Present and future of Spanish Military Telemedicine
Sanid. mil. 2020; 76 (3) 201
image to increase resolution (for example, of a suspicious lesion
in the oral cavity).
Cold Light Source images transmission: tele-otoscope, tele-oph-
thalmoscope and tele-dermatoscope: (RT). With these medical
instruments connected to the equipment, otoscopy, ophthalmo-
scopy and dermatoscopy images obtained from the patient can
also be sent in real time to help the specialist give remote support.
Tele-Ultrasound (RT). Ultrasound is a widely used technol-ogy
and very useful for diagnostic and therapeutic procedures.
The remote operator needs some basic training, but with the so
called Dual Video Technology (diagnostic ultrasound image and
an image of the hand of the remote operator with the probe on
the screen at the same time), and what we call «Agreed Language
for tele-ultrasound26», the radiologist (or other specialist with ul-trasound
skills like a cardiologist27, urologist, etc.) is able to guide
the remote operator to move the probe to get the needed image for
ultrasound diagnosis. (Fig. 4)
Surgical Tele-Mentoring (RT)28,29. Some years ago, we star- ted
to use this technology. It consists of obtaining a surgical field im-age
in the operating room at the remote site projected on monitors
both in the remote operating room and in the Reference Center of
the Telemedicine Unit in Role 4, so that both (usually junior) sur-gical
personnel at the remote site and experienced/ senior surgeons
in the Hospital can watch it. Then, senior surgeons at the Role 4
use what we call the Surgical Tele-assistant. This system allows the
drawings of the senior surgeons to be seen over the surgical field
image and permits them to point specific areas of the surgical field
image to highlight some key structure (such as a vessel, nerve, etc.)
or aspect of the field. (Fig. 5)
SPANISH MILITARY TELEMEDICINE EQUIPMENT
The equipment used for telemedicine in Spain has different
electro-medical devices that get different records from the pa-
tient (from vital signs to EKG, ultrasound image, ophthalmos-
copy, otoscopy or dermatoscopy images, etc) and a CIS system
able to send them in real time to the Medical Treatment Facility
(Role) that is going to give remote health support. (Fig. 6)
SPANISH MILITARY TELEMEDICINE
COMMUNICATIONS
As our mission is remote health support to health profession-
als or military personnel deployed in Operations and remote/
difficult-to-access locations all over the world, our main com-
munication is by Satellite, civilian or military, depending of the
coverage in the area where teleconsultation is needed.
This is one of the big differences with civilian telemedicine,
where optic fiber (or soon 5G or a combination of both) can be
used with much more bandwidth (our system is very efficient, as
we work usually with so very low bandwidth as 100-200 Kbps).
SPANISH MILITARY TELEMEDICINE FUTURE:
RESEARCH AND DEVELOPMENT
There are several areas in which we have already done or are
currently doing research:
Sensors (wearables): A project called e-Safe Tag30 was de-
veloped to send information from wearables (Instant Applicable
Plaster Sensor) to portable devices to help in casualty classifica-
tion and care in the field. Our vision about wearables is that if
they are part of the soldier´s armor, there is a risk that they are
damaged (by explosions or shrapnel, etc.) or mal-function due to
blood, so they would be better carried (and put on the casualty)
by the military health personnel at the point of injury as soon as
they approach to the patient. (Fig. 7)
Figure 5. Surgical Tele-mentoring.
Figure 6. Spanish Telemedicine ruggerized equipment «Telemedi-cine
Tower».