After the Gulf War, thousands of service members returned from duty without proof of combat-related illnesses and injuries, resulting in loss of benefits. In 1997, Presidential and Congressional mandates called for a medical tracking system and a lifelong electronic medical record for all service members. MC4 is the response.

Even before MC4, the military learned that treating wounded soldiers most efficiently called for better management of medical data, such as exactly how a soldier has been wounded and what care the soldier has received. The wounded are often moved from hospital to hospital, so up-to-date information for the staff makes the next phase of care clearer and more immediate. Several novel devices in the system are helping Army and Air Force medical personnel collect and share information. Hand-held data loggers, for one, let medics record patient data on the battlefield and later combine it with care from field hospitals. Other new devices may help diagnose concussions, a frequent and often missed battlefield trauma.

Electronic medical records

To improve record collection and storage, the military has fielded the Medical Communications for Combat Casualty Care. MC4 is several information-collection devices, software, databases, and servers for use on battlefields and in field hospitals. For example, when a soldier is wounded, a medic would first attend to the soldier and then describe the wound, treatment, and vital signs on a handheld device. Later, the medic plugs the device into to a portable computer to combine the data with other treatment records. Later, it's uploaded to a central database so it can be retrieved and updated at any military hospital in the world. “In this way, MC4 will help users improve patient care in combat zones by giving doctors and nurses access to current information so they can reshape their battlefield best practices,” says the Army's MC4 program commander Lt. Col. Edward Clayson.

Staff Sgt. Matthew Sims adds that he has experienced the benefits of MC4 after recently being wounded. “Having my records available electronically let doctors track and follow the treatment I received at several different facilities,” says Sims.

MC4 ensures that service members have an electronic, lifelong medical record, says Clayson. The system is also said to give combat commanders a better picture of medical assets and situations. More than five million electronic medical records have been captured since MC4's deployment in 2003.

To date, the program has fielded more than 25,000 data-collection devices and trained more than 29,000 healthcare professionals throughout Iraq, Kuwait, Afghanistan, Qatar, Europe, Egypt, and South Korea. They have recorded more than 5 million electronic health documents. Air Force Lt. Col. John Mansfield, M.D., a proponent of a joint medical-record initiative, says having most military bases work on a single platform makes sense. “At Balad Air Force Base in Iraq, 95% of the hospital staff is Air Force personnel, but most U.S. patients treated here are soldiers and marines,” he says. “We don't care what uniform our patients wear, but it would drive us crazy if we had to use different systems to document care based on their service.”

Two upgrades since deployment in 2003 include improved medical recording and a medical logistics-management application. This latter system, called Medlog, helps logisticians manage and maintain supplies on the battlefront and provide a more uniform approach to ordering medical supplies.

And the formation of MC4 Best Business Practices has helped Iraq-based medical forces implement best practices and standard operating procedures for incoming units. “For example, the Army has created a standard for all military units documenting patient care and has improved the quality of recorded data,” says Clayson. “And two years ago, I discovered that most medical units used MC4 in different ways. In some cases, they defeated some of its capability or features. So we defined the five basic pieces of demographic information that must be input for proper patient documentation,” he says.

In addition, says Clayson, the growing database has let medical researchers at the Institute of Medical Research at Ft. Sam Houston, San Antonio, Texas, change how field units treat trauma. “For instance, medics record the temperature of wounded soldiers on the battlefield and again when they arrive at field hospitals. Remember, they've had their uniforms opened or removed for treatment. It turned out that after a helicopter flight, the soldiers were cooling too much. Research indicated that simply covering them with a blanket during air transport improved their chances of recovery,” says Clayson.

He adds that MC4 should give service members confidence that their medical data is complete and available when they return home. This aids in getting healthcare benefits from the VA and establishes a lifetime of continuous care.

Civilian applications are somewhat obvious, especially when considering the extensive amount the U.S. population travels. When someone needs medical attention far from home, readily accessible medical records can be immensely useful in a person's treatment. The MC4 program provides a model for such a system.