Telemedicine's role in emergency care is growing, but it's still typically subject to serious limitations. Patients may have to come to a clinic to be linked to a physician, or a community hospital to consult a big-city specialist. Even in those advanced systems where EMS vehicles are telemedicine-equipped, patients usually have to come to the truck.

With a new portable, stretcher-mounted telemedicine system conceived by a pediatric emergency physician in Cincinnati, that capability can be taken to the patient, wherever they may be.

The system was conceived by Hamilton Schwartz, MD, medical director of the critical care transport team at Cincinnati Children's Hospital Medical Center, and developed by Scottsdale, AZ-based GlobalMedia. It features audio and video connections that let physicians at CCHMC examine and treat critical children not only in ambulances, but across a range of settings.

"We didn't want something mounted inside the ambulance, because so much of the care of the child is delivered before they actually physically get into the ambulance," says Schwartz. "We wanted something that could actually go with the team to wherever they first interact with patient. For our critical-care team, that may be a community hospital's emergency department or another hospital's ICU where we're picking a child up. For EMS providers, it could be their living room or kitchen floor."

The system, known as TransportAV, includes a military-grade touch-screen PC, 3G AirCard, controllable camera, echo-canceling microphone, ClearSteth stethoscope, TotalExam examination camera and Bluetooth wireless keyboard with headset. That's all combined in a compact package weighing approximately 30 lbs. The components can attach to virtually any stretcher or be mounted to a mobile cart for use in hospitals or clinics.

CCHMC acquired four of the units, but is only using one during the pilot phase of its implementation, which began in October. Once that's complete and any wrinkles are smoothed out, the hospital will equip all of its critical-care ambulances with them.

"Right now we're using it for almost all the patients with whom we interact," says Schwartz. "We want to increase the familiarity of the doctors and transport team with the equipment, and see what's easy to use and what might work better. Then in the future we'll define criteria, anatomic or physiologic, that trigger the team to communicate with medical control using it."

The benefits of such a system go beyond bringing the eyes and hands of pediatric specialists to the sickest of sick children. Having easy access to a doc should ease the minds of even the best transport crew--"Our teams are very capable of delivering care, and when they need orders from a physician, it's usually a very targeted sort of thing," notes Schwartz--and being able to observe and direct care should enhance any control physician's comfort with a transport crew's abilities. Thus it can potentially increase comfort and trust on all sides.

There's also an obvious educational benefit. Instead of reviewing cases long after they happen, TransportAV allows real-time, real-life point-of-care teaching moments.

This all seems very applicable to EMS organizations and traditional 9-1-1 response. The challenge in that setting will be figuring out when, where and on whom such technology is best utilized.

"Some communities will be more excited about this technology than others, depending on their average transport times to their local hospital or trauma center, how big their system is and how willing their medical control physicians are to use this equipment," says Schwartz. "But I'm sure there are a lot of EMS systems and hospitals that would be very excited to use this kind of thing."

For more information, visit GlobalMedia.