title: The clinical and technical evaluation of a remote telementored telesonography system during the acute resuscitation and transfer of the injured patient.
abstract: BACKGROUND
  Ultrasound (US) has an ever increasing scope in the evaluation of trauma, but relies greatly on operator experience. NASA has refined telesongraphy (TS) protocols for traumatic injury, especially in reference to mentoring inexperienced users. We hypothesized that such TS might benefit remote terrestrial caregivers. We thus explored using real-time US and video communication between a remote (Banff) and central (Calgary) site during acute trauma resuscitations.
  
  
  METHODS
  A existing internet link, allowing bidirectional videoconferencing and unidirectional US transmission was used between the Banff and Calgary ERs. Protocols to direct or observe an extended focused assessment with sonography for trauma (EFAST) were adapted from NASA algorithms. A call rota was established. Technical feasibility was ascertained through review of completed checklists. Involved personnel were interviewed with a semistructured interview.
  
  
  RESULTS
  In addition to three normal volunteers, 20 acute clinical examinations were completed. Technical challenges requiring solution included initiating US; audio and video communications; image freezing; and US transmission delays. FAST exams were completed in all cases and EFASTs in 14. The critical anatomic features of a diagnostic examination were identified in 98% of all FAST exams and a 100% of all EFASTs that were attempted. Enhancement of clinical care included confirmation of five cases of hemoperitoneum and two pneumothoraces (PTXs), as well as educational benefits. Remote personnel were appreciative of the remote direction particularly when instructions were given sequentially in simple, nontechnical language.
  
  
  CONCLUSIONS
  The remote real-time guidance or observation of an EFAST using TS appears feasible. Most technical problems were quickly overcome. Further evaluation of this approach and technology is warranted in more remote settings with less experienced personnel.
authors.affiliation: Department of Regional Trauma Services, Calgary Heath Region and Foothills Medical Centre, Calgary, Alberta, Canada.
authors.forename: Dianne
authors.initials: D
authors.lastname: Dyer
authors.forename: Jane
authors.initials: J
authors.lastname: Cusden
authors.forename: Chris
authors.initials: C
authors.lastname: Turner
authors.forename: Jeff
authors.initials: J
authors.lastname: Boyd
authors.forename: Rob
authors.initials: R
authors.lastname: Hall
authors.forename: David
authors.initials: D
authors.lastname: Lautner
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Hamilton
authors.forename: Lance
authors.initials: L
authors.lastname: Shepherd
authors.forename: Michael
authors.initials: M
authors.lastname: Dunham
authors.forename: Andre
authors.initials: A
authors.lastname: Bigras
authors.forename: Guy
authors.initials: G
authors.lastname: Bigras
authors.forename: Paul
authors.initials: P
authors.lastname: McBeth
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kirkpatrick
mesh_terms: D000328:Adult; D000416:Alberta; D001265:Athletic Injuries / Q000000981:diagnostic imaging; D003444:Crush Syndrome / Q000000981:diagnostic imaging; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006465:Hemoperitoneum / Q000000981:diagnostic imaging; D006780:Hospitals, Rural; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D020407:Internet / Q000295:instrumentation; D008297:Male; D009104:Multiple Trauma / Q000000981:diagnostic imaging*; D010348:Patient Care Team; D010360:Patient Transfer / Q000379:methods*; D010865:Pilot Projects; D011030:Pneumothorax / Q000000981:diagnostic imaging; D019114:Remote Consultation / Q000295:instrumentation*; D012151:Resuscitation / Q000295:instrumentation*; D012680:Sensitivity and Specificity; D012865:Skiing / Q000293:injuries; D012984:Software; D013685:Telecommunications / Q000295:instrumentation; D013686:Telemetry / Q000295:instrumentation*; D014193:Trauma Centers; D014463:Ultrasonography / Q000295:instrumentation*; D055815:Young Adult