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An article in the UC Davis Medicine spring newsletter points out how video conferencing was used to effectively treat an eleven year old boy involved in a motorcycle accident. He was taken by ambulance to the nearest emergency room located in the Mercy Medical Center in Redding California and arrived with several serious injuries and in critical condition. The doctors were debating whether to remove the spleen and knew that the surgery might require blood transfusions.  

What made this case unique was the fact that the boy’s parents are Jehovah’s Witnesses and their faith bars them from accepting any foreign blood products in the body. The parents told the hospital of their family’s beliefs and suggested an alternative to blood transfusions that is allowed by the church such as taking the drug erythropoietin.

The medical team decided that they needed to seek a second opinion and so they were able to use a video conferencing hookup to confer with Dr. Kourosh Parsapour, a pediatric critical-care specialist at the UC Davis Medical Center. The physician was able to talk to the boy and see that although the boy was in pain he looked to be stable.

Dr. Parsapour determined that the boy would not need to be transferred to another hospital and recommended putting the boy on erythropoietin the medication that had been suggested by the boy’s family that stimulates bone marrow to make more red blood cells. The boy was checked on via video conferencing for the next four days to observe his progress.

Dr. Parsapour used the medication to buy time and waited for the medication to work, so that the spleen would not have to be removed and therefore avoiding the necessity for a blood transfusion. The treatment worked and after six days, the patient left the hospital and is fully recovered.

The UC Davis telemedicine program is operational not only at the Mercy Medical Center, but connections are also operational at three other inpatient wards and nine emergency rooms in rural hospitals. UC Davis pediatric physicians have conducted over 200 video based consultations connecting with remote site emergency rooms and intensive care units since the system was established six years ago with 30 percent of the consults involving trauma. UC Davis also provides distance learning opportunities for rural physicians.

Since only about ten percent of calls to emergency medical providers involve a child, nurses and physicians often have limited exposure to certain pediatric emergency situations especially in rural areas. Children’s Hospital Medical Center in Cincinnati is trying to improve this situation by using a pediatric human patient simulator called PediaSim to educate and train pediatricians in emergency rooms.

PedisSim is the size of a seven year old child weighing 20 kilograms and features realistic systems that can be programmed to display a wide range of conditions and symptoms. The simulator is able to provide countless training applications for emergency and critical care professionals, community physicians, and nurses and is helping to change the face of pediatric education especially in emergency situations.
 
To help provide care not only for rural emergency rooms but improve emergency medical services for all children, Congressman Jim Matheson from Utah, together with California Congresswoman Lois Capps and New York Congressman Peter King have recently introduced legislation called the “Wakefield Act” to continue a federal program designed to improve emergency medical services for children.

Matheson’s bill (H.R 2464) would reauthorize the federal Emergency Medical Services for Children (EMSC) program authorized under the Public Health Service Act. When it was established, EMSC was the only federal program focusing specifically on improving the pediatric components of emergency medical care. The program’s purpose was to provide state funding for grants and demonstration projects focusing on a wide array of emerging and critical topics such as medical errors, patient safety, computer-based emergency department screening, and provide online training for physicians in the states.

In the last five fiscal years, the program received approximately $20 million dollars, but the FY 2008 budget request provides no funding for this program. The proposed legislation would provide $25, 000,000 for FY 2008 and similar funds as necessary for each of the fiscal years 2009 through 2011. It would also promote the use of existing and innovative technologies to care for children.

In Tennessee there are several bills in both the state senate and house under consideration to help improve emergency services for children, by addressing the rules and regulations that are needed to improve emergency medical and surgical services for pediatric patients.