Telemedicine Consultation: Lessons Learned from the Pararescue Experience

Clinical Snapshot

Key Findings

• P Value: Not reported — no inferential statistics performed

• Effect Size: Not applicable — no quantitative outcome comparison performed; descriptive case series only

• Primary Outcome: Across 13 telemedicine consultations involving 28 patients, the most common clinical presentations were cave entrapment (n=13), trauma (n=7), burns (n=4), and illness (n=4). The most frequent consultation recommendations were medication selection (n=6), advisement against mission launch (n=3), and burn care guidance (n=2). Seven secondary specialist consultations were obtained (dental, dermatology, burn/critical care, orthopedics, pediatric anesthesiology, thoracic surgery).

• Nnt Or Sensitivity: Not calculable from available data — no control group, no outcome frequency data enabling NNT estimation; consultation effectiveness was impacted by unclear directions (n=3) and degraded communications (n=2)

• Confidence Interval: Not reported — qualitative/descriptive study design

Clinical Application

Telemedicine consultation via satellite phone, mobile voice, text, and email is technically feasible in austere military environments but is subject to communication degradation. The study highlights that effectiveness depends heavily on pre-mission rehearsal, standardised patient reporting frameworks (ATMIST, MARCH PAWS), and a shared mental model between the consulting medic and the remote physician. These prerequisites are achievable in both military and civilian remote medicine contexts with appropriate training investment. Australia's vast geographic footprint, including remote and very remote communities comprising approximately 2% of the population but covering 86% of land area, makes telemedicine consultation directly relevant to Australian practice. The Royal Flying Doctor Service (RFDS), Remote Area Health Corps, and state-based retrieval services (e.g., CareFlight, HEMS) already employ telemedicine consultation models. The RACGP's Standards for General Practices and the National Rural Health Strategy both support expanded telehealth capability. The TGA does not regulate telemedicine platforms per se, but the Therapeutic Goods Act governs any software classified as a medical device. The PBS does not directly fund telemedicine hardware, but MBS telehealth item numbers (introduced broadly post-2020) support remote consultation billing. The ATMIST and MARCH PAWS frameworks referenced in this paper are consistent with those used in Australian Defence Force and civilian retrieval medicine training. The study's lessons regarding communication rehearsal and standardised handover tools are directly applicable to Australian remote medicine training curricula. Military special operations medics, flight surgeons, and remote/austere-environment medical providers requiring real-time specialist consultation. Findings are also relevant to civilian pre-hospital providers, retrieval medicine teams, rural and remote general practitioners, and disaster medicine responders operating with limited on-site specialist support.

Abstract

BACKGROUND: Telemedicine is a critical military medicine capability in austere, remote, and denied environments where prolonged casualty care and knowledge gaps exist. Despite significant military investment in telemedicine, the literature lacks detailed lessons from real-world cases. METHODS: U.S. Air Force Pararescue missions between 1 January 2010 and 31 December 2020 that included telemedicine consultation were reviewed. Participating flight surgeons (FS) and Pararescuemen (PJ) were interviewed, and available after-action reports were analyzed. Mission parameters, outcomes, and technical or human factors affecting communication were evaluated. RESULTS: Across 13 telemedicine consultations, the 28 patients experienced: cave entrapment (13), trauma (7), burns (4), and illness (4). Consultations were from PJ to FS (11), U.S. Coast Guard to FS (1), and FS to neurosurgery (1). Secondary consultations (7) were from FS to dental (1), dermatology, burn/critical care, orthopedics (2), pediatric anesthesiology, and thoracic surgery specialists. Missions used voice over mobile or satellite phone, text, and email. Recommendations commonly involved medication selection (6), advisement against mission launch (3), and burn care (2). Consultation effectiveness was impacted by unclear directions (3) and degraded communications (2). CONCLUSION: Telemedicine is valuable to PJs during complicated cases and rarely performed procedures, but cannot replace pre-deployment medical exposure and training. Rehearsals may optimize telemedicine, and training should focus on synchronizing a shared mental model of the patient using well-understood patient report and evaluation tools (ATMIST and MARCH PAWS). Telemedicine may reduce human error, give medics the confidence to take action, and limit the psychological impact of difficult care decisions.

References

1. 1.Gottschalk, A., Oeding, J. F., Blacker, M. M., DeSoucy, E. S., & Rush, S. C. (2026). Telemedicine consultation: Lessons learned from the Pararescue experience. Journal of Special Operations Medicine: A Peer Reviewed Journal for SOF Medical Professionals. https://doi.org/10.55460/J.Spec.Oper.Med.2026.KJL1-1PL3