{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T01:45:54Z","timestamp":1788227154812,"version":"build-2803163510"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"9-10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,9,18]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>While deployed, military medical personnel manage routine medical issues that fall under the category of Disease Non-Battle Injury (DNBI). The 86th Combat Support Hospital (CSH) partnered with Combined Joint Task Force-Operation Inherent Resolve (CJTF-OIR) Surgeon Cell, and Special Operations Joint Task Force-Operation Inherent Resolve (SOJTF-OIR) Surgeon Cell, to introduce the Health Experts onLine Portal (HELP) telemedicine system to medical personnel in Iraq and Syria. HELP is an asynchronous (store and forward) online system that provides secure provider-to-provider teleconsultation services for routine patient care and medical evacuation (MEDEVAC) coordination. The goal was to reduce the need for MEDEVAC by providing expert consultation to medical providers in farther-forward deployed units.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>In June 2017, the 86th CSH launched HELP telemedicine services for Kuwait. Following the successful implementation of the telemedicine system in Kuwait, the 86th CSH leadership partnered with CJTF-OIR and SOJTF-OIR medical leadership in launching the system within Iraq and Syria as well as making the system available to all deployed locations in Central Command (CENTCOM). This was a prospective cohort study designed to determine if having convenient and secure access to remote subspecialty consultation would be associated with a reduction in routine MEDEVACs from far forward in the battle space. In August 2017, new-user training was completed and the program launched in Iraq and Syria. This study analyzes the baseline MEDEVAC rate in 3 months before the implementation of HELP telemedicine compared to 3 months following the implementation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Iraq and Syria cases in the HELP telemedicine system accounted for 17.2% (76) of total CENTCOM telemedicine case volume over the 7-month study period. Comparing the 3-month period before and after implementation of HELP, use of asynchronous telemedicine in Iraq and Syria was associated with a reduction in total MEDEVACs from 157 to 68 (56.7% reduction, p\u00a0&amp;lt;\u00a00.001). DNBI represented the majority of the change, (65.0% reduction, p\u00a0&amp;lt;\u00a00.001). MEDEVAC for battle-related injuries decreased slightly from 13 to 6 per 3-month period (p\u00a0=\u00a00.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This is the first prospective study to demonstrate an association between the initiation of asynchronous telemedicine capabilities in a combat zone and decreased MEDEVACs. Annualized numbers would predict a reduction of 328 MEDEVACs\/year for each 10,000 personnel by utilizing asynchronous telemedicine. This represents a significant potential cost savings of $1.2 million\/year through avoidance of routine medical movement of personnel and supports unit readiness by retaining service members in areas of combat operations.<\/jats:p><\/jats:sec>","DOI":"10.1093\/milmed\/usaa091","type":"journal-article","created":{"date-parts":[[2020,6,27]],"date-time":"2020-06-27T10:54:19Z","timestamp":1593255259000},"page":"e1693-e1699","source":"Crossref","is-referenced-by-count":16,"title":["Reduction in Medical Evacuations from Iraq and Syria Following Introduction of an Asynchronous Telehealth System"],"prefix":"10.1093","volume":"185","author":[{"given":"Charles","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859"},{"name":"Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Mbuthia","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859"},{"name":"Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig P","family":"Dobson","sequence":"additional","affiliation":[{"name":"Pediatric Subspecialty Services, Department of Pediatrics, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889"},{"name":"Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,6,27]]},"reference":[{"issue":"4","key":"2020092112244068500_ref1","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1001\/archpedi.159.4.389","article-title":"Effectiveness of an internet-based store-and-forward telemedicine system for pediatric subspecialty consultation","volume":"159","author":"Callahan","year":"2005","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"3","key":"2020092112244068500_ref2","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1089\/tmj.1.1996.2.201","article-title":"Tertiary telemedicine support during global military humanitarian missions","volume":"2","author":"Gomez","year":"1996","journal-title":"Telemed J"},{"issue":"2","key":"2020092112244068500_ref3","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1089\/153056203766437462","article-title":"Military health care and telemedicine","volume":"9","author":"Carmona","year":"2003","journal-title":"Telemed J E Health"},{"issue":"11","key":"2020092112244068500_ref4","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.7205\/MILMED-D-14-00115","article-title":"Utilization of telemedicine in the U.S. military in a deployed setting","volume":"179","author":"Hwang","year":"2014","journal-title":"Mil Med"},{"key":"2020092112244068500_ref5","doi-asserted-by":"crossref","first-page":"e462","DOI":"10.1093\/milmed\/usy127","article-title":"Telemedical support for military medicine","volume":"183","author":"Nettesheim","year":"2018","journal-title":"Mil Med"},{"issue":"8","key":"2020092112244068500_ref6","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1377\/hlthaff.2019.00273","article-title":"Military telehealth: a model for delivering expertise to the point of need in austere and operational environments","volume":"38","author":"Pamplin","year":"2019","journal-title":"Health Aff"},{"issue":"1","key":"2020092112244068500_ref7","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1089\/tmj.2010.0089","article-title":"The Pacific asynchronous TeleHealth (PATH) system: review of 1,000 pediatric teleconsultations","volume":"17","author":"Mahnke","year":"2011","journal-title":"Telemedicine and e-Health"},{"key":"2020092112244068500_ref8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/2050312115626433","article-title":"The health experts online at Portsmouth (HELP): one-year review of adult and pediatric asynchronous telehealth consultations","volume":"4","author":"Lin","year":"2016","journal-title":"SAGE Open Medicine"},{"key":"2020092112244068500_ref9","first-page":"9","volume-title":"Military Airlift: C-17 Aircraft Program","author":"Congressional Research Report","year":"2007"},{"key":"2020092112244068500_ref10","author":"US. 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