Italian Military Medical Services and Telemedi

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DEFENCE GENERAL STAFF - ITALY STATO MAGGIORE DELLA DIFESA IV Reparto - Ufficio Logistico THE ITALIAN MILITARY MEDICAL SERVICES AND TELEMEDICINE LtCol (MD) Glauco CALI’ TELEMEDICINE WORKSHOP AND 3RD MEETING OF THE SIMIHO NEW EXPERTS TECHNICAL GROUP Rome, 7 - 8 July 2003

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MILITARY MEDICAL SERVICES

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BATTLE OF QADESH (1298 b.C.) EGYPTIANS HITTITES XX AMON RHA PTAH SETH ?? 5000 men 5000 men 5000 men 5000 men XX XX XX ? AUXILIARIES AMORRITES ?? men MEDICAL SERVICE ? 19.000 men 18.000 men ? 200 CARTS 3.500 CARTS

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INDEPENDENCE WARS 1848 - 1870 WORLD WAR I 1914 - 1918 WORLD WAR II 1940 - 1945 PEACE SUPPORT 1980 - 2003 ETHIOPIA WAR 1935 - 1936 CRIMEAN WAR 1853 - 1855 HYSTORY THE BIRTH OF THE MODERN MILITARY MEDICAL SERVICE IN ITALY DATES BACK IN JUNE 1833 BY A ROYAL DECREE OF THE KING OF SARDINIA

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THE MISSION OF THE ITALIAN MILITARY MEDICAL SERVICES IS: TO PROTECT, AT ALL TIME, LIFE AND HEALTH OF MILITARY PERSONNEL (NATIONAL AND INTERNATIONAL, WITH NO DISTINCTION) AND, SECONDLY, CIVILIAN POPULATION. THIS MISSION IS CAPTURED BY THE MEDICAL CORPS MOTTO: “FRATRIBUS UT VITAM SERVARES” (“IN ORDER TO SAVE OUR BROTHERS’ LIFE”) MILITARY MEDICAL SERVICES : THE MISSION

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MILITARY MEDICAL SERVICES

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MILITARY MEDICAL SERVICES : INSTITUTIONAL TASKS

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FOUR MEDICAL SERVICES, ONE FOR EACH ARMED FORCE (ARMY, NAVY, AIR FORCE AND CARABINIERI). THEY ARE UNDER THE AUTHORITY OF THEIR CHIEF OF THE STAFF, THROUGH FOUR SURGEON GENERALS. MOREOVER, A “DIRECTOR GENERAL” OF THE MEDICAL SERVICES ESTABLISHES TECHNICAL GUIDELINES, WITH NO OPERATIONAL AUTHORITY. MILITARY MEDICAL SERVICES : PRESENT SITUATION

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MILITARY MEDICAL SERVICES : PRESENT SITUATION

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MILITARY MEDICAL SERVICES : HUMAN RESOURCES ITALIAN ARMY MED. SERVICES

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MILITARY MEDICAL SERVICES : THE FUTURE IN DECEMBER 2002, IN ORDER TO UPDATE THE ORGANIZATION OF THE MILITARY MEDICAL SERVICES, THE MINISTRY OF DEFENCE AND THE GENERAL STAFF PROPOSED A REFORM LAW TO THE PARLIAMENT. THE NEW ASSET IS BASED ON A JOINT MEDICAL SERVICE

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MILITARY MEDICAL FACILITIES : THE POSSIBLE WAY AHEAD RESPECT OF TRADITION

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MILITARY MEDICAL SERVICES : DOCTRINE & ORGANIZATION

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ALBANIA NORWAY SOMALIA BOSNIA TURKEY LEBANON IRAQ CAMBODIA (Carabinieri) MOZAMB. EGYPT WESTERN SAHARA ETHIOPIA NAMIBIA RWANDA GUATEMALA MALTA FYROM KOSOVO

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MILITARY MEDICAL SERVICES : OUT OF AREA OPERATIONS

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THE PATIENT’S LIFE OFTEN DEPENDS UPON: EFFECTIVE & PROFESSIONAL TREATMENT DURING THE FIRST HOUR (“GOLDEN HOUR”) CORRECT AND RAPID MEDICAL EVACUATION (IAW NATO STANDARDS) MILITARY MEDICAL SERVICES : DOCTRINE & ORGANIZATION

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MILITARY MEDICAL SERVICES : NATO ROLES EVACUATION FROM PREVIOUS ROLES LONG TERM TREATMENT REHABILITATION FIRST AID LIFE SUPPORT TRIAGE EVACUATION EVACUATION FROM ROLE 1 TRIAGE & RESUSCITATION PATIENTS TREATMENT EVACUATION TO ROLE 3 / 4 EVACUATION FROM ROLES 1 & 2 SPECIALIZED TREATMENT EVACUATION TO ROLE 4

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FIRE LINE

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QUICK MEDICAL EVACUATION TELEMEDICINE

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MILITARY MEDICAL SERVICES

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2 SERVICE TROLLEYS OTHER MEDICAL FACILITIES IN PNEUMATIC TENTS OR PORTA-CABINS MILITARY MEDICAL SERVICES : FIELD HOSPITAL (ROLE 2 +)

SHELTERS CAN BE TRANSPORTED BY:: 

SHELTERS CAN BE TRANSPORTED BY: HERCULES C 130 - FIAT G 222 TRUCK TRAIN CH 47

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MILITARY MEDICAL SERVICES : BEGINNING OF THE TELEMEDICINE EXPERIENCE “SHARED PROJECT”

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SPECIALITIES OPHTALMOLOGY PATHOLOGY RADIOLOGY NEURORADIOLOGY NEUROSURGERY PAEDIATRICS DERMATOLOGY SURGERY ENDOCRINOLOGY GYNAECOLOGY CARDIOLOGY HAEMATOLOGY ACTIVITY (16 September 1996 - 15 September 2002) 6,203 hours of satellite connection 722 hours of technical tests 2,194 hours of Telemedicine sessions 759 teleconsultation sessions 537 civilian cases (296 diagnosis e therapy; 241 only therapy) 222 military cases (174 Italians; 48 Allied) "on line" surgical operations

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AREA OF MILITARY INTEREST : N = Northern Sea S = Equatorial Africa E = Middle East W = Atlantic Ocean

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OBSOLESCENCE OF TELEMEDICINE DEVICES AND STATIONS TELEMEDICINE UPGRADING AND UPDATING PROJECT APPROVED BY THE DEFENCE GENERAL STAFF OPERATIONALLY ORIENTED COMPATIBLE WITH THE NATO TM REQUIREMENTS

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BUDGET OF THE PROJECT 5 MILLION € IN 4 YEARS (2003 – 2007)

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CONNECTION WITH MEDICAL UNITS IN REMOTE AREAS CONNECTION WITH TELEMEDICINE NETWORKS TELECONSULTATION (SECOND OPINION) ASSISTANCE DURING MEDICAL EVACUATION DIRECT ACQUISITION & TRANSMISSION OF MEDICAL DATA (TELERADIOLOGY, TELEIMAGING, MICROSCOPE IMAGES, ETC.) TELEBOOKING SYSTEM FOR MEDICAL EXAMINATIONS, EXCHANGE OF MEDICAL RECORDS AND DATA WITH DATA BANKS, HARMONIZATION WITH THE MILITARY INDIVIDUAL SMART CARD (IN PROGRESS) PATIENT (FIGHTER) TELEMONITORING DISTANCE MEDICAL EDUCATION MILITARY MEDICAL SERVICES : PURPOSES AND FEATURES OF THE TELEMEDICINE SERVICE

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MILITARY HOSPITALS OF MILAN, BARI, TARANTO AND FIELD HOSPITALS Digital scanners (DICOM 3 format) iPACS servers ROME MILIT. GEN. HOSPITAL Installation of the telebooking & data exchange system Acquisition of software for teleradiology Installation of gateways interfacing satellite and terrestrial nets THREE TELEMEDICINE STATIONS IN MINI SHELTERS 3 new Ku satellite terminals (“fully redundant” – DVB format - 2Mbps) INSTALLATION OF TERRESTRIAL BROAD BAND COMMUNICATIONS in the main military medical centers

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MINI – SHELTER F IAT VM 90 THREE TELEMEDICINE STATIONS IN MINI SHELTERS

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NAVAL TELEMEDICINE SHIPS TO BE PROBABLY PROVIDED WITH A TM SYSTEM:

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IN ORDER TO FACE THE FUTURE CHALLENGES IN OUT OF AREA MEDICINE CONCLUSIONS