The need for a robust 24/7 subspecialty “clearing house” response for telementored trauma care

Kirkpatrick, Andrew W.; Hamilton, Douglas R.; Beckett, Andrew; LaPorta, Anthony J.; Brien, Susan; Glassberg, Elon; Ball, Chad G.; Roberts, Derek J.; Tien, Homer

doi:10.1503/cjs.013914

Cited by 14 publications

(1 citation statement)

References 8 publications

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“…Procedures to follow in case of lost communications should be established, including principles to help an isolated operator decide whether to terminate or complete the procedure. Previous authors have emphasised the importance of deliberate training in mentoring and communication, even for expert surgeons 26 27. We agree with this recommendation.…”

Section: Discussionsupporting

confidence: 75%

Augmented-reality telementoring for leg fasciotomy: a proof-of-concept study

et al. 2022

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BackgroundProlonged field care is required when casualty evacuation to a surgical facility is delayed by distance, weather or tactical constraints. This situation can occur in both civilian and military environments. In these circumstances, there are no established treatment options for extremity compartment syndrome. Telementoring by a surgeon may enable the local clinician to perform a fasciotomy to decompress the affected compartments.MethodsSix military clinicians were asked to perform a two-incision leg fasciotomy in synthetic models under the guidance of an orthopaedic surgeon located 380 km away. Communication occurred through commercially available software and smartglasses, which also allowed the surgeon to send augmented-reality graphics to the operators. Two blinded surgeons evaluated the specimens according to objective criteria. Control specimens were added to ensure the integrity of the evaluation process.ResultsThe six study participants were military physician assistants who had extensive clinical experience but had never performed a fasciotomy. The average duration of the procedure was 53 min. All six procedures were completed without major errors: release of all four compartments was achieved through full-length incisions in the skin and fascia. The only surgical complication was a laceration of the saphenous vein. All three control specimens were correctly assessed by the evaluators. None of the participants experienced adverse effects from wearing the smartglasses. Four dropped calls occurred, but the connection was re-established in all cases.ConclusionAll six surgical procedures were completed successfully. We attribute the dropped calls to a mismatch between the size of the graphic files and the available bandwidth. A better technical understanding of the software by the mentoring surgeon would have avoided this problem. Important considerations for future research and practice include protocols for dropped communications, surgical skills training for the operators and communication training for the surgeons.

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Section: Discussionsupporting

confidence: 75%