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Maine may only be the 39th biggest state, but the northern two-thirds contain vast stretches of forest and fields.
When it comes to the "golden hour" between injury and treatment, the speed with which those distances can be traversed to get a patient to a trauma center is critical.
Unless, of course, the patient can just stay put.
Venezuela native Rafael J. Grossmann Zamora, MD, is a trauma surgeon at Eastern Maine Medical Center in Bangor. He was instrumental in getting EMMC certified as a Trauma Center by the American College of Surgeons.
For the past few years he's also been keenly interested in virtual presence and teletrauma as ways to diagnose and treat patients in rural or remote areas of the state.
Nationwide, injury is the first cause of death and disability in children and adults up to age 44, said Grossmann Zamora, causing 150,000 fatalities a year. Timely care can reduce the risk of dying by 25 percent.
But with just three trauma centers – all of them in the bottom half of the state – and some pretty unreliable roads (especially in winter), getting patients to that care can offer an acute challenge in Maine.
Telemedicine, said Grossmann Zamora, is just the thing to get care to "the right patient, at right place, at the right time" – meaning, of course, "right away."
He spoke of these issues on September 10 in Portland at TEDxDirigo, an independently organized offshoot of the national TED conferences, which curate day-long slates of thought-provoking speakers. The events are meant to amplify the “power of ideas to change attitudes, lives and, ultimately, the world,” according to organizers.
Clearly, the transformative potential of telemedicine technology fits that bill.
EMMCs teletrauma program links the hospital to 11 satellite centers in northern and central areas of Maine – an area spanning roughly 26,000 square miles and home to approximately 462,000 people.
Often, Grossman Zamora's consultations are conducted via high-resolution video and synced audio, relayed over dedicated networks, for video conferencing with a large screen. But sometimes even that setup can take too much time. One has to "find a camera, turn it on, connect," he said. It can be "complex, expensive, not intuitive."
At TED, he screened a video showing how he uses an iPod touch with FaceTime capabilities to help diagnose and guide treatment. With just a few taps on the screen, “boom, seconds later you’re connected,” he said.
In a reenactment, he asked a head trauma patient a few basic diagnostic questions. He examined the face for bruising. He examined the eyes with a close-up zoom, checking for movement and pupil dilation. He made a diagnosis and suggested next steps.
As a medical professional, “the feeling is incredible,” said Grossmann Zamora. And “the most incredible thing is not that the technology makes this connection possible. It’s that it’s so simple, obvious and inexpensive and we never thought of this before.”
For less than $300, he said, EMMC was able to essentially turn an enormous area of rural Maine into a “130,000,000-square-foot trauma room.”
He recalled doing a similar consultation on a girl who had injured herself skiing on one of western Maine's snow-covered slopes. The girl’s mother was amazed at the quickness and efficacy of the process. But the patient took it for granted: "What's the big deal mom This is like Skype, I use it all the time!"
If a picture is a worth a thousand words, said Grossmann Zamora, "a video is worth a thousand pictures."
And in a country where 90 million people don't have access to trauma center within 60 minutes, and where there's a dwindling number of trauma surgeons to begin with – 1,702 of them at 460 trauma centers nationwide, with just 60 new ones graduating med school each year – it could be worth a lot more than that.
That teletrauma technology helps increase survival time and reduces the chance for medical errors is "really priceless," said Grossmann Zamora, who still seems amazed that a "gadget made for playing" can do so much to improve care and lower costs.
"I really think," he said, "that the best is yet to come."
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