MC4 Training in Iraq Versus CONUS - SGT(P) Larry R. Rogers, 1st Infantry, Battalion Aid Station NCOIC

I just completed the system administrator (SA) training at Al Assad, Iraq. I think that if the providers received a brief on what MC4 does before they deployed, it would be a great help to the setup and use of the system. There were several things that I didn't know about the capabilities of MC4 that I will now be able to implement when I get back to my forward operating base.

The training that I received at Fort Carson, Colo., was nowhere near the total capacity of what the medical systems are doing in theater. The training lab at Al Assad should be an example for the training classes in CONUS. During new equipment training it is great to go over the programs but you don't get the experience of using all the systems. Some applications, such as Theater Medical Data Server (TMDS) and Joint Medical Workstation (JMeWS), were not even covered during my initial training. Now I can access patient notes from level 2 and 3 facilities that didn't usually make it back to CONUS with the patients.

This system is a great improvement over the paper trail that was used in the past. If we could get the physicians to train on the applications, I don't think that there would be so much angst about the difference between CHCS II T (AHLTA-T) and AHLTA.

It seams that the physicians that talk badly about MC4 do not understand the complexity of the system or they have never used MC4 in theater. My physicians love with the system because it means completing a lot less paperwork even though they do not fully understand the capabilities of Theater Medical Information Program (TMIP) yet. When I get back and teach them what they can do, they're not going to want to go back to AHLTA.

Comments From the Field

SPC James Elliott, 1st Infantry Division
The MC4 service is great. They are the best. I am so grateful to have them.

SSG Muriel Nash, 352nd Combat Support Hospital
Great hardware!

SPC Teya Smith, C Company, 2nd Infantry Division
Easy, convenient, user-friendly system. Truly a great way to track patients and patient progress without the fear of losing paperwork.

Additional Uses for the MC4 Handheld - LTC William Smith, 550th Area Support Medical Company

My biggest criticism is not so much about the MC4 system, but the fact that we routinely lose power causing the servers to not work. To combat the power loss and continue doing our job, I think the providers should try using an MC4 handheld as a backup instead of using pen and paper. This way, you can upload your notes when the MC4 system is up and running again. Another idea is to have a flatbed scanner available so hand-written notes can be included into a patient's electronic medical record (EMR).

During my deployment, I have been to Kandahar, Afghanistan, where the conditions are really austere and since this is a multi-national base with the Canadians running the hospital, there is no MC4 system. We often get patients flown into Kandahar without documentation of injuries or previous treatments.

I have had two HP 4700s to document patient care. Both of which I purchased myself. The dust over here destroys them, even with the protective case. Also, the case makes the handheld very cumbersome to use.

I would like to try an experiment where we use the new Motorola handheld to record patient data every day. Then at the end of the day, we burn a CD-ROM. This way, when we return to an area with the MC4 system, we can upload the records on the CD-ROM so they are part of the EMRs.

Are flight medics getting and using the handhelds? I truly think that point-of-contact documentation is going to be essential. When the patient gets to a level II facility, which may not have MC4, one can continue to document care with the handheld.

I want to help refine this technology for our troops.

MC4 Handheld Used During Treatment of a Sniper Victim - MAJ John Rumbaugh, Battalion Surgeon, 36th Infantry Division

While deployed to Hit, Iraq, the 36th Infantry Division used MC4 handhelds and laptops to document the care given to all of the patients that came into our aid station. We called our aid station the "Shine on the Crazy Diamond Aid Station" and our motto was "No diamond stops shining in our aid station." We understood the importance of the PDAs and we gave training sessions to document patient care on a daily basis.

One day, the system was used to document an injury for a Soldier in our unit – he was shot in the head by a sniper. Upon learning of the injury, I ran into the aid station to get additional medical personnel to come out and help the Soldier.

Providers ran to the Soldier's location and began treatment. The injury, vital information and the treatments performed were also being documented into the MC4 handheld. The Soldier was moved into the aid station where treatment continued.

We evacuated the injured Soldier to a level II medical treatment facility (MTF) with Navy providers and then he went on to a level III MTF to be treated by an Air Force neurosurgeon. From that location, he was transported to Landstuhl Regional Medical Center for additional medical attention. I was able to track the Soldier's treatments through the various levels of care since his information was entered into the MC4 system.

I think it is extraordinary that a Soldier was shot in the head, and within 24 hours, he was operated on by a neurosurgeon and then transported to Germany to be with his family.
We thought the system was a success during our deployment.

A Sailor's Perspective of MC4 -HM1 Thomas L. Mendenhall14th Marine Regiment Medical Department

I was deployed with my unit to Kuwait in 2003 during the first rotation supporting Operation Iraqi Freedom (OIF). During my tour of duty, I was stationed at Expeditionary Medical Facility-Dallas (EMF-Dallas), which operated all the clinics and troop medical centers (TMCs) in Kuwait.

When my unit arrived in Kuwait, we received MC4 equipment to record medical data. At first we were very wary of Composite Health Care
System II-Theater [CHCS II-T (AHLTA-T)] because MC4 is an Army system. Besides the fact that the system was in its infancy, the system was new to us and we found it confusing to use.

Shortly after our arrival in theater, we attended a 4-hour class on how to use the system, but this did very little to help due to the tremendous amount of information that was covered. We might have grasped the system a little better if we had been given student guides, but since we were in a combat zone, I can understand why they were not provided.

One of the first difficulties we experienced with MC4 was getting logon permission into the system. Even our IT personnel were new to the system. They were still learning how to get personnel logged in and how to unfreeze individual passwords. I guess that happens with most new network-based computer systems.

After approximately three weeks, we became better acquainted with the system. We mainly used MC4 for the standard Subjective, Objective, Assessment and Plan (SOAP) medical report functionality and to request labs. I realize that we could have used MC4 for additional uses – including readiness data and pre- and post-deployment health assessments – but we did not use it to its fullest capability.

If my unit used the system to its full potential, it would have made pre- and post health deployment assessments a little easier. It took us a while to learn how a non-provider could close a SOAP note so it could be later signed by a provider.

In time, we became more comfortable with the technology. It was great to print out neat, readable SF600s – chronological record of medical care – and SOAP reports in the desert. Not only were we able to give the Soldiers, Sailors and Marines a copy of their medical records, the electronic documentation ensured that the records would not get lost in the fast moving environment of Kuwait. This is important since units are continuously moving through the region.

Another aspect of the MC4 system that we were impressed with was the anatomic body within CHCS II-T (AHLTA-T). It was good to be able to click on areas of the body to designate wounds.

I think the MC4 handheld would be a tremendous resource for Marine corpsmen and invaluable to have during drills and maneuvers. I'm a believer in training like you want to perform. Having the systems during training exercises would only increase familiarity with the system and makes its use second-nature.

Many times a Marine corpsman will be out in the field with their unit and is the only person to document and apply medical treatments. Being able to legibly and accurately document any ailment – from minor rashes to major wounds – would be great. Additionally, the handheld would reduce the amount of gear to be carried into the field and improve documentation.

Then when the corpsmen return to the medical facility, the handheld is synched with laptop and the data is entered into CHCS II-T (AHLTA-T) and any additional documentation can be added to the record. At that time, if hardcopy documentation needs to be kept, the records are printed out and placed in individual folders.

My only concern would be that the data entered into
CHCS II-T (AHLTA-T) by the corpsmen could be merged into or accessed by the Medical Readiness Reporting System (MRRS), the Internet-based system currently used by the Marines.

Continuity of Care via First Generation of MC4 CPT Jason R. Weir, HHD Commander / USAMITC Chief, Network Support Branch / USAMITC

When I was deployed to Mosul, Iraq, from 2003-2004 as a Medical Platoon Leader in the “1st Stryker Brigade” 3rd Brigade, 2nd Infantry Division, we were fielded the MC4 system and began using it during its infancy stage.

The Soldiers at the aid station and Company level used MC4 handhelds to document sick call and saved the encounters to Soldiers’ individual Personal Information Carriers (PICs).

The PIC didn’t always work well because of space limitations and terminals often corroded. Also, because we didn’t have solid communications connectivity dedicated for Medical Ops, when we docked our handhelds to our MC4 laptops the information flow stopped there. It wasn’t until we returned home 12 months later that the data was pulled off of the MC4 laptops and added into the Central Data Repository (CDR).

As a fail safe, we kept paper records. While deployed, we had Soldiers attached to our Infantry Battalion from the Brigade Support Battalion. As redeployment grew closer, the Support Medical Company asked that any records we had for the attached Soldiers be handed back over to the Support Medical Company for redeployment. Of course we complied with the request and handed the records over to the Support Medical Company in typical controlled fashion. However, once everything was unpacked back at home the records were nowhere to be found.

One of the Soldiers we had treated for back injuries in Iraq had no documentation to share with his doctor to continue treatment because his records were lost. Fortunately, by working with the Fort Lewis MC4 Site Lead (Mr. M.D. Mandeville) and everyone’s favorite MC4 Systems Administrator (Mr. Cody Smith) we were able to retrieve his encounters that had been saved to the Soldiers PIC.

While we had a gallon size bag of these PICs that didn’t work, in this instance the PIC did work and proved essential. It’s not a proof of longevity for the PIC device, but it helped the Soldier get access to medical benefits at the VA upon his ETS.

Another problem that I encountered was keeping my veteran medics and new medics interested in using the MC4 system during training. I attributed this to the lack of interoperability of the system when in a garrison environment.

After we returned home, I had such a hard time getting my Soldiers to willingly training with our MC4 systems because we could not use the MC4 laptops LAN in our Battalion Aid Station (BAS), which was provided by Madigan Army Medical Center. But my Platoon Sergeant (SFC Douglas D. Wallace) and I pushed hard tbuy into theo get it approved for use on the network.

Once connectivity was approved and the drops were installed, my Soldiers almost instantly took ownership of the systems and felt more comfortable with the laptops and were much more willing to train with the handheld devices as well. No longer did they see it as just a “dumb box” to dump info from the field into. No, it was also useful to them in garrison as well.

In my opinion, if you want MC4 to really take off, the system should be approved for use in Garrison BAS’s and configured so there’s a seamless transition from field to garrison and back. That way, if you go to a three-week field exercise you’re using the same hardware system being used in theater. It’s only logical that we “train as we fight” and practice using the same system we’re equipped with when we’re deployed. There also needs to be a standalone means of establishing connectivity for medical ops and info that is part of the Medical Platoon’s Modified Task Organization and Equipment (MTO&E).

Traumatic Brain Injuries Diagnosed with MC4 - CPT Sheldon Watson, Army Medical Specialist Corps

One of my focuses is on traumatic brain injury (TBI). TBI is often missed in the acute phase, but the condition can well be debilitating. Basically the brain is compressed by the shock-wave of a blast; something goes "boom", a blast overpressure wave develops and is immediately followed by underpressure prior to equilibration at normal atmospheric pressure.

Internal organs are not protected from the effects, so when brain tissue is in the way, this event causes rupture of cells, bleeding in brain tissue and brain damage. This is not always diagnosed in the acute setting, especially if there are other obvious injuries. And if a soldier is medevac'd for other injuries, his chances of not being diagnosed increase. Strangers don't know what is normal for the patients' personality and behavior.

With MC4, serial neurological exams and patient notes are readily available throughout the evacuation chain, and more importantly providers can get in touch with one another if they have questions.

It's a great system.

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