MC4's Rugged Technologies Save Lives

SPECIAL REPORT: Rugged IT 


By Jeff Erlichman, 1105 Government Information Group Custom Media

The Army's Medical Communications for Combat Casualty Care (MC4) uses rugged technologies to save lives.

As they were crossing the cold, icy river a hail and sleet storm broke out. But those rugged conditions did not stop General George Washington and his 2,400 Continental Army troops from crossing the Delaware on Christmas night 1776. The question was: would the rifles be rugged enough to withstand the elements and provide the firepower for victory.

As the events played out, the nation's fate hung in the balance. When it was over, only three Americans were killed and six wounded, while 22 Hessians were killed with 98 wounded. The Americans were able to capture 1,000 prisoners and seize muskets, powder, and artillery.  It was a victory for the “rugged technology” of the day.

Fast forward to the present and there are U.S. Army soldiers stationed in outposts in Iraq, Afghanistan, Germany, Italy, Japan, South Korea and other bases scattered across the globe.  Like Washington's troops, they rely on the “rugged technology” of today to secure victory – no matter the conditions.



Republic of Korea Army Captain Park, Seong Dae (left) demonstrates to MC4's LTC William Geesey (right) the electronic medical record system used at the Korean hospital in Bagram, Afghanistan.

Using Rugged Technology For Gentle Care
“MC4 has deployed more than 28,000 systems in support of 250 medical units in Operations Iraqi and Enduring Freedom, as well as contingency operations around the world,” MC4 Product Manager LTC William E. Geesey told 1105 Government Information Group Custom Media in a recent interview.

What President Obama is envisioning for medical records in the U.S. is already happening on the battlefield. The DoD has a system in place to record and share Service members' medical data anywhere in the world.

MC4 has also trained more than 33,000 medical personnel on how to use the system. As a result, since 2003, more than 9.8 million electronic patient encounters have been captured. Each year, the system has improved in use and functionality, and has expanded to 13 countries and is used by the Air Force, Navy and Army Special Forces personnel in combat.

According to the Army, MC4 is its combat health support information management system and “it integrates, fields and supports medical (patient) information for tactical medical forces, enabling a comprehensive, lifelong electronic medical record for all Service members, as well as enhancing medical situational awareness for operational commanders.”

By accomplishing this mission, MC4 is providing the Army's solution to Presidential and Congressional objectives which called for a medical tracking system for all deployed Service members.

“What President Obama is envisioning for medical records in the U.S. is already happening on the battlefield. The DoD has a system in place to record and share Service members' medical data anywhere in the world,” declared LTC Geesey.

Rugged Rigors
LTC Geesey described the MC4 system as the deployed medical forces' system of systems for electronic medical recording and medical logistics. “At every level of care on the battlefield, MC4 is used to document patient care from the point of injury to battalion aid stations to combat support hospitals, ensuring Service members have their medical history permanently recorded and available
throughout the continuum of care.”

MC4 also supports the medical logistics community by facilitating the ability to electronically order and track medical supplies on the battlefield. Logisticians have the ability to research requirements, view catalogs and submit orders to their supplier while maintaining an inventory database in the combat zone.

“Because MC4 is a “tactical” or battlefield system, it is engineered to work in austere communications environments,” said LTC Geesey. 

“It has a store-and-forward capability that allows medical professionals to document care without connectivity. When communications are available, the system forwards critical medical data to a centralized database. This is invaluable because it not only provides the next level of care information they'll need to continue caring for that patient, but it provides commanders with a complete medical picture.”

Thus they can use the system and its data to mobilize medical personnel and assets based on data that would have otherwise taken personnel weeks to pull together. Now it's available at their fingertips in a matter of minutes.  This is a decisive advantage in decision making for tactical commanders.

Rugged Must Be Reliable
For LTC Geesey rugged IT is “any system that can withstand the rigors of a combat situation or environment.”

“MC4 systems include ruggedized, cutting-edge hardware and joint, government software,” said LTC Geesey.  “MC4's success depends on its ability to provide durable, reliable hardware that can withstand theater conditions.

“The MC4 handheld is used as a point-of-care handheld assistant, enabling military providers to record, store, retrieve and transfer the essential elements of patient encounters by synchronizing it with an MC4 laptop”, LTC Geesey noted. MC4 laptops host a variety of software applications that facilitate electronic medical recording. Some laptops can be used as standalone servers.

“MC4 deploys a variety of servers to best meet the size and location of the healthcare facility,” said LTC Geesey. “Additionally, MC4 printers enable pharmaceutical label printing as well as paper orders. MC4 provides a wide variety of system packages tailored to the size and mission of the unit.”



Hospital Corpsman Third Class Kevin Sanchez (right), an orthopedic at a specialty clinic in the Expeditionary Medical Facility in Kuwait, demonstrates his use of MC4 to LTC William E. Geesey (back), MC4 product manager.

Rugged Advice
For LTC Geesey, having some level of ruggedness throughout the IT system is not an option. But for others the first question that needs to be asked is “do I even need rugged?” That's because with added capabilities comes added costs - up to 4 times the cost of non-ruggedized units – for example if you are looking to buy notebooks.

If you have determined you need rugged IT, LTC Geesey has some advice.

“We look at the failure rates and service records of fielded equipment to determine if technical specifications need to be modified. We also do market research and product evaluations prior to our technical refresh cycle,” explained LTC Geesey. “Users are provided an opportunity to respond to proposed replacement equipment. Technical specifications are supplied to the RFQ/purchasing process.”

In short, LTC Geesey counseled:
*Don't take a vendor's word for the quality of a rugged product. Ask for detailed test results and, if possible, a copy of the test plans itself.

*Get your hands on the equipment and put it through real-world (user) testing. We have seen certified "rugged" equipment rendered useless after a two-foot drop.

*Make sure that you understand the real environments that your equipment will be used. There are enormous cost savings to be had if semi-rugged is “good enough” compared to fully-rugged.

LTC Geesey added there are several levels of ruggedness necessary to fulfill his mission and that most products are "carrier grade.” These are industrial communications quality for use in fixed medical facilities. “Semi-rugged laptops and industrial rugged handhelds are used in the mobile clinics and vehicles. Currently we do not use fully rugged products.”

He further urged government rugged IT buyers to ensure buy-in from all stakeholders, which includes aligning policies and guidelines to track usage and compliance.

That means involving users up front in the decision-making and communication processes.  According to LTC Geesey, not only does having user input help develop a better system on the front end, but it creates a mutual playing ground whereby everyone can take responsibility for the system from the onset.

“By maintaining an open environment for gathering feedback on system upgrades, training and support, the system can be managed dynamically from the get-go.”

Then, “ensure there is a truly comprehensive commitment to training and supporting the systems.” This includes multiple levels of training, documentation, distance learning and onsite resources.

At first MC4 couldn't commit the resources to technically support the system during the initial fielding of MC4 because of funding, which is one reason why it didn't succeed initially noted LTC Geesey.



MC4 Product Manager LTC William E. Geesey reviews MC4's servers alongside MC4 Kuwait Site Lead Mikki Manning (left) and MC4 Director of Business and Support Bill Weed (right).

“Once we received funding, we provided onsite support and began educating medical unit systems administrators on how to support the system,” LTC Geesey reported. Now the mission has resonated with medical units and MC4 is working closely with units to improve their business processes to include the use of MC4 on the frontlines.

Moving Ever Forward
LTC Geesey said that in the future MC4 plans include sustaining and enhancing operational support, providing a “state of the practice” medical information system and broadening the use of the MC4 system.

Of course, technology does not stand still. So how does LTC Geesey see rugged technology evolving over the next decade? 

“There will be advances made in the connectivity of medical personnel. This means communications down to the individual, not just the facility level. With the new Army wireless products, every MC4 laptop or handheld device will have data and VoIP capability,” explained LTC Geesey.

“It is important to understand that this capability will be some of the first non-combat and control communications available in any new theater of operations.” And it will be rugged.