Telemedicine's role in emergency care is growing, but it's still typically subject to serious limitations. Patients may have to come to a clinic to be linked to a physician, or a community hospital to consult a big-city specialist. Even in those advanced systems where EMS vehicles are telemedicine-equipped, patients usually have to come to the truck.

With a new portable, stretcher-mounted telemedicine system conceived by a pediatric emergency physician in Cincinnati, that capability can be taken to the patient, wherever they may be.

The system was conceived by Hamilton Schwartz, MD, medical director of the critical care transport team at Cincinnati Children's Hospital Medical Center, and developed by Scottsdale, AZ-based GlobalMedia. It features audio and video connections that let physicians at CCHMC examine and treat critical children not only in ambulances, but across a range of settings.

"We didn't want something mounted inside the ambulance, because so much of the care of the child is delivered before they actually physically get into the ambulance," says Schwartz. "We wanted something that could actually go with the team to wherever they first interact with patient. For our critical-care team, that may be a community hospital's emergency department or another hospital's ICU where we're picking a child up. For EMS providers, it could be their living room or kitchen floor."

The system, known as TransportAV, includes a military-grade touch-screen PC, 3G AirCard, controllable camera, echo-canceling microphone, ClearSteth stethoscope, TotalExam examination camera and Bluetooth wireless keyboard with headset. That's all combined in a compact package weighing approximately 30 lbs. The components can attach to virtually any stretcher or be mounted to a mobile cart for use in hospitals or clinics.

CCHMC acquired four of the units, but is only using one during the pilot phase of its implementation, which began in October. Once that's complete and any wrinkles are smoothed out, the hospital will equip all of its critical-care ambulances with them.

"Right now we're using it for almost all the patients with whom we interact," says Schwartz. "We want to increase the familiarity of the doctors and transport team with the equipment, and see what's easy to use and what might work better. Then in the future we'll define criteria, anatomic or physiologic, that trigger the team to communicate with medical control using it."