Telemedicine has the potential to support regionalization and facilitate the sharing of cognitive resources with local hospitals, allowing patients to be treated locally, avoiding the added costs of transportation, while allowing them to stay close to family support systems. In addition, the technology has the potential to positively impact many of the challenges to rural MCI response that were identified throughout the workshop, noted several panelists. Some participants believed that telemedicine communications between first responders at the incident scene and hospitals could facilitate triage and transportation decisions; telemedicine technology aboard ambulances might counterbalance the long travel time between the scene and the hospital to positively affect patient outcomes; common technology platforms could assist communication of best practices between rural emergency responders and caregivers across regional jurisdictions; and telemedicine technology might even ease the burden of providers to measure and record outcomes and quicken metrics development by aggregating the data automatically and centrally. While some participants heralded the potential of such advances, others remained concerned about issues of funding, feasibility, and ethics not yet resolved. As highlighted during discussions, currently there are more impediments to implementation than solutions, e.g. of cost, reimbursement, frequency of use, credentialing, and others.

The Arizona Example

To illustrate the potential of telemedicine for rural health systems, Rifat Latifi, director of the Southern Arizona Teletrauma and Telepresence Program, and vice chair of International Relations in the Department of Surgery at the University of Arizona, presented the case of an 18-month-old female who arrived at Southeast Arizona Medical Center in Douglass, Arizona, 3 hours after a motor vehicle crash. Complicating the treatment of her severe injuries, including severe head trauma, was the fact that it was a new ER physician’s first day on the job. Via the telemedicine link, Latifi was able to review the patient’s X-rays and direct care remotely from University Medical Center. With a series of interventions, some proposed remotely by Latifi, the child was stabilized, and ultimately recovered.

This case was actually the first use of the new telemedicine system, and there were many practical lessons learned, Latifi noted, such as the need for earpieces rather than speakerphones, to allow for private consultation between the surgeons.

In addition to the interhospital telemedicine and telepresence network, Latifi said the “ER Link” program has 17 of the ambulances, from the Tucson Fire Department, that are equipped with video and audio equipment to connect with the hospital.

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