Teletrauma... From myth to reality? An interview with Dr. Rifat Latifi, Associate Professor of Surgery and Trauma and Critical Care, University Medical Center, Tucson, Arizona

Tucson 11 May 2005In a recent interview with Dr. Anton V, Dr. Latifi brought up the topic of Teletrauma and the other day, I found an interesting e-mail in my inbox about an active Teletrauma programme in Tucson Arizona and I realized that I needed to follow on the use of telemedicine in trauma care. Interview by Bob Pyke, with Rifat Latifi, MD, FACS.

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Bob Pyke (BP): So how did you become involved in telemedicine?

Dr. Rifat Latifi (RL): Looking back in my past, I have been involved in one or another in telemedicine since I graduated from medical school. Initially, I had a medical column in an Albanian daily newspaper called Rilindja, and later I had a medical radio show on the Voice of America, and then finally started the telemedicine project in Kosova, after the work at MITAC with Dr. Merrell. Sharing the medical knowledge and spreading it to as many people as possible from a distance is the key concept of telemedicine. I maintain that concept as my main guidepost in my surgical academic carrier. Teaching health care providers things that they do not know at the moment that they really need, educating and making patients partners in their care, are the dictum of my work. And telemedicine does exactly that. I love it.

BP: Can you tell me about the demographics of your programme? Who are the patients that you serve, and what are their numbers and locations?

RL: At the ATP, we serve rural Arizona, the patient population that does not have specialist care and that needs specialists the most. The Southern Arizona Teletrauma and Telepresence Programme, when fully operational, will serve more than 1,2 million. In addition, there are lots of patients who cross the border from Mexico and need trauma and emergency care services.

BP: Tell me a little about the hardware and software you are using.

RL: Currently we are using the ATP network and VitelNet equipment.

BP: What about post op care or follow and monitoring in the ICU or PICU, the eICU? RL: That is most natural use of telemedicine. Stabilization of the patient before the transfer (if needed), and then post operative follow-up is the best use of telemedicine in trauma and emergency care. This is the perfect use of telemedicine. Once the infrastructure becomes more wide spread, we can do all the above: monitor the patient in the small hospital intensive care unit, and become true partners with rural doctors and other health care providers.

BP: What else are you doing in telemedicine as far as distance education and grand rounds?

RL: All grand rounds at the University of Arizona are broadcasted and available on the net and to our partners.

BP: What research is the university's telemedicine programme involved with?

RL: We are using the Arizona Telemedicine Network for many different research projects. Most of our work in published at our Arizona Telemedicine Network Web site.

BP: How is your programme funded for teletrauma?

RL: Currently this work is being done as a pilot project, but it will become part of the ATP. Physicians will charge for the consults.

BP: What do you want to do, and in what direction would you like to see your programme go in the future?

RL: Popularize telemedicine. And do so in 1 year: have the entire SATT network completed, and in 5 years: all trauma centres will perform teletrauma as part of their outreach programmes. Using telemedicine will become a routine practical issue in 10 years. At that point, use of telemedicine will not be news any longer.

BP: I am convinced that one of the most exciting areas in telemedicine is the potential role it may have in international health care and disaster responses. And of course teletrauma can play an important role. What is your view?

RL: This is where all the values of telemedicine culminate. This is a reason why I and many others have started with this. It is the best feeling in the world when you can resuscitate someone from the jaws of death from the distance. Nothing better. Nothing more valuable. You know that if you have not been there virtually, the patient would have died.

BP: What can be done to continue to promote telemedicine/teletrauma in the United States, in Eurasia, and other parts of the world?

RL: We need to promote it, publish the work done, persist with development and document every case that we manage. Network. Push industry to lower their prices. The day will come that if a trauma patient dies in the small hospital that does not have trauma surgeon, someone will ask the question: Did you use your teletrauma system for help to call the regional trauma centre? No one should die because there was no trauma expertise in a small hospital. No one!

BP: David Balch, who recently retired form the Advanced Telemedicine Training Center at Eastern Carolina University told me that he thought telemedicine as we know it would disappear, that it would be so common on our desk top, that we will take telemedicine for granted. What do you think?

RL: I hope he is correct. I share that thought too.

BP: What do you want to say or add to your colleagues out there? And what words of advice can you offer?

RL: Do not be afraid to use telemedicine. Use the technology and experiment with it. If I can do it, every one should be able to do it. We are obligated to share the knowledge, to guide those who do not know how to treat the patient. That is our job. We need to push the envelope as far as we can.

BP: Dr. Latifi, I want to thank you for your time and I wish you continued success.

RL: Thank you.

Dr. Rifat Latifi is Associate Professor of Clinical Surgery, Director, Surgical Critical Care, and Associate Director of Trauma and Critical Care at the University of Arizona, Tucson. He is a director of the Southern Arizona Teletrauma and Telemedicine (SATT) Programme and an Associate Director of Arizona Telemedicine Programme where he leads Telesurgery and International Affairs for this programme. He is founding Co-Director of the Arizona Surgery and Technology Education Center (ASTEC) at the University of Arizona's College of Medicine.

In addition, he is the founder of the International Virtual e-Hospital, and Director of the Telemedicine Project of Kosova. He is also a founder of the Kosova Foundation for Medical Development, a non profit organisation dedicated to establishing telemedicine in the Balkans and other developing countries.

Dr. Latifi's principal interests in telemedicine are international collaborations and development of telemedicine in underdeveloped countries worldwide and in rural America. Furthermore he has special interest in developing and applying telemedicine principles in surgery, trauma and critical care, telementoring and teaching, as well as developing multimedia learning modules and Internet applications for international teaching.

Among his recent accomplishments, in his role as director of the Telemedicine Project of Kosova, Dr. Latifi introduced the idea of the creation of the Telemedicine Programme of Kosova and International Virtual e-Hospital, at the Final conference of G8 in Berlin, on May 5, 2000, on Global Health Application Project (GHAP). The Telemedicine Centre of Kosova was inaugurated on December 10, 2002, and is one of the best telemedicine centres in Europe. Its development represents the first step of implementation of the Telemedicine Project of Kosova and in the Balkans. Subsequently, Dr. Latifi chaired the organisation of the First Intensive Balkan Telemedicine Seminar held in Prishtina, where there were 400 participants from 21 countries, in October 2002. Since that time, Dr. Latifi has served on the advisory board of European Space Agency for application of satellite in telemedicine and is the author of the section on e-health education and co-author of trauma, emergency and disaster management. In addition, he is co-founder of the International Forum for Surgical Research and Telemedicine based at the University of Graz, Austria and at the University of Arizona in Tucson, Arizona, USA.

Dr. Latifi was born in Kllodernice, a village in the Drenica region of Kosova. He graduated from medical school at the University of Prishtina in 1982. He served as a house staff in the Orthopaedic and Surgery Clinic at the University Clinical Center in Prishtina Kosova until 1985, when he emigrated to the United States, and worked in clinical research in the field of clinical nutrition and metabolism of critically ill surgical patients with Dr. Stanley J. Dudrick, the founding father of modern surgical nutrition and innovator of Total Parenteral Nutrition at the University of Texas, Houston, Texas and Pennsylvania Hospital, in Philadelphia, Pennsylvania. He completed an Internship in General Surgery at the Cleveland Clinic Foundation in Cleveland, Ohio in 1994 and the Residency in General Surgery at Yale University, New Haven, Connecticut in 1999. He also completed a fellowship in Surgical Critical Care at New York Medical College - Lincoln Medical Center in the Bronx, New York in 1997.

Upon completion of the Residency programme at Yale, Dr. Latifi became an assistant Professor of Surgery at Medical College of Virginia Hospitals, Virginia Commonwealth University (VCU) in Richmond, Virginia, where he practised general, trauma, and critical care surgery until December 2002. In January 2003 he joined the faculty at the University of Arizona as an Associate Professor of Clinical Surgery where he still practises trauma, critical care and general surgery. While at the VCU, Dr. Latifi was Director of Surgical Nutrition Support Services, and Director of Education and Distance Learning at Medical Informatics and Technology Applications Consortium (MITAC), a NASA commercial space centre in Richmond, Virginia, USA.

Dr. Latifi is the author and/or editor of 8 books and more then 100 articles, reviews, and chapters on surgical nutrition and metabolism, and laparoscopic surgery, and telemedicine and telesurgery. Currently he is working on two more books: "Guidelines to establishing e-Health and telemedicine in developing countries: The do's and don'ts" and "Complete Surgical Critical Care".

You may contact Dr. Latifi at Rlatifi@email.arizona.edu or at Rlatifi@pol.net

More news on Dr. Latifi and his work is available in the VMW Februay 2005 article Trauma surgery goes virtual to aid rural Arizona.


Bob Pyke Jr.

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