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Area of Science:

  • Military Medicine
  • Infectious Diseases
  • Telemedicine
  • Global Health Security

Background:

  • The ADvanced VIrtual Support for OpeRational Forces (ADVISOR) program, established in 2017, provides 24/7 remote expert support to U.S. Military and NATO clinicians in austere locations.
  • Infectious disease (ID) consultations represent the highest service demand within the ADVISOR program since 2018.
  • The military health system's ID service is staffed by 10 physicians, necessitating efficient support mechanisms for overseas operations.

Purpose of the Study:

  • To retrospectively review Infectious Disease (ID) ADVISOR calls from 2017 to 2022.
  • To identify trends in urgent ID consultations among military personnel in overseas settings.
  • To enhance the preparedness of military ID physicians for critical consultations in austere environments.

Main Methods:

  • Retrospective review of health records for ID consultations between July 2017 and January 2022.
  • Data collected included demographics, case descriptions, consultant recommendations, and patient outcomes.
  • Consultations were primarily physician-initiated phone calls, with some extending via email.

Main Results:

  • Fifty-seven calls were received for 60 urgent patient consultations, predominantly from the Middle East/Southwest Asia and Africa.
  • Most patients were active-duty U.S. Military males (median age 25 years); 70% of consults involved treatment/diagnostics, and 33% concerned disease prevention.
  • Common consults included multidrug-resistant/nosocomial infections, animal/bite exposures, malaria, febrile illness, and blood-borne pathogens; medical evacuation was rare.

Conclusions:

  • A significant proportion of ID ADVISOR consultations relate to infection prevention, force protection, and outbreak response.
  • Successful management of most urgent ID cases was achieved without the need for medical evacuation.
  • The findings align with the military ID fellowship curriculum, highlighting key topics for training and preparedness.