Feds mount telemed expedition on Everest

When veteran mountain climber Rob Hall and seven others realized they were about to perish in a fierce snowstorm on the south summit of Mount Everest in 1996, their last hope was a satellite phone that Hall had carried with him during their ascent. Although it allowed Hall to say his last goodbye to his wife, the phone was not enough to save his life.

With the fate of Hall and the others acting as a poignant backdrop, as portrayed in books and movies, several federal agencies last month threw their support behind a team of doctors from Yale University who proved it was possible to extend telemedicine technologies to the world's most remote and harshest environment.

"We validated a number of the advanced technologies in the most remote and extreme environment," said Richard Satava, director of the Yale University-NASA Commercial Space Center for Medical Informatics and Technology Applications. "We've proved that we can do telemedicine" anywhere, he said.

Dubbed the Everest Extreme Expedition (E3), the project focuses on speeding the deployment of technologies that are being developed under the Defense Advanced Research Project Agency's (DARPA) Combat Casualty program, which Satava manages. Combat Casualty includes telemedicine-related projects in the areas of sensors, imaging systems, medical simulation and telepresence surgery.

In addition, NASA has teamed with Yale to establish the Yale-NASA Commercial Space Center to facilitate the transition of DARPA telemedicine technologies into their space flight programs and eventually to commercial use. "We're looking at point-of-service care," delivering treatment to where patients are located, Satava said.

Over the next three to five years, Satava sees such things as "Smart T-shirts" coming into use, where sensors are embedded into the fabric for real-time monitoring of vital signs. The goal, he said, is to make biosensors and imaging technology accessible to the general public.

NASA and the Army's Medical Research and Materiel Command were major contributors to the expedition's funding. Part humanitarian effort and part field exercise, the expedition to Mount Everest allowed doctors to conduct experiments on how the human body reacts to high altitudes, such as those on Mount Everest, and also to treat local climbers.

The team established a deployable telemedicine clinic at a Mount Everest base camp located 17,500 feet above the city of Kathmandu, Nepal. From there, the team was able to conduct research, test new technologies and treat climbers for minor injuries.

The expedition team was virtually linked to medical support teams located at Walter Reed Army Medical Center in Washington, D.C., and Yale's School of Medicine in New Haven, Conn., with the help of notebook computers, satellite phones and video teleconferencing tools.

The team— which included Jim Bruton, the team's information technology guru; Dr. Chris Macedonia, an Army physician from Georgetown University and Dr. Vincent Grasso of Yale University— was outfitted with four FW7666P ruggedized notebook computers from FieldWorks Inc.

Each of the four notebooks was used for different tasks during the expedition. For example, Bruton dedicated one notebook to communications with support teams in the United States and another notebook for day-to-day things such as word processing and still-image manipulation. He also acted as the communications hub for the team, receiving data from them and instantly pushing it out to physicians in the United States. The satellite phone attached to his FieldWorks notebook provided him with 128 kilobits/sec bandwidth for videoconferencing.

Macedonia, an expert in ultrasound imaging technology, connected his FieldWorks notebook to body sensors that monitored vital signs of climbers and provided a 3-D peek into the workings of internal organs. The data was regularly transmitted back to the base camp and then instantly sent back to Walter Reed Hospital and Yale for further study. The transmission of vital signs and video in this medium allowed doctors in the United States to make virtual "rounds" and keep track of patients at the Mount Everest base camp.

The FieldWorks FW7666P is part of the Medical UltraSound, Three-dimensional and Portable with Advanced Communications system being used at Walter Reed Hospital. The remote FieldWorks notebook is supported by a diagnostic workstation located at the medical facility. Use of the system is being evaluated by the National Naval Medical Center in Bethesda, Md., for possible shipboard use later this year.

Grasso, who led the medical portion of the expedition, used his FieldWorks FW7666P to conduct lung-capacity studies, monitor heart rates and conduct cardiology studies. The focus was to study the effects of extreme exertion, cold temperatures and lack of oxygen on climbers.

DARPA's Combat Casualty program is in its fifth and final year. It is based on what Satava called "the original DARPA premise of dual-use." The program has had 12 of its 38 technologies rapidly transitioned out to commercial use in the past five years, a process that Satava said normally takes 25 to 30 years.

The successes of E3 have proved the viability of the technology, and the ripple effect will be felt by many, Bruton said.

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