Building upon the technologies and applications developed for the Remote Community Services Telecentre (RCST) project, the Integrated Emergency Medicine Network (IEMN) seeks to develop, implement and test a multi-tier emergency service to serve as the basis of a province-wide emergency medicine network. The IEMN will provide the following emergency response capacities within Newfoundland and Labrador (Canada).
- Giving rural and community health care services direct and immediate access to emergency medicine physicians and resources within a province-wide network (with real-time video consultation and medical data transfer facilities).
- Allowing continuous communications and patient data transfer between emergency response staff and the emergency facility during an emergency situation or patient transfer between health care sites (road or air-based).
- Creating a mobile emergency response facility that can quickly be deployed to a disaster location to extend the facilities and capabilities of the IEMN to the emergency response personnel.
To create the IEMN a number of new fixed and mobile emergency response facilities and systems will be developed and tested, including:
- A Provincial TeleEmergency Centre in St. John's consisting of facilities in the Emergency Room (ER) facilities the Health Science Center for adult emergency services and the Charles Janeway Hospital for pediatric emergency services (both facilities are in the process of being co-located).
- Enhanced ER facilities at four regional hospitals (Gander, Corner Brook, St. Anthony, and Goose Bay) to allow them to project emergency services to the community sites they serve as well as tying them in to the provincial site in St. John's.
- Telemedicine facilities in the ER's at two community hospitals (Twillingate and Port aux Basques) and two remote sites (the Nain Community Clinic and the Forteau Community Clinic).
- A mobile ER facility that can be quickly moved to a community or emergency site, consisting of mobile communications systems as well as medical facilities.
- Enhancements to ambulance and air ambulance facilities to provide real-time transmission of critical patient data and vehicle tracking during an emergency response or patient transfer.
The principle challenges which the project addresses include:
- The implementation of an H.323 compliant video bridging system to support multipoint consultations
- The enhancement of the existing Bandwidth on Demand user interface and process to allow instantaneous connections under user control.
- The creation of a functional portable telemedicine system.
- The creation of a function mobile system marrying MSAT satellite technology with vital signs monitoring peripherals, fully integrated with the telemedicine/monitoring stations with the ER's
- The creation of an integrated service model for the IEMN service that defines the specific applications needed to build the service.
- The sourcing of the required application components, or there development where necessary.
- The creation of a simple, functional user interface that quickly provides access to all the features of IEMN without intruding into the treatment process
The development of an Applications Team comprised of project staff and end users from the project sites that will lead the design and testing of the IEMN service using a structured development process.
- The implementation of a training and orientation program for users in the project sites, as well as the provision of 7*24 technical support.
- The design and implementation of a health outcomes-focused evaluation process that will ensure that the project is meeting its objectives from a user and health care institution perspective.
- Enhanced access to medical specialists across the provincial system.
- Improved response capabilities at emergency or disaster locations.
- Improved monitoring and treatment of patients during medical transport
- Improved communications between health care facilities on a provincial basis.
- The development of a critical mass of users that will lead to the expansion of the service on a province-wide basis.
The IEMN project will implement a multi-tier emergency medicine network based upon the current health care infrastructure in Newfoundland and Labrador. The structure is tiered as follows:
- Tier 1: Provincial Centres
- Tier 2: Regional Hospitals
- Tier 3: Community Hospitals
- Tier 4: Remote Community sites (i.e. Nursing Clinics)
In addition the project will address mobile facilities that service various sites within the system.
Figure 1 provides the conceptual view of the IEMN project.
Figure 2 provides a Schematic of a site.
The IEMN project is planned to run for 18 months from November 1999 to May 2001. The project will progress through five distinct phases (along with a Project Management Phase), taking the IEMN from its initial design through implementation, operations, and evaluation:
- Project Management (WP 10000)
- The design of the network infrastructure and application systems (WP 20000);
- The development, testing and refinement of the basic systems using a prototype infrastructure in the St. John's region (WP 30000);
- The expansion of the refined infrastructure to the other project sites and the conduct of operational pilots (WP 40000);
- Maintenance of the Strategic Plan (WP 50000)
- A formal project evaluation coupled with the ongoing refinement of the Strategic Plan (IEMN-5) (WP 60000)
TETRA has deployed videoconferencing systems and supporting equipment to implement two new medical videoconference suites within the Health Science Centre (HSC). These are being used on an ongoing basis to support a range of clinical and medical professional development applications in support of the IEMN project. These services have been expanded considerably with the addition of one new hospital and ten new community clinics under the SmartLabrador initiative, which has adopted the Remote Community Services Technologies (RCST) model developed under the ARTES 3 Programme and has implemented the IEMN emergency services framework.
All project sites are operational and have trained staff in place. This training has included familiarity and acceptance of the new videoconferencing technology and familiarity with clinical practices, continuing medical education, and professional development activities. Clinical applications have included:
1. Renal Dialysis
2. Emergency Rounds
3. Telepsychiatry / Mental Health Assessments
4. Autism Consultations
6. General Emergency Consultations
7. Medical and Emergency Grand Rounds
An H.323 Video Bridge and H.320 gateway facilities have been installed and are operational in the provision of multipoint consultations and conferencing sessions. The bridge has been used to support a number of multi-point applications, such as medical grand rounds for several institutions and video-based nursing education programs.
A portable satellite earth station has been developed for disaster and emergency deployments, combining both the bandwidth on demand technology for medical consultations and a Mobile Satellite (MSAT) system for voice-only communications. A number of test deployments have been made to test the system and to refine the technical and operational procedures for the system. This included the deployment of a telemedicine video conference system to the Bay Bytes Conference on Rural Economic Development. During the course of the conference a number of simulated emergency consults were performed, modeled on the type of situations that could be seen at a remote site (e.g. possible heart attack, diabetic patient having problems controlling blood sugar levels, etc.), with these sessions recorded for distribution to other project sites. The unit is currently available for deployment and is being used as a model in the ARTES 5 Project called Real-Time Emergency Management via Satellite (REMSAT).
An initial mobile deployment was made in an ambulance belonging to the St. John's Health Care Corporation to test the suitability of the MSAT facilities and to conduct a trial on the Ortivus patient monitoring system. The system was used for a number of patient transports and a summary report prepared showing that Ortivus product could be paired with the MSAT technology to create an effective mobile patient monitoring and communications solution. As a follow-up activity an MSAT system has now been installed in a private ambulance operating within the area covered by the IEMN project site in Forteau, Labrador.
In addition to the clinical services delivered under IEMN the project team also conducted a series of emergency medicine simulations in cardiology and trauma to test and refine the technology and protocols under a range of different operating scenarios. The initial series of simulations were completed between the project sites in Forteau, St. Anthony, and St. Johns, with a further series of simulations run between the regional hospital in Goose Bay and the community health centre in Nain.
The project has now been completed with a number of positive results. These include the use of the IEMN portable model under REMSAT, the expansion of the IEMN clinical model throughout Labrador under the Smart Labrador project, and the transfer of technologies to the Marine Integrated Satellite Technologies (MIST) project, under which medical emergency services, teletourism and eCommerce services have been demonstrated in a marine environment. The final reports for the project have been completed and approved. The public version of the IEMN final report is now available.