Last month, the Madigan Army Medical Center opened its new Virtual Critical Care Center (VC3).

"It is a location where telecritical clinicians (nurses, doctors, and someday other specialties like pharmacists, respiratory therapists and nutritionists) can use telecritical care workstations to deliver critical care services to spoke-site military treatment facilities supported by the Joint TeleCritical Care Network (JTCCN)," said Dr. (Lt. Col.) Jeremy Pamplin, the center's director. "Simply put, it is the future."

A VC3 requires four basic technologies to provide critical care from a distance.

• Access to the patient's electronic record.
• The ability to review images (e.g., x-rays, CAT scans, MRIs and ultrasounds).
• The ability to see and review physiologic vital signs (e.g., electrocardiograms, blood pressure and respiratory rate) in real time.
• The ability to see the patient and the care environment through video teleconferencing technology (VTC).

The delivery of critical care at a distance is a reality at the JTCCN, a vital network that functions 24/7/365 to monitor patients in intensive care units at multiple facilities. 

The JTCCN evolved out of the Army's effort to provide critical care consultation to deployed forces. The VC3 part of the equation grew out of the techniques, tactics and procedures to deliver critical care consultation to the 3rd Special Forces Group (Airborne).

"This project led to the development of the Advanced Virtual Support for Special Operations (ADVISSOR) project," continued Pamplin, "and it is an expansion of teleconsultation services from critical care to other specialties using automatic call distribution (ACD) technology."

He also pointed out that VC3 and ADVISSOR are low-cost, low-technology, high-reliability telemedicine solutions for Special Operations Forces worldwide.

Stateside, the JTCCN functions as a "second set of eyes" at small military treatment centers and larger medical centers with critical care resources to help local care teams monitor patients and maintain quality and safety of patient care.

"JTCCN clinicians are focused on data, documentation, process and safety without the distractions of the bedside clinician," explained Pamplin. "Given this focus, the JTCCN services provide additional checks and balances that help to ensure optimal care."

To illustrate his point, Pamplin related a story about an internist at Naval Hospital Camp Lejeune with limited critical care experience who had concerns about intubating a patient. Utilizing the JTCCN, the internist contacted the VC3 at Madigan for consultation.

The patient was a 25-year-old female with no past medical history who had been admitted earlier with a presumed neurologic disorder causing respiratory distress. She was having difficulty breathing. Utilizing remote video teleconferencing and other remote capabilities, the telecritical care physician at Madigan identified the woman's breathing pattern to be consistent with a thoracic obstruction. Consequently, the physician at Madigan advised the internist at Naval Hospital Camp Lejeune to not intubate the patient and recommended a routine pulmonary consultation for a bronchoscopy.

The result was avoidance of an unnecessary intubation.

"The future of medicine will be defined by virtual services as these services continue to advance to improve healthcare," Pamplin said.