Successful Telemedicine Consultation at a Mass Gathering Sporting Event to Loma Linda University Medical Center Emergency Department

Michael Ghim, MD, Jeff Grange MD, Jeff Bender, BSN, EMT-P

Telemedicine has been used since the late 1980s to bring health care to individuals that may be remote from the health-care providers using communications technology. Although obvious modalities such as telephone and fax machines have been used to transmit simple documents and information, increasingly, more advanced technology in communications have been used to transmit photographs, streaming video, radiographic images, and even real-time examination findings including vital signs, lab results, and even cardiac auscultation from a patient to care providers across the world. The military have used satellite to send images from patients in disaster situations such as the earthquake in Mexico City of 1985, Armenian earthquake in 1988, and the Virgin Islands in the aftermath of Hurricane Hugo in 1990¹. On a smaller scale, primary care physician offices have used telemedicine images to obtain specialty care consultations such as dermatology or otolaryngology. Other uses include providing services for extremely rural environments, prisons, or for long-term care patients with diabetes or hypertension².

On September 3, 2005, we successfully used a T1 line to send patient information from the California Speedway to an emergency medicine physician consultant at the Loma Linda University Medical Center to assess the need for immediate emergency department care via patient transport. The patient was a NASCAR team employee who suffered a crush injury to his thumb. The patient was seen and evaluated by medical personnel at the Infield Care Center at the California Speedway during the NASCAR Nextel race.

Over 250,000 spectators came to the Speedway over Labor Day weekend, which makes it the largest sporting event in California. The event itself employs thousands more not including the race drivers and supporting teams. Almost a thousand patients were seen at several aid stations including the Infield Care Center throughout the weekend for acute potentially hazardous symptoms such as chest pain and heat illnesses to motor vehicle and other traumas as well as minor complaints. Often, patients have complaints or medical findings suggestive of injuries or conditions that require further diagnostic testing or treatment that must be met in an emergency department or as an inpatient. However, it is often difficult to find those individuals that would definitely require extended services, especially for non-physician providers. There are significant costs to the patient for transports, which may be avoided with better resources including telemedicine.

Using streaming real-time video as well as a hand-held exam camera, the emergency medicine physician consultant was given the patient's complaint, vitals signs, and visual images of the patient's injuries. The consultant was able to see with excellent clarity two lacerations on the thumb, which created concern for a possible open phalangeal fracture requiring diagnostic x-rays. Thus the recommendation was made to transfer the patient to the emergency department. A Polycom Practitioner Cart with VSX 7000 camera was used at the Speedway and a VSX 7000 camera in the consultation room at LLUMC ED.

We believe this is the first time that real-time video telemedicine was used at a mass gathering event. Although this was not a formal study, this demonstrates the possibility of obtaining real-time consultation for patients at a mass gathering event that may contribute to expedited medical care. It has been suggested by previous studies and literature reviews that telemedicine consultations with specialists may prevent unnecessary transports or provide improved medical care at a facility with fewer resources than a full-time hospital³. Events which are a mass gathering and are prone to disaster situations are often staffed by first responders who do not have the complete resources necessary to care for certain patients. Having the ability to consult with a physician provider is another potential use for telemedicine and may be an important application in pre-hospital medical care in the future. This opens an arena with vast economical and medical consequences, which will require further study to assess for efficacy and cost effectiveness.