First Young Neurosurgeons Forum quarterly online symposium 29 th January, 2011 Muhammad Raji Mahmud, MD, FWACS Chair, Young Neurosurgeons Forum of the World Federation of Neurosurgical Societies (WFNS) Neurosurgical Service for Disasters: Telemedicine/ Telesurgery & the Mobile Emergency/ Neurosurgical Unit (MEU/MNU) Concept Part 2 – Hardware and Logistics It can be done!!

Disaster Response: The Problem Disasters destroy medical facilities – NO HOSPITALS, NO O.R.s Disasters destroy local infrastructure – NO ELECTRICITY, NO WATER, NO FOOD, NO HEAT, NO LIGHT, NO STERILIZATION Disasters destroy local supply lines – NO ROADS, NO AIRPORTS, NO REPLACEMENT EQUIPMENT, NO RESTOCKING SUPPLIES Disasters may destroy personnel – LOCAL MEDICAL PERSONNEL ARE NOT IMMUNE FROM INJURY or DEATH

Disaster Response: The Requirements Disasters destroy medical facilities – SELF-CONTAINED PORTABLE O.R., WARD, CLINIC Disasters destroy local infrastructure – IMPORTED FOOD, ELECTRICITY, HOUSING Disasters destroy local supply lines – ALL RESOURCES MUST BE IMPORTED BY HELICOPTER Disasters may destroy personnel – NEUROSURGEON IS USELESS without ANESTHESIOLOGIST, NURSES, SUPPORT STAFF (and TRAUMA SURGEONS, etc)

CH-47 Chinook Helicopter range ~ 1,100 km

Chinook Helicopter payload ~ 12,000 kg

CereTom® Portable CT Scanner

CT Angiography, Contrast & Xenon Perfusion Mobile – On Rollers Can be powered by a car or truck battery with an inverter! Retail cost: $350,000 US

Disaster Response: Telesurgery Disasters do not occur with a neurosurgeon next door – NEUROSURGEONS NEED TO BE AVAILABLE REMOTELY Disasters do not always create simple neurosurgical problems – EXPERT SUBSPECIALTY NEUROSURGEONS NEED TO BE ABLE TO ASSIST Disasters can create excellent teaching opportunities – NEUROSURGEON INSTRUCTORS NEED TO BE ABLE TO GUIDE IMMEDIATELY

2010: ATNF & Cisco sign MOU to develop laptop-based telemedicine

Disaster Response: Telemedicine in Remote Regions is Possible! We have installed the Cisco solution in a number of centres in rural India and in several locations within our tertiary hospitals. However, the logistics are mind-boggling – easier to clip a basilar artery aneurysm than to make this happen in a town in India!!! We have recently entered into providing health care through mobile phones – confident it will become reality in the next 2 years. Krishnan Ganapathy , December, 2010

Disaster Response: Effective Neurosurgery is Our Responsibility as the WFNS! You must be the change you wish to see in the world. As Neurosurgeons, we must create the effective response to disasters that we wish to see throughout the world. Mahatma Gandhi