Regional air transport of burn patients: a case for telemedicine?
BACKGROUND
Air transport of burn patients is plagued by frequent "overtriage." We examined the use of air transport and the feasibility of using alternative methods such as telemedicine to assist in evaluation and treatment of burn patients within our region.


METHODS
We reviewed all burn patients transported by air during 2000 to 2001. Each patient was classified as being most appropriate for air, ground, or family transport. In addition, a decision was made regarding whether telemedicine evaluation of the patient before transport could have significantly altered initial treatment decisions.


RESULTS
Two hundred twenty-five acutely burned patients were transferred from referring hospitals in nine states, at a mean distance of 246 air miles. Mean burn size calculated by burn center physicians was 19.7% total body surface area, whereas referring physicians' mean estimate was 29% total body surface area. In 92 cases, over- or underestimation of burn size by referring physicians of as much as 560% or decisions regarding performance of endotracheal intubation suggested that telemedicine evaluation before transport might have significantly altered transport decisions or care. Air transport charges exceeded hospital charges in 21 cases.


CONCLUSIONS
Frequent discrepancies in burn assessment contribute to overuse of air transport. The ability to evaluate burn patients by telemedicine may have the potential to assist decisions regarding transfer, avoid errors in initial care, and reduce costs. We are currently attempting to develop and test such a system.
Saffle
Jeffrey R
JR
Department of Surgery and the Intermountain Burn Center, University of Utah Health Center, Salt Lake City, Utah 84132, USA. jeffrey.saffle@hsc.utah.edu
Edelman
Linda
L
Morris
Stephen E
SE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017732:Air Ambulances / Q000706:statistics & numerical data*; D002053:Burn Units / Q000706:statistics & numerical data*; D002056:Burns / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012041:Regional Medical Programs; D012189:Retrospective Studies; D015206:Southwestern United States / Q000453:epidemiology; D017216:Telemedicine / Q000706:statistics & numerical data*; D014218:Triage / Q000706:statistics & numerical data; D014589:Utah / Q000453:epidemiology