The Aroostook Medical Center and Eastern Maine Medical Center made history this past April by bridging the 160-mile gap between their facilities in a matter of seconds, using the newest tool available in teletrauma technology today: an Apple iPod Touch mobile device. “This was the first reported teletrauma consultation via a mobile device in the world,” says Eastern Maine Medical Center trauma surgeon Dr. Rafael J. Grossman.
Teletrauma is an application of telemedicine that uses interactive audiovisual devices for examinations and remote procedures and has become an indispensable resource for Maine physicians. According to the Health Resources and Services Administration, people living in rural areas are more likely to incur blunt trauma [when the body hits or is hit by a large object] than those living in urban areas, contributing to an estimated 160,000 deaths in America each year. Dealing with the combined challenges of a rural landscape—longer discovery times after injury, extended traveling distances between hospitals, and fewer available medical specialists on-site—requires ingenuity in treating Maine trauma patients.
The Trauma Specialists of Maine, a department of Eastern Maine Medical Center (EMMC) saw implementing the audiovisual capabilities of the iPod Touch as one way to expand the variety of telemedicine services already offered. A grant from Eastern Maine Health Services made possible the purchase and distribution of the devices to seven participating Maine health care providers. It wasn’t long before the new program was put to the test.
In April, a teenage girl was rushed into The Aroostook Medical Center (TAMC) emergency room a little after midnight suffering craniofacial injuries as a result of a skiing accident. This situation usually required the patient to be transported by ambulance or LifeFlight aircraft helicopter to EMMC in Bangor, where a specialist could perform an examination and determine the next step in treatment. Thanks to the first-of-its-kind mobile health pilot activated around the state two days before the girl’s injuries occurred, the TAMC physician on the scene had access to an iPod Touch device enabled with video conferencing technology—software which allows voice and video calls to be made through a broadband Internet connection—and was put in contact with Dr. Rafael J. Grossman at EMMC for a real-time, high-definition video consultation.
“The iPod has changed teletrauma in the County, because it offers portability and quicker access,” says TAMC’s Dr. John Beaulieu.
“The patient never had to leave her bed. She was seeing my face on the screen and talking with me live, over 100 miles away,” Grossman says. Grossman is of the doctors who spearheaded the implementation of the iPod pilot program. “The definition of the image and sound are incredible. By way of the referring provider, I was able to examine the patient’s injuries—even the dilation of her pupils—with excellent clarity via the iPod. My advice was that she could be treated locally in Presque Isle, and both the patient and her mother were reassured. It saved them the worry, cost, and an ambulance trip in the middle of the night, while still providing them with a trauma surgeon’s advisement.”
Telemedicine is about keeping the right people in the right beds at the right time says Mary McCarthy, a registered nurse and manager of the Telemedicine Center at EMMC. “Patients seem to recover better in familiar areas where they have the support of their community,” she says. “By being able to receive treatment at their local hospital instead of traveling all the way to Bangor, they are able to stay close to their families.”
Since that April night, Blue Hill Memorial Hospital, Mayo Regional Hospital in Dover-Foxcroft, Sebasticook Valley Hospital in Pittsfield, and Penobscot Bay Medical Center in Rockport have all utilized the iPod Touch connection multiple times with encouraging results.
“Ten years ago, all I had was a telephone and a pager,” says Dr. Joseph Babbitt, emergency department hospitalist at Blue Hill Memorial Hospital. “I would call EMMC and attempt to describe a patient’s injuries or detail an X-ray to a trauma surgeon over the phone, which could be challenging. Then, three years ago, we saw the introduction of the Tandberg video communication units, a prelude to the iPod technology.”
The Tandberg units—enabled flat-screen monitors equipped with a remote-controlled robotic camera steered by the viewer—allow for similar audiovisual conferencing with distant hospitals and up-close patient examinations. “These units provide a high-resolution picture, but they are mostly fixed to one location due to their large size,” Babbitt says. “Now, I place a call to the Transfer Center, drop the iPod in my pocket, and attend to other tasks while waiting to be connected to the right specialist to examine and advise treatment for my patient.”
This connection is provided by the Transfer Center of Eastern Maine, a 24-hour EMMC hotline staffed by experienced registered nurses. These nurses process urgent patient evaluation calls and determine the proper specialist to handle each case. “If transfer to another facility is deemed necessary, the patient may not always end up coming to Eastern Maine for treatment,” McCarthy says. “After performing a consultation, our trauma surgeon may advise that a patient be transferred to EMMC or to a hospital in Boston.”
Time is of the essence in trauma situations. “The goal is to create a hospital without walls,” Grossman says. “Patient reaction has been very positive so far. As we get more comfortable with this technology, I believe this will become the standard means of communication.”
