182 COMMUNITY HEALTH
Telemedicine is the transmission of laboratory infor-
mation, radiologic interpretations, and clinical information,
including actual examination of patients, by audio-visual
communication via fiber optic telephone line or satellite
transmission between isolated areas and medical specialists
in urban teaching hospitals. Begun in Scotland in the 1960s to
provide medical consultations to explorer units in Antarctica,
telemedicine is now established as a medical subspecialty
with its own journals.^19 Telecare refers to the delivery of
health care by means of telecommunications technology, and
is relevant to community care.
An early example of telemedicine in the United States was
a cable linkage that provided one-way transmission of black-
and-white video and two-way audio between a medical facility
at Logan Field, the major airport of Boston, MA, and physi-
cians several miles away at the Massachusetts General Hospital.
Patients could be interviewed and even their urines and simple
blood stains examined microscopically through this electronic
hook up. More complex equipment and communication alter-
natives helped to increase use of telemedicine in the U.S., and
$85 million in federal funds was made available in 1995 for
this field. Several states established telemedicine networks to
link hospitals and clinics with correctional facilities for more
readily available medical consultations, and to join universities
for mutual support of medical student education.
Quick and accurate transfer of information between pri-
mary care physicians, the “gatekeepers” in health care nets,
with tertiary care centers hundreds of miles away has resulted
in telemedicine expansion especially in states with large rural
populations or great distances between medical centers.^20
Telemedicine also enables the Cancer Treatment Center at
the University of Kansas to follow-up patients undergoing
medicinal treatment but who have returned home. When U.S.
troops were deployed to Bosnia in 1996, telemedicine inter-
change between medical commands in field hospitals and
their home bases in Landstuhl, Germany, and various military
medical facilities in the U.S. was arranged through facilities
at Fort Detrick, Maryland.
J.H. Sanders has described telemedicine services estab-
lished in 1991 at the Medical College of Georgia to provide
continuing medical education and consultations for rural
practitioners, using a system described as “totally distance-
insensitive.” A digital communication link integrates modalities
from twisted pair 56 k copper wire to cable, fiber, microwave,
or to satellite in series or in parallel, Sanders notes. 21,22
The efficacy of telemedicine in supervising continued
care and patient education has been proven. Efforts are now
underway to extend its value to medicine and personal health,
including improved sensors that substitute for palpation of a
tumor mass or body parts, electronic stethoscopes, cardiac
ultrasound, and radiographs. Distant physicians can visualize
the ocular retina and the tympanic membrane of the ear by
scopes that have been adapted for telemedicine use.
Ethical and legal concerns also have arisen, given that
telemedicine transmits patient data over publicly acces-
sible lines to physicians in another state or country. Privacy
and confidentiality are not yet fully protected, even though
several varieties of patient consent forms have been used.Current requirements that physicians be licensed by the state
or nation in which they practice must be modified to permit
effective telemedicine examinations of patients in another
state, as well as consultations between physicians similarly
located in different jurisdiction, must be resolved.DISASTER CAREAll health units are important when disasters such as floods,
tornadoes, hurricanes, earthquakes, train derailments, major
air crashes, or major acts of terrorism strike a community.
Disasters of any size are accompanied by varying degrees
of incoordination in rescue operations, and complicated by
stress and fatigue of both trained and volunteer personnel
who have responded to the emergency. Roads that are usu-
ally available for patient transport may be obstructed by
fallen buildings, large trees, and other debris. Water supply,
sewerage, communication, and power lines may have been
damaged so that hospitals that respond to unusual casualty
loads find that equipment may be inoperable, lighting inade-
quate, telephones out of order, and water supplies for cleans-
ing or sterilization impaired.
Although many calamities are relatively small and local-
ized, each community must prepare plans for rapid responses
and quick resolutions. Relatively simple planning brings
together the several agencies that will respond to disasters
to discuss staffing and organization for recovery, define
available resources, list locations of supplies and equip-
ment, determine the availability of outside help in rescue
work, clarify usable radio frequencies, and work out the
multitude of other elements of a disaster plan. Ideally, rep-
resentatives of community physicians, hospital information
officers, and many other health care workers, even morgue
attendants, should be brought into disaster drills to share
information with fire and police units. As a plan develops,
each department or agency should become familiar with the
others’ capabilities because in the throes of an emergency
it may not be possible to refer to a written plan, page by
page. “Planning is everything, the plan is nothing,” General
Dwight Eisenhower is reported to have said. In regional
disaster planning, Eisenhower’s dictum applies.
First responder agencies strive to develop a radio commu-
nication network with compatible radio frequencies that will
link rescue units whose usual work does not require regular
exchange of on-the-scene communications. Rescuers must
learn to know where community supply depots and equip-
ment pools are located, who owns or manages the mate-
riel, plus knowledge of what is available in civilian depots.
Responsibilities for establishing refugee centers with food
and shelter, and locations of emergency medical sites should
be defined. Repeated drills prepare a community’s disaster
workers for their duties in response to a disaster, and are the
key to rescue and rapid resolution of disorder.
Training of health and allied workers begins with stan-
dard courses prepared for firefighters and police officers
who, along with public works personnel, are often known as
“first responders.” Training is available from state agenciesC003_002_r03.indd 182C003_002_r03.indd 182 11/18/2005 10:17:42 AM11/18/2005 10:17:42 AM