Saving lives is more than virtual’ with teletrauma

System adds value by eliminating some transfers

On Nov. 21, 2004, an 18-month-old baby was injured critically in a car accident with three fatalities. The baby was rushed by paramedics to the ED at Southeast Arizona Medical Center in Douglas, a small, rural town along the U.S.-Mexico border. The baby was in shock and had lost almost two-thirds of her blood from multiple injuries. She was minutes from death, and the nearest trauma center was in Tucson, more than 100 miles away.

In the Douglas ED, the doctor called the University Medical Center (UMC) Level 1 Trauma Center in Tucson for assistance. Activating the new teletrauma system using the Arizona Telemedicine Program network, the trauma surgeon at UMC, Rifat Latifi, MD, University of Arizona associate professor of clinical surgery and associate director of the UMC trauma program, was able to see the baby and examine her injuries.

He and UMC’s trauma team looked at 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.

"The physician here was relatively new — it was maybe her first or second shift, and it was a major pediatric trauma," recalls Debra Thornby, RN, the ED nurse manager. "Doing a femoral IV [on an infant] is not the easiest thing, and Dr. Latifi helped talk her through it; it’s so unbelievably helpful."

Latifi is even more emphatic: "If we had not had this connection, that child would have died," he asserts. "I have been a physician since 1982 and have never felt better in my life for saving a patient’s life than I did saving that little girl that day."

System aids rural facilities

The University of Arizona Department of Surgery Section of Trauma and Critical Care, the Arizona Telemedicine Program, and UMC, Southern Arizona’s only Level 1 Trauma Center, created the Southern Arizona Teletrauma and Telepresence (SATT) Program to assist trauma patients in rural communities. 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 EDs in the southern section of the state.

Douglas was hooked up to the system, which is subsidized by the state, in November. "Dr. Latifi contacted me last summer with a proposal to accept having the system placed in our hospital," recalls Edward Young, MD, medical director of the Douglas ED. He notes that there was no cost at all to his hospital.

The system basically is a workstation with a computer screen, Thornby explains. "You can type in the patient’s name, the medical problem, then a vital sign monitor can be put into the patient and read up at UMC. There’s also a camera, so the doc at UMC can actually look at the patient and zoom in if they need to. They can even look at the X-rays when we put them on the view box."

The incident with the infant was the most dramatic so far because, according to Latifi, 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. Trauma victims have the best chance of survival if the right resources and expertise intervene within the "golden hour," the first hour after injury, he explains.

Still, it’s not the only time the teletrauma system has proved invaluable, Thornby adds. "We recently used it with a bad eye injury," she says. "The doctor in Tucson was able to actually see the pupil, and assess and recommend treatment for the damage to the eye."

It’s clear that you also can manage very serious traumas over the network, adds Latifi, recalling the time he was invited to see a patient who had a Glascow coma scale of 15. "From the time Dr. Young saw the patient until three minutes later when I was at our telesystem site, the guy’s mental status had deteriorated significantly,"he explains. "I zoomed to the face and saw his eyes were closed. We got his eyes open, and he had gone into coma."

In light of this change in condition, the patient’s management was totally changed; he was intubated before he could be transferred to UMC.

"Then he was operated on within one hour of getting here for the major head injury," Latifi concludes.

Such assistance is especially important in the Tucson area, where there is only one trauma center, Thornby notes. "It even helps the doctors up there [in Tucson] see what’s going on and determine whether a patient needs to come there," she explains.

That aspect of the system has made it "immensely helpful," Young adds. "Their physicians can see the patient, aid with stabilization, recommend various treatments, and make transfers faster and a lot easier without duplicating interventions."

Sources

For more information on the Arizona teletrauma system, contact:

  • Rifat Latifi, MD, Associate Professor of Clinical Surgery; Director, Surgical Critical Care; Associate Director, Trauma and Critical Care; Associate Director, Telesurgery and International Affairs, Arizona Health Sciences Center, Department of Surgery, 1501 N. Campbell Ave., Room. 5411A, P.O. Box 245063, Tucson, AZ 85724-5071. Phone: (520) 626-5095. Fax: (520) 626-5016. E-mail: latifi@surgery.arizona.edu.
  • Debra Thornby, RN, BSN, ER Nurse Manager, Southeast Arizona Medical Center, 1205 F Ave., Douglas, AZ 85607. Phone: (520) 364-7931. E-mail: thorn@c2i2.com.
  • Edward Young, MD, Medical Director, Emergency Department, Southeast Arizona Medical Center, 1205 F Ave., Douglas, AZ 85607. Phone: (520) 364-7931.