The clinical and technical evaluation of a remote telementored telesonography system during the acute resuscitation and transfer of the injured patient.
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.
Dyer
Dianne
D
Department of Regional Trauma Services, Calgary Heath Region and Foothills Medical Centre, Calgary, Alberta, Canada.
Cusden
Jane
J
Turner
Chris
C
Boyd
Jeff
J
Hall
Rob
R
Lautner
David
D
Hamilton
Douglas R
DR
Shepherd
Lance
L
Dunham
Michael
M
Bigras
Andre
A
Bigras
Guy
G
McBeth
Paul
P
Kirkpatrick
Andrew W
AW
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