'Telemedicine is a capability, not a platform': lessons learned in the Ranger Regiment and the urgent requirement for...

Ranger Regiment medics often work alone and at reach, supporting small teams with extended timelines to definitive care. Enhanced telemedical support was identified as an operational requirement to mitigate this, leading to the development of a system which can stream live clinical data and video to a remote supporting physician. With this reachback, medics can deliver care above their intrinsic capabilities, including advanced decision making, enhanced analgesia and procedural capability.Ranger Telemed was developed 'ground-up' with a training and systems-based approach, using existing hardware and personnel. It was honed through experimentation on exercise and operations and enabled by a supportive and engaged chain of command. It has potential to recruit live secondary care input into both medical evacuation and prolonged casualty care scenarios, bringing specialist care as close to the point of wounding as possible. Ranger can now deliver enhanced telemedicine on operations globally, improving survivability of our patients and pushing the boundaries of remote support in the pre-hospital space.Telemedicine can empower medics, improve clinical care and mitigate against provider moral injury, yet it is not taught conceptually nor exercised as a military capability. Telemedicine must be understood conceptually as a device and software-agnostic capability to create realistic and resilient operational reachback systems and maximise its future potential. The changing nature of the battlespace and communications through the patient journey requires agility not provided by reliance on a single platform, but by an organisation trained and equipped to deliver a capability across a range of scalable mediums, innovating to overcome battlefield constraints.