test for long-distance monitors
The same technology used to monitor the vital signs of climbers ascending Mt. Everest also could be utilized by physicians to keep watch over patients when the patients are home, according to a study by a Yale researcher and collaborators.
"The mountain served as an extreme testing ground for telemedicine," says Dr. Richard Satava, professor of surgery and gastroenterology at the School of Medicine and an investigator in the National Aeronautics and Space Administration (NASA) project on Mt. Everest. "The lessons learned further clarify the ability to provide better health care in remote and extreme environments, which for some may even be their home environment during or after a medical illness."
The Yale-NASA Commercial Space Center, known as the Medical Informatics and Technology Applications Consortium, organized Mt. Everest Extreme Expeditions in 1998 and 1999 during the spring Himalayan climbing seasons. Members of the team included Satava, other physicians based at Yale at the time, as well as other researchers.
The primary mission, according to two articles published in the current issue of the Telemedicine Journal and e-Health, was to deliver advanced medical support with global telemedicine capabilities to one of the world's most remote and hostile settings. The team provided medical care for the Everest Base Camp community, conducted validation experiments for several types of advanced medical technologies, and performed real-time monitoring of selected climbers while assessing the basic science of altitude physiology.
A group of 15 physicians, climbers and scientists traveled to Katmandu, Nepal, and were then shuttled by aircraft to the village of Lukla. From there the team undertook a 10-day trek to the Base Camp of Mt. Everest. The team then lived and worked at Everest Base Camp,
17,500 feet above sea level, for about three weeks.
While the team was there, telemedicine connections brought high-resolution images, real-time interactive video, and audio communication to the Yale campus in New Haven. Advanced medical care via telemedicine was achieved on a daily basis while the Base Camp team presented "morning rounds" to the medical support team at Yale during scheduled 60- to 90-minute videoconferences.
The medical problems were usually typical of a high-altitude environment -- headaches, abdominal pain, gastroenteritis, blurred vision and uncomplicated pneumonias. There were more serious cases in the 1999 expedition, including cases of respiratory failure in climbers who had reached higher elevations but had to turn back because of compromised pulmonary function. Emergency videoconferences were conducted with physicians at Yale to co-manage the patients. Only three times in two years was there difficulty establishing the telemedicine connection.
Another purpose of the expedition was to test a vital signs monitor (VSM), which is a lightweight wearable system that consists of three components: sensors, a global positioning system (GPS) and a telecommunications system. The VSM monitors heart rate, temperature, respiratory rate, electrocardiogram (EKG), motion detection (accelerometers) and pulse oximetry. The VSM was typically strapped across the chest or wrist or swallowed in pill form. The telecommunications system was usually a radio-frequency transmission system repackaged into a miniaturized wearable configuration.
"This is the first time that there has actually been documentation of long distance monitoring of vital signs in real time," Satava says. "One of the more exciting developments from these efforts is that data transfer from remote locations is plausible."
The system is commercially viable, he adds, because of its low bandwidth requirement and the use of commercial off-the-shelf products. The communication conduit is already in place in the form of ISDN lines and the Internet. The software needed is readily available and affordable -- in fact, the most expensive element is the hardware, says Satava. Each VSM unit costs about $15,000, but the cost could be reduced significantly by eliminating the GPS, making the monitoring system an option for home-based care, he notes.
"If these devices could work on the mountain, their applications are limitless in the homes of patients suffering from chronic conditions such as diabetes, heart disease and emphysema," Satava says.
-- By Jacqueline Weaver
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