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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Events of September 11, 2006 in Afghanistan - Daniel Fitzwilliam, MC4

On September 11, 2006, I was providing supporting for the MC4 system at Forward Operating Base (FOB) Salerno, Afghanistan. That morning the FOB was busy and a flag ceremony was held in front of the hospital in memory for those who lost their lives during the terrorist attacks in the U.S. on September 11, 2001.

During the ceremony, we received word that there had been a suicide bombing at the funeral of the governor of Khost province in eastern Afghanistan who had been assassinated the day before. According to press reports, the blast during the funeral occurred near a tent where more than 1,000 people had congregated.

The local hospital was beset with casualties and realized it did not have the ability to treat all of the injured. Many were turned away and told to seek treatment at FOB Salerno. Shortly after learning of the attack, preparations began to receive mass casualties at the front gate. I helped the medical staff prepare a triage area at the front gate by moving stretchers and medical supplies. It seemed like there wasn't much time between the time we learned of the suicide bombing and the casualties began arriving.

The medical staff worked at a furious pace to check and document injuries, distinguish the severity of injuries and begin treatment. There seemed to be more people injured than what was manageable. As the injured arrived outside the gates of Salerno continued to grow, it was obvious that more people would be needed to help treat the wounded. An announcement was made over the loudspeaker requesting volunteers, so Soldiers and contractors from various disciplines turned out to support the effort.

Casualties continued to come to the gates of Salerno throughout the day and into the night. As evening approached, KBR employees set up generators and floodlights so the rescue work could continue working.

Most of the caregivers had been working non-stop and not eaten or taken a break since breakfast. I called the dining facility and asked if there was anyway they could prepare food, drinks and snacks for two-hundred people and bring everything to the hospital entrance. The normal treatment area for sick and wounded Soldiers now became an area for treating the weary caregivers and volunteers' hunger.

A cafeteria-style serving area was set up and a line formed outside the entrance to the hospital and into the street until everyone was fed. Food was brought to the surgical and emergency medical teams as they were unable to leave their posts.

The surgeries continued throughout the night and into the morning. On September 12th, the most critically wounded patients were evacuated for further treatment.

The day of remembrance for the victims of September 11, 2001, and the reason for our being in Afghanistan had turned full circle. We now had first-hand experience of the victims, emergency responders and caregivers of a suicide attack on a democracy, albeit one in its infancy, and only a microcosm of the events that unfolded in 2001.

Early Days of MC4 Remembered - Cody Smith, MC4

MC4 launched a new blog giving users of the MC4 system the opportunity post your stories and experiences while deployed. Below is a story submitted by an MC4 systems administrator. Cody Smith, the first MC4 SA deployed to Iraq, relays a trip via Stryker convoy to Tal Afar, Iraq.

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I forget the exact date but it was in late 2003 or early 2004 when I was the first and only MC4 Systems Administrator (SA) in Iraq. At that time there were no established rules of engagement on how to support the units...I was basically figuring things out as I went along.

The unit I was supporting at the time was covering a division-sized area with about one-fourth of the needed troops, so they were spread out pretty far. The air taxi service (UH-60 Blackhawks) had not really been established for travel within Northern Iraq, especially in places near the Syrian border. So I had to convoy from place to place.

One of the units I supported, 1-14th Cavalry Squadron, 3rd Stryker Brigade Combat Team, 2nd Infantry Division, had a small element of personnel who were manning a location in the middle of Tal Afar city. This particular unit had been requesting to have me setup their MC4 systems and train their providers and medics. So I coordinated my movement through Squadron Headquarters and was told that I would be riding in the back of a Stryker the following day.

I wasn't really nervous about the trip since, just two weeks before, I convoyed from Balad to Tal Afar in a vehicle with no armor. So the following day I showed up at the manifest area, received my convoy brief and got in the back of the Stryker with all my gear. I had no idea where exactly I was going, I just knew it was in the city.

During the ride to this particular location, I became very disoriented with all of the twists and turns and driving on curbs and through the median. I was not able to see anything outside of the vehicle as the Long Range Advanced Scout Surveillance System (LRAS3) monitor was not turned on. It was a relatively short ride to the location, about 20 minutes or so.

When we finally arrived and the Stryker vehicle came to a stop, the platoon leader (PL) ordered his troops to drop the back hatch and to establish a security perimeter around the three Strykers in the convoy. The back hatch dropped and all of the Soldiers ran out of the Stryker to setup their positions. The hatch went back up to protect the remaining personnel in the Stryker.

After sitting for a few minutes, the platoon leader looked down through his hatch and asked if I was ready to make a run for the front entrance of the compound. I responded with a nod and grabbed my computer case and my assault pack.

Seconds later the back hatch dropped once again and the PL yelled, "Go!," and so I did! Keep in mind I had no idea where I was or where I was supposed to be running to. I just knew that I was outside of the compound on some street in the city and I had to get inside the compound as soon as possible.

So after the hatch dropped I ran out of the Stryker and started heading the exact opposite direction of the compound and into the city! I was clued in on this fact by a few Soldiers who were pointing and yelling, "Not that way, the other way!"

When I finally made it into the front entrance of the compound, I felt very relieved.

Looking back, it was a great time.

One of the soldiers who rode in one of the Stryker vehicles that day has since left the military and works down the street from where I live. I took a picture of him sitting on the back hatch of one of the Strykers eating lunch. Later, I was able to send him a copy of that picture and reminisce about everything that happened during that deployment.

Differences in Recording Medical Data - Jorge Guzman, MC4

MC4 Systems Administrator Jorge Guzman describes his experiences collecting medical data with the old paper-based system as an Army medic and and how different the process has become with MC4.

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During my 20 years in the Army as a medic, I always complained that there should be a better way to capture patient documentation in combat and field environments. We always used SF600s – Chronological Record of Medical Care – or the DD Form 1380 – field medical card. Both forms very rarely made it to the patient records – including my own records from Operation Desert Storm.

Then along comes MC4 with its CHCS II-T and BMIST-J. "No!! Change!! I don't like change!! Nobody likes change!!"

There is an old saying, “If it ain’t broke, don’t fix it.” Well, the old system really was broken and needed to be fixed.

I’ve been training units around the world on the MC4 applications since 2003. First it was just theory. Then I had the opportunity to see it in action. First in Kuwait, then Iraq. In its infancy CHCS II-T wasn’t welcomed. It was a change.

By 2005, CHCS II-T was being used by most of the medical units in Iraq and all of the units in Kuwait.

In 2005, I became ill in Kuwait. I woke up dizzy one day. I couldn’t even stand up. Lucky for me, the Arifjan clinic was close by. I was seen by a provider from the Navy and my care was documented on an MC4 system using CHCS II-T.

The check-in process was very smooth. The clerk asked for my CAC and an MC4-provided scanner was used. He quickly entered my demographic information, name, SSN, gender, DOB, as well as all of the information needed to create an electronic medical record.

I was told to have a seat and would be seen in a short time. Before I could sit, the medic called me for a screening. In the screening room, the medic pulled up my encounter in the MC4 computer and entered my vital signs, added any allergies and other medical information the physicians may need to know.

I asked the medic how he felt using the CHCS II-T compared to paper. He told me it made his job go faster. He no longer had to wait for a paper record. As soon as the clerk initiated the record, the medic could see the visit and immediately start the documentation.

Once the medic completed the initial screening, he took me to a chair outside of the provider’s exam room where I waited to be seen by the provider. The facility was very busy that day. I waited about 10 minutes until a Navy physician's assistant called me into the room.

My provider documented all her findings and tests in CHCS II-T and wrote me a referral for an eye exam at Camp Doha, Kuwait. When I had my eye exam, the provider at that location also documented my care on CHCS II-T.

Upon my return to the Arifjan clinic, I was seen by another provider, a neuron specialist, and she was able to read the care that the first provider conducted. Although she couldn’t see my encounter from Camp Doha on the local CHCS II-T terminal, she was able to log into TMDS (Theater Medical Data Server) and see my documentation there. The neuron specialist was surprised to see how easy the site was to navigate and to find my encounter.

I was examined a few more times in Kuwait during follow-up visits and received excellent care each time. My last provider in Kuwait gave me all my encounters in paper format so that I could receive follow-up treatments when I returned to San Antonio.

When I returned home from Kuwait, I made an appointment with my primary provider at Brooke Army Medical Center (BAMC), Texas. Like a good patient, I followed my instructions and took all my paper encounter documentation with me in case the provider had any questions. BAMC uses AHLTA which is very similar to CHCS II-T. I checked in for my appointment and went through the screening process. It was identical to the screening process performed for CHCS II-T in theater.

After a short wait, I went in to see my provider with my encounter documentation from Kuwait in hand. As I was talking to the provider, I told her that my care was documented in CHCS II-T while I was in Kuwait. I informed her that if she had access to TMDS, she could see my encounters or I could give her my paper SF600s. She checked the documents tab in AHLTA and, low and behold, my encounters from Kuwait were in the system. My test results were even entered into the notes.

My provider was very impressed with the capabilities of the MC4 system. She now had all of my documentation and was able to continue the treatment that was started in Kuwait. She commented that with this system, providers are able to provide a better continuity of care then in previous years.

I was confident in the capabilities of the MC4 systems before this experience, but this solidified my belief. I was able to be assessed, diagnosed and treated for my sickness in theater and my medical care was continued without having to start the process all over again. This is a huge leap in the quality of patient documentation and tracking from my experience in 1990 during Desert Storm.

I’m sold.