In July 1999, the Swinfen Charitable Trust in the UK established a telemedicine link in Bangladesh, between the Centre for the Rehabilitation of the Paralysed (CRP) in Dhaka and medical consultants abroad. This low-cost telemedicine system used a digital camera to capture still images, which were then transmitted by email. During the first 12 months, 27 telemedicine referrals were made. The following specialties were consulted: neurology (44%), orthopaedics (40%), rheumatology (8%), nephrology (4%) and paediatrics (4%). Initial email replies were received at the CRP within a day of referral in 70% of cases and within thee days in 100%, which shows that store-and-forward telemedicine can be both fast and reliable. Telemedicine consultation was complete within three days in 14 cases (52%) and within three weeks in 24 cases (89%). Referral was judged to be beneficial in 24 cases (89%), the benefits including establishment of the diagnosis, the provision of reassurance to the patient and referring doctor, and a change of management. Four patients (15% of the total) and their families were spared the considerable expense and unnecessary stress of travelling abroad for a second opinion, and the savings from this alone outweighed the set-up and running costs in Bangladesh. The latter are limited to an email account with an Internet service provider and the local-rate telephone call charges from the CRP. This successful telemedicine system is a model for further telemedicine projects in the developing world.

We assessed the feasibility of a store-and-forward email teleneurology service between a UK neurologist and a rehabilitation hospital in Bangladesh. Over 12 months, email advice was requested for 12 patients (mean age 43 years, range 15-57 years). Each patient generated an average of 5.2 email messages. Eight cases were considered complicated by the neurologist, who would have preferred a video-link consultation for these. The referring doctor found the neurologist's advice beneficial in 75% of the complex cases and in all of the more straightforward cases. Patient care was changed in 50% of the cases as a result of the specialist advice and one patient transfer out of the country was avoided. Store-and-forward teleneurology is effective for delivering expert neurological advice.

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Over the last few years the Surgeon General's Department has overseen a major update in equipment scales for medical units in the field; anaesthesia and intensive care. This is to meet the aspiration of the Defence Chiefs, that injured servicemen on active service should receive the same standard of care as available in the United Kingdom. This paper discusses the experiences of the Intensive Care Unit operating within a Field Hospital both during the initial war fighting phase and subsequent peace keeping phase of the 2003 Gulf conflict (OP TELIC). Observations are made on patient activity, treatment strategy, and equipment adequacy.

We assessed the feasibility of a store-and-forward email teleneurology service between a UK neurologist and a rehabilitation hospital in Bangladesh. Over 12 months, email advice was requested for 12 patients (mean age 43 years, range 15-57 years). Each patient generated an average of 5.2 email messages. Eight cases were considered complicated by the neurologist, who would have preferred a video-link consultation for these. The referring doctor found the neurologist's advice beneficial in 75% of the complex cases and in all of the more straightforward cases. Patient care was changed in 50% of the cases as a result of the specialist advice and one patient transfer out of the country was avoided. Store-and-forward teleneurology is effective for delivering expert neurological advice.