Telemedicine for trauma emergencies and disaster management
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Telemedicine for Trauma, Emergencies, and Disaster Management by Rifat Latifi, MD, FACS Professor of Surgery, University of Arizona, Tucson, Arizona President and Founder International Virtual e-Hospital Foundation, Know more here:http://transformhealth-it.org/

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Telemedicine for Trauma, Emergencies and Disaster Management

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Telemedicine for trauma emergencies and disaster management

Telemedicine for Trauma, Emergencies, and Disaster Management

Rifat Latifi, MD, FACS

Professor of Surgery, University of Arizona, Tucson, Arizona

President and Founder International Virtual e-Hospital Foundation

Hyderabad, September 7, 2013


Telemedicine for trauma emergencies and disaster management

Disclosure


Current telemedicine programs

Current Telemedicine Programs

  • Elective Telemedicine Program

  • Inter-hospital telemedicine and telepresence and network- Emergency and Trauma

  • Digital ambulances and monitored patient transport; EMS, Trauma

  • Deployable mobile telemedicine systems- Disasters,Medical Missions


Telemedicine for trauma emergencies and disaster management

Telemedicine for Emergency and Disaster

Most importantly

Pre Event

Media

Effect, research papers…

During the Event

Chaotic situation, difficult to create “de novo” programs, short term, ?? utility

Post Event


Vital signs

Vital Signs


Store and forward

Store and Forward


Need for telepresence

Need for telepresence:

“Patients involved in MVC in rural America have twice the rate of mortality with those in an urban settings with the same ISS”

JAMA 2000;284


Telemedicine for trauma emergencies and disaster management

So what is the all the fuss about ?


Trauma toll

Trauma Toll

  • 16,000 X 365=5,800,000

  • Up to 50 million are significantly injured or disabled

Mock C et al. Guidelines to Essential Trauma Care, 2004


Natural disasters

Natural Disasters

327 Natural disasters in 2009

Earthquakes, floods, extreme temperature, storms

2010 Haiti earthquake, roughly 230,000 died

Death tolls due to construction, infrastructure, and overcrowding


Trauma disasters as a worldwide problem

Trauma & Disasters as a Worldwide Problem

  • “Disaster – Serious event where needs exceed the local capacity to respond” –WHO

  • Most victims of disaster are usually also trauma victims


Disasters

Disasters

  • Natural


Disasters1

Disasters…


Published evidence

Published Evidence

  • Australia: Smith et al (2004), Kumar et al (2006)

  • Canada :Dyer et al ( 2008)

  • China: Wong et al (2006)

  • France: Knobloch et al (2009), Dulou et al (2010)

  • Germany: Kreutzer et al (2008), Juhra et al (2009)

  • Israel: Ashkenazi et al (2007) Todder et al (2007)

  • Italy: Do Paolo et al (2009)


Published evidence1

Published Evidence

  • Taiwan: Hsieh et al (2004),Tsai et al (2007)

  • Thailand: Chandhanayingyon et al (2007)

  • United Kingdom: Keane (2009), Noble et al (2005), Benger et al (2004)

  • USA: Sposaro and Tyson (2009), Saffle et al (2006, 2009), Latifi et al (2007, 2009), Waran et al (2008), Duchesne et al (2008), Ma et al (2007), Kwon et al (2007), Ngyuen et al(2004), Marcin et al (2004)


Telemedicine for trauma emergencies and disaster management

CASE PRESENTATION

Pull the ET tube back,

decompress

the stomach…

Results:

Clinical

Improvement

Better SBP

Improvement of Saturation

Small intervention

Initial Chest x-ray of the patient managed by telemedicine 11/21/2004


Telemedicine for trauma emergencies and disaster management

Patient at the UMC Trauma center being attended by trauma team


Interventions routine for trauma

Interventions (routine for trauma)

  • Intubate the patient

  • Reposition the ET tube from the right main bronchus

  • Sedate, paralyze the patient

  • Obtain femoral vein/arterial access

  • Resuscitate with lactated ringer

  • Obtain a blood gas, CBC

  • Blood transfusion, antibiotics

  • Suction the ET tube

  • Place the orogastric tube to decompress stomach


Extreme conditions low bandwidth portable satellite

The Amazon Swim Expedition

Martin Strel and virtual physicians

Lessons learned: telepresence 24 hours day, 7 days week, 66 days – usage of mobile satellite, BGAN

Extreme Conditions: Low-bandwidth Portable Satellite


Conclusion

Conclusion

  • Telemedicine in acute phase injury : works and it is beneficial

  • Cost effective

  • Save lives


Telemedicine for trauma

Telemedicine for Trauma:

  • Safety and practicality has been demonstrated

  • Vastly underutilized

  • It’s time has come


Telemedicine for trauma emergencies and disaster management1

Telemedicine for Trauma, Emergencies and Disaster Management

The Greatest Unused Tool !


Telemedicine for trauma emergencies and disaster management

  • What we need to do?


Create

Create

  • Infrastructure and Connectivity

  • Policies, procedures, protocols (both clinical and technical)

  • Credentialing process

  • Quality control


Telemedicine for trauma and emergencies

Telemedicine for Trauma and Emergencies

Non-

Disruptive-Very helpful

Improving

Quality of

Patients

Care

Cost effective

Partnership

Between healthcare

providers

Virtual Participation


Inaccuracy of measurement of trauma injury

Inaccuracy of Measurement of Trauma & Injury

  • Unreliable measurement globally

  • Lack of consistency in coding and gathering of data

  • www.emdat.be : contains 18,000 natural & technological disasters since 1900


Problems facing medical and emergency experts during disasters and emergency

PROBLEMS FACING MEDICAL AND EMERGENCY EXPERTS DURING DISASTERS AND EMERGENCY

The largest problem is accessing people affected by disasters and emergency situations and being adequately prepared to respond!


Wireless technologies potential use in emergencies and disasters

Wireless Technologies: Potential Use In Emergencies and Disasters

  • Multi-patient monitoring systems using wireless technologies in disaster situations

  • Long-range data transmission

  • Connect among regions of experts

    • GPS technology/satellite

    • Useful for monitoring multiple patients in disasters


Problems facing medical and emergency experts during disasters and emergency1

PROBLEMS FACING MEDICAL AND EMERGENCY EXPERTS DURING DISASTERS AND EMERGENCY

  • Wireless technologies

  • Remote access to experts

  • Communications

  • Organization & Coordination

  • Provide relief to disaster management teams on location


Potential uses of remote technologies in remote settings

Potential Uses of Remote Technologies in Remote Settings

  • FAST, Focused Assessment with Sonography for Trauma = real-time remote physician guidance for trauma examination

  • Teleultrasound as a transformational technology for under-resourced settings

    Crawford, I. et al., (2011). Telementorable, “just-in-time” lung ultrasound on an iPhone. Journal of Emergencies, Trauma, and Shock, 4, pp. 526-527.

    Pian, L.. et al. (2013). Potential use of remote telesonography as a transformational technology in underresourced and/or remote settings. Emergency Medicine International.


Telemedicine for trauma emergencies and disaster management

FAST

Emergency situations:

EMT lack of training

FAST technology applications

Boniface, K.S., Shokoohi, H., Smith, E.R., & Scantelbury, K. (2011). Tele-ultrasound and paramedics: real-time remote phyisician guidance of the Focused Assessment with Sonography for Trauma examination. American Journal of Emergency Medicine, 29, pp 477-481.


Telepointer technology

Telepointer Technology

Interaction style presentation system interactive television, and other systems, where the user is positioned at a remote site from the display. The main function of a telepointer is to point at the specific display so that its motion could represent the human gesture. Meanwhile, display devices allow the collaborator to view the same scene as seen by the other parties

Abdul Karim, R., Farizan Zakara, N. et al., (2013). Telepointer technology in telemedicine: A review. Biomedical Engineering Online.


The military approach

Establishing Clinical Protocols & Standards

Standardization may not always be necessary

Not all military's follow the same approach!!

Lam, D.M. (2011). Establishing clinical protocols and standards: The military approach. pp. 147-160. In Telemedicine for Trauma, Emergencies and Disaster Managment, R. Latifi, Ed.

The Military Approach


The military approach 2

NATO – successful international standardization

Clinical, Technical, Business Standards

NATO: 1) standardization voluntary, 2) Not an end of itself, only done if useful and makes process more efficient, use of common terminology

Lam, D.M. (2011). Establishing clinical protocols and standards: The military approach. pp. 147-160. In Telemedicine for Trauma, Emergencies and Disaster Managment, R. Latifi, Ed.

The Military Approach 2


U s army telemedicine in iraq afghanistan

U.S. Army Telemedicine in Iraq & Afghanistan

  • Can telemedicine effectively be used across national boundaries?

  • U.S. Army Theater Teleconsult program

  • Online management of consultation requests

  • Consultant is primary responder

  • 7,255 consultations over 6 year period

  • Avoided 90 medical flight evacuations ($2 million cost savings)

  • Considerations for NATO operations – lessons learned

  • Poropatich, R.K., Lappan, C., & Lam, D.M. (2011). Operational use of U.S. Army telemedicine information systems in Iraq and Afghanistan – Considerations for NATO operations.pp. 173-182. In Telemedicine for Trauma, Emergencies and Disaster Managment, R. Latifi, Ed.


India disaster management amrita

INDIA – Disaster Management Amrita

Amrita Institute of Medical Sciences and Indian Space Research Organization (ISRO) partnering to provide remote care to over 60 hospitals in preparation for disaster management


Recent developments pakistan

RECENT DEVELOPMENTS - PAKISTAN

Pakistan - Telmedpak

SUPARCO, an autonomous research entity under the federal government has recently launched Pakistan’s First Satellite based telemedicine network.

Telmedpak.com.

Www.suparco.gov.pk


Recent developments armenia mobile ecg telemonitoring

Recent Developments – ArmeniaMobile ECG Telemonitoring

Armenia – recent development of Mobile ECG telemonitoring device

Lightweight ultra-portable sensor & smartphone

ECG registered regardless of patient's location

ECG monitoring is live streamed, provided by specialized personnel

Data stored in patient databased, viewed anywhere

Www.armtelemed.com


Keeping up with industry development

Dissolving legal barriers to industry growth and development are key to unlocking potential of the use of telemedicine in disaster and trauma management

Gupta, A. & McHugh, M. (2011). Keeping up with industry development. pp. 373-388. In Telemedicine for Trauma, Emergencies and Disaster Managment, R. Latifi, Ed.

Keeping up with Industry Development


Telemedicine for trauma emergencies and disaster management

Telemedicine for Emergency and Disaster

Most importantly

Pre Event

Media

Effect, research papers…

During the Event

Chaotic situation, difficult to create “de novo” programs, short term, ?? utility

Post Event


Reconstruction

Reconstruction

  • The entire medical infrastructure and human capacity destroyed

  • No medical standards

  • Infant mortality 51.2 per 1000

  • In-efficient and broken

    medical system

  • Crowded hospitals

  • Not a single scientific journal in any library


Summary

SUMMARY

Preparedness

Organization

Coordination

Communication technology

Telemedicine

Saving lives!


Telemedicine for trauma emergencies and disaster management

“There are no more excuses for any critically ill or trauma patient to die in any emergency room of any country just because there was no specialist available on site to help with the resuscitation.”


What do we needed was and still is

What do we needed was and still is:

  • Radical changes of the configuration of medical care

  • Coalition of new partners with innovative boundaries

  • Penetrating eyes of revolutionary and champions of the unconventional

  • The rebels of the hospital as we know it


The vacuum of knowledge and the vacuum of hope

THE VACUUM OF KNOWLEDGE AND THE Vacuum of hope

Digital divide was getting bigger and wider…


Telemedicine for trauma emergencies and disaster management

INTEGRATED MIDDLE EASTERN TELEMEDICINE AND E-HEALTH PROGRAM FOR PREVENTION, TREATMENT AND REHABILITATION OF LANDMINE INJURIES AND OTHER TRAUMAS


Telemedicine for trauma emergencies and disaster management

INTEGRATED MIDDLE EASTERN TELEMEDICINE AND E-HEALTH PROGRAM FOR PREVENTION, TREATMENT AND REHABILITATION OF LANDMINE INJURIES AND OTHER TRAUMAS


What we do

What we do:

Change the delivery of existing medical care

Bring together new coalition of partners with innovative boundaries and clear vision

Create a modern and efficient medical

system that will prevent morbidity and death, and improve lives


We demand

We Demand

A new generation of leaders with different intellectual capital and a new direction

Global and not focused on

self limited projects, or

driven by institutional

and/or national interest

Universal Thinking and Actions


Disasters2

Disasters

  • Landmines & Unexploded Devices


Telemedicine in the balkans

Telemedicine in the Balkans

  • =


Telemedicine for trauma emergencies and disaster management

Thank You!

[email protected]

[email protected]


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