Trauma Surgery Goes Virtual to Aid Rural Arizona

Teletrauma system links the ER in Douglas, AZ and the Level 1 Trauma Center at UMC in Tucson.

A new "teletrauma" system that links the emergency room at Southeast Arizona Medical Center in Douglas, Ariz., and the Level 1 Trauma Center at University Medical Center in Tucson is saving lives.

On Nov. 21, an 18-month-old baby was injured critically in a car accident with three fatalities. The baby was rushed by paramedics to the hospital in Douglas, a small, rural town along the U.S.-Mexico border. The baby was in shock, having lost almost two-thirds of her blood from multiple injuries. She was minutes from death and the nearest trauma center was in Tucson, more than 100 miles away.

In the Douglas emergency room, the doctor called the UMC Level 1 Trauma Center in Tucson for assistance. Activating the new teletrauma system using the Arizona Telemedicine Program network, the trauma surgeon at UMC, Dr. Rifat Latifi, was able to see the baby and examine her injuries. He and UMC's trauma team looked at the patient's vital signs, X-rays and lab test results and "virtually" led the doctor and nurses in Douglas through the emergency medical procedures. The baby was resuscitated and once stabilized, transported to UMC for further treatment. She is expected to recover.

UMC trauma surgeon Rifat Latifi, MD, said, "If we had not had this connection today, that child would have died."

Southern Arizona Teletrauma and Telepresence (SATT) Program
The UA Department of Surgery Section of Trauma and Critical Care, the Arizona Telemedicine Program and University Medical Center, Southern Arizona's only Level 1 Trauma Center, have created the Southern Arizona Teletrauma and Telepresence (SATT) Program to assist trauma patients in rural communities. The UA Department of Surgery Section of Trauma and Critical Care, the Arizona Telemedicine Program and University Medical Center, Southern Arizona's only Level 1 Trauma Center, have created the Southern Arizona Teletrauma and Telepresence (SATT) Program to assist trauma patients in rural communities.

Using advances in technology (ViTel Net(tm)), SATT provides a live consultation link -- including state-of-the-art videoconferencing, telemetry, digital X-rays and ultrasound -- between the trauma team at UMC and rural emergency departments in the southern section of the state.

A person injured in a car accident in a small town is nearly twice as likely to die from his/her injuries as a person in an urban area, explains Dr. Latifi, UA associate professor of clinical surgery and associate director of the UMC trauma program.

Trauma victims have the best chance of survival if the right resources and expertise intervene within the "golden hour," the first hour after injury. However, in rural areas resources and experts are scarce, forcing smaller emergency departments to waste critical time transporting patients to the nearest city with a trauma center.

"Through this program, remote emergency rooms can have access to an entire team of surgeons and specialists at UMC that can help with diagnoses and critical care," says Dr. Latifi, director of SATT. "This program allows us to virtually transport the trauma surgeon to that hospital."

Dr. Latifi, who also is a director of telesurgery and international affairs for the Arizona Telemedicine Program, the largest telemedicine program in the country, says he can take another doctor through a procedure if necessary, providing state-of-the-art trauma and surgical care by "telepresence."

The program's first remote site is in the Southeast Arizona Medical Center's emergency room in Douglas. Other sites will be added in the emergency rooms along Arizona's southern border, including in Sierra Vista, Benson, Bisbee, Safford and Nogales, he says.

About 60 percent of transports to UMC possibly could be avoided if specialists were available for consultations, saving hundreds of thousands of dollars and many lives, Dr. Latifi says. Another major benefit of SATT is the opportunity to train rural doctors in the latest trauma care and emergency medicine techniques with neither having to leave their own hospitals, he says.

Dr. Latifi plans to expand the program even further south -- across the border into the Sonora, Mexico, municipalities of Nogales, Hermosillo, Caborca, Puerto Penasco and Aqua Prieta. In partnership with the Arizona Department of Health Services, the Arizona-Mexico Tele-trauma and Telepresence (AMTT) Program is an international telemedicine initiative that will ensure the telepresence of trauma surgeons and emergency care specialists in the emergency rooms of medical centers in these towns.

"This will create a unique opportunity to provide large-scale educational trauma and emergency programs, and make available equal standards of medical care for trauma and emergency patients on both sides of the border," Dr. Latifi says.

Dr. Latifi is the author of the book, Telemedicine and Telehealth in Developing Countries: From Inception to Implementation, published in July 2004, and is director of the Telemedicine Project in Kosova.