Introduction
For all the intense political controversy that has surrounded the wars in Iraq and Afghanistan, and for all the unfortunate deaths on both sides, there can be no doubt that these wars have been remarkable for many reasons. One of the most important long-term impacts of the wars will be the vast strides that have been made in battlefield medicine during the conflict. In fact, despite the horrific injuries sustained by thousands of American and coalition troops and support personnel, particularly stemming from the use of Improvised Explosive Devices (IEDs), no war in history has seen a higher percentage of those combatants wounded in the field actually survive.
In fact, of those wounded soldiers who are alive when brought to their first field hospital for treatment, a stunning 96 percent survive. In large part, the success of keeping American soldiers, airmen and sailors alive along with many contractors and civilian casualties, can be attributed not just to the bravery of the medical personnel involved and the improvements in medical care and technology. No, one of the principal reasons behind this success is the introduction of the RFID tagging of casualties, which represents a quantum leap over military ID methods that have remained largely unchanged in the over 120 years since the US Civil War.
Old Patient Records Misplaced
Unfortunately, tracking patients from the battlefield and through the military medical system has historically often been haphazard in nature. Patient records such as they were were most often in paper form, and even in the best of situations, were often lost, misplaced, or rendered unreadable. This was especially true when a casualty needed to be transferred. As reported in the Navy Times, it was quite common for a patients medical paperwork to be lost in the rotor wash of the helicopters, in the exhaust of jet aircraft, or simply bounced from the vehicle being used to transport them from facility to facility. If what were known as triage tags bearing important medical information on the patient were torn away or stained by fluids, a patient could easily be lost in the system.
Thus, treating corpsmen, doctors, and nurses would be faced with the impossible task of dealing with patients with no paperwork and no identification, and often, unconscious and/or unable to speak. Such concerns over lost paperwork often led medical personnel to fall back on an old World War II ID method of scrawling key medical information on patients arms or even on their foreheads, so as to assure that the next party treating them would be aware of their condition, allergies, blood type, etc.
From the Battlefield to Safety
Throughout the history of warfare, the first goal of military medicine has always been to rush injured soldiers away from the battlefield to safe zones for treatment. Until now, this usually meant evacuation to a facility close to the action (think the Korean War-era M*A*S*H [Mobile Army Surgical Hospital] unit, depicted in the 1970s movie and television series of the same name). In fact, as recently as the 1991 Gulf War, wounded soldiers would remain in hospitals in Kuwait, Saudi Arabia, or other nearby countries for days, weeks or even months of treatment and therapy. However, both in Afghanistan and in Iraq, the US military has dramatically changed its approach for treating wounded warriors.
Now, near-action Combat Support Hospitals (CSHs) are employed strictly to stabilize patients before they are transferred to larger US medical facilities in the theater of operations. However, the soldier-patients stays at these facilities are brief often one to two days, and sometimes, only hours. Mammoth C-17 cargo planes converted into flying intensive care units - depart Iraq and Afghanistan almost daily to whisk the wounded to large military hospitals in Germany and in the United States.
These high capability facilities improve injured warfighters chances for recovery by providing them with access to the finest specialists and standards of care, and, just as important, the out-of-theater location provides them with far easier access to family and friends. Yet, the emphasis on the long-range transport of patients also makes it critical to have accurate medical records available on every patient, and not just to the treating physician, but also to the other parties who will be treating and transporting the injured soldier along the way.
Smart Dog Tags to Track Wounded Patients
Enter the Tactical Medical Coordination System (dubbed TacMedCS in military parlance). TacMedCS was jointly developed by the Naval Aerospace Medical Research Laboratory (NAMRL) in Pensacola, Florida and the Pacific Northwest National Laboratory in Richland, Washington. These agencies wanted to find a better way of identifying and tracking wounded patients in the field.
Working with systems integrator ScenPro, the two research labs developed TacMedCS and had the system ready to deploy in Navy and Marine units at the start of Operation Iraqi Freedom in 2003. The system makes use of smart wrist bands and smart dog tags (wearable over the head) from Precision Dynamics , embedded with 13.56 MHz RFID inlays - readable from a distance of approximately four feet from Texas Instruments.
When a wounded soldier is first encountered, the corpsman in the field or in the hospital provides necessary stabilization treatment, and then, quickly affixes a TacMedCS tag to them. TacMedCS makes use of handheld readers, designed for use in rugged conditions, supplied through a collaborative effort between SkyeTek and ACC Systems. The corpsman uses the scanner to register the tag to the patient, then inputs details on the casualtys injuries and status.
This data is also written to the read/write tag, so that the information travels with the patient eliminating the problem of lost charts through the military healthcare and transport system. The readers are equipped with GPS technology, so as to combine the responders location information with the patients medical status data and the date/time of the last treatment provided. From the perspective of chief medical corpsman Michael Stiney of the US Navy, it is vital to have the ability to keep important information with each patient, and to track his or her whereabouts automatically.
Real-time Casualty Data
What is gained through the use of TacMedCS is far more than an electronic medical record that travels with the injured solider. Rather, the RFID-wristband becomes the foundational element in making the militarys medical system work with far better coordination than ever before. In many ways, it is akin to the greater intelligence and visibility that becomes possible when RFID is leveraged in a supply chain situation. In this all-important application, by tracking incoming tagged patients, medical facilities and transport functions can plan for the staffing, supplies, and space necessary to provide them with the best possible care.
Likewise, by having constant surveillance of patients within the system, developing trends (i.e. specific causalities and categories/severity of injuries, localities of injured personnel, etc.) can be spotted earlier and planned for in a military medical system than spans thousands of miles - from the streets of Baghdad and Kabul to hospitals back home in the United States.
Also, from a command standpoint, having accurate, real-time casualty data enables military commanders to have far better intelligence on where casualties are occurring and to better allocate their personnel to fill the necessary roles that have been lost to units depleted by injuries. Likewise, this increased intelligence enables commanders to spot any developing trends in non-combat injuries and even self-inflicted wounds, pinpointing the need for increased training and/or monitoring. Finally, the system allows for not just family and friends of the patient wanting to know about their loved ones, but also the patients comrades, to be able to quickly get status reports on injured brother or sister in arms.
Applications in War and Peacekeeping
This patient ID technology has countless possible applications, both inside the military realm in conventional warfare as well as peacekeeping and humanitarian relief roles and beyond into other civilian scenarios. It can be used to better coordinate and deal with any number of large scale, fluid people management tasks, in everything from humanitarian relief efforts to natural disaster aftermath management to terrorist incident responses.
In any scenario where agencies must depend on medical information coming in from the field to better allocate medical, transport, and human resources, RFID-based systems such as this will foster better response capabilities in the not too distant future. According to ScenPro, such systems could assist in a wide variety of civilian applications, including:
Logging first responders in or out of a chemical/biological hot zone
Providing Homeland Security monitoring
Facilitating the preparation of aircraft manifestsand
Managing the interfacility movement of casualties and personnel.
With such systems in place, where patient data will travel with the patient, who will be affixed with an RFID-tagged wristband or dog-tag, the productivity of caregivers and the level of care received will be enhanced by the assurance of medical personnel to be able to read patient data, regardless of their connectivity.
Emergency Units Adopt Technology
Already, we are seeing this technology transfer to the civilian sector. Take the St. Louis Area Regional Response System (STARRS) for example. STARRS is a regional organization that was formed to coordinate planning for responses to large-scale critical incidents in the St. Louis, Missouri areas. With funding from a Department of Homeland Security grant program, STARRSs mission is to help local governments, businesses and citizens plan for, protect against and recover from critical incidents, such as natural disasters, as well as any potential chemical, biological, radiological, nuclear and explosive terrorist attacks. A centerpiece of the STARRS program is improving the ability of emergency medical services (EMS) workers to better identify and deal with incident victims in the field and coordinate potential care and transfer of patients for hospital care. With over 200 hospitals and 40 fire departments in the greater St. Louis area, the communication and coordination challe nges are immense.
IBM Global Business Services designed and implemented the communication solution, enabling EMS workers to quickly identify and take medical information in the field and attach an RFID-equipped wristband to the patient, which can then be wirelessly transmitted to authorized parties in the STARRS network. The RFID-based solution allows fire and police commanders to better allocate resources to where they are needed in responding to a critical incident, and enabling hospitals to better anticipate their patient loads and coordinate care and staffing needs in a mass casualty event. Another benefit is to the families of those who might be impacted in such a natural disaster or terrorist attack, as they will be able to more quickly learn of the medical condition and location of their loved ones. STARRS deputy director Nick Gragnani recently commented: In any emergency situation where human lives are at stake, seconds count. Better medical information provided more quickly means bet ter patient care and more lives saved.
In the end, the success stories of the TagMedCS system in the military realm and STARRS in the civilian setting make a strong case for the wider use of RFID in tracking individuals be they patients, casualties, refugees, or survivors in any emergent, fast-moving situation where coordination between various agencies and entities is critical. A recent report from consulting firm Frost & Sullivan deemed hospitals the most attractive market for RFID, but cautioned that RFID-based solutions are often seen as cost prohibitive versus barcode-based applications.
Analysis: Technology Saving Lives
However, with an increasing emphasis on homeland security and interagency coordination, developments such as these could go a long way to providing increased value from RFID-based solutions and make an attractive business case for implementing such tracking systems even within a hospitals four-walls so that individual healthcare entities can be a vital link in bettering emergency response capabilities across an entire area. Such developments could make healthcare an especially attractive area for RFID hardware, integrators and solutions providers, while improving the health and welfare of both military and civilian personnel in the process.
In doing so, some scary situations can be made better through the innovative use of RFID. But even more importantly, survival rates and treatment for those injured can be improved even more. In the US military today, the wounded speak of their Alive Day the day on which they were injured and survived. With better identification and coordination, more injured servicemen and women and civilians can look back on what may have been the worst day of their lives as a milestone from which they can indeed recover.
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David C. Wyld () is the Robert Maurin Professor of Management at Southeastern Louisiana University in Hammond, Louisiana. He is a management consultant, researcher/writer, and executive educator. His blog, Wyld About Business, can be viewed at /.
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