Emergency medicine without borders

November 7, 2019 Aldous Vijh

I recently read an article in Emergency Physicians Monthly where yet another patient could have been saved with an accurate diagnosis. But in low- and middle-income African countries like Kenya, where there is a lack of training in emergency medicine, medical errors are par for the course. In many such countries where resources are stretched, every physician must be trained to handle a greater of emergency situations.

But what struck me was how, in the not-too-distant future, technology will help patients and their providers break down barriers to access timely medical expertise―no matter where they live. In fact, we’re already working on it.

Below are some recent initiatives we’ve been working on to improve access to technology and training in emergency medicine in very different parts of the world.

Rwanda

Improving access to ultrasound expertise

There was a great piece posted recently on Devex (the global development media platform) about how the Rwandan government has invested in rebuilding its healthcare system and improving access to life-saving technology. Among other initiatives, they describe how the University Teaching Hospital of Kigali (CHUK) began using crucial diagnostic technology such as the Philips Lumify point-of-care ultrasound system with integrated Reacts collaborative application (check out the video).

Once a technology becomes more accessible, the principal constraint is no longer the purchase of equipment― it’s training for medical staff to operate it. “Not too many people have been trained on point-of-care ultrasound, therefore we have limited human resources to train other residents,” says Dr. Vincent Ndebwanimana, a final year resident at CHUK.

PURE-led training with Lumify and Reacts

PURE (Point-of-Care Ultrasound in Resource-limited Environments)―a non-profit organization dedicated to enhancing ultrasound use and education in low- and middle-income countries―brought in overseas experts to train the first cohort of emergency medicine residents and students from the University of Rwanda Medical School in point-of-care ultrasound.

Following in-person training, PURE paired residents with remote mentors―emergency medicine physicians in the United States. The goal was to ensure local physicians can use ultrasound effectively and sustainably transfer these skills to other healthcare practitioners.

Using a tablet equipped with the Lumify with Reacts tele-ultrasound system, the mentors and mentees were able to communicate, consult each other and share live ultrasound images remotely via the cloud in real-time. Doctors performing an ultrasound who need assistance with diagnoses can reach a colleague via the Reacts platform―even from the bedside.

Final year resident Dr. Vincent Ndebwanimana and Philadelphia-based mentor Dr. Trish Henwood, who co-founded PURE, demonstrate how the Lumify with Reacts platform works. (Photo via: Devex)

Results

Since the Lumify with Reacts systems were first introduced to the hospital, the local care team has achieved notable improvements: diagnosing patients more efficiently, speeding up the time it takes to administer treatment, and in some cases, even changed the course of treatment. Due to the program’s success, the Rwandan Ministries of Health and of Education plan to integrate ultrasound training into their academic system. With their support, PURE is also planning to roll out point-of-care ultrasound in departments beyond emergency medicine―in areas like surgery, internal medicine and pediatrics.

Peru

A model for longitudinal ultrasound education across borders

In Peru, health officials recently required that all emergency departments across the country be provided with access to ultrasound technology. What they hadn’t foresee was the need for training to support the initiative. This created a lag in developing the proper expertise to use point-of-care ultrasound, and consequently adoption by healthcare professionals was slower than intended.

Dr. Andrea Dreyfuss, an emergency medicine resident at the Highland Hospital in Oakland, CA at the time, saw this gap as an opportunity. She set up an Emergency Ultrasound Fellowship program with a clinical rotation exchange to fill it, and paired fellows at the Hospital Dos de Mayo in Lima with key physicians at the Highland Hospital Emergency Department to support them. With access to expertise and the Philips’ Lumify with Reacts tele-ultrasound system, they began to see an impact.

Diagnostic impact

Along with adoption, diagnostic accuracy and treatment outcomes improved. In one case, expertise from a real-time remote consultation helped a Peruvian clinician determine that their patient was suffering from cardiogenic shock, not sepsis from pneumonia as they originally thought. As a result, the clinician changed the course of treatment immediately.

In another case, a resident noticed a patient in the waiting room with a gunshot wound who looked seriously ill. Using the ultrasound system and with the guidance of a remote consult, she was able to determine that the patient had a hemothorax which was missed in the x-ray. Using ultrasound guidance, they placed a needle in the patient’s chest and found blood, and subsequently placed a chest tube to treat them.

Future promise

Clearly, the adoption of technology and the democratization of care need no longer be held back for lack of expertise. With the will and backing of health care institutions, more physicians will obtain the support and training they need. Soon, a time when medical expertise was out of reach will become a thing of the past.

I encourage you to visit our news page to get inspired by all the ways in which physicians around the world are already employing Reacts to facilitate training and care practice―such as our work with Doctors Without Borders, how a medical charity in the Dominican Republic uses tele-ultrasound to enhance patient care and how a remote team of sonographers lead a point-of-care ultrasound training program for physicians in Haiti.

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Sources

About the author

Aldous Vijh

Aldous Vijh is the Product Marketing Manager at Innovative Imaging Technologies (IIT), the Montreal-based software firm behind the Reacts collaborative platform. He has dedicated the last 20 years to helping with the development and adoption of innovative health care, web and professional services applications with organizations ranging from small agencies to Fortune 500 companies and advocacy groups such as the Canadian Medical Association.

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