Trauma surgery goes virtual to aid rural Arizona

Tucson 03 January 2005A new "teletrauma" system that links the emergency room at Southeast Arizona Medical Center in Douglas, Arizona, and the Level 1 Trauma Center at University Medical Center (UMC) in Tucson is saving lives. On November 21, an 18-month-old baby was critically injured in a car accident with three fatalities. The baby was rushed by paramedics to the hospital in Douglas, a small, rural town along the U.S.-Mexico border. The baby was in shock, having lost almost two-thirds of her blood from multiple injuries. She was minutes from death and the nearest trauma centre was in Tucson, more than 100 miles away...


In the Douglas emergency room, the doctor called the UMC Level 1 Trauma Center in Tucson for assistance. Activating the new teletrauma system using the Arizona Telemedicine Programme network, the trauma surgeon at UMC, Dr. Rifat Latifi, was able to see the baby and examine her injuries. He and UMC's trauma team looked the patient's vital signs, X-rays and lab test results and "virtually" led the doctor and nurses in Douglas through the emergency medical procedures. The baby was resuscitated and once stabilized, transported to UMC for further treatment. She is expected to recover. UMC trauma surgeon Rifat Latifi, MD, stated: "If we had not had this connection today, that child would have died."

The University of Arizona (UA) Department of Surgery Section of Trauma and Critical Care, Arizona Telemedicine Programme and University Medical Center, Southern Arizona's only Level 1 Trauma Center, have created the Southern Arizona Teletrauma and Telepresence (SATT) Programme to assist trauma patients in rural communities. Using advances in technology, more particularly ViTel Net, SATT provides a live consultation link including state-of-the-art videoconferencing, telemetry, digital X-rays and ultrasound, between the trauma team at UMC and rural emergency departments in the southern section of the state.

A person injured in a car accident in a small town is nearly twice as likely to die from his/her injuries as a person in an urban area, explains Dr. Latifi, UA associate professor of clinical surgery and associate director of the UMC trauma programme. Trauma victims have the best chance of survival if the right resources and expertise intervene within the "golden hour", the first hour after injury. However, in rural areas resources and experts are scarce, forcing smaller emergency departments to waste critical time transporting patients to the nearest city with a trauma centre.

"Through this programme, remote emergency rooms can have access to an entire team of surgeons and specialists at UMC that can help with diagnoses and critical care", stated Dr. Latifi, director of SATT. "This programme allows us to virtually transport the trauma surgeon to that hospital." Dr. Latifi, who also is a director of telesurgery and international affairs for the Arizona Telemedicine Programme, the largest telemedicine programme in the country, says he can take another doctor through a procedure if necessary, providing state-of-the-art trauma and surgical care by "telepresence".

The programme's first remote site is in the Southeast Arizona Medical Center's emergency room in the border town of Douglas. Other sites will be added in the emergency rooms along Arizona's southern border, including in Sierra Vista, Benson, Bisbee, Safford and Nogales, according to Dr. Latifi. About 60 percent of transports to UMC possibly could be avoided if specialists were available for consultations, saving hundreds of thousands of dollars and many lives, Dr. Latifi stated. Another major benefit of SATT is the opportunity to train rural doctors in the latest trauma care and emergency medicine techniques with neither having to leave their own hospitals.

Dr. Latifi plans to expand the programme even further south across the border into the Sonora, Mexico, municipalities of Nogales, Hermosillo, Caborca, Puerto Penasco and Aqua Prieta. In partnership with the Arizona Department of Public Health, the Arizona-Mexico Tele-trauma and Telepresence (AMTT) Programme is an international telemedicine initiative that will ensure the telepresence of trauma surgeons and emergency care specialists in the emergency rooms of medical centres in these towns.

"This will create a unique opportunity to provide large-scale educational trauma and emergency programmes, and make available equal standards of medical care for trauma and emergency patients on both sides of the border", Dr. Latifi concluded. Dr. Latifi is the author of the book, "Telemedicine and Telehealth in Developing Countries: From Inception to Implementation", published in July 2004, and is director of the Telemedicine Project in Kosova.

Leslie Versweyveld

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