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Medicine Under Fire

"There is a growing popular expectation that our military operations should be without casualties." Stephen C. Joseph, M.D. Former assistant secretary of defense for health affairs

The carnage of the battlefield has often inspired advances in medical care. From the blood-soaked hospital tents of the Civil War came innovations in emergency surgery and anesthesia. Penicillin first saw widespread use during World War II, and modern trauma centers owe much to the medevac helicopters and MASH units field-tested in Korea and Vietnam.

Over the past decade, the U.S. Department of Defense has invested more than $500 million in research and development in what it sees as one of the next major advances in medical care--telemedicine, or the delivery of medical care at a distance. Through telemedicine, the military hopes to put new and more effective lifesaving tools into the hands of medics and physicians working in the field, give field commanders instant access to information about the status of troops under their command, and increase combat readiness by keeping troops healthier and returning sick or wounded troops to service sooner.

The push for new telemedicine applications is part of a larger effort to equip tomorrow's soldiers with technology that will make them more effective and informed fighters, better protect them from the hazards of combat, and increase their odds of survival should they be wounded or become ill--everything from high-tech guns that can shoot around corners to Robocop-like exoskeletons that augment a soldier's strengths and running speed.

When the U.S. joined a United Nations intervention during the Bosnian War in the 1990s, medics used satellite hookups to transmit medical images, such as those pictured at the teleradiology view station (far right). Physicians in field hospitals had access to medical specialists via satellite telephones and videoconferencing systems.

"There is a growing popular expectation that our military operations should be without casualties," noted Stephen C. Joseph, M.D., former assistant secretary of defense for health affairs, in a 1996 speech. "This, in the age of instant global video journalism, has significantly raised the expectation for sophisticated casualty care and medical services whenever and wherever casualties may occur."

One of the earliest military experiments with modern medical technology was a research project launched by the U.S. Army Medical Research and Materiel Command (USAMRMC) in 1990 to develop digital X-rays, eliminating the need to store X-ray film. The project gave rise to a new unit within

USAMRMC called the Telemedicine and Advanced Technology Research Center (TATRC). This subordinate unit focuses exclusively on telemedicine and advanced medical technologies. (WPI's funding is being administered by the USAMRMC and TATRC project offices.)


In the 1990s, TATRC field-tested a series of increasingly sophisticated telemedicine systems in Somalia, Macedonia, Croatia and Bosnia. The systems enabled physicians at field hospitals to transmit medical images and converse with medical specialists via videoconferencing or satellite hookups.

The U.S. Navy has used ship-to-shore telemedicine for more than a decade. And when troops began shipping out to the Persian Gulf in preparation for action in Iraq, medics took along laptops and PDAs (personal digital assistants) to record information about injuries and illnesses that beset soldiers. The information will be transmitted to a central database that will help military planners spot trends that may allow for early detection of chemical or biological weapon attacks.

Moving from telemedicine to truly untethered healthcare will take a major leap forward in technology. TATRC, DARPA (the Defense Advanced Research Projects Agency) and other U.S. military organizations are funding a number of projects aimed at bridging the gap. Wireless technology, physiological sensors and ultrasound units for field conditions--the projects being pursued by WPI's Center for Untethered Healthcare-- are widely seen as among the most critical technical needs.

Images courtesy of the United States Army Medical Research and Materiel Command's Telemedicine and Advanced Technology Research Center.

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