Background

Trauma and emergency management require fast resuscitative measures and definitive care, as well as major resources and advanced continuous expertise. These recourses and the expertise around the world are concentrated in the major trauma centers (Level I trauma centers) in urban settings. Subsequently, most of the population of the world is not covered by specialized trauma expertise. Establishing trauma systems to cover, not only the urban area but vast rural areas is not an easy task, and requires major resources, and expertise.

With advances in communication technology and experience gained with routine telemedicine services, the implementation of teletrauma as an integral part of modern trauma care has become possible.

Materials and methods

The University Medical Center (UMC) in Tucson Arizona, USA, is the only Level I trauma center in Southern Arizona and treats 4500-5000 trauma patients a year from all southern Arizona, northern Mexico, and other neighboring states. In collaboration with the existing network of Arizona Telemedicine Program (T1 line), UMC has embarked on establishing the Southern Arizona Teletrauma (SATT) Program in an attempt to narrow the gap of trauma and emergency care of patients in rural Arizona by providing  telepresence of trauma surgeons 24/7 in all emergency rooms in the region. Using Vitel NetTM Teletrauma system for audio, video and electronic medical records transmission, the Teletrauma system at  UMC has been active since November 21, 2004. The policies and procedures, educational programs and the protocols have been created, and implemented to ensure standardization.

Results:  The initial experience with teletrauma in saving lives, managing critically ill and injured trauma patients at the rural site, or safely transferring when needed, and reducing the overall cost of trauma care has been rewarding and very successful. The acceptance by trauma surgeons, referring physicians, nurses, and other providers, as well as patients, has been excellent. Other clinical specialties are making preparations and creating protocols to use the system as well. Through clinical interaction with rural hospitals using the teletrauma system many knowledge gaps have been identified, and has prompted instituting new outreach educational programs to those healthcare providers.

Conclusion

Telementoring through telepresence for initial trauma resuscitation can be performed successfully and safely using telemedicine principles.  We suggest that using telemedicine for initial trauma resuscitation at rural hospitals and emergency rooms should be an integral part of outreach mission of any Level I trauma centers.