Re: [binfenv] required levels of information for diagnosis???

["Andrew Berry" <Aberry@nets.org.au>]

The greatest challenge here is for there to be a method of initial, early notification of the problem to the 'system'.

If the unlikely event your drover had a method of voice communication such as a satellite phone (these devices are far to expensive to be used by drovers!), he could communicate with the emergency health system by calling 000 in Australia (equiivalent to 911 (Nth America), 999 in the UK and 112 in continental Europe and most other places).

More likely he would rely on the serendipity of a passing traveller who did have one or a nearby homestead which had a fixed line phone or an HF radio. Using those devices, contact with the Royal Flying Doctor Service would activate both an emergency medical team by plane from the nearest RFDS Base. More importantly, medical advice by telephone could assist and support the process of first aid and basic life support by fellow drovers and others in the vicinity. I never cease to be amazed by the number of passing tourists in the Australian outback! Solitary Japanese pedal cyclists, convoys of Parisian L15 Citroen drivers and outback rally drivers in ancient sedans are ubiquitous. More recently, you may find the drovers in the proximity of well-tanned and extrovert 'Survivors' competiting with each other for some fantastic prize and surrounded by strangely misplaced TV crews and their luxury mobile homes. If your drovers are close to this unlikely scenario, the full resources of global television are immediately available to solve the problem. [Have him check with his lawyer and agent before signing anything]

Once initial notification has happened, the challenge is not technological. While 3D animated graphics of the injury and digital subtraction x-rarys by satellite may sound alluring, when it comes to using them, reading the manual takes nearly a lifetime, let alone setting up the equipment and plugging in the cables. Just attend an industry demontration of multimedia telemedicine; you'll die waiting for action.

No the challenge is correct information and people. The right information (was that 1 drover or 10?  Is he on the road to Nhill or the Nhill Rd? (cinematic reference here). The right people available in the right time-trame (stat) to activate the right process. This may been mobilising resources (both regional and tertiary/central) while at the same time establishing a line of communication. I am reminded of the challenge of hostage negotation. It isn't the sophistication of the telephone which achieves the result but the skill of the negotiator. Maybe your drover would be advised to use the portable GPS receiver from Dick Smith (Radio Shack). Everyone in the outback should carry one - hardly larger than a watch and more accurate time!

Finally, the drover needs a multiple level, regionally organised trauma response system which deals with the injury and it's implications efficiently and effectively. A single point of contact activation phone call should precipitate a process of clinical thinking and decision-making which is followed by a carefully structured emergency medical response. It's no good have a single phone number if it simply activates a vehicle or an incremental response as the full nature of the injuries becomes clearer with more accurate information. It's no good a system based around competing services competing for the drovers' business. [Did you know our helicopter flies more often than anyone else?  It's no good a system based around individual hospitals which compete to have this patient in their trauma service when they are all more than 2,000km away and the outcome will be determined well before reaching their hallowed walls.

ps. When all is over and the dust settles and the debriefs are over, a word on prevention. No one droves any more. Tell him to get into trucking. A road train is a much more cost-effective method of getting livestock to market. And they come with an CB radio in the HF band which for less than $200 which will permit contact with other truckers, nearby stations (ranches)  and fareoff CB'ers in the attics who will activate the 'system'.

Seriously, I am no luddite, but telemedicine has been promising support for acute medical decision-making for several decades. It's potential timeliness has not been taken advantage of in most of what I have seen offered. 

Sorry for the bandwith but just wait until your competing with pretty pictures! 

Dr Andrew Berry ABerry@nets.org.au
State Director
NSW Emergency Transport Service 
www.nets.org.au

Hotline    1300 36 2500   +615 0055 NETS
Office      05 005 24453   +615 005 CHILD
Facsimile 05 008 24453   +615 008 CHILD
Direct      05 005 23779   +615 005 BERRY

>>> s359711@student.uq.edu.au 5/29/01 10:00:43 >>>
Good day,

Recently a classmate of mine sent an email describing our university project (supporting remote medicine).  Given your basic acquaintance with this I thought I might ask for your help on my topic.

I am looking at the project from a very scenario driven manner.  I am setting up a scene where two drovers are on their way home (yet still half a day away from everywhere) and due to fatigue and rugged terrain one of the men falls off his horse and lands on his chest/abdomen and ruptures his spleen.

What I would like to know is firstly given this scenario can this kind of injuring and secondly what level of information would you require to diagnose this.  Assume you could get a basic video feed (perhaps using modified satellite phone) operated by his fellow drover, basic vital signs over same or different channel.

My aim is find out what the barest level of information required is and also the desired level of information you would ultimately like, then see what technologies exist or are in the near future that could be used to support the gathering and delivery of this information in remote settings.

Ideas range from first aid kit with GPS positioning so you can accurately gauge the patient's location and fly to the most convenient point.  Possible video as mentioned before.  Small vital signs measuring kit that can be sent over the phone or some other means (HF, VHF?).  Anything else you could dream up?

Your thoughts on this would be most appreciated.
Stuart Fraser.

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