Ting Louise, Wilkes Matt
Great Western Hospitals NHS Foundation Trust, Swindon, United Kingdom.
Extreme Environments Laboratory, University of Portsmouth, Portsmouth, United Kingdom.
Wilderness Environ Med. 2021 Mar;32(1):102-111. doi: 10.1016/j.wem.2020.09.009. Epub 2021 Jan 8.
Telemedicine potentially offers enormous value to expeditions to remote environments. For healthcare professionals, telemedicine can provide access to specialist advice. Where no healthcare professionals are present, telemedicine may be the sole source of expert care. This systematic review appraises and summarizes the current literature regarding telemedicine in patient management on expeditions to remote locations and identifies areas for future research. MEDLINE and EMBASE were systematically searched for relevant articles from 1980 through February 2018. Data were handled according to the PRISMA process and analyzed using type-specific critical appraisal checklists where possible. Two hundred twenty-five articles were identified, 33 of which were included in this systematic review. They encompassed a variety of remote environments, including maritime (13), polar (9), mountainous (5), jungle (1), and multiple austere environments (6). Although some environments were better reported than others, many overarching concepts were generalizable. Through channels of communication that included telephone, radio, videoconferencing, and email, telemedicine has been used effectively in a range of environments to initiate treatment, follow up with patients, and determine the appropriateness of evacuation. Telementoring, in which a remote expert guides a local care provider in performing a procedure or task, is a promising aspect of telemedicine that is currently being developed. As technology advances, the scope of telemedicine will continue to expand. However, each new telemedical development must be shown to do more than simply function in a remote environment. Instead, new technologies should be tested for improved patient, practitioner, or expedition outcomes, within a telemedical system.
远程医疗可能为前往偏远地区的探险活动带来巨大价值。对于医疗保健专业人员而言，远程医疗可以提供获取专家建议的途径。在没有医疗保健专业人员的地方，远程医疗可能是专家护理的唯一来源。本系统评价评估并总结了当前关于远程医疗在偏远地区探险患者管理中的文献，并确定了未来研究的领域。对1980年至2018年2月期间的MEDLINE和EMBASE系统检索相关文章。数据按照PRISMA流程处理，并尽可能使用特定类型的批判性评价清单进行分析。共识别出225篇文章，其中33篇纳入本系统评价。它们涵盖了各种偏远环境，包括海上（13篇）、极地（9篇）、山区（5篇）、丛林（1篇）和多个严峻环境（6篇）。尽管有些环境的报道比其他环境更好，但许多总体概念是可推广的。通过包括电话、无线电、视频会议和电子邮件在内的通信渠道，远程医疗已在一系列环境中有效地用于启动治疗、随访患者以及确定撤离的适宜性。远程指导是远程医疗一个很有前景的方面，目前正在发展，即由远程专家指导当地护理人员执行一项操作或任务。随着技术的进步，远程医疗的范围将继续扩大。然而，每一项新的远程医疗发展都必须证明其不仅仅是在偏远环境中发挥作用。相反，新技术应该在远程医疗系统中进行测试，以改善患者、从业者或探险的结果。
