Additionally, the program has provided 427 training consultations across all military branches, predominantly in critical care and general surgery.

User feedback for ADVISOR has been overwhelmingly positive. More than 90% of those surveyed said ADVISOR was easy to access, and the quality of their remote consultant's recommendations were above average or exceptional.

COVID-19 Response

ADVISOR's capabilities became profoundly useful in addressing the COVID-19 pandemic that swept the globe in March 2020. All U.S.-based MHS medical treatment facilities faced an unprecedented surge in cases while enforcing distancing requirements to keep patients and providers safe. These constraints limited providers' ability to evacuate many patients to higher-level care and made ensuring continuity of care and high-quality outcomes more challenging.

To help MHS clinicians, ADVISOR immediately reworked its workflows to provide on-demand COVID-19-related services for pediatric and adult critical care, infectious disease, and palliative care to all military hospitals and clinics. ADVISOR continues to contribute to the MHS' five-tier COVID-19 response plan, which supports virtual health throughout the enterprise from a foundation of telephone-based communication all the way up to tele-critical care.

Looking Forward

Offering access to capabilities across the MHS anytime, anywhere by phone and other electronic means is a dream MHS providers have had for decades. For instance, when I was chief wardmaster of the 47th Combat Support Hospital at the former Fort Lewis in Washington state, during Operation Iraqi Freedom, I brought a copy of Madigan Army Medical Center's phone book with me on every deployment. ADVISOR helps fulfill that dream and is a successful example of virtual health technology solutions that make it easy to deliver more capability wherever and whenever needed.

The COVID-19 pandemic accelerated demand for such solutions, which will be a permanent and growing part of the health care landscape going forward. This ongoing evolution will in turn improve operational readiness while decreasing the costs and complexities of care delivery.

Through ADVISOR and other virtual health programs, the MHS can leverage the capabilities of the largest health care system in the world to improve the readiness, health, and well-being of all MHS beneficiaries.

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