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Lessons from the use of telemedicine in the austere military environment and the implications for deployed surgical teams
  1. Gerard McKnight1,
  2. D O'Reilly2,3,
  3. H Guthrie2,
  4. N Aye Maung4,
  5. J Bull5,6,
  6. O Bartels7 and
  7. D Baxter5
  1. 1 Institute of Naval Medicine, Royal Navy, Gosport, UK
  2. 2 Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
  3. 3 Department of General Surgery, Cardiff and Vale University Health Board, Cardiff, UK
  4. 4 Army Special Operations Brigade, Aldershot, UK
  5. 5 Department of Neurosurgery, Royal Centre for Defence Medicine, Birmingham, UK
  6. 6 Department of Neurosurgery, The Royal London Hospital, London, UK
  7. 7 Medical Information Services, Defence Medical Services, Lichfield, UK
  1. Correspondence to Surg Lt Cdr Gerard McKnight, Institute of Naval Medicine, Gosport PO12 2DL, UK; gerardmcknight8{at}


Over the last 20 years, there have been significant changes in UK surgical training. Civilian surgical training may no longer prepare military surgeons for the range of skills they require on operations. One method to address gaps in knowledge or experience is to use telemedicine to facilitate specialist consultations from UK-based specialists to deployed medical teams. In the UK Defence Medical Services (DMS), this capability is called real-time clinical support (RTCS). RTCS provides a direct audio-visual link from a deployed location anywhere in the world to a supporting medical specialist in the UK. RTCS is currently delivered via a combination of off-the-shelf hardware and commercially available software. This article will outline the current use of RTCS, with emphasis on deployed surgical teams in austere environments, and discuss the advantages and limitations of this capability. However, it must be emphasised that no technology can be a substitute for clinical training and experience. Although several limitations remain, the authors believe that RTCS offers potential benefits for the DMS and could be an important tool aiding deployed clinicians. It can also be argued that by engaging with the concept now, the DMS can shape future developments in this sphere.

  • Telemedicine
  • Trauma management

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  • Contributors The article was proposed by DB who was also senior author. OB is Officer Commanding Project LARA and GM drafted the article. DB, HG and DO'R were the remote and deployed surgeons involved in the early operational trials. All authors critiqued and approved the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.