The use of DCL was significantly decreased by 78% during the study with significantly improved outcome. The improved outcome and decreased resource utilization can reduce health care costs and charges. Although DCL may be a vital aspect of trauma surgery, it can be used more selectively with improved outcome.

The use of telemedicine is long-standing, but only in recent years has it been applied to the specialities of trauma, emergency care, and surgery.despite being relatively new,the concept of teletrauma, telepresence, and telesurgery is evolving and is being integrated into modernc are of trauma and surgical patients. This paper will address the current applications of telemedicine and telepresence to trauma and emergency care as the new frontiers of telemedicine application. The university medical center and the arizona Te lemedicine program (aTp) in Tu cson, arizona have two functional teletrauma and emergency telemedicine programs and one ad-hoc program, the mobilet elemedicine program. The southern arizona Te lemedicine and Te lepresence (saTT) program is an inter-hospital telemedicine program, while the Tu cson eR-link is al ink between prehospital and emergency room system,and both are built upon asuccessful existing award winning aTpand the technical infrastructureofthe city of Tu cson. These two programs represent examples of integrated and collaborative community approaches to solvingthe lack of trauma and emergency care issue in the region. These networks will not only be used by trauma, but also by all other medical disciplines, and as such have become an example of innovation and dedication to trauma care. The first case of trauma managed over the telemedicine trauma program or "teletrauma" was that of an 18 month-old girl who was the only survival of acar crash with three fatalities. The success of this case and the pilot project of saTT that ensued led to the development of ar egional teletrauma program serving close to 1.5 million people. The telepresence of the trauma surgeon, Latifi, R. S. Weinstein,J.M.Porter,M.Ziemba, D. Judkins,D.Ridings, R. Nassi, T. Valenzuela, M. Holcomb, F. Leyva through teletrauma, has infused confidencea mong local doctors and communities and is beingu sed to identifyk nowledgeg aps of rural health care providers and the needs for instituting new outreach educational programs.

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