1. Teletrauma: Preliminary Design & Findings From Vermont’s Rural Telemedicine Network Michael Caputo, MS Michael Ricci, MD Frederick Rogers, MDKen Sartorelli, MD Medical Disaster Conference: June 14, 2001

2. Discovery - Late Discovery - Late Rudimentary Rudimentary Prehospital Capabilities Prehospital Capabilities Prolonged Transport Prolonged Transport Times Times Rural Trauma Problems

3. Could Telemedicine be used in Vermont’s “hostile” rural environment?

4. Use TMED to bring the eyes and ears of an experienced trauma surgeon into the community hospital to help with the initial stabilization of a trauma patient. A Trauma Solution?

5. U.S. Department of Commerce Technologies Opportunities Programs (TOP) Technologies Opportunities Programs (TOP) $300,000 in matching funds $300,000 in matching funds http://www.ntia.doc.gov http://www.ntia.doc.gov /oiahome/top/index.html /oiahome/top/index.html

6. Telemedicine System Desktop System Desktop System ISDN, 384 kbps ISDN, 384 kbps Intel microprocessor Intel microprocessor 17” Sony Monitor 17” Sony Monitor Zydacron Z250 video conferencing board Zydacron Z250 video conferencing board Zydacron Z206 multiple BRI comm board Zydacron Z206 multiple BRI comm board

7. Implementation 4 Trauma Sites & 3 Surgeon’s homes + + + + +

8. Trauma TMED Protocol Any one of the following:  1. GCS < 13  2. Hypotension (systolic BP < 90 mmHg) (systolic BP < 90 mmHg)  3. Penetrating truncal trauma  4. Respiratory Distress (10 > RR RR< 30) Continued 

9. Trauma TMED Protocol  5. Amputation proximal to the wrist or ankle. wrist or ankle.  6. Any patient not meeting the above criteria for whom the above criteria for whom the treating physician feels it is treating physician feels it is appropriate to call a appropriate to call a telemedicine consult. telemedicine consult.

10. Electronic Eyes & Ears

13. Results 26 tele-trauma consults 26 tele-trauma consults (4/2000 - 1/2001) (4/2000 - 1/2001) Ages 14 - 81 years old Ages 14 - 81 years old 96% blunt mechanism 96% blunt mechanism 50% MVC, 12% ATV, 50% MVC, 12% ATV, 12% pedestrian struck 12% pedestrian struck

14. 2 Cases of Potentially Lifesaving Tele-trauma Consults Case #1 41 year-old with severe CHI unable to intubate Emergent cricothyroidotomy Continued 

15. 2 Cases of Potentially Lifesaving Tele-trauma Consults Case #2 24 year-old severe multi-trauma hypotensive, severe CHI Case #2 24 year-old severe multi-trauma hypotensive, severe CHI DPL -> to OR for control of intracavitary hemorrhage intracavitary hemorrhage

16. Technical Problems 4 times unable to connect 4 times unable to connect Remote control failure Remote control failure Audio failure Audio failure

17. Conclusion Tele-trauma enhances rural trauma care Tele-trauma enhances rural trauma care -Rapid response -2 lives potentially saved. -well received by rural trauma providers. Occasional technical difficulties Occasional technical difficulties

18. Questions? Michael Caputo, MS Director of Information Services & Director of Telehealth Operations University of Vermont – College of Medicine (802) 656-9658 michael.caputo@uvm.edu