What is telemedicine, and what might it mean to the future of EMS? This three-part series will discuss potential benefits and offer thoughts on approaching this emerging technology. Part 1 outlined its basics and history. Part 2 discussed potential applications and essential steps.
There have been two new EMS telemedicine effort launched in the past four years: Tucson’s ER-Link and Baton Rouge’s BR Med-Connect.
In 2006, the University Medical Center in Tucson, AZ, the Tucson Fire Department and the Tucson Department of Transportation (DOT) teamed up to initiate ER-Link, the nation’s first citywide EMS telemedicine system.1 This system, built around Tucson DOT’s new mesh broadband wireless network, promised two-way telemedicine from a moving ambulance. Funded through a federal DOT grant and using General Devices' e-Bridge EMS telemedicine technology, the system was to be deployed throughout the Tucson Fire Department.2 The initial goals of the system were to address: 1) a set of special trauma needs identified by Dr. Rifat Latifi, a recognized leader in telemedicine; and 2) all other (day-to-day) non-telemedicine needs of EMS.
The hospital side of the system was located in both the ED and the telemedicine room on the trauma floor of the University Medical Center in Tucson. The ED workstation was fully integrated with day-to-day EMS activities to ensure ease of use when the telemedicine elements were used in trauma-related applications. The mobile side was installed in all 19 of the city’s ambulances, with interior and exterior remotely controlled cameras. A 19-inch touch-screen monitor located on the cabin’s rear wall provided user controls and allowed the patient to fully interact with the distant physician. The interior camera was located above and to the rear of the cot, allowing the physician to fully visualize the patient. An optional exterior camera provided 360-degree visualization of the scene, a feature valued by the fire department.
The mesh system employed by ER-Link was designed primarily for DOT use and, because of budgetary constraints, followed the city’s major transportation corridors. Because this provided only limited coverage for ER-Link, plans were made, pending additional funding, to implement a larger mesh network that would extend ER-Link’s range of coverage throughout the city.
By any measure this was a large project, as it involved the entire Tucson FD/EMS organization. As with any pioneering effort, there were many initial technical and operational problems; however, in October 2007, after passing acceptance testing, the system, with full two-way telemedicine capability, was placed into use.
The limited coverage provided by the mesh system proved to be the system’s main shortcoming. Where the mesh system had coverage, ER-Link worked, and where it didn’t, it didn’t work. From the medic’s point of view, the system was unreliable because it could not work where and when it was needed. In 2008, a comprehensive one-year study was conducted on all aspects of the project and the results proved that the system worked within its operation limits and most, though not all, of the medics thought the system was worthwhile. To date, this study has not been released for publication. The system is described in a 2011 paper discussing its value for providing assistance in intubation.3
Unfortunately, the economic downturn hit the city of Tucson and the second round of funding to complete the coverage of the wireless network did not materialize, severely limiting ER-Link’s usefulness. In February 2011, the telemedicine part of the system was formally discontinued. The workstation in the ED remains in use, supporting the day-to-day EMS activities of the Tucson Fire Department.
Some of the lessons to be learned from the ER-Link implementation are: