title: Telemedicine reduces discrepancies in rural trauma care.
abstract: Patients injured in rural areas die at roughly twice the rate of those patients with similar injuries in urban areas. A multitude of explanations have been suggested for higher mortality rates from trauma in the rural areas of the United States. Since rural emergency room (ER) staff see far fewer traumas than ER staff at large metropolitan trauma centers, their lack of exposure to this low-volume problem certainly contributes to the problem. To address discrepancies in trauma education and the delivery of care in our rural region, a telemedicine system was utilized to provide rapid consultation from surgeons at the level 1 trauma center and to provide enhanced educational opportunities for rural ambulance emergency first responders. Clinical outcome measures and evaluation questionnaires were designed in advance of implementation. Forty-one "tele-trauma consults" were performed over the first 30 months of the project, all for major, multi-system trauma. Though many clinical recommendations were made, the system was judged to be life saving in three instances, and both rural and trauma center providers felt the system enhanced clinical care. In addition, educational sessions for rural first responders were well attended and favorably reviewed. Early results of a telemedicine system provide encouragement as a means to address discrepancies in the outcomes after major trauma in rural areas, although more work needs to be completed and evaluated.
authors.affiliation: Allen Health Care and the Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont 05405-0068, USA. michael.ricci@uvm.edu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Ricci
authors.forename: Michael
authors.initials: M
authors.lastname: Caputo
authors.forename: Judith
authors.initials: J
authors.lastname: Amour
authors.forename: Frederick B
authors.initials: FB
authors.lastname: Rogers
authors.forename: Kenneth
authors.initials: K
authors.lastname: Sartorelli
authors.forename: Peter W
authors.initials: PW
authors.lastname: Callas
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Malone
mesh_terms: D000552:Ambulances / Q000592:standards; D004634:Emergency Medical Technicians / Q000193:education; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards*; D017052:Hospital Mortality; D006780:Hospitals, Rural / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation; D019114:Remote Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013995:Time; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*