Trauma Telemedicine: Providing real-time solutions to real-time problems Antonio Marttos, M.D. Assistant Professor of Surgery, Director Trauma Telemedicine Fernanda Kuchkarian, MPH, Telemedicine Research Manager Daniel Rojas, Telemedicine Research Associate Gabriel Alonso, Telemedicine Engineer Jeffrey Augenstein, MD, PHD Ryder Trauma Center/ Jackson Memorial Hospital University of Miami Miller School of Medicine Division of Trauma and Surgical Critical Care William Lehman Injury Research Center Welcome to the Ryder Trauma Center A Living Laboratory • UM Teaching Hospital • Largest Trauma Fellowship program in USA • US Army Trauma Training Center • Dissemination of research findings through publications, presentations, and conferences • National and international recognition • Testing of new and emerging technologies Welcome to Ryder TeleTrauma Center How Did We Begin? Delivery of medical expertise from a distance Daily ICU Tele-Rounds Telemedicine Control Station Telemedicine and US Department of Defense TeleConsult in OR Mass Casualty Triage Burn Clinic Remote Consults Why Trauma: The Facts • Trauma is a leading cause of death in the young population worldwide • Trauma Centers are high-complexity hospitals • Need to support remote hospitals that do not have all specialties available • Need to manage surgeons shortage • Need to maintain good medical care 24hrs, despite of localization Educational Meetings: Expanding Knowledge International Trauma and Critical Care Grand Rounds Official Panamerican Trauma Society Conference Every Friday CME credits Objectives • Expand medical educational from teaching hospitals to other medical centers • Enhance the quality of specialized medical care Methods • Videoconference • Presentation of trauma/critical care cases • Language : English • Presented by the medical resident or fellow treating the patient • Expert opinion •Conclusions • Review of literature Results • Great tool to share expertise between different centers in the world • Medical residents and students consider it to have outstanding educational qualities • The program has now grown considerably and has received notice of interest from several others Participating Institutions • Universidade de Sao Paulo - Brazil Professor Juan Bosch- Dominican Republic • UNICAMP- Campinas - Brazil • Universidad Iberoamericana –Dominican • Military Hospital, Bogota, Colombia. Republic •UC –San Diego • St. Michael’s Hospital Toronto-Canada • University of Amazonas, Brazil. • Chulalongkorn University –Thailand • UNIRIO • Iraq ( Bagdhad, Basrah, Kirkut, Shield, Tikrit, • Lower Keys Medical Center, Key West, Erbil) Florida. • Hospital Santo Tomas-Panama • Faculdade De Medicina Do ABC, Santo • Hospital APN – Rio de Janeiro – Brasil Andre, Brazil. • PUC-Porto Alegre, Brazil • Holmes Regional Medical Center, Center • SBAIT, Brazil Florida. • Hospital Joao XXIII – Belo Horizonte • Walter Reed Army Medical Center, • Hospital General Plaza de la Salud- DR Washington D.C. • Gov. Juan F. Luis Hospital, St. Croix • Hospital Univ. de Gran Canaria-Spain • University of Florida Shands Hospitals • Insituto Medico la Floresta -Venezuela •Hospital BuenSamaritano-Puerto Rico Telemedicine Educational Meetings Florida: Disaster Management Tallahassee Memorial Okaloosa Holmes Santa Rosa Jackson Nassau Washington Gadsden Walton Madison Shands/Jacksonville Calhoun Leon Bay ClDuval Liberty Baker Taylor Union a Gulf Franklin Columbia Alachua Bradford y St. Pensacola Sacred Heart Johns Dixie Flagler Levy Marion Orlando Regional Shands/UF Gainesville Volusia Citrus Seminole Lake Hernando Sumter Orange Holmes Pasco Osceola = Critical Access/Rural Hospitals Hillsborough Brevard Polk Indian = Level I Trauma Center Telemedicine Network Trauma Sites River = Okeechobee St Telemedicine Network Distant Facility Sites Manatee Hardee (Critical Access/Rural Hospitals) Highlands . Sarasota Lucie = Link from Trauma Center Telemedicine Network to the DeSoto Martin Distant Facility Sites Charlotte Hendry Lee Palm Beach Broward Collier Dade Jackson Memorial/Ryder Trauma Center Lower Keys Medical Center Florida Telemedicine Trauma Network Goals: • To connect all Trauma Centers in Florida • To connect Trauma Centers with remote hospitals with no specialized care • To improve Trauma Centers ability to manage surges and disasters • To help Pre-Hospital triage and management • To increase healthcare professionals knowledge • To increase the quality of medical care Florida Telemedicine Trauma Network Implementation: – Video conference capability to Trauma Centers in Florida and remote hospitals (internet, hardware, connectivity) • Weekly educational meetings – Increase synergy between health care professionals – Share health care professionals knowledge • Real-time Assistance to remote hospitals » Expedite patient transfer » Improve safety prior to transfer » Assist patient management in remote location – Disaster simulation Florida Telemedicine Trauma Network– PHASE I DOH REGIONAL HOSPITAL #1 FIXED MULTI POINT VC SYSTEM MOBILE PC VC SYSTEM 384 Kbps 512K/2.0Mbps RYDER TRAUMA CENTER 2.0M/2.0 Mbps FIXED MULTI POINT VC SYSTEM PUBLIC INTERNET 512K/2.0Mbps University of Florida- Gainesville FIXED MULTI POINT VC SYSTEM 384 Kbps REGIONAL HOSPITAL #N MOBILE PC VC SYSTEM 23-Jun-12 DSV INC. - CONFIDENTIAL 24 Florida Telemedicine Trauma Network– PHASE II REGIONAL HOSPITAL #1 REGIONAL HOSPITAL # 2 DOH MOBILE PC VC SYSTEM MOBILE PC VC SYSTEM FIXED MULTI POINT VC SYSTEM 384 Kbps 384 Kbps 512K/2.0Mbps RYDER TRAUMA CENTER #1 2.0M/2.0 Mbps FIXED MULTI POINT VC SYSTEM PUBLIC INTERNET 512K/2.0Mbps TRAUMA CENTER HOSPITAL #2 512K/2.0 Mbps FIXED MULTI POINT VC SYSTEM TRAUMA CENTER HOSPITAL#3 FIXED MULTI POINT 384 Kbps VC SYSTEM 384 Kbps 384 Kbps 384 Kbps REGIONAL HOSPITAL #3 REGIONAL HOSPITAL #N REGIONAL HOSPITAL #4 REGIONAL HOSPITAL #N MOBILE PC VC SYSTEM MOBILE PC VC SYSTEM MOBILE PC VC SYSTEM MOBILE PC VC SYSTEM 23-Jun-12 DSV INC. - CONFIDENTIAL 25 Leading the State, connecting the Ryder Trauma Center to remote hospitals in the Florida Keys Real-Time Assistance: Remote Hospitals Specialists Available for Consultation 24/7 Disaster Simulation: Key West, Florida Category V Hurricane Simulation: U.S Air Force Pre-Hospital Project • Wireless, high-speed powerful tablet PCs and high definition cameras deployed to emergency responders • Placed in fire rescue ambulances and two helicopters • Equipment used during trauma calls, stroke patients, and patients that deteriorate during transport Pre-Hospital Care: Telemedicine for First Responders Real Test to Our Network: Earthquake in Haiti Chaos Safety Deaths Day 1: University of Miami in Haiti 18 hrs after the earthquake First UM Team in Haiti 1 neurosurgeon, 1 physician assistant 2 trauma surgeons 1 anesthesiologist Challenges • Multiple patients • Complex medical conditions • Few healthcare resources • Lack of efficient communication between UM team in Miami and UM team in Haiti • Lack of organization Challenges Challenges: Surgeries on the Streets Day 3: Telemedicine Implementation Effective Communication Changing Response Management Telemedicine Center Teleconferences Strategic Decisions We Needed to Help!! Rehabilitation Hope Replicating the Network Worldwide: Collaboration with Colombia Military Hospital Treating Patient in the Jungle Iraq Telemedicine Project RTTC Global Response Center •Two consoles •Each console is able to respond to two simultaneous calls •Access to EMR and radiology •Multipoint specialist capabilities First Call… Tablet Mobile Solution Baghdad Basrah Olympics Telemedicine Project Used for The First Time: 2011 Panamerican Games - Mexico Remote Consultation We Continue to Expand This Network Worldwide Ryder Trauma Center TEAM. This is only possible because of them !!!!! Every human being has the right to have the best medical care possible, 24/7, anywhere in the world. Telemedicine can help to save lives! Let’s develop Telemedicine Together !!! [email protected] Thank you!.