EMS World

AUG 2011

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Long-Distance Intubation Saving lives with telemedicine always capture everything that happened on a call. Now docs get detailed electronic records, plus audio recordings of interactions between crews and doctors/nurses. “What’s really neat is that if you have a question, you can go back and listen,” says Hebert. “Did the patient get aspirin? Yes, they said it right there: ‘Patient gets aspirin.’ So it’s another way for checks and balances to happen.” What’s more, tying the prehos- pital data electronically in to hospital records also goes a long way toward legitimizing it as part of the care continuum. It’s a rare EMS provider who hasn’t been frustrated by having their reports and assess- ments underappreciated at the ED. BR Med-Connect ties it institution- ally into the record. “Many times, ERs would run their own tests and things once we got there,” says Guillot, “and what we did in the fi eld wasn’t looked at real well. This gives us an opportunity to better share that data and make it more meaningful to patient care.” The next step involves collecting data from all the hospitals to quan- tify the benefit of BR Med-Connect across the community. Besides the STEMIs, it’s being used to facilitate treatment of patients with cardiac arrhythmias (v-tach, v-fib), and work is ongoing to expand it to stroke evaluations. ● —John Erich, Associate Editor When an elderly woman with severe COPD exacerbation arrived at the ED at Northern Cochise Community Hospital in Willcox, AZ, in September 2009, she was aggressively treated with conven- tional medical therapies and noninvasive ventilatory support, but failed to respond. The treating physician fi nally decided to perform an emergent intubation using the GlideScope video laryngoscope and contacted the Tucson Telebation group at the University of Arizona for assistance. John Sakles, MD, FACEP, professor in the Department of Emergency Medicine at the University, supervised the remotely performed intubation. Over the telemedi- cine network, Dr. Sakles watched Dr. Jacob Poulsen prepare the patient and administer rapid sequence intubation drugs. Then the monitor view was transferred to the view coming from the GlideScope video laryn- goscope in use by the Willcox team, and the Tucson Telebation team provided real- time intubation guidance as the procedure took place. The intubation went smoothly, and the stabilized patient was flown by helicopter to Tucson for further intensive care management. The Telebation Program at the University of Arizona is built upon the Southern Arizona Teletrauma and Telepresence Program (SATT), which facilitates the virtual pres- ence of an experienced trauma surgeon using high-quality live audio and video streamed from a dedicated telemedicine network. The Telebation Program piggybacks on the existing Teletrauma network and adds emergency airway assistance to the trauma/critical care consultation. “The whole goal of the program was to lend intubation assistance to providers in rural areas,” says Sakles. “Prior to video laryngoscopes with direct laryngoscopy, there was no way of supervising or seeing what the operator was doing. With the video laryngoscope, we could see exactly what the operator was seeing, even though he was hundreds of miles away. I could be at the university and watch intubations at any of the seven hospitals we’re linked with and provide real-time feedback to them during an intubation.” “With the video laryngoscope, we could see exactly what the operator was seeing, even though he was hundreds of miles away.” In addition to the remote hospitals, there is also an EMS component set up. “The only test we did was to intubate a manikin in a moving ambulance to make sure the system works,” says Sakles. “We were able to successfully intubate the manikin with a GlideScope Ranger and send it wirelessly to the hospital.” Sakles and his colleagues recently published a paper describing the Willcox experience and the actual procedure.1 ● REFERENCE 1. Sakles JC, et al. Telemedicine and telepresence for prehospital and remote hospital tracheal intubation using a GlideScope videolaryngoscope: A model for tele-intubation. Telemedicine and e-Health 17(3):185–188, April 2011. —Marie Nordberg, Associate Editor EMSWORLD.com | AUGUST 2011 53

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