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Mon, 22 Apr 2002 21:11:54 -0500

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Karim:

Comments between the lines

Barry Armstrong
General Surgeon
Dryden, Ontario, Canada

-----Original Message-----
From: Karim Brohi
Subject: Use of the Internet to improve trauma care

I am due to give a talk at the ITACCS meeting in Stavanger entitled 'Use of
the Internet to improve trauma care'.  So in  the spirit of the Internet,
global villages and people power I thought I'd ask the list for your
opinions and predictions.

How (if at all) does the Internet improve trauma care?

Increased access to information--medical literature searches,
tele-radiology, tele-presence.  We can fill vacant moments in the OR
schedule by reading e-mail or surfing Trauma.org.

What do you get out of it?

This rural area is 360 km from the nearest medical school.  There is no
other surgeon in town.  The nearest is 100 km away.  I gain the benefits of
a virtual "Operating Room Lounge", where I can listen to the experience of
medical and paramedical colleagues and seek their advice.

Continuing education is available, through discussion groups, Medline
searching and major medical websites.

How might it be used in the future?
        - with current services

Medical journals without Internet components will join the dinosaurs. The
Internet democratizes rights of access to intellectual property.   New ideas
can be tested and disseminated quickly.  As with popular music and movies,
copyright laws are being undermined, freeing the words.  Access to new ideas
is enhanced at lower cost to the user.  In the waiting room, next of kin
will use their pocket electronic organizers to e-mail Uncle Bob (a urologist
in Miami?) or review the medical literature while the trauma team is working
on the patient.

        - with future technology

Tele-presence with hyperbroadband connections will allow the trauma team to
be better informed and more accurate in decision-making, during
resuscitation.  The trauma team leader will wear a video camera and observe
through a heads-up display that is connected to the Web.  He will see
patient data globally-accepted algorithms,and global consensus.

Trauma teams will depend more upon science and patient data, less upon the
"art" of trauma care.  Treatment plans will be accessed through web services
funded by international medical societies, governments, WHO and medical
insurance companies.  Such web services would consider the patient's medical
history database, genomic data, lab/x-ray results  and current physiologic
status.

Other inputs, automatically considered, will include the facilities of the
local EMS/hospitals, financial restrictions and other factors -- tailoring
the recommendations for the local trauma system and the specific patient.

Variable/flexible recommendations will be given by the software, according
to the strength of the scientific evidence and the fuzziness of the
ultrasound images.  The specific patient's anatomy, including radiologic
estimates of the bullet's path, will be displayed in "heads-up" mode during
surgical exploration.

During the patient's care, real-time video will be recorded with electronic
vital signs and diagnostic information -- for scientific research and
individual case debriefing.

Are there any negative effects?

When we brought fire into the cave, someone complained about the smoke.
Patient and provider privacy will be reduced.  Authors will lose control of
their books and reports.  Some will complain about the lost "art" of trauma
care.

It'd be good to get a global view of such issues.

Many thanks

Karim

_____________________________________________
Karim Brohi BSc FRCS FRCA
Trauma Service, Royal London Hospital
director, trauma.org

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<DIV>Karim:</DIV>
<DIV>&nbsp;</DIV>
<DIV>Comments between the=20
lines</DIV>
<DIV>&nbsp;</DIV>
<DIV>Barry =
Armstrong</DIV>
<DIV>General =
Surgeon</DIV>
<DIV>Dryden, Ontario, =
Canada</DIV>
<DIV> </DIV>
-----Original Message----- From: Karim =
Brohi Subject: Use=20
of the Internet to improve trauma care I am due to give a =
talk at the=20
ITACCS meeting in Stavanger entitled 'Use of the Internet to improve =
trauma=20
care'.&nbsp; So in&nbsp; the spirit of the Internet, global villages =
and=20
people power I thought I'd ask the list for your opinions and=20
predictions. How (if at all) does the Internet improve trauma=20
care?
Increased access to =
information--medical=20
literature searches, tele-radiology, tele-presence.&nbsp; We can fill =
vacant=20
moments in the OR schedule by reading e-mail or surfing Trauma.org.=20

 <FONT=20
size=3D2>What do you get out of it?
This rural area is 360 km from =
the nearest=20
medical school.&nbsp; There is no other surgeon in town.&nbsp; The =
nearest is=20
100 km away.&nbsp; I gain the benefits of a virtual "Operating Room =
Lounge",=20
where I can listen to the experience of medical and paramedical =
colleagues and=20
seek their advice.&nbsp; 
Continuing education is =
available, through=20
discussion groups, Medline searching and&nbsp;major medical=20
websites.
<FONT=20
color=3D#0000ff> How might it be used in the=20
future? &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; - with current=20
services
Medical journals without Internet =
components will=20
join the dinosaurs. The Internet democratizes rights of access to =
intellectual=20
property.&nbsp;&nbsp; New ideas can be tested and disseminated =
quickly.&nbsp; As=20
with popular music and movies, copyright laws are being undermined, =
freeing the=20
words.&nbsp; Access to new ideas is enhanced at lower cost to the=20
user.&nbsp;&nbsp;In the waiting room, next of kin will use their pocket=20
electronic organizers to e-mail Uncle Bob (a urologist in Miami?) or =
review the=20
medical literature&nbsp;while the trauma team is working on the=20
patient.&nbsp;&nbsp;&nbsp;
 &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; - with =
future=20
technology
 Tele-presence with =
hyperbroadband=20
connections will allow the trauma team to be better informed and more =
accurate=20
in decision-making, during resuscitation.&nbsp; The trauma team leader =
will wear=20
a video camera and observe through a heads-up display that is connected =
to the=20
Web.&nbsp; He will see patient data globally-accepted algorithms,and =
global=20
consensus.&nbsp; 
Trauma teams will depend more upon =
science and=20
patient data, less upon the "art" of trauma care.&nbsp; Treatment plans =
will be=20
accessed through web services funded by international medical societies, =

governments, WHO&nbsp;and medical insurance companies.&nbsp; Such web =
services=20
would consider the patient's medical history database, genomic data, =
lab/x-ray=20
results&nbsp;&nbsp;and current physiologic status.&nbsp; </FONT></P>
<P><FONT color=3D#0000ff size=3D2>Other inputs, automatically =
considered, will=20
include the facilities&nbsp;of the local EMS/hospitals, financial =
restrictions=20
and other factors --&nbsp;tailoring the recommendations for =
the&nbsp;local=20
trauma system and the specific patient.&nbsp; </FONT></P>
<P><FONT color=3D#0000ff size=3D2>Variable/flexible recommendations will =
be=20
given&nbsp;by the software, according to the strength of the scientific =
evidence=20
and the fuzziness of the ultrasound images.&nbsp; The specific patient's =

anatomy, including radiologic estimates of the bullet's path, will be =
displayed=20
in "heads-up" mode during surgical exploration. 
During the patient's care, real-time =
video will be=20
recorded with electronic vital signs and diagnostic information -- for=20
scientific research and individual case debriefing.&nbsp; 
Are there any negative effects?
When we brought fire into the =
cave, someone=20
complained about the smoke.&nbsp; Patient and provider privacy will be=20
reduced.&nbsp; Authors will lose control of their books and =
reports.&nbsp; Some=20
will complain about the lost "art" of trauma care. It'd be =
good to=20
get a global view of such issues. Many=20
thanks Karim _____________________________________________<=
BR>Karim=20
Brohi BSc FRCS FRCA Trauma Service, Royal London =
Hospital director,=20
trauma.org </BODY></HTML>

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