Telemedicine can optimize trauma care delivery

Telemedicine can help health care providers in rural areas stabilize and treat trauma victims when long distances or inclement weather prevents immediate transfer to an accredited trauma center. Trauma surgeons in a telemedicine program in Maine reported on their experience at the 95th annual Clinical Congress of the American College of Surgeons through a scientific exhibit presentation.

According to Rafael Grossmann, MD, FACS, lead study author and general surgeon at Eastern Maine Medical Center in Bangor, an analysis of 59 telemedicine consultations has shown fewer medical errors and a virtual elimination of unnecessary transport compared with telephone consultations. Eastern Maine Medical Center is an American College of Surgeons Level II trauma center where trauma surgeons provide consultation via telemedicine to 11 satellite centers in northern and central Maine. That network covers an area of approximately

26,000 square miles with a population of approximately 462,000 between the Atlantic coast and Canadian border. The area is approximately the size of Vermont, New Hampshire, and Massachusetts combined.

Telemedicine is two-way video and audio link between two or more locations. The Eastern Maine system, known as TeleTrauma, uses high-resolution video with synchronized audio via an Internet connection. While telemedicine is not a new concept in medicine, the study by Dr. Grossmann and colleagues illustrates how surgeons are using this technology to expedite emergency care to underserved areas and how it can impact care.

Specifically, their report collected data on 59 TeleTrauma consultations and an unspecified number of telephone-only consultations. The level of trauma and age of patients were similar in both groups, but the level of medical errors in the TeleTrauma group was about one-quarter of that in the telephone consultation group. Unnecessary transfers were seen only in the telephone consultation group.

"There is a shortage of surgeon coverage for rural areas in the United States, and this is an improved way of communicating with local providers and expanding the reach of trained trauma surgeons in Maine," according to Dr. Grossmann. The study authors also found that tele-medicine improved surgeon preparation when receiving cases, enhanced cooperation between providers on both ends of the connection, and increased satisfaction among patients and families in understanding treatment plans.

TeleTrauma has also proved valuable in treating burn victims. "It is very difficult to objectively quantify burns," according to Dr. Grossmann. "Having one of us look at the burn wounds over the high-resolution camera, we can say, 'Yes, you can treat that locally with pain control,' or 'This is way over your and our heads. This patient will have to go to an ABA/ACS certified burn center.' The closest one is in Boston, and the helicopter can go directly from the local hospital to Boston.

The study findings indicate telemedicine has the potential to optimize trauma care delivery, according to Dr. Grossmann. "Given the times in which we live, with all the tech-nology available to us and the difficulties regarding shortage of providers and the cost of health care, that equation really summarizes to me that a tool like telemedicine, specifically TeleTrauma, definitely has a role in providing trauma care," he said.