Telemedicine in Austere Conditions

Doarn, Charles R.

doi:10.1007/978-3-030-56917-4_29

Cited by 1 publication

(1 citation statement)

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“…Telemedicine is a powerful force multiplier in resource limited healthcare (13–16). The right expertise can be delivered to the point of need faster and at less cost using technology rather than physical resource deployment to local capabilities and thus capacity by increasing local caregiver scope of practice (16–18).…”

Section: Introductionmentioning

confidence: 99%

Technology and Disasters: The Evolution of the National Emergency Tele-Critical Care Network

Pamplin

Scott

Quinn

et al. 2021

Critical Care Medicine

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BACKGROUNDThe coronavirus disease 2019 (COVID-19) pandemic and the resulting public health emergency have placed incredible strains on U.S. healthcare infrastructure. Faced with the threat of large-scale shortages of resources, our nation reacted by making things-ventilators, face masks, and personal protective equipment-and seeking new disease-specific diagnostic and therapeutic solutions to combat the virus. Less attention, however, was given to another critical resource: clinical experts in critical care medicine, who understand how, and more importantly when, to apply both old and new tools to achieve the best outcomes for the sickest patients. The purpose of this article is to describe the origins, development, and proof-of-concept testing of the National Emergency Tele-Critical Care Network (NETCCN), a system intended to deliver expertise anywhere needed, at a moment's notice.The U.S. healthcare "industry" is poorly designed to address pandemics or other disasters (1, 2), especially those producing large volumes of critically ill or injured patients. Resources are clustered in population centers: indeed, fewer than half the counties in the United States have ICUs (3), and those that do have highly variable capacity (4). When and where critical care capacity is insufficient, hospitals expect to rapidly transfer patients to referral centers. Unfortunately, during patient surges, referral centers and transfer systems become overwhelmed, and smaller hospitals are forced to manage patients beyond their expertise and resources. Even when limited capacity exists, the most precious resource-trained and experienced clinicians-is vulnerable to exhaustion, burnout, and disease itself, which increases their risk for mental illness (5-8).Traditional solutions, which involve sending additional clinicians and equipment into the distressed environment (9), are reasonable for disasters of limited size and short duration but are reactive in nature, slow to mobilize, costly, and place deployed clinicians at risk for the same sequelae of overwhelming patient volume-exhaustion, burnout, and disease.When overwhelmed, healthcare systems are forced to triage "patients to conserve resources" (10). But, triage decisions are terrible to make for any clinician and are inherently devastating for patients. Both patients and providers deserve better whenever possible. As the U.S. military and the National Disaster Medical System (NDMS) shift focus to great power competition and heightened risk of large-scale disaster, they must prepare to address massive casualty numbers and concomitant resource limitations (11,12). For this reason, the U.S. Army Medical Research and Development Command (USAMRDC) has partnered with federal and civilian disaster response systems to devise solutions that minimize triage.Telemedicine is a powerful force multiplier in resource limited healthcare (13-16). The right expertise can be delivered to the point of need faster and at less cost using technology rather than physical resource deployment to local

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Section: Introductionmentioning

confidence: 99%