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1	The Use of Telemedicine for Real-Time Video Consultation Between Trauma Center and Community Hospital in a Rural Setting Improves Early Trauma Care: Preliminary Results Frederick B. Rogers, M.D., F.A.C.S. Michael Ricci, M.D., F.A.C.S. Michael Caputo, M.S. Steven R. Shackford, M.D., F.A.C.S Ken Sartorelli, M.D., F.A.C.S. Peter Callas, Ph.D. Jay Dewell, M.D. Suhail Daye, M.D.
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8	U.S. Department of Commerce Technologies Opportunities Programs (TOP) $300,000 in matching funds http://www.ntia.doc.gov/otiahome/top/index.html
9	Telemedicine Network Systems deployed in 7 rural trauma rooms. System deployed in 6 trauma surgeon’s homes at the Level I trauma center
10	Telemedicine System
11	Implementation
12	Trauma TMED Protocol
13	Trauma TMED Protocol Contact Provider Access (800#) 6 Surgeons Assigned to Project Pager Cell phone Home Nearest Telemedicine Workstation
14	Trauma Room Configuration 3 Sites have ceiling mounted Polycom Units with 20” SONY TV 4 Sites have shelf mounted units All sites have ceiling mounted mics 2 Sites have document cameras
15	Rural Trauma Room
16	Electronic Eyes & Ears
17	Results 36 tele-trauma consults (4/2000 - 11/2002) Ages 14 - 81 years old 96% blunt mechanism 54% MVC, 9% ATV, 9% pedestrian struck, GSW 6%
18	Comparison of Telemedicine consults population vs. the general trauma population during time course of the study
19	The reason for transfer recorded No neurosurgeon available 15 (56%) Ortho unable to care for injury 9 (33%) Unstable 2 ( 8%) Possible vascular injury 1 ( 4%) Multiple Injuries 1 ( 4%) No Cardiac Surgeon 1 ( 4%) ENT Care 1 (4%)
20	Recommendations of Tele-consults
21	Referring providers impression of tele-trauma consult
22	2 Cases of Potentially Lifesaving Tele-trauma Consults Case #1 41 year-old with severe CHI unable to intubate emergent cricothyroidotomy Case #2 24 year-old severe multi-trauma hypotensive, severe CHI DPL -> to OR for control of intracavitary hemorrhage
23	Technical Problems Connection failures Remote camera control failures Audio failures
24	Discussion ACS - COT requires the presence of attending trauma surgeon within minutes in-house of arrival of a major trauma victim ATLS philosophy incorporates team approach with a “no hands-on” team leader Trauma telemedicine provides virtual “in-house” trauma surgeon who can fulfill role of no hands-on team leader
25	Conclusion Tele-trauma enhances rural trauma care 2 lives potentially saved well received by rural trauma providers Occasional technical difficulties
26	Future Expansion to other rural community hospitals in upstate New York and Vermont ? Consultation fees