Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Department of Plastic Surgery, Herlev and Gentofte Hospital, Herlev, Denmark.
Wilderness Environ Med. 2022 Jun;33(2):224-231. doi: 10.1016/j.wem.2022.02.012. Epub 2022 Apr 19.
Wilderness medicine and telemedicine seemingly exist at opposite ends of the clinical continuum. However, these 2 specialties share a common history and the literature abounds with examples of successful deployment of telemedicine to resource limited settings. The recent widespread adoption of telemedicine has important ramifications for wilderness providers. Telemedicine is inherently reliant on some sort of technology. There is a wide spectrum of complexity involved, but in general these systems rely on a hardware component, a software component, and a network system to transmit information from place to place. Today, connectivity is nearly ubiquitous through access to cellular networks, Wi-Fi, or communication satellites. However, bandwidth, defined as the amount of data which can be transmitted through a given connection over time, remains a limiting factor for many austere settings. Telemedicine services are typically organized into 4 categories: 1) live/interactive; 2) store and forward; 3) remote patient monitoring; and 4) mHealth. Each of these categories has an applicable wilderness medicine use case which will be reviewed in this paper. Though the regulatory environment remains complex, there is enormous potential for telemedicine to enhance the practice of wilderness medicine. Drones are likely to transform wilderness medicine supply chains by facilitating delivery of food, shelter, and medicines and are able to enhance search and rescue efforts. Remote consultations can be paired with remote patient monitoring technology to deliver highly specialized care to austere environments. Early feasibility studies are promising, but further prospective data will be required to define future best practices for wilderness telemedicine.
荒野医学和远程医疗似乎处于临床连续体的两端。然而，这两个专业有共同的历史，文献中充满了成功将远程医疗应用于资源有限环境的例子。远程医疗的广泛采用对荒野医疗提供者有重要影响。远程医疗本质上依赖于某种技术。它涉及到广泛的复杂性，但通常这些系统依赖于硬件组件、软件组件和网络系统来传输信息。如今，通过访问蜂窝网络、Wi-Fi 或通信卫星，几乎无处不在都可以实现连接。然而，对于许多偏远地区来说，带宽（定义为在给定连接上通过给定连接在给定时间内传输的数据量）仍然是一个限制因素。远程医疗服务通常分为四类：1）实时/互动；2）存储和转发；3）远程患者监测；4）移动医疗。本文将回顾这些类别中每个类别在荒野医学中的应用案例。尽管监管环境仍然复杂，但远程医疗有很大的潜力来增强荒野医学的实践。无人机通过促进食物、住所和药品的交付，有可能改变荒野医学的供应链，并能够加强搜索和救援工作。远程咨询可以与远程患者监测技术相结合，为偏远环境提供高度专业化的护理。早期的可行性研究很有希望，但需要进一步的前瞻性数据来定义未来荒野远程医疗的最佳实践。
