Bldg. 160, Krukowski Road
COE Disaster Mgt and Humanitarian Assistance
1 Jarrett White Road (MCPA-DM)
Tripler Army Medical Center
Honolulu, HI 96859-5000
The mission of the Center of Excellence in Disaster Management and Humanitarian Assistance (COE-DMH) is to educate, train, conduct research and assist in international disaster preparedness, mitigation, management and response, as well as health security, humanitarian assistance and societal resiliency. The Center’s Vision is the Asia Pacific region prepared to respond, collaborate and manage natural and manmade disasters. Our aim is to assist Asia Pacific nations with disaster management plans, response to plausible contingencies, and participation in a regional collaborative framework.
The Center of Excellence (COE) was established in 1994 through congressional legislation sponsored by Senator Daniel K. Inouye. It is a direct reporting unit to U.S. Pacific Command and takes its policy guidance from the Office of the Secretary of Defense (OSD). COE is headquartered on the Army installation where Tripler Army Medical Center is also located. Subject matter experts from around the world supplement the staff of 35 civil service, military active-duty and contract personnel. COE operates in an unclassified environment.
Video-teleconferencing (VTC) applications are currently in use for Adult and Child and Adolescent Behavioral Health (BH), and Traumatic Brain Injury (TBI) treatment between Tripler Army Medical Center (TAMC) providers and near and distant patient locations. Locations include on-island telehealth suites at Tripler Army Medical Center (TAMC), U.S. Army Health Clinic-Schofield Barracks, 25th Infantry Division Headquarters, Schofield Soldier Readiness Processing (SRP) site at Conroy Bowl, and Warrior Ohana Medical Home; the VA Community-Based Outpatient Clinic in American Samoa; the Army’s military treatment facilities (MTFs) at Camp Zama, Japan and in Korea; Navy and Air Force MTFs in Guam, Japan, and Okinawa; MTFs on the mainland at Fort Wainwright and Fort Hood; USAREC facilities across the U.S. and Pacific; and schools on Oahu military bases. Policies and infrastructure are being developed to extend this capability to DoD beneficiaries through Army Reserve or National Guard Armories on neighbor islands and Naval Health Clinic Hawaii. Other locations may be added as needs and sites (patient location) are identified.
The Tele-Behavioral Health and Surge Support (TBHSS) cell links Soldiers/family members to TBHSS providers located on the TAMC campus via computers, webcams, and VTC technology. Under the clinical direction of a USPHSC psychologist, the staff of psychiatrist, psychologists, and clinical and admin support provide an array of behavioral health assessment, evaluation, treatment and consultation services during pre-deployment and post-deployment surges to warfighters and families, downrange or in garrison, where ever there is a need for augmented behavioral health resources.
The CATS (Child & Adolescent Telebehavioral Services) Program was initiated to respond to the needs of Army youth impacted by military deployments, particularly National Guard/Reserve populations where access to services is limited. Clinical social workers at on-base schools and on Maui and Hawaii identify high-risk children and link them with child psychiatrists and psychologists at Tripler via telehealth equipment. Services are being more broadly marketed to other MTFs where there are limited or no child behavioral services.
The TBI or Concussion Clinic uses VTC technology to connect with patients at Schofield Barracks and American Samoa. Their efforts are credited with establishing the early links to both locations and funding much of the VTC equipment that is used across TAMC and PRMC for TBI and BH. Their multidisciplinary program includes primary care for concussion patients, BH, speech therapy, and case management.
Pacific Asynchronous Tele-Health (PATH) is an Internet-based, asynchronous (store-&-forward), provider-to-provider teleconsultation system. The PATH website is hosted at TAMC and readily available any time to distant providers with an Internet connection and browser software. Distant providers enter patient clinical needs and supplementary pictures, video, or sound which are screened by physicians at TAMC and routed to specialists to respond. PATH is currently processing over 850 teleconsultations/year, from over 20 hospitals and clinics in the Pacific, for 40 different pediatric and adult medical and surgical specialties. The newest application facilitates air evacuation referral and coordination throughout the Pacific.
The Tele-Critical Care Unit (TCCU) was conceived in response to a need for access to critical care specialists from distant medical treatment facilities. It started in 2001 with monitoring and managing patients at distant ICUs, first in Guam Naval and then Brian Allgood Army Community Hospital-Korea in 2007. The program converted to high-
definition teleconferencing systems in 2011. Sites at Navy facilities in Okinawa and Yokosuka are now operational.
The Pacific Islands Health Care Project (PIHCP) is another asynchronous program that benefits Graduate Medical Education (GME) for medical interns and residents at TAMC and provides humanitarian medical care to medically underserved Pacific Islanders. Patients are referred from the islands using PIHCP’s Internet-based referral system. Patient acceptance into the project is based on medical need, the capability of caring for the patient at TAMC, and the unique GME opportunities the case will provide. If approved their costs for travel to Tripler and per diem are covered; if not, the specialty provider will usually offer recommendations for treatment to the referring provider.
Other programs using telehealth technology to facilitate treatment are the LEAN Healthy Lifestyle and Smoking Cessation programs, digital Echocardiography, tele-pharmaceutical consultations to a satellite pharmacy at the NEX and tele-diabetic groups.
PRMC Telehealth Office continues to support telehealth programs and identify opportunities to exploit the use of telehealth to extend access to specialty services to locations across the Western Pacific. Under Development are tele-pain, PCMH TH programs, tele-bariatric screening and support, Better Depression follow-up, and expansion of GME and CME programs.