RFID in Iraq The TacMedCS Project

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RFID in IraqThe TacMedCS Project

• Bob Hoyt MD
• CAPT USNR

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Background

• In late 2002 the Naval Aerospace Medical Research
  Laboratory and SCENPRO evaluated RFID for
  tracking of military personnel thru a research
  grant
• Original concept was to be able to track military
  members from day 1 throughout the combat
  theater. Wrist band, dog tag or implantable chip
  would be issued to all military deployed

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Background

• No thought given to use it to track inpatients or
  non-military
• By coincidence fleet hospital members learned
  about the project in early 2003 and asked if they
  could alpha test the product during an upcoming
  deployment to Iraq

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Background

• Several fleet hospital members provided input as
  to how we thought we might use RFID
• Once our perceived needs were outlined to SCENPRO
  the timeline to modify the software was extremely
  short
• The modified system was delivered to us by
  SCENPRO in 11 days one week before deployment

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Backgroundfleet hospitals

• We deployed a 116 bed EMF (expeditionary medical
  force) for three months in March 2003.
• EMF was staffed by about 277 Naval personnel
  primarily from the Naval Hospital Pensacola
• There are 6 active duty and 4 reserve fleet
  hospitals
• Fleet hospitals are pre-positioned in various
  CONUS (continental US) OCONUS (out of
  continental US) locations.

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Backgroundfleet hospitals

• Capable of operating in a variety of climates.
• Mobile and capable of rapid relocation.
• Capable of supporting long-term operations of 60
  days or greater
• Essentially self supporting for 30 days with
  exception of water, fuel and blood.

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Backgroundfleet hospitals

• Rapidly Assembled. 500 Bed - 10 days EMF - 3 to
  5 days
• Shore Based. 500 Bed - 28 Acres EMF - 2 Acres.
• A large footprint. 160 ISO containers to
  transport an EMF via trucks or by ship

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Echelons of care
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EMF Clinical Characteristics

• 2 - Operating Room Tables
• 20 - Intensive Care Beds
• 96 - Acute Ward Beds
• Crew 277

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Fleet Hospital Components

• Operating Room Preparation and Hold
• Operating Room
• Oral Surgery/Dental
• Central Sterile Reprocessing
• Blood Bank
• Medical Repair
• Preventive Medicine

• Casualty Receiving and Treatment
• Surgical Suite
• Laboratory
• Intensive Care Unit
• Radiology
• Treatment/Recovery Wards
• Pharmacy

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Modular design of an EMF
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Patient flow
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Background

• After staging in Kuwait for almost one month we
  proceeded into southern central Iraq just after
  the war began
• We were operational in 5 days
• We were the first fleet hospital to move into a
  war zone

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War Begins-Camp Luzon , Kuwait
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Transiting to Iraq from Kuwait
Camp Viper
Camp Luzon
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CAMP VIPER
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First 96 Hours of Operations

• 82 Admissions
• 36 US 46 Iraqi
• 50 Surgical Cases
• 9 US 41 Iraqi
• 25 Outpatient Urgent Care Visits

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FH3 Statistics

• 52 Days of Operations
• 355 Surgical Cases
• 578 Admissions
• 454 Outpatients Treated in CASREC
  and returned to duty

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Casualty Receiving and Triage
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Preparing CASREC for Patients
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Operating Room 1
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Critical EPW Patient
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Sleeping Bag Critters
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Other Distractions

• Temperatures between 110-130 degrees during the
  day
• Constant dirt/sand/dust, making floppy disks and
  CD-ROMs useless
• Panasonic Tough Book laptops held up well
• Frequent, sudden and unpredictable sand storms
  would down tents and fill all cavities with
  dirt/sand/dust
• Tents have metal frames possibly interfering with
  wireless capability

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Identification Challenges

• Casualties often arrived from a combat zone with
  no information as to their injuries or where they
  came from
• Iraqis changed from EPW (enemy prisoner of war)
  to displaced civilian status and back multiple
  times
• No database for ID of Iraqi patients
• No universal combat database for coalition forces
• Multiple ways to spell same Iraqi name
• Patient could be sent to hospital ship and then
  back to fleet hospital with four wrist ID bands
• Difficult to identify members of a family
  especially the children

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What is TACMED-CS ?

• Tactical Medical Coordination System is a
  wireless communication system utilizing Radio
  Frequency (RF) technology to capture, store and
  display real-time casualty data in the field.
• These data may be incorporated in the
  identification, location, and acuity of patients
  in order to track casualties and manage medical
  resources.

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TacMedCS Background

• Real-time awareness of casualty status and
  location will allow Medical personnel to more
  quickly respond with needed evacuation resources.
• This real-time information will also help Medical
  personnel plan for incoming casualties. With
  advanced warning, medical personnel will be able
  to more quickly identify the resources required
  for specific injury types and severity.

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TACMED Concept of Operations at Fleet Hospital 3

• Incoming casualties are tagged and registered by
  Patient Admin Staff
• Pertinent casualty data is stored on RF Tag and
  Handheld unit by the Casualty Receiving Corpsman
• Data stored in handheld unit is uploaded to local
  database
• If connectivity is intermittent, casualty data is
  still available on RF Tag (medical data moves
  with the casualty)
• Visual displays provide enhanced, real-time
  situational awareness of hospital census

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Fleet Hospital 3 Configuration of TACMED-CS
Handhelds
Second database
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Hardware supplied

• 400 RFID wristbands 13.56MHz. 2 K memory
• 5 RFID hand held reader-writers. 16 MB of SDARM
  and 16 MB of flash memory. Windows CE OS. 802.11b
  wireless card.
• Laptop server with TacMedCS database
• Wireless network that linked handheld units and
  server stored in CasRec

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Triage-ID band applied

• Picture of hospital staff

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TacMed-CS Wristband
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Scanning a Patient
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Demographic Data Capture
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Splash Screen at TRIAGE
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Disposition Screen
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Microsoft Access Database
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Administrative Console

• Splash screen shot

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Lessons Learned
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Lessons Learned
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Lessons Learned
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Lessons learned
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Overview

• Identification of all military members is very
  important. Should be available prior to
  deployment and consist of basic information to
  include blood type, etc
• ID needs to be encrypted and physically secure.
• Identification of EPWs and displaced civilians
  is also very important and should also include
  photos on ID band

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Overview

• RFID has great potential for battlefield
  casualties
• Technology will have to evolve to guarantee fast
  and reliable transfer of information to and from
  an ID tag
• Technology will have to match fast moving
  surgical companies forward as well as ships,
  planes and fleet hospitals in the rear