1. Applications of Telemedicine and Telecommunications to Disaster Medicine: Historical and Future Perspectives Victoria Garshnek and Frederick M. Burkle Presented by: Michele Romano

2. What is Telemedicine? “… the use of electronic information and communications technologies to provide and support health care when distance separates the participants…” Institute of Medicine: Telemedicine: A Guide to Assessing Telecommunications in Health Care

3. Telemedicine Encompasses Diagnosis Treatment Monitoring Expert advice Patient information Education of patients

4. What is in this paper? Review of the history of telemedicine Issues that must be addressed Future improvements

5. History: 1985 Earthquake in Mexico City NASA used their ATS-3 satellite to provide critical voice communication

6. History: 1988 Armenian earthquake Space Bridge project – Intelsat and Comsat satellite communication Data and fax lines provided additional bandwidth Remote medical consultation 209 patients care was augmented

7. History: 1990 Hurricane Hugo – Virgin Islands MASH used CT scanner, digitizer and INMARSAT Deployable teleradiology

8. History: 1992 - 1996 Gulf WarDifficult geographic and climatological conditions SomaliaLow bandwidth to send high resolution images Haiti56 Kbps -> T1/VSAT Macedonia, Croatia, Bosnia Reported problems with telemedicine equipment and with the training

9. History: Overview

10. Challenges Communication Pathway selection Bandwidth limited Environmental conditions Power interruptions Training

11. Communication Information Pathways Direct (“land”) lines Metallic twisted pairs Fiber Wireless transmissions Radio satellite

12. Communication Tools 1. The Internet 2. Virtual Reality 3. Computer miniaturization 4. Advanced Sensors and Medical Monitoring

13. 1. The Internet GHNet / GHDNet Relief Web Virtual Information Center (VIC) Rapid Health Assessment Module

14. 2. Virtual Reality Virtual environments are used to train medics for disaster medicine MediSim trainer MediSim Trainer picture from: http://www.cis.upenn.edu/~hms/medisim/medisim.html Simulator picture from: http://www.meti.com/university.html

15. 3. Computer Miniaturization PDAs Wearable Computing Picture from: http://www.praecogito.com/~brudy/wearable.html Picture from: http://www.eecs.harvard.edu/~mdw/proj/vitaldust/

16. 4. Advanced Sensors and Medical Monitoring US military developing advanced sensors and smart materials Personnel Status Monitor (PSM) Life Support for Trauma and Transport Sensate liner Mobile Medical Monitor (M3)

17. Conclusion Telemedicine can be used in a variety of disaster situations. Advances in communications led to improvements in telemedicine. Simulations and training is ongoing in this area.

18. References http://telemed.medicine.uiowa.edu/TRC Docs/slides/intro_telemed/sld011.htm http://tie.telemed.org/links/applications.asp#62