By Lt. Olivia Peduzzi, Lt. Cmdr. Rebecca Miranda, Cmdr. Andrew McDermott, Lt. Cmdr. Christopher Weiss, Lt. Cmdr. Brandon Hadfield, Cmdr.David A. Paz, Capt. Timothy Quast
Acute mental health (MH) care for is critical Sailors at sea, and poor MH can have disastrous consequences if not addressed effectively and with expedience. Frequently, the only option is a potentially hazardous and costly emergent medical evacuation (MEDEVAC), which can not only alter the overarching mission and result in lost on-station days for the ship, but also yields fragmented health care to warfighters in a mental health crisis. As the Military Health System (MHS) adjusts course with the Department of Defense’s focus on warfighter readiness, Navy Medicine, working with the Defense Health Agency, is ensuring both a ready medical force and a medically ready force. Navy Medicine must find innovative ways to integrate with operational units and their existing schedules to provide adequate support as we work to keep Sailors mission-ready at sea.
As of August 2019, the use of existing shipboard technology to treat patients virtually was merely conceptual. For non-emergent cases, secure video teleconference (VTC) consultation from a shore-based medical specialist assigned to a Military Treatment Facility had only been demonstrated once as a proof of concept. The success of an underway “VT-Sea” consultation performed aboard the Arleigh Burke-class guided-missile destroyer USS Chung-Hoon (DDG 93) entitled “Treatment on the Waves: Exploring the Potential of Medical VT-Sea” was published by Carrier Strike Group Three in April 2018 on the Defense Visual Information Distribution Service.
In 2019, U.S. Naval Hospital (NAVHOSP) Rota used their corporate knowledge of the 2018 proof of concept aboard Chung-Hoon to collaborate with U.S. Navy destroyers homeported at Naval Station (NAVSTA) Rota and embedded MH assets at Destroyer Squadron (DESRON) 60 to explore the potential expansion of medical VTC for MH patients while underway. The hospital leveraged this proof of concept into a pilot focused on acute MH patients, broadening the virtual health aperture with the goal of having a positive impact on mission completion for Rota’s four forward-deployed naval forces (FDNF) destroyers.
MH VTC, at sea’s primary intent, ensured Sailors receive adequate care while underway, thereby limiting the need for MEDEVAC, which keeps ships on station to accomplish their mission. These Sailors would normally require MH evaluations and treatments ashore. Still, by utilizing the pilot program, they can remain aboard their ship with the support of the MH provider via VTC. Additionally, specialists were able to more rapidly determine the need for emergent MH MEDEVAC through virtual assessment. The secondary benefit of the program was the ability to assess the overall impact to ship’s mission, including the monetary amount saved and the number of on-station work days not lost due to MEDEVAC, as well as demonstrate how a MEDEVAC can impact operational tempo, electronic emissions control, and diversion from planned navigation. To assist in these efforts, NAVHOSP Rota performed a cost analysis that estimated an MH MEDEVAC, while underway, equates to a cost of up to $175,000 and 60 lost manpower days, on average, in addition to the operational impact to the mission by losing key personnel.
In 2018, 12 DESRON 60 Sailors required underway MEDEVAC for acute MH concerns, totaling an estimated cost of $2.4 million and 720 lost days on station. The embedded MH asset at DESRON 60, a Licensed Clinical Social Worker, conducted connectivity testing with the homeported destroyers to demonstrate a reliable service with appropriate therapy algorithms prior to launching the NAVHOSP Rota pilot program in August 2019, when the capability was deployed to the four ships. MH evaluations and treatments were offered to Sailors who expressed acute distress while underway, with full support from the ship’s Independent Duty Corpsman, commanding officer, and DESRON 60.
From August to December 2019, a total of 11 Sailors received MH services via the NAVHOSP Rota VT-Sea pilot program. One patient was properly identified for MEDEVAC, with the remaining 10 Sailors staying aboard for the duration of the mission. The 10 Sailors who remained on station were provided acute MH treatment upon return to Rota, as determined during the MH VTC evaluations. Following deployment of MH VTC at sea in 2019, there was only one MH MEDEVAC over five months, an 80 percent reduction in MEDEVACs compared to 2018 when the average was one MH MEDEVAC per month.
It is challenging to prove a true cause-effect relationship from the limited data pool. Still, it is likely that the Sailors diagnosed with acute MH crises would have needed an emergent MEDEVAC had they not had access to MH VTC at sea. It is also possible that knowing there was readily accessible specialty care while underway provided a form of support for MH patients. The ability to successfully evaluate and effectively treat a Sailor via MH VTC at sea, potentially preventing MEDEVAC, demonstrates the value-added for warfighter readiness.
"Building and sustaining resilient Sailors are at the core of our combat readiness, and our embedded mental health team is excelling in that task by speaking directly with the Sailors when combat readiness matters most... at sea,” said Capt. Joseph Gagliano, DESRON 60 Commodore.
This ongoing pilot has demonstrated rapid success in two areas. First, there is the capability to use existing technology aboard U.S. Navy warships to provide previously underdeveloped healthcare resources to deployed Sailors. This likely carries value in mission completion and support of the forward-deployed warfighter. Second, there are tangible cost and manpower savings that can demonstrate effective use of MHS spending. However, the largest benefit to the individual Sailor in MH crisis carries no fiscal value as our human capital is our greatest resource.
“Using secure VTC with our MH care providers offers commanders a wonderful avenue for keeping Sailors healthy and in the fight at sea,” said Cmdr. Craig Trent, commanding officer, USS Porter (DDG 78). Porter is one of the Rota-based destroyers and was vital in helping develop MH VTC at sea. “It’s a clear win-win for the ship and crew with no additional costs to the ship. Sailors are able to stay at sea and get the care they need!”
The future implications for this pilot are potentially far-reaching. While the NAVHOSP Rota pilot focused on MH, the system could reasonably be utilized for additional medical issues to assist in the decision-making process for MEDEVAC. Extension into this care delivery across the medical spectrum could further decrease mission disruption, saving money and preventing days off station. Leveraging extant communication systems within our warships enables Navy Medicine to properly integrate into how our Navy operates at sea, a concept that is essential as Navy Medicine adapts to provide care within the spectrum of how our Navy maintains maritime superiority.
“We are eager to continue with virtual visits to support the fleet as we are focused on ensuring readiness and will continue to work to establish all means necessary to get to our end-state goals,” said Capt. Andrew Archila, NAVHOSP Rota Commanding Officer.
As our Navy continues to evolve with modernizing technology, it is imperative that Navy Medicine align with whatever is the next communication platform, realizing that medicine, albeit important, is just one of many competing priorities our line commanders must balance while at sea and in harm’s way.
Biography
Lt. Olivia Peduzzi is an ambulatory care nurse currently stationed at U.S. Naval Hospital Rota. She has led the tremendous growth of the telehealth program in the region, coordinating support to ships home-ported at Naval Station Rota as well as specialty care services with European alliance commands.
I am a military service member or federal/contracted employee of the United States government. This work was prepared as part of my official duties. Title 17 U.S.C. 105 provides that `copyright protection under this title is not available for any work of the United States Government.' Title 17 U.S.C. 101 defines a U.S. Government work as work prepared by a military service member or employee of the U.S. Government as part of that person's official duties.
| Date Taken: | 07.29.2020 |
| Date Posted: | 07.29.2020 08:08 |
| Story ID: | 374789 |
| Location: | ROTA, ES |
| Web Views: | 262 |
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