EMERGENCY SERVICES
Flanking an eCareMobile unit live feed of Lisa Goetz from the Health First VitalWatch eICU Clinical Operations Room in Rockledge, are, from left to right, Dr. Peter Pappas, HRMC trauma surgeon; Dr. Antonio Marttos, Director of TeleTrauma at the University of Miami William Lehman Injury Research Center; Mike Gavigan, Vital Watch Nurse Manager; Dr. Jim Shaffer, VitalWatch Medical Director; and Dr. David Mozingo, Chief of the University of Florida’s burn surgery program. Telemedicine technology was a hot topic at Health First’s annual “Bomb, Blast and Burn” seminar, where Drs. Marttos and Mozingo spoke. Particularly compelling were Dr. Mozingo’s recounting of casualty care after September 11th and Dr. Marttos’s use of telemedicine to aid the victims of Haiti’s earthquake.
BREVARD COUNTY, FLORIDA – Disaster strikes. The drone of mid-morning traffic is cut by the roar of crushed machinery and cries of panic. A train car derails spilling volatile chemicals across a major road. In an instant, the chemicals ignite in a fireball.
The shock wave shatters windows and snaps trees; bystanders are hurled through the air and pummeled with debris. Brevard’s finest answer the call and race into action, securing the scene, dousing the flames and rescuing the wounded.
Our community’s trauma center and its area partners go on mass casualty alert. Resources are mobilized, and as ambulances roll from the scene, the first casualties arrive at hospitals on foot and by car…
University of Miami Telemedicine video technician beams real time view of a mass casualty victim to physicians at the Center for Trauma Telemedicine at the University of Miami/Ryder Trauma Center while HRMC trauma surgeons Peter Pappas, left, and Ernie Block examine and triage the patient during the mass casualty drill at HRMC.
This was the scenario of Brevard’s county-wide mass casualty drill held recently as part of ongoing efforts by Brevard’s hospitals to provide the highest level of care to our community in any situation.
Led by Holmes Regional Medical Center, home to Brevard County’s trauma center, and including Palm Bay Hospital, Cape Canaveral Hospital, Parrish Medical Center and Wuesthoff Hospitals, both Melbourne and Rockledge, all five Brevard hospitals worked together to test their abilities to deal with a sudden influx of disaster victims.
New Dimension
At Holmes Regional, an entirely new dimension was brought to the drill. For the first time ever in Brevard County, the ability for physicians to triage and manage injured patients by telemedicine was tested.
The Trauma Center at HRMC brought together the resources and talent of the HRMC Department of Emergency Medicine, Health First’s Vital Watch program and the Center for Trauma Telemedicine at the University of Miami/Ryder Trauma Center to implement the triage telemedicine concept during the drill.
Our entire community should take pride in the fact that this drill exceeded the expectations of all participants, becoming one of the largest ever tests of telemedicine for mass casualty management.
HRMC’s response followed detailed plans overseen by Jim Kendig, Health First’s Vice President for Safety and Security. The scenario involved mock casualties with blast and burn injuries played by local volunteers. Dianna Liebnitzky RN, HRMC Trauma Program Manager, coordinated the complex task of making sure casualties fit the part – complete with torn clothing and make-up to simulate injuries.
Dr. Marty Brown, HRMC Director of Emergency Medicine, performed on-site triage. Based on their injuries and vital signs, casualties were prioritized for care and transferred to the emergency room and Trauma Center.
But, before entering HRMC, all casualties were triaged once more. This time, the triage was done by physicians at the Ryder Trauma Center in Miami via a web-connected camera.
Once triaged, patients proceeded on to care. Trauma co-Medical Directors Dr. Bartel Turk and Dr. Samuel Pellegrino coordinated the Trauma Center’s response with emergency room physicians and nursing staff led by Nurse Manager Nicki Andersen.
E-Care Mobile
To supplement available care-providers, the E-Care Mobile was put to the test. The newest addition to Vital Watch’s telemedicine resources, the E-Care Mobile is a high-definition digital video and audio system that allows for two-way communication between the patient’s bedside and a distant location.
Mounted on a durable cart, the equipment can be quickly rolled into position and bring real-time medical expertise from a distance directly to the patients’ bedside.
THE HEALTH FIRST eICU CENTRAL COMMAND center is busy around the clock, 365 days a year. Staffed by critical care nurses in the daytime, a nurse and a physician are on hand from early evening to early morning, 24 hours a day, 7 days a week. The patented eICU® Program allows hospitals to create a system-wide critical care program, built on a powerful technology infrastructure that improves quality, operating efficiency and economic performance.
Led by Dr. James Shaffer and Vital Watch operations manager Mike Gavigan RN, the eICU team of Critical Care nurse Melissa Haynes, RN, and board certified Intensivist Dr. Ted Barnett assisted with casualty care – assessing patients, ordering treatments and monitoring patient status.
The results of the trial were impressive. The priority given to casualties by physicians in Miami closely matched that of the on-site triage physician, while the E-Care mobile proved itself to be a valuable tool for extending the reach of physicians and nurses.
That a physician over 150 miles away could accurately provide triage assessment for patients through a hand-held camera and a laptop computer is an incredible feat. Add to this the ability of E-Care mobile units to bring medical decision-making rapidly to the bedside and one begins to realize the potential of this technology to redefine not only disaster care, but medicine itself in the 21st Century.
On the Forefront
Our community is at the forefront of this technology. Vital Watch’s e-ICU service is a fixture of intensive care units at all Health First hospitals, and now E-Care Mobile units will extend medical “tele-presence” to any hospital bed or ER ward in the Health First family of hospitals.
The Trauma Center at Holmes Regional is proud to partner with the University of Miami in developing this technology for all Floridians. Led by Dr. Antonio Marttos, the Trauma Telemedicine program is leading the state of Florida’s efforts to develop a comprehensive trauma “tele-network,” linking Florida’s trauma centers together.
“Bomb Blast Burn”
This year’s drill was followed a few days later, by Health First’s annual “Bomb Blast Burn” seminar, where Dr. Marttos spoke alongside Dr. David Mozingo, Chief of the University of Florida’s burn surgery program.
Attended by healthcare, emergency and law enforcement professionals from across Brevard County, the seminar reinforced valuable lessons on disaster management. Particularly compelling were Dr. Mozingo’s recounting of casualty care after September 11th and Dr. Marttos’s use of telemedicine to aid the victims of Haiti’s earthquake.
The potential for telemedicine to enrich medical care has only begun to be explored. Just as Brevard County has been at the forefront in exploring the frontier of space, the Space Coast is ready once again to lead the way into this new frontier.
Dr. Peter Pappas
ABOUT THE AUTHOR
Dr. Peter Pappas
Dr. Peter A. Pappas MD is a Trauma Surgeon with the Trauma Center at Holmes Regional Medical Center and leads the Center’s telemedicine projects. Originally from Orlando, Dr. Pappas underwent medical school and General Surgery residency at the University of Miami/Jackson Memorial Hospital in Miami and completed fellowship in Surgical Critical Care and Trauma at Orlando Regional Medical Center. He is board certified in General Surgery and Surgical Critical Care and has an active interest in research, education and injury prevention.
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