Telecommunications Testbed in Shock Trauma Center

The Shock Trauma Center is the Adult Trauma Resource Center for the State of Maryland. Over 5,000 patient admissions are treated per year with over 40% arriving directly from the scene of trauma by helicopter. The Trauma Resuscitation Unit (TRU) has 10 identical resuscitation bays and 6 OR’s, all connected by audio-video-data links to the telecontrol room. These sixteen locations have ceiling mounted microphones for audio capture and six of the most commonly used resuscitation bays have a dual camera system including one fixed camera and one pan-tilt-zoom camera. Each area has the entire wiring infrastructure in place to fully connect up four audio and four video links in every location as well as two 100 megabit switched Ethernet and fiber optic connections. All locations have an AV switchbox located in them. They are the interface for the audio-video connections. Audio-video devices connect to a system wide time code generator, which can then be imprinted on recorded material.

The telecontrol room is the hub for the audio-video information that comes from the TRU bays and OR’s. The room contains a rack which connects to all the AV switchboxes throughout the TRU and OR’s. Audio-video information can then be viewed on three 27” monitors in the room or bank of 3” preview monitors, delivered to other areas on campus, or transmitted off site. Locally, the room is equipped with fiber optic cabling and 100 megabit switched Ethernet connections, which can allow communication via computer conferencing software. For remote viewing, three ISDN lines provide connectivity to the outside world. Images can be recorded here as well on two VCRs that are attached to the system wide time code generator.

An infrared communications system has been set up and is being used by resuscitation team members. The Infra Red (IR) Voice Loop Communications system (Temco Communications, Inc., Barrington, IL) includes nine operator headpieces with IR transmission capability. These are bone-conducting receiving and standard transmitting microphones built into the headset. The bone conducting receiver microphones are placed in front of the ear so they do not interfere with hearing other team communications or clinical tasks such as insertion of a stethoscope into the ears. Forty IR transceiver control units are installed in the ceiling of the TRU and Operating Rooms to allow IR voice receipt and transmission as the user moves around the 2nd floor of the Shock Trauma Center. The voice loop has nine channels available for the individually worn units as well as four channels for fixed location devices, similar to telephones, one channel for an operator control box and two channels for intercom and broadcast.

The equipment has been used in a variety of circumstances and studies. One study was based on telementoring personnel through intubation procedures to determine the feasibility and efficacy of remote instruction. The subject would be in the Operating Room with the patient and the doctor would be in the telecontrol room viewing patient’s vital signs and viewing the scene through a fixed camera and a head mounted camera on the subject. The system has also been used for team review of certain cases to look at potential areas of improvement. We have transmitted images from the OR’s to classrooms elsewhere on campus during a lecture to give students a view of actual equipment and instruction on how they are used. A link to a hospital in Western Maryland was established from the telecontrol room to allow a doctor from their facility to consult with one of our doctors on a patient to determine whether or not they should transfer the patient to our center.