Technical challenges and solutions for high-fidelity patient simulation in support of telemedicine research in remote and extreme environments

Abstract

Telemedicine is emerging as a valuable tool to improve access to health care in pre-hospital and acute care settings. Unfortunately, clinical research and the development of telemedicine technologies are severely limited by the extreme variation in experimental variables alongside legal and ethical concerns. High-fidelity medical simulation, the use of a robotic manikin that mimics a human patient, may overcome some of these challenges by allowing rare or complex medical procedures to be reproduced in a controlled manner. Improvements in simulation technology have increased the portability of these systems and enabled their use in remote and extreme environments. These locations have limited access to medical resources and expertise, and may benefit greatly from telemedicine support. This research describes initial attempts at defining the requirements for running high-fidelity simulation in remote and extreme environments in support of telemedicine research. Three additional variations were evaluated to explore possible applications: 1) remote operation and instruction of the simulation, 2) progressive simulations (movement from one location to another), and 3) telemedical support under time delay. iv Fourteen 30-minute simulations were conducted on Devon Island, Nunavut, Canada, and on Mauna Kea, Hawaii, USA. Two medically naïve participants rendered care to a simulated patient experiencing an acute medical emergency. Participants were connected through a videoconferencing link over satellite to an experienced physician who provided medical support. All but one simulation was completed successfully, however, all encountered unanticipated technical barriers related to the videoconferencing system, network connection, or simulation technology. The results show that running high-fidelity patient simulation in extreme environments is technically feasible. They also highlight the importance of rigorous pre-deployment system testing and an appreciation of the effect of network infrastructure and environmental conditions on equipment. Nevertheless, it is clear that high-fidelity simulation holds the potential to unlock new and exciting findings in acute care telemedicine research.