Sustained demand for dermatologic care throughout military medicine, in conjunction with increasing dermatologic provider shortages, has led to increase use of teledermatology in military treatment facilities (MTFs). Initially used to aid in the differentiation of suspicious melanocytic lesions, dermoscopy has found increasing clinical utility in an expanding realm of general dermatologic conditions. We demonstrate the use of synchronous teledermoscopy within a remote MTF by repurposing webcam technology already available at most MTFs. Two patients were seen in clinic at a remote naval primary care clinic with limited subspecialties. Once written consent was retrieved, an on-site dermatologist evaluated each patient and performed a history and skin exam with dermoscopy. Synchronous consultations were conducted with the Global Med Cart (GlobalMed(R) Clinical Access Station with TotalExam(R) 3 HDUSB camera), and Cisco webcam video jabber (Cisco TelePresence PrecisionHD USB Camera part number TTC8-03). The patients then underwent individual synchronous teledermatology consultations with an off-site U.S. Navy dermatologist located in the continental United States. The methodology for the consultation involved the use of a standard dermatoscope and jabber webcam. Two synchronous teledermatology consultations were completed successfully on patients in MTFs with limited subspecialty capabilities. Both cases, with two lesions of concern per case, had 100% concordance between the on-site and teleconsulted dermatologist. Through observing inter-rater agreements between the on-site and remote dermatologists, this small study demonstrates a novel application of technology readily available at most MTFs.

In August 2017, the USS Bataan received a mass casualty incident (MCI) of 6 foreign special forces operators after a helicopter crash. All 6 patients were medically evacuated successfully to the USS Bataan, and all patients survived and were successfully returned to their allied country. Four of the patients received whole blood with 2 receiving over 10 units of blood or massive transfusions. One patient required 44 units of blood, and at 1 point in his resuscitation, he received 12 units of whole blood every 30 minutes. Due to administrative factors outside of the ship’s control, these 6 patients had prolonged stabilization during the MCI. This factor differentiates this MCI on the USS Bataan from previous cases. Internal medicine trained physicians with their expertise in inpatient care, postsurgical management, and critical care were instrumental in sustaining these casualties in this prolonged stabilization environment. In the era of distributed maritime operations, where casualty-receiving ships will experience more geographic and resource isolation, there is a potential for the need for prolonged stabilization above the 6 to 12-hour window typical of role II platforms. The known increase in cardiac and pulmonary morbidity and mortality with medical evacuation delay highlights the importance of internal medicine physicians in the role II setting. It is critical that we emphasize the inpatient and critical care principles of these patients in the prolonged field care environment.

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