Presentation by R. Uries, G. Conti, The National Alpine Cliff and Cave Rescue Corps (CNSAS), Italy.

TELEMEDICINE IN A CAVE… between fiction and reality

Telemedicine in the cave

Premise

This project was born few years ago when a group of people start thinking of using the phone line, inside and outside the cave, not just in a traditional way, but as an opportunity to transmit data in a digital format.

Unfortunately, I don’t have the details to say something more about this experience, but a couple of years ago this project gained the attention of the Speleological Medical Commission. During this time some first aid practices were organised in order to test the transmission system.

In Autumn 2017 I was invited to join a first aid training in the Arapanui abyss as a health care professional. Here the injured person was at about minus 200 metres. Our targets included the ones of testing the transmission of medical data gathered through the expedition in a digital format.

Procedure in sequence

A. Positioning a multi-parametric monitor (HR, SpO2, RR, TC, ECG) on the injured. We didn’t focus on the quality of the data we collected over the monitoring, but just on the data as an information: this one should be a crucial point in the future. The ideal monitor in the future should be little, light, reliable, well tolerated, not too invasive, resistant to the cave condition, with a good autonomy and reduced costs.

B. The data collected from the injured were transferred on a palmtop using the Bluetooth mode. We tested different data format (JPEG, PNG;…). Our covered transmission area was between 20 and 30 meters depending on the cave structure. We didn’t worry about how to process the data and I think that this one is going to be a health care professionals’ issue according to our needs. During the rescue we tested the continuous monitoring of an injured person at the bottom of a well (15-20 meters) with good results. This kind of continuous monitoring require a good energy autonomy of the palmtop.

C. Data transmission from the palmtop to the base at the cave entrance. At this point it was necessary to use the phone line. We have to bare in mind that the phone line can’t be engaged in any other ways during the transmission. At the present time the phone line doesn’t allow two things, in that case the data transmission and the communication, happening at the same time. Perhaps in the future this is a topic that deserve further attention. When the transmission begin it is crucial for all the parts involved to be well coordinated. I would like to underline that it doesn’t have to be necessarily a health care professional in charge of the data collection.

D. When the data reach the cave entrance they can be analyzed, interpreted and also sent out to third parts like hospitals, specialists or the Medical Commission. Probably at this point an internet connection with 3G would be enough.

Other test during the training

  1. The transmission of some small video file with the ABCDE assessment of the injured recorded by using a GoPro. All the file can be saved on the palmtop in order to be sent outside as soon as we have access to the phone line. It’s important not to have heavy files to facilitate the transmission.
  2. We tried some video calls from the injured to the cave entrance, but the procedure has to be improved. This is a possibility for the team working close to the injured to have a psychological support and improve the quality of cares inside the cave (if a medical support is available at the cave entrance). At the same time all the conversations can be sent to other people: health care professionals involved in the rescue, the Medical Commission.
  3. During the training I used a little recording device, as small as a lighter. I found it very useful to record all the information about the clinical condition of the injured. It gave me the possibility to write down the data recorded when we stopped for a break, sometimes I could even manage to save them on the palmtop using a mp3 format and send them outside through the phone line. Compared to a phone call this procedure can give a better opportunity to the outside team to analyze the information, send them to others and think about the best answers to give inside the cave.

What we used during the training

  1. Multi-parametric monitor
  2. A palmtop (or a small computer) inside the cave
  3. Small recording device with the people operating on the injured
  4. Phone line
  5. A laptop and a phone with internet coverage outside the cave

CONCLUSIONS

  1. The transmission of medical data using different format…works very well! To avoid engaging the line for more than 5/10 minutes better to use more files of light dimensions.
  2. Videos require more time to be sent out, but they can be fragmented to ease the process.
  3. Video calls connecting the inside with the outside of the cave were difficult: the voice wasn’t very clear and video and sounds were often interrupted.
  4. The recording device was very useful: it gives you the chance to write down your observations in short time and it is very handy.

29.10.2018 Romeo Uries, member of the Italian Speleological Medical Commission

Telemedicine in the cave
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