Remote trauma management--setting up a system

A telemedicine link to enable nurse practitioners at a remote minor injuries unit to obtain advice from an emergency physician at a main accident and emergency department is feasible and worthwhile. However, it is fraught with difficulties. These include technical difficulties, training problems, familiarization with the technology and provision of enough emergency physician time for the much longer duration of a full consultation. When choosing the equipment, attention has to be paid to the cameras, lighting, echo cancellation, layout of rooms, privacy and ambience. It is useful to obtain the system from suppliers who know what they are doing and have adequate backup of appropriate technical expertise, because each installation is different and difficult. Our experience suggests that anyone wishing to use similar technology should be prepared to be doggedly determined to learn the system, iron out kinks and motivate all concerned. The project will need to be driven. The technology is still at a stage where frustration and delay are significant. However, it is rewarding and very useful if the staff overcome its shortcomings and in due course all are pleased that they participated.