FOR IMMEDIATE RELEASE April 21, 1999
CONTACT: Barbara Peck (847) 692-9500 [email protected]
Brain Surgery on the High Seas
For highly trained pilots and other seamen executing missions in Kosovo, physical condition and peak performance are essential. But, if illness or injuries arise, medical care, especially specialty medical attention, isn't always accessible. Evaluation and treatment by a medical specialist can mean the difference between a pilot flying missions or being grounded on board a ship, a skilled crewman performing his duties or being cooped up in an onboard clinic, or the child of serviceman located on a remote base getting the healthcare he or she needs.
In the United States Navy, all bases and most ships are serviced by at least one onsite physician. Larger, more sophisticated ships often have several physicians, including a general surgeon on board, and are outfitted with a medical ward that might include a basic operating room, intensive care unit and imaging and laboratory equipment. There also are two hospital ships, the USNS Mercy and USNS Comfort, that are designed to provide emergency, on-site care for U.S. combat forces and contain over 1,000 hospital beds each.
However, the entire U.S. Navy is only serviced by approximately 12 neurosurgeons, the majority of whom are based at the largest military hospitals in the United States. So, how do trained specialists treated patients who are scattered around the world? They use satellites and the Internet.
"The Navy has developed a sophisticated telemedicine program utilizing direct satellite links and the Internet that allows specialists to evaluate patients in real-time anywhere in the world," said Ross R. Moquin, MD, a navy neurosurgeon. "If a patient is brought to one of the larger combatant ships, such as a carrier, using telemedicine, I can personally interview the patient, evaluate his or her symptoms, perform an examination, review x-rays and CT scans, and suggest a treatment plan all from Bethesda Naval Hospital outside of Washington D.C."
Dr. Moquin will describe this technology April 27, 1999 at the 67th Annual Meeting of The American Association of Neurological Surgeons (AANS), which will be held April 24 - 29 in New Orleans, Louisiana.
It is anticipated that as this technology becomes more readily available, smaller, remote hospitals, or first-responders like paramedics throughout the United States, will be able to access this technology to send images and perform evaluations in large trauma centers.
In the past, there was no way for a neurosurgeon to evaluate a patient on a ship or on the battlefield in a remote location. The patient would either have to be shipped to a stateside base for evaluation, or wait until the ship came home. Not only does telemedicine allow physicians to send images, but because of the "real-time" technology, using video telconferencing, the neurosurgeon can "examine" the patient with only a two- to three-second delay.
"We had an F-14 aviator flying combat missions over Kosovo who was having trouble controlling his plane when pulling a certain amount of G's," Dr. Moquin said. "The onboard doctors performed an MRI of his neck and sent the image to me over the Internet. I examined the pilot in real-time transmission from over 4,000 miles away. Between the exam and the images, I could accurately diagnose a herniated disk in his cervical spine that was causing weakness in his arm and recommended surgery. He was shipped to Bethesda, had surgery and is expected to go back into action in about two weeks. Normally, he would have just been grounded indefinitely and kept on board, or sent home without knowing if or when he might return."
Once the aviator returns to action, telemedicine will be used for follow-up care. Dr. Moquin estimates that he evaluates approximately one to two patients a week via telemedicine and that about half need neurosurgical care while the other half can be treated onsite by the staff physician. Of those he later treats first-hand, he said that his initial telemedicine diagnose has never been wrong.
"This technology can also be used in the field because forward deployed physicians and corpsmen can be equipped with digital cameras," Dr. Moquin said. "They can take an image, send it via satellite uplink over the Internet to me, then we can determine who is in need of urgent neurosurgical care. This method isn't in real-time, but we can still get and process the information in a matter of minutes."
Telemedicine is not only used to treat serviceman during a conflict, but also to treat those located on remote bases around the world. Neurosurgical evaluation, treatment and follow-up for brain tumors, hydrocephalus, spinal disorders, head injuries and more can be given to serviceman and their families via telemedicine.
"Not only do we treat servicemembers and their families, but sometimes the general public," Dr. Moquin said. "The Navy hospital ship USNS Comfort was in the Baltic Sea last summer when the mother of a Lithuanian child with a congenital brain deformity saw the ship. Because prior local surgical attempts had failed, the family went to the U.S. Embassy and asked if the doctors on board could see the child. The child and his mother were brought to the ship, where further diagnostic studies were performed using the ship's CT Scanner. Satellite telemedicine capabilities were used to obtain even more sophisticated image processing at Naval Hospital Bethesda. That same night on the ship, surgery was successfully performed to repair the child's skull and brain defect. Today the boy is doing very well and is now leading a normal life. We continue to communicate every few weeks via e-mail.
"The telemedicine system can also work in reverse when the neurosurgeon is deployed to remote locations and needs to follow routine patients he is treating back at home," Dr. Moquin said.
"Telemedicine not only improves patient care by bringing higher level specialty care to service members in distant areas, but also gives the local commanders valuable feedback on the diagnosis and treatment status for patients transferred out of areas of military operations. In times of shrinking defense dollars, Telemedicine is extremely effective in maintaining the medical readiness of our deployed forces."
Founded in 1931 as the Harvey Cushing Society, The American Association of Neurological Surgeons is a scientific and education association with approximately 5,300 members in the United States, Canada and Mexico. It is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members must be certified by the American Board of Neurological Surgeons. Neurosurgery is the medical specialty dealing with the diagnosis and treatment of disorders affecting the nervous system, brain, spinal cord and spinal column.
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For more information on the AANS, visit our Web site at www.neurosurgery.org.
Media Representatives: If you would like to attend the conference or interview a neurosurgeon - either on-site or via telephone - please contact the AANS Communications Department at (847) 692-9500 or call the Press Room at the meeting beginning Sunday afternoon, April 25, 1999 at (504) 670-6434.
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