Medicine from a Distance

In some countries, physicians routinely ride in ambulances. That's not standard practice in the U.S., but the technological equivalent is at hand, in the form of a pioneering telemedicine project that will give hospital-based MDs eyes and ears in all of Tucson's ambulances.

The Arizona city's ER-Link EMS Telemedicine Program will allow the transmission of still and video images, physiologic data, ultrasound scans and more from Tucson Fire Department ambulances to the city's University Medical Center. The goal is to provide docs at that Level 1 trauma center early information on trauma patients' conditions, so they can assist field crews as necessary and begin preparations before such patients arrive at the ED.

"The idea is to have presence at a distance as a trauma or emergency event unfolds," says Rifat Latifi, MD, FACS, director of telemedicine programs at UMC. "We think we should really see what the paramedics see from the start. We have superb paramedics-we're not doing this to be Big Brother. We're doing it to help our paramedics when they need help and, bottom line, to help the patients."

The equipment to make it happen comes from New Jersey-based General Devices. Ambulances will be outfitted with the company's Rosetta-VC (Vehicular Controller), which manages communications and interfaces with cameras and monitoring equipment. At the ED, CAREpoint Workstations will let docs control cameras inside and outside the ambulances, view patient data and images, and quickly access protocols and other information. Linking them will be a digital wireless mesh network that can prioritize service to guarantee access in an emergency.

Implementation of the system began in early 2006 and is expected to be completed in 2-3 months. The program is eventually expected to extend to other area hospitals and paramedic vehicles.

Obviously, it will bring direct benefits to patient care, as doctors can coach field crews through odd or difficult cases. Remote clinicians could also be useful in the event of terrorism, such as a bio-attack.

UMC already has an existing fixed-site telemedicine link to the border town of Douglas, more than 100 miles away, that has saved thousands by preventing unnecessary air transports to Tucson.

"We've been able to keep a few patients in Douglas who didn't need to be transported," says Latifi. "Had I not had the ability to see them, they would have been flown here. One helicopter ride costs between $15,000 and $20,000, so if you keep a couple of patients down there, you basically pay for the entire system."