CUT OUT FOR AMAZON FIRE TABLET PILOTING MOBILE TELEMEDICINE CRITICAL CARE REFERRAL - A Proof of Concept Dr Steven McVea1, Dr Caroline Hart2, Dr Christopher Flannigan3, Dr Thomas Bourke4, Dr Andrew Thompson4.   1 Paediatric Registrar, Royal Belfast Hospital for Sick Children 2 Paediatric Simulation Fellow, Royal Belfast Hospital for Sick Children 3 Paediatric Intensive Care Consultant, Royal Belfast Hospital for Sick Children 4 General Paediatric Consultant, Royal Belfast Hospital for Sick Children BACKGROUND In recent years telemedicine has been increasingly used within medical practice. Systems involve specially developed, expensive equipment, which is localized into specific departments. However, with mobile phone video technology advancements and increasing availability of superfast mobile internet connections it is possible that telemedicine could soon be within the reach, or pocket, of all practitioners within the hospital. AIMS The aims of this project are To test the feasibility of remote paediatric critical care assessment via FacetimeTM To determine if such assessment will add value to Paediatric Intensive Care Unit (PICU) referral To guide development of simulation research project for future study METHODS   A paediatric emergency simulation session was carried out in the high fidelity simulation suite within the Royal Belfast Hospital for Sick Children. The assessing doctors within the simulation suite were equipped with a mobile device placed on a chest harness (Figure 1). The mobile device was connected to a critical care consultant for advise via FacetimeTM. Following completion of the simulation a focus group was convened, consisting of all involved during the simulation, including a critical care consultant, a general paediatrician and 3 middle grade paediatric trainees with district general hospital experience. RESULTS & CONCLUSIONS The focus group ultimately found the concept feasible and added value to remote assessment. Video quality was sufficient to allow assessment. The apparatus was comfortable to wear, allowing the wearer to remain hands free to carry out procedures, assessments and prescriptions as needed. Communication was of good quality from the harness wearer but disjointed from others. This may deteriorate further in situ with normal ambient noise. A Bluetooth microphone/speaker combination was suggested as a solution (Figure 2). A further in-situ simulation was carried out with Bluetooth conference speaker at the end of the bed which corrected this issue (Video, Figure 3). We plan to develop a randomized control trial comparing mobile telelink and standard telephone communication with PICU during a critical care simulation scenario. FIGURE 1 – Chest Mounted Mobile Device FIGURE 2 – Bluetooth Conference Speaker VIDEO – Critical Care Referral Simulation CUT OUT FOR AMAZON FIRE TABLET FIGURE 3 – Critical Care Referral Simulation Video Screenshots