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Improving Rural Trauma Care, Education and Prevention through Telemedicine

Improving Rural Trauma Care, Education and Prevention through Telemedicine. Michael A. Ricci, MD Roger H. Allbee Professor of Surgery Clinical Director of Telemedicine. Vermont Telemedicine. Vermont-New Hampshire Interactive Television 1960’s Microwave transmission Medical education

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Improving Rural Trauma Care, Education and Prevention through Telemedicine

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  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 • 1960’s • Microwave transmission • Medical education • Limited clinical use • Expensive, technology intensive • Based upon Federal funding

  3. Video Teleconferencing Internet Video E-mail • FAHC Intranet • patient data • test results • practice guidelines World Wide Web Forms-based E-mail Microsoft Office Vermont Telemedicine 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. Desktop PC system ISDN, 384 kbps 17” monitor Pan-tilt-zoom camera Zydacron Z350 video-conferencing board Zydacron Z206 multiple BRI board Telemedicine System

  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? • Michael.ricci@uvm.edu • www.vtmednet.org/telemedicine

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