MC4 Plays Integral Part in the U.S. Army's Casualty Care System for Roles 1-3

Fort Detrick, MD. - The Medical Communications for Combat Casualty Care (MC4) systems support Roles 1-3 of the U.S. Army’s modern health services support system covering the operational environment to the hospital facility. The U.S. Army supports the effective distribution of resources across facilities at various levels of command, across different locations, each with differing levels of capability. The goal for the U.S. Army is to provide the most efficient means to save the Soldier’s life and “ensure the stabilization and survivability of the patient through advanced trauma management and far-forward resuscitative surgery prior to movement between medical treatment facilities,” as stated in DoD’s fourth revision of Emergency War Surgery.

MC4 plays a key part in support of Roles 1-3 by integrating and fielding the Army capability to digitally capture medical treatment data, specifically the Soldiers’ electronic health record (EHR), in these dynamic operational environments. The EHR is accessible by the Soldier and his/her medical treatment providers throughout their military career and retirement, and eventually by Veterans Affairs (VA).

In support of the Soldier’s EHR in operational environments, MC4 enables the clinical documentation and management software application called AHLTA-Theater. The AHLTA-Theater application suite is available at all Roles (1-3) and includes access to Defense Medical Logistics Standard Support (DMLSS) Customer Assistance Module (DCAM), a logistical support tool for ordering medical supplies, access to medical references, the Medical Situational Awareness in the Theater (MSAT) which combines information to provide decision support and a common operating picture, the Theater Medical Data Store (TMDS) and DoD’s Clinical Data Repository (CDR).

The Roles 1-3 process begins when the patient moves from the point of injury (POI) into the care of specialized medical professionals trained in tactical combat casualty care, stabilizing surgical treatment and trauma management. Depending on the critical or urgent nature of the patients’ condition, it is possible to bypass a role in order to move to a higher level of capability that matches the needs of trauma management, resuscitative care and stabilization.

Point of Injury (POI): 

Before Roles 1-3 even begins the actual start of the process occurs at the POI. At this early stage, first-aid care is provided by a combat medic, buddy or combat lifesaver (non-medical team or squad member trained in enhanced first-aid) in order to take immediate lifesaving measures to the injured Soldier.

Role 1: Role 1 is the battalion aid station where the patient is treated by a physician, physician assistant or medic. If necessary, after triage, treatment and stabilization, the Soldier either returns to duty or is evacuated to a role 2 or appropriate medical treatment facility (MTF). Treatment in Role 1 does not have to be combat related. Patients with non-battle injuries, disease, and behavioral and operational stress conditions can also be treated. Role 1 facilities do not have the capability for patient holding (inpatient type treatment).

MC4 provides systems support at the POI and Role 1 stages with Mobile Computing Capability (MCC) and AHLTA-Theater.

Role 2: Role 2 MTFs are brigade level support with levels of care that range from basic primary care to lifesaving emergency treatment. This role can provide advanced trauma management and emergency measures that go beyond Role 1. Role 2 provides an advanced level of capabilities than Role 1 which can include 72-hour patient hold, blood transfusions, x-ray, clinical labs, dental support, optometry services, physical therapy and combat operational stress control when augmented. A forward surgical team (FST) can be collocated with the medical company to provide resuscitative surgical care. The main assets that make up Role 2 are located in medical companies (brigade support battalion) assigned to armored, infantry and Stryker battalion combat teams and area support units that directly support divisions and echelons above brigade.

MC4 provides systems support at the Role 2 stage with AHLTA-Theater and DCAM.

Role 3: In Role 3, patients are treated at a non-mobile facility known as a Combat Support Hospital (CSH) that is equipped to provide care to all categories of patients: wound surgery, resuscitation, damage control surgery and postoperative treatment. The CSH provides inpatient (emergency room (ER), intensive care unit (ICU), operating room (OR), nursing care) and outpatient (pharmacy, psychiatry, public health nursing, physical therapy, clinical laboratory, blood banking, radiology and nutrition care services) capabilities. Patients who cannot survive movement over long distance are treated at a Role 3 CSH. The Role 3 CSH can support as many as 248 patients for up to six OR tables. Surgical specialties at a Role 3 CSH include general, orthopedic, thoracic, urological, gynecological, and oral and maxillofacial surgery.

MC4 provides systems support at the Role 3 level with AHLTA-Theater, which includes TC2 server and inpatient documentation.

Finally, it is important to note that MC4 systems indirectly support Role 4 hospitals as well. The TMDS cloud application transmits patient medical treatment information from the combat zone through theater levels of care (Roles 1-3). These theater levels of care and MTFs access and share patient data with hospitals and the VA (Role 4). In essence, MC4’s support of the lifelong digital record enables that Soldier’s EHR to be transmitted from the battlefront to the homefront.