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The Clinical and Technical Evaluation of a Remote Telementored Telesonography System During the Acute Resuscitation and Transfer of the Injured Patient

Dyer, Dianne MN, RN; Cusden, Jane RGN, MA; Turner, Chris MD; Boyd, Jeff MD; Hall, Rob MD; Lautner, David MD, FRCPC; Hamilton, Douglas R. MD, PhD; Shepherd, Lance MD; Dunham, Michael MD, FRCSC; Bigras, Andre P Eng; Bigras, Guy CET; McBeth, Paul MD; Kirkpatrick, Andrew W. MD, MHSc, FACS

The Journal of Trauma: Injury, Infection, and Critical Care: December 2008 - Volume 65 - Issue 6 - p 1209-1216
doi: 10.1097/TA.0b013e3181878052
Original Articles

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.

From the Departments of Surgery (M.D., P.M., A.W.K.), Critical Care Medicine (M.D., A.K.W.), Regional Trauma Services (D.D., M.D., P.M., A.K.W.), Emergency Medicine (R.H.), and Radiology (D.L.), Calgary Heath Region and Foothills Medical Centre, Calgary, Alberta, Canada; Banff Mineral Springs Hospital (J.C., C.T., J.B., L.S.), Banff, Alberta, Canada; Wyle Life Sciences (D.R.H.), Houston, Texas; and Telesat Corporation (A.B., G.B.), Ottawa, Ontario, Canada.

Submitted for publication May 6, 2008.

Accepted for publication July 21, 2008.

Presented at the Annual Scientific Meeting of the Trauma Association of Canada, April 3–5, 2008, Whistler, British Columbia, Canada.

This project was funded by the Canadian Space Agency (CSA #9F028-052804/001/SR).

Andre Bigras and Guy Bigras are employees of the Telesat Corporation.

This article was presented at the Trauma Association of Canada Meeting, April 2008, Whistler, British Columbia.

Address for correspondence: Andrew W. Kirkpatrick, MD, MHSc, FACS, Regional Trauma Services, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta T2N 2T9; email:

© 2008 Lippincott Williams & Wilkins, Inc.