Background from Capstone Project
Health care delivery in the modern era is marked with resources extending beyond the four walls of a single hospital. Advances in technology and communications have supported the electronic exchange of data across geographical locations. Some examples include medical data through health information exchanges and voice data over voice-over-IP applications. The use of communications technologies for telemedicine have been in place since the 1900s with two-way radios (Wesson & Kupperschmidt, 2013). In 1978, Dr. R. Adams Cowley demonstrated the use of telemedicine for trauma resuscitation in real time for a staged disaster exercise at Friendship Airport. He used an old satellite technology for the data transfer (R. Latifi, Ong, Peck, Porter, & Williams, 2005).
In the United States and similarly in other countries, the majority of specialized trauma centers and specialists in trauma management are based in urban settings. This framework leaves rural areas vulnerable to the management of severe traumas without adequate and timely access to resources (R. Latifi et al., 2005; Wesson & Kupperschmidt, 2013). In fact, while only a quarter of the population in the US lives in rural regions, 56.9% of mortalities due to motor vehicle collisions occur here. When
patients are matched by severity score of injury, those who are treated in rural regions have twice the mortality rate (R. Latifi et al., 2005).
Reasons for the vast discrepancy in mortality rates between urban settings with immediate trauma management capabilities and rural settings include lack of timely access to the subspecialty, adjunctive care (neurosurgery, orthopedics, vascular, cardiothoracic, trauma surgery) needed in comprehensive trauma care (R. Latifi et al., 2005). Additionally, with infrequent exposure to injuries requiring activation of trauma management protocols, the rural health care providers often lack the competencies to manage these injuries. The lack of adept knowledge and resources in trauma management can result in higher patient morbidity and mortality, length of hospitalizations, patient care costs, and transfers to other hospitals (Wesson & Kupperschmidt, 2013). Currently, most rural health care providers and trauma specialists in dedicated trauma centers rely on phone communication to assess and determine the plan of care for a patient suffering from traumatic injuries. The trauma specialists must rely on the assessment of the rural health care provider to determine whether the patient should be transferred to the dedicated trauma center, managed locally, and/or suggest a plan of action (Wesson & Kupperschmidt, 2013).
In an era where we are gathering and have access to vast amounts of data which support clinical decision making (human-based and computerized), telemedicine and telepresence modalities should be used to connect rural health care settings with dedicated trauma centers in the management of traumatic injuries. This potential power of this interconnected web of healthcare providers with immediate access to each other, supplemented with innovative methods to share data surrounding patients such as shared cardiac monitors, radiology image viewing applications, and laboratory values could make the absence of telemedicine in trauma management seem arcane in the next few decades.
Latifi, R., Ong, C. A., Peck, K. A., Porter, J. M., & Williams, M. D. (2005). Telepresence and telemedicine in trauma and emergency care management.(Author abstract). European Surgery, 37(5).
Wesson, J. B. A., & Kupperschmidt, B. E. (2013). Rural Trauma Telemedicine. Journal of Trauma Nursing October, 20(4), 199–202. doi:10.1097/JTN.0000000000000012
A Multidisciplinary Teletrauma Program: Connecting Regional Level I Trauma Expertise To Community and Rural Hospitals