Teletrauma care goes mobile

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As camera phones have become widespread, many emergency medical technicians have taken to snapping photos of wounds and forwarding the images to hospitals so clinical teams could be ready when the ambulance arrives. That's an easy, low-cost way of improving efficiency and perhaps triaging cases in overcrowded EDs, but I doubt too many emergency physicians would make a diagnosis based on a grainy, low-quality photograph.

Now, imagine if doctors and nurses could provide real medical advice to help EMTs treat patients in transit based on high-quality, two-way live video. That's exactly what they have been doing in Tucson, AZ, for nearly two years, thanks to a 227-square-mile Wi-Fi grid that covers most of the city. East Baton Rouge Parish, LA, which includes the city of Baton Rouge, recently launched a similar system that eventually will link to seven hospitals across the parish.

Tucson's University Medical Center saves $5,000 each time it can prevent an unnecessary activation of a Level 1 trauma team and, more importantly, can save lives by providing remote diagnoses and triage and making sure the trauma team is ready while the patient is still in transit. I wrote about this technology in the May issue of Hospitals and Health Networks, but that short piece only tells part of the story.

Telemedicine and teletrauma experts I quoted in the HHN piece suggested that this technology would become commonplace within a reasonably short amount of time. What makes them so sure? While in Tucson a few months ago, I met with the head of emergency medical services for the city, toured an ambulance and saw a demo of a live video consult with a nurse in UMC trauma unit. The picture was much clearer than anything you would see on a mobile phone, and people on both ends of the conversation could control the camera inside the ambulance.

One of the 18 Tucson Fire Department ambulances has an external camera as well, so the remote consultant could examine patients outside the vehicle, such as at an accident scene. Other ambulances will add external cameras as funding allows. The department also has equipped a pick-up truck with the portable video equipment to help connect low-acuity patients with non-emergency care and social services.

When EMS adds an electronic medical record starting this summer, technicians will be able to upload data to the hospital on the network, and the department is working to tie EKG readings to the same system.

Being a short-range technology, Wi-Fi is but one option for mobile telemedicine and teletrauma care. Hospitals in San Antonio and San Diego have smaller-scale mobile systems based on cellular networks that have sent more data than video. But as cellular bandwidth improves, expect to see other municipalities embrace this option. Also in the works is Wi-Max, a wireless Internet option with much longer range than Wi-Fi.

Some day in the not-too-distant future, it might be unusual not to see video and EMR equipment, integrated with hospital information systems, aboard ambulances. - Neil