Forum Summary

In the military, medical care is divided into discrete levels, and soldiers wounded on the battlefield are usually transferred from one level to the next without skipping any levels.  The first level of care is provided on the battlefield by a soldier’s buddies or by combat medics.  Next, a wounded soldier is placed under the care of a forward surgical team (FST), which is a highly mobile unit designed to perform major surgical procedures.  Finally, the wounded soldier is transferred to a combat support hospital (CSH), which is a stationary hospital designed to operate continuously with almost unlimited surgical capacity.  In practice, the efficacy of this system is limited by the difficulty of transferring medical information from one level of care to the next.

In the middle of a combat situation, it is not easy to transfer medical documentation along with wounded soldiers.  While stationed at a CSH in Baghdad, David King, MD, cared for 105 soldiers who were transferred to the hospital from either an FST or from the battlefield.  Of these 105 soldiers, only 17 had dog tags, and none had a field medical card.  Nine of the soldiers had paper charts describing the care that they had already received, and thirty-seven others had improvised medical records, most of which were written on bandages.  Of these thirty-seven improvised records, only thirty-one were legible.  When Dr. King was stationed with an FST, he transferred 44 soldiers to a CSH.  He wrote a paper medical record and an improvised medical record for every patient.  Only 11 out of 44 paper medical records arrived, and 42 out of 44 improvised medical records arrived.  Of the improvised records that arrived, 40 were legible. 
These statistics suggest that communication between FST’s and CSH’s is not very good, even when the care providers do their best to provide medical documentation with every patient.  This lack of communication can have very serious consequences because if a CSH receives a patient with a large incision and no documentation, surgeons at the CSH have no choice but to open the patient up again, even if the patient has already undergone definitive surgery.

One way to ensure that medical records are effectively transferred from one level of care to the next would be to embed a microchip filled with health information inside every soldier.  Existing devices would have to be adapted in a number of ways in order to make them suitable for the military.  They would need to have expanded memory so that they could store images, and they would have to allow one to write to the device in real time.  They would also have to be secure, and they would have to have a low energy profile so that enemy troops could not use signals from the devices to locate American soldiers on the battlefield.  With these modifications, implantable microchips could provide a way to ensure that medical information is not lost as wounded soldiers are transferred from the battlefield to the hospital.      

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