Doctors propose video help line Now used with ambulances, it has saved critical time; Whitbread


A year ago, physicians at the University of Maryland Medical Center equipped two ambulances with telecommunications equipment that is used to beam live images of stroke patients on their way to the hospital.

Doctors sitting at computer terminals can watch for a drooping lip, listen for garbled speech and monitor vital signs blipping across the screen. By the time the person gets to the hospital, doctors have made crucial decisions about treating the patient.

And saved precious minutes in doing so.

Now, the physicians are thinking about establishing a video link with boats in the next round-the-world sailing race, scheduled to begin in 2001. With such an arrangement, doctors in Baltimore could advise medics treating injured sailors wherever they are.

"The persons on board are trained to deal with crises, but they're sailors, not doctors," said Dr. Colin F. Mackenzie, a Shock Trauma anesthesiologist who helped devise the system. "We have physicians around 24 hours a day, 365 days a year. We could give them assistance when requested."

Mackenzie, who has had preliminary discussions with Whitbread officials, said the system would be most useful in the critical minutes after a life-threatening injury. Doctors, for instance, would be able to advise medics as they insert breathing tubes. They could watch the patient's responses and monitor vital signs along the way.

Just as important, they could suggest whether an air-rescue is needed -- or whether the athlete can be treated at sea.

"The potential for this is enormous," said Dr. Reynaldo Rodriguez, an Annapolis physician who was team doctor for Chessie Racing, Maryland's entry in the recently concluded Whitbread. "You could even do teleconferencing if necessary -- you wouldn't have to have physicians in the same locale."

Through the Internet, he explained, video images could be distributed to specialists wherever they live.

Dr. Marian LaMonte, director of the UM's "brain attack" team, said the video hookup saves valuable time in evaluating and treating a stroke patient.

Under normal circumstances in a stroke situation, crucial minutes -- even hours -- elapse before a family calls for help and the ambulance delivers the patient to the hospital. Once the patient arrives, physicians begin tests to determine whether the patient is a candidate for the drugs. More time is lost.

Now, doctors can start those tests when the ambulance ride begins. "No time is wasted," LaMonte said.

The system has been tried on 12 patients. In a few cases, the doctors were able to rush the patient to intensive care right away, bypassing the emergency room where many of the diagnostic tests would normally be done.

"We're using the transport time as a diagnostic time," said Mackenzie. "It's no longer a down time."

The Whitbread boats were equipped with video cameras and digital cell phones capable of transmitting images to an Internet Web site. Rodriguez was able to inspect skin rashes and lacerations and recommend ointments and antibiotics.

But he said the system did not operate fast enough to enable physicians to view scenes in real time. Usually, there was as much as a 45-minute delay before the image appeared on someone's screen -- too late to be of much use when each moment counts.

"The technology is moving so quickly, when people were ordering things for the boat this was state of the art," he said.

Pub Date: 5/30/98

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