Medical breakthrough

During a routine foot patrol looking for insurgentsin Mosul, Iraq, Master Sgt. WyntonHodges broke his ankle in two places.He was placed on a vehicle and broughtback to the Army's combat support hospitalfor treatment. As soon as Hodges'treatment began, every detail ofhis care was recorded electronically in theMedical Communication for Combat CasualtyCare (MC4) system.Hodges was treated in theater and receivedphysical therapy in Iraq, all of which wasrecorded in MC4.When his 2006 deployment ended, Hodgeswas stationed in San Antonio, where he startedhaving problems with the same leg.Hodges went to the Brooke Army MedicalCenter for follow-up care. A physical therapistat the center peppered Hodges withquestions: When did you break your ankle?Which bones were broken? What treatmentwas rendered? What kind of physical therapydid you undergo?"I'm looking at him and trying to think,"Hodges said. "It was 15 months ago, hundredsof missions later. I had limited information.I couldn't give him all the details."However, Hodges knew all that informationwas stored in MC4, and he asked thetherapist if he could access it.The therapist could. "He was able to bringup my treatments and everything I receivedin Iraq, which led him to [send me] to anorthopedic surgeon," Hodges said.Hodges had successful surgery on bothlegs. He said MC4 led him towardthe correct care.The MC4 program relies heavily on ruggedizedhardware from communications andcomputing giants Hewlett-Packard Co.,Motorola Inc. and Panasonic Corp. Thesecompanies provide a wide variety of devicesfor MC4, including handheld devices, laptopPCs, servers and printers.The handheld computers used for MC4 arethe HP iPaq 4700 and Motorola MC70. Forlaptops, MC4 uses the Panasonic ToughbookCF51 computer. In some instances, thePanasonic Toughbook is used as a serveraccessed by other Toughbooks.The ability to record medical records electronicallyand have those records accessiblefrom anywhere could be the model for otherhealth care systems, said Col. Kelly Wolgast,deputy commander at the 14th Combat SupportHospital.Wolgast was deployed to Afghanistan,where her unit used the MC4 system extensivelyin treating patients. "With MC4, soldiersnever have to worry about their recordbeing lost," she said, "It is all archived andsaved for them in the future."MC4 is used at all Army and Air Forcemedical facilities, on the battlefield, and in theMultinational Forces and Observers Effort inSinai, Egypt. Army Special Forces, Navy andMarine health care providers throughoutSouthwest Asia also use the system.More than 5 million electronic medical records have been captured since MC4'sdeployment in 2003.The system gives soldiers better continuityof care while giving providers up-to-dateinformation to avoid repeat procedures. It alsoprovides commanders with improved medicalsituational awareness to better place medicalresources and personnel on the battlefield.Important medical information about apatient can be sent via MC4 from the battlefieldto any hospital or doctor's office withaccess to the system."I don't think a lot of people realize thatwhen soldiers deploy, they don't deploy withtheir medical records," Hodges said. "Havingthis computer system and being able to go inand query the system anywhere in the worldis a huge step forward."Hodges worked as a medic and remembershow the system helped a wounded soldier whowas hit by an improvised explosive device inIraq. As he was evacuated to the Green Zonein Baghdad, doctors there were able to see thedetails about his injuries and care so theycould be prepared to meet his specific needs.Those kinds of electronic records were notavailable in the recent past, said Hodges, whoalso was a medic in Bosnia in the 1990s.Hodges said he recalls being hospitalizedthere, and all the charting and recordkeepingwas done by hand."I'm not sure the care I received in Bosniais in my permanent paper medical records,"he said. "But I can tell you with certainty thateverything that happened to me in Iraq is inthe digital MC4 system."Using the MC4 handhelds, even soldierswho are wounded in remote parts ofAfghanistan start having their medical informationrecorded automatically as soon ascare is provided so medical staff at BagramAir Base are able to monitor the care.The system records a patient's injuries,vital signs and treatments. All that informationwasn't necessarily recorded in the oldpaper-based days, Wolgast said."In the old days, in the heat of taking care ofa soldier in a casualty situation where youmight have been taking enemy fire, you didwhat you had to and then you recorded theinformation by hand later," Wolgast said. Tryingto recall details after the fact occasionally led toomissions or inaccuracies, she added.With MC4, the information is recordedautomatically.The Army's MC4 program has deployed morethan 24,000 systems to medical units in Iraqand 13 other countries and has trained morethan 26,000 field medics, doctors, nurses andcommanders on use of the system in combatsupport hospitals and battalion aid stations.The system will even follow soldiers as theyenter the Veterans Health Administration.Hodges said he expects it will benefit himwhen he retires from the service."The VA doctor can either flip through thepaper record and hope that the informationhe wants is there, or he can click a mouse anduse the MC4 system to see the details of myinjury and care," he said.