Gil-López P., et al.
hospitals, Smart Operating Room- Telemedicine Unit con-nection
for surgery students/ residents/ nurses training, etc..
• R &D: New equipment/ devices for the tactical environment.
• Consulting: National / International (ESA, NATO) Work-
ing Groups.
• Other: support to Military Medical Legal Assessment
Boards and Military Justice Courts (declaration of Med-ical
Experts in Trials).
Organization
One of the main needs when starting a Telemedicine System
is organization (more than equipment, personnel or communi-
cations). So, before implementing the system, it is necessary to
answer some questions, which could be called the Five Ws of a
Telemedicine System:
Who is going to exchange information (only health care pro-
fessionals, patients and health care professionals)?
Which ICT (information and communications technology) is
going to be used to transmit the information (terrestrial lines or
wireless; optic fiber or 5G; a combination)?
What kind of information is going to be transmitted (e-con-
sultation, videoconference, patient registers, such as vitals and
images including ultrasound)?
When will the exchange of information happen (in real time
or synchronous, delayed or asynchronous, or both?
Why are you going to use Telemedicine (better diagnosis/
treatment, evaluate the need for evacuation/ transfer the patient,
follow up)?
In the Spanish Military Telemedicine System, this organiza-tion
is established25 so that any Remote Node (Medical Units
in the Operational Theatre, Military or Civilians Ships, even
military personnel) can reach our Telemedicine Unit through a
200 Sanid. mil. 2020; 76 (3)
24/7 mobile phone/ e-mail. Most importantly, this call/ e-mail is
received by Military Health Care Personnel (Military Nurse) in
the Telemedicine Unit.
Our experience dictates that the teleconsultation usually
needs some kind of management which must be done by Mili-tary
Health Care personnel and not simply by a Call Center (for
example, the specialist required to give remote support).
When the Alert Telemedicine Officer (as we call the Military
Nurse Officer that receives and answers this e-mail/ call) receives
the request of a teleconsultation, they get in touch with the spe-cialist
required to give remote support, sometimes answering by
e-mail (e-consultation) or, if videoconference or additional tests
(like tele-otoscopy, tele- ultrasound, etc.) are needed, they meet at
the Reference Centre in the Telemedicine Unit. The 24/7 availability
of the medical/ surgical specialist is guaranteed by the personnel
on duty at the Central Defense Hospital and the command´s order
that this hospital is the Role 4 or Higher Echelon for the Operations.
SPANISH MILITARY TELEMEDICINE CAPABILITIES
The capabilities are a key point when talking about Teleme-
dicine. Telemedicine is frequently confused with videoconfer-ence,
but telemedicine has many other capabilities that Spanish
Miliary Telemedicine has used for a long time :
Vital Signs and EKG transmission (in Real Time = RT). A
patient can be monitored and his/ her vitals (heart rate, respira-
tory rate, temperature, pulse oximetry, and the most important,
EKG) sent and received at that moment, what is called «in real
time» at the Reference Centre, so the specialist can study them
and give better medical remote support.
External Exam Camera images transmission (RT). The de-
ployed Telemedicine equipment has a high-resolution external
camera that sends dynamic imaging but also allows freezing the
Figure 4. Agreed language for Tele- Ul-trasound
(Hernandez-Abadía, A., Mo-lina,
P. et al, not published).