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

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

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

4. 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

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

6. 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

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

8. Implementation
4 hospitals
3 surgeons’ homes
Multiple sites on campus

9. 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

10. Rural ER Setup

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

12. Telemedicine vs. General Trauma Population

13. 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%

14. 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

15. 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

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

17. Next Steps
Fill the void between hospitals

18. Questions?