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. A comprehensive information system is planned for our region in Vermont and upstate New York. Video telemedicine is planned to be a major component of this system. Vermont Telemedicine

4. FAHC Forms-based E-mail Microsoft Office Video Teleconferencing Video E-mail FAHC Intranet - patient data - test results - practice guidelines World Wide Web Internet Vermont Telemedicine

5. 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

6. Could telemedicine be used for trauma care in Vermont’s “hostile” rural environment?

7. 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..

8. Telemedicine System Desktop PC system ISDN, 384 kbps 17” monitor Pan-tilt-zoom camera Zydacron Z350 video- conferencing board Zydacron Z206 multiple BRI board

9. Implementation 4 hospitals 3 surgeons’ homes Multiple sites on campus

10. Trauma Procedures Significant trauma (per pre- existing protocol) Single phone call from community hospital (800#) Three surgeons available 7 X 24 Surgeon places video call to community hospital ER

11. Rural ER Setup

12. Results April 2000 – June 2001 28 consults 14 – 81 years old 96% blunt trauma 46% MVA 75% transferred to FAHC

13. Telemedicine vs. General Trauma Population

14. 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%

15. 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

16. 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

17. Next Steps Expansion (more hospitals, more surgeons) Improve on equipment –Polycomm Viewstation –Stand-alone system –27” SONY monitor

18. Next Steps Fill the void between hospitals

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