Telehealth implementation for military combat casualty care and evacuation: a qualitative study

The application of telehealth in combat zones offers transformative potential for casualty care but presents unique and complex challenges. Successfully leveraging this technology requires a deep understanding of its foundational requirements and operational barriers in high-stakes military environments. This study aimed to explore the foundational requirements, challenges, and enablers for the successful implementation of telehealth systems in military combat environments from the perspective of experienced personnel.

We conducted a qualitative study using a conventional content analysis approach. We recruited ten military personnel through purposive and snowball sampling until reaching data saturation. We collected data via in-depth, semi-structured interviews and interviewer notes, and analyzed them using the five-step Graneheim and Lundman method. We ensured the trustworthiness of the data using Lincoln and Guba's criteria.

The analysis resulted in the extraction of two main categories: "Disruption in the Care and Evacuation Chain: Operational and Structural Vulnerabilities" and "Designing a Resilient Military Health Ecosystem: Requirements and Vision" which encompassed 14 generic categories and 43 subcategories. Key findings highlight the necessity of a resilient, mission-oriented technical infrastructure and human-centered design. Crucially, the study underscores the paramount importance of a robust "Cyber Defense Shield," featuring end-to-end encryption and remote data wipe capabilities to navigate the paradox between data accessibility and operational security. Furthermore, redefining organizational culture to view telehealth as a "strategic imperative" rather than an option, and "empowering the human element" through continuous, integrated training were identified as critical determinants of success.

The successful deployment of telehealth in combat zones requires a holistic, socio-technical approach. It demands more than advanced technological solutions, necessitating integrated strategies that address robust cybersecurity, standardized governance, comprehensive human factor development, and strong organizational and command-level commitment to ensure clinical effectiveness and tactical advantage.