Docs, paramedics using new two-way video link

Puts hospital physicians 'inside the ambulance'

Physicians at the University Medical Center (UMC) in Tucson, AZ, a level I trauma center, and the city's 17 paramedic units are participating in a pilot program for what its proponents say is a worldwide first — a two-way video system that enables them to see and communicate with each other in real-time as the patient is being treated and brought to the hospital.

Some of the units also have cameras on the outside of their vehicles, which enable those using the system to see what's happening at the accident scene as well.

The videoconferencing system uses the city's safety and public works wireless Internet system to connect the video cameras installed both in the paramedic units and in the hospital. The cameras can be manipulated at both ends of the system, so not only can the doctors view the patients and the paramedics, but the paramedics can see the physicians through a computer monitor on the walls of their vehicles.

The project, funded by a $1.6 million federal grant and matching funds from the city of Tucson, is an extension of the Southern Arizona Teletrauma and Telepresence Program. The program provides live videoconferencing, telemetry, digital X-rays, and ultrasounds to the trauma physicians at UMC, as well as to rural emergency departments and nurses in the southern part of the state.

"When I got here (several years ago) the grant for the telemedicine/ER link had been under way, with some funds from the Department of Transportation," recalls Rifat Latifi, MD, interim medical director of UMC's level 1 trauma center. "But somehow, things were kind of quiet. We helped reinvigorate the process; we wrote [a request for proposal] and did the other things we needed to do."

The three partners in the project, he explains, are the Tucson Fire Department, the Tucson Department of Transportation, and UMC. "We had a number of people present bids, and, ultimately, we picked the equipment from General Devices, which is based in Ridgefield, NJ. We thought at that time that they were the best at providing real access to the patient, as well as vital signs."

A real 'first'

Is this truly the first system of its kind in the world? "To my knowledge, this is true," says Latifi. "A few others have tried it before, but they did not succeed."

With the pilot program, which began in August, "we have access to the patient, to the paramedics, and to everything outside and inside the ambulance," says Latifi. "And once we know what's going on, we share that knowledge with the paramedics."

Why is it so important to have a system such as this? "In Europe they send the [trauma] docs out to pick patients up at the scene," Latifi notes. "We do not have enough physicians to do that, so this is basically an extension of manpower to the scene of the accident."

The system will improve quality on a couple of different levels, says Latifi. "Patient care will get better," he predicts, noting the immediacy of treatment. "Number two, the cohesiveness of the team — the pre-hospital and hospital providers — will be much better. Any time a team works better, the patient receives better quality of care." Theoretically, observers note, such a system can also reduce potential liability by reducing errors.

Some mixed emotions

Lafiti concedes that the system has been met "with mixed emotions" by the paramedics, because some feel people are now looking over their shoulders.

"We need to do a better job overall to educate them that this is not a 'big brother is watching you' concept, but that we are just trying to be more helpful," he explains. "If you have a really sick patient trying to die on you and your colleague is driving the ambulance at 70 miles per hour and you are there in the back, you feel pretty lonely. The new system will remove the loneliness, and make physicians more a part of the team." Patient privacy (and more specifically HIPAA), on the other hand, should not be an issue because the city will not have access to the videos.

There are a few other "bugs" that need to be worked out of the system, Ratifi adds. "We had some issues with the [sound of the] voice initially, but we are getting used to it, as we are the whole system," he says. "All of a sudden we are seeing inside the ambulance. We see the patient come in. We have to adjust our concentration, since now we can also see and not just hear, and that will take some time."

[For more information, contact:

Rifat Latifi, MD, Interim Medical Director, Trauma and Critical Care; University Medical Center, 1501 N. Campbell Avenue, Tucson, AZ 85724. Phone: (520) 694-6093. E-mail: rlatifi@email.arizona.edu.

For information about the video conferencing equipment, contact:

General Devices, 1000 River Street, Ridgefield, NJ 07657-1610. Phone: (201) 313-7075. Fax: (201) 313-5671 Email: info@general-devices.com.]