How medical tech cobbled together care for one wounded soldier
Powered in part by commercial tech, MC4 system tracked wounded soldier's records
In September 2009, a sniper's round struck Maj. Andy Ingalsbe in the back, one inch below his Kevlar vest. The reservist and his civil affairs team had just completed a humanitarian mission in southeastern Afghanistan's Paktika province.
The projectile inflicted extensive damage, ending Ingalsbe’s service in theater. The bullet cracked two vertebrae, destroyed his right kidney, and tore his liver and digestive tract. Unable to brace himself for the fall, Ingalsbe also injured his neck when his head slammed against the ground.
Surgical teams treated him at Forward Operating Base Sharana and Bagram Airfield. They also digitally documented Ingalsbe's care in computer systems fielded and supported by the Army's Medical Communications for Combat Casualty Care program. MC4 integrates, fields and supports a comprehensive medical information system, enabling lifelong electronic medical records, streamlined medical logistics and enhanced situational awareness for Army tactical forces. By accomplishing this mission, MC4 is providing the Army’s solution to presidential and congressional objectives set forth in 1997, which called for a medical tracking system for all deployed service members.
The Army's Program Executive Office for Enterprise Information Systems at Fort Belvoir, Va., oversees the MC4 Product Management Office headquartered at Fort Detrick, Md. MC4 is a rugged system of systems that contains medical software packages fielded to tactical medical forces throughout combat zones and in the United States. Comprised of joint, commercial off-the-shelf and government off-the-shelf software, MC4 provides the tools needed to digitally record and transfer critical medical data from the foxhole to medical treatment facilities worldwide. The MC4 Product Management Office uses the Army Computer Hardware, Enterprise Software and Solutions website as its primary source to support and meet MC4 hardware and COTS requirements.
Deployable medical forces use MC4 systems to gain quick and accurate access to patient histories and forward casualty resuscitation information. The system also provides units with automated tools facilitating patient tracking, medical reporting and medical logistical support. Combatant commanders use the MC4 system to access medical surveillance information, resulting in enhanced medical situational awareness.
Most important, MC4 is helping deployed service members such as Ingalsbe.
By equipping deployed medical units with automated resources, MC4 helps ensure service members have a secure, accessible, lifelong electronic medical record, which results in better informed health care providers and easier access to the Veterans Affairs Department's medical benefits.
With more than 10 years of experience managing the Defense Department's first battlefield medical recording system, MC4’s vision is to be the premier enabler for improved tactical health care and better decision-making through the power of IT.
Ingalsbe’s ongoing care
Ingalsbe’s digital medical history helped physicians at Walter Reed Army Medical Center in Washington, D.C., piece together the entire traumatic story. “I arrived at Walter Reed five days after my injury but regained consciousness on the 18th day,” Ingalsbe said.
“The doctors told me about my injuries, and I required a lot of replumbing. Surgeons in Afghanistan removed a kidney and my right colon. The entire time I lived at Walter Reed, the doctors never asked me about any of my prior treatments. They had all of the information in my digital records. One doctor said that I looked better medically in person than what was documented in my chart.”
The timing of his injury was devastating to Ingalsbe. For 25 years, he trained for combat as a military policeman. In 2005, he voluntarily came out of retirement to serve in a civil affairs role just to get to the battlefield. From 2005 to 2006, he led more than 80 missions throughout Iraq. Ingalsbe's teams dug wells, repaired schools and handed out food. However, his humanitarian experience came with a price. An improvised explosive device damaged his hearing, yet he remained committed to the mission.
At the end of his tour, Ingalsbe retired for a second time. In 2008, he returned to active duty and deployed in the same capacity, but this time for one year in Afghanistan. While in theater, he decided to extend for a second year. Two days before he was set to begin another year-long tour, he was hit by a sniper's bullet in theater. Ingalsbe recuperated at Walter Reed for eight months. The digital history from the battlefield and home enables Maj. Jane Dickler, nurse case manager with the Warrior Transition Brigade at Walter Reed, to keep a close watch on Ingalsbe and others. “I review the electronic records and treatment plan to make sure my patients receive the medical attention they require,” Dickler said.
“Since the medical staff captures patient data electronically, it eliminates the need to hunt for paper forms. It also significantly reduces the possibility of losing patient information. My team also reviews appointment schedules so that patients are where they need to be at the correct times.”
Ingalsbe underwent a second surgical procedure in March 2010. To repair the damage in his neck, a neurosurgeon inserted two titanium discs, as well as a metal plate to hold them in place. Three months after the operation, he transferred to the Community Based Warrior Transition Unit-Arkansas. Ingalsbe continues his rehabilitation at outpatient facilities in his hometown of West Plaines, Mo. “Many times, being near friends and family are better recuperative agents for certain injuries than a stay in a hospital bed,” said Maj. Barbara Schulz, nurse case manager at the Arkansas facility, who manages Ingalsbe's care.
“Patients, such as Ingalsbe are able to receive medical care in their own communities. I stay in contact on a daily or weekly basis. When Ingalsbe receives physical therapy at his local hospital or meets with his family physician, we receive documentation from the civilian providers. Ultimately, all of the records we collect will go to the Department of Veterans Affairs, allowing future providers to view his complete medical history.”
Although digital medical records have replaced paper forms, Ingalsbe stays set in his ways. He still collects paper copies of every form from every appointment. After he was shot, the paper folder has since been replaced by a plastic binder. He also has CD-ROMs and DVDs that hold the results from his radiology exams. “The military is much different today than when I began my career 30 years ago,” Ingalsbe said.
“For most of my career, service members kept paper copies of their medical records to protect against a clinic misplacing months or years of medical information. Today, digital notes build upon older records like e-mail messages. I don't have a medical background, but the digital records are pretty easy to follow.”
Periodically, Ingalsbe returns to Walter Reed for follow-up appointments with his doctors. He said that when it comes time for a medical review board to determine his future medical benefits, they will be well informed. “Between my paper copies and the digital records in the military's computer system, I have my medical history covered,” Ingalsbe said.
“The medical board will have a complete medical picture of my military service. I have a lot of good memories from my military career. As a permanent reminder of my deployment to Afghanistan, I have a 12-inch scar on my abdomen and the sniper's round mounted on my wall with my Purple Heart.”