Improving Rural Trauma Care, Education and Prevention through Telemedicine Michael A. Ricci, MD Roger H. Allbee Professor of Surgery Clinical Director of Telemedicine

Vermont Telemedicine Vermont-New Hampshire Interactive Television Microwave transmission Medical education Limited clinical use Expensive, technology intensive Based upon Federal funding

Vermont Telemedicine Video Internet Teleconferencing FAHC FAHC Intranet patient data test results practice guidelines Video E-mail Forms-based E-mail Microsoft Office World Wide Web FAHC

Applying Technology to a Problem - Rural Trauma Risk of death twice that of urban patients with similar injuries Why? Discovery times Transport times Low volume Inexperienced providers

Could telemedicine be used for trauma care in Vermont’s “hostile” rural environment?

Tele-trauma Solution? Use telemedicine to bring the experienced eyes and ears of the trauma surgeon into the community hospital to assist with early care of the injured patient. .

Telemedicine System Desktop PC system ISDN, 384 kbps 17” monitor Pan-tilt-zoom camera Zydacron Z350 video-conferencing board Zydacron Z206 multiple BRI board

Implementation 4 hospitals 3 surgeons’ homes Multiple sites on campus

Trauma Procedures Significant trauma (per pre-existing protocol) Single phone call from community hospital (800#) Three surgeons available 7X24 Surgeon places video call to community hospital ER

Rural ER Setup

Results April 2000 – June 2001 28 consults 14 – 81 years old 96% blunt trauma 46% MVA 75% transferred to FAHC

Telemedicine vs. General Trauma Population

Provider Surveys Teleconsult improved quality of care Referring Providers – 83% Consulting Providers - 63% Communication was good or very good Referring Providers – 100% Consulting Providers - 83%

Potential Life-Saving Consults 41 year old MVA with severe CHI Unable to intubate X 1 hour Tele-consult surgeon helped ER physician perform emergency cricothyroidotomy

Potential Life-Saving Consults 24 year old MVA victim CHI, hypotensive Tele-consult advised different course of action than on-site surgeon (DPL) Emergency laportomy for control of hemorrhage

Next Steps Expansion (more hospitals, more surgeons) Improve on equipment Polycomm Viewstation Stand-alone system 27” SONY monitor

Next Steps Fill the void between hospitals

Questions? Michael.ricci@uvm.edu www.vtmednet.org/telemedicine