Supervising trauma life support by telemedicine

The resuscitation room in a community hospital was linked with a main hospi tal accident and emergency department using telemedicine equipment working at 384 kbit/s. Fifteen simulated casualties replicated the 'moulage' scenar ios in the Advanced Trauma Life Support Course Manual of the American Colle ge of Surgeons. Each of the 15 scenarios was broken down into three main pa rts: the primary survey, resuscitation and the secondary survey. While a ph ysician in the community hospital undertook each task, a senior doctor in t he accident and emergency department recorded his degree of confidence in t he supervision of the task on a five-point scale. There were features of th e management which the supervisor found difficult, mainly related to the ca mera view and the use of a proxy examiner. However, supervising major traum a management by telemedicine was feasible. The average scores were mostly a bove 3 and often above 4 in the assessment of the primary survey and the re suscitation. The average scores were mostly above 3 for the secondary surve y but were less often above 4 than for the primary survey and the resuscita tion. Trials of remote trauma management with real patients appear to be ju stified.