Neurosurgical Service for Disasters. Prof. Dr. Leonidas Quintana Marín


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Neurosurgical Service for Disasters. Prof. Dr. Leonidas Quintana Marín

  1. 1. First Young Neurosurgeons Forum quarterly online symposium 29 th January , 2011 Muhammad Raji Mahmud, MD, FWACS Chair, Young Neurosurgeons Forum of the World Federation of Neurosurgical Societies (WFNS) Neurosurgical Service for Disasters: Telemedicine/Telesurgery & the Mobile Emergency/Neurosurgical Unit (MEU/MNU) Concept
  2. 2. Neurosurgical Service for Disasters: Telemedicine/Telesurgery & the Mobile Emergency/Neurosurgical Unit (MEU/MNU) Concept <ul><li>Prof. Dr. Leónidas Quintana, WFNS 2 nd Vice President </li></ul><ul><li>Prof. Dr. Russell Andrews, WFNS Education & Training Committee </li></ul><ul><li>Prof. Dr. Yoko Kato, WFNS Education & Training Committee Chair </li></ul>
  3. 3. World Federation of Neurosurgical Societies Mission Statement <ul><li>To facilitate the personal association of neurological surgeons throughout the world. </li></ul><ul><li>To aid in the exchange and dissemination of knowledge and ideas in the field of neurological surgery. </li></ul><ul><li>To encourage research in neurological surgery and allied sciences. </li></ul><ul><li>To address issues of neurosurgical demography. </li></ul><ul><li>To address issues of Public Health. </li></ul><ul><li>To implement, improve and promote the standards of neurosurgical care and training worldwide. </li></ul>
  4. 4. World Federation of Neurosurgical Societies Main Priorities <ul><li>Training of neurosurgeons from developing areas, both with Educational Courses in different countries and with grants to enable them to train at selected neurosurgical centers in different parts of the world. </li></ul><ul><li>Donation of instruments and equipment and the necessary technical advice to implement them in the neurosurgical units in economically challenged regions. </li></ul><ul><li>Priority to public health issues: prevention & treatment of head injuries & spinal trauma, vascular pathology with special attention to the elderly, treatment of degenerative diseases, prevention of developmental & neonatal malformations. </li></ul><ul><li>Research in neurosurgical subspecialties, such as brain tumours, vascular pathologies and degenerative diseases. </li></ul><ul><li>The assessment and introduction of new technologies. </li></ul><ul><li>A forum for young neurosurgeons. </li></ul><ul><li>Maintenance of a Website which addresses neurosurgical interests of physicians, corporations, and the general public. </li></ul>
  5. 5. SOME BACKGROUND OF THIS CONFERENCE….. Personal report against AC WFNS – Nyon, Switzerland, February 27 th , 2010 - Humanitarian Assistance to Undeveloped Countries A serious matter is Haiti , this country isn´t federated to FLANC, this society is affiliated to the Caribbean Society of Neurosurgery,but in this country, the social- economical situation is extremely bad. My proposal is we could form a team, of humanitarian assistance , included our specialty of course,and the sequence to act , could be: 1- First to contact some representative of this country ( administrative,Health Ministry, or Government), to offer and give our assistance as a team. 2-In the near future, when we could have more information of the real health situation related with our specialty, 3- Contact the authorities, and we could propose to travel with instruments promoted by the WFNS,and give our assistance. 4-If it´s needed, the team could stay some time, eg: 1 or 2 months, operate some urgent cases, and give, as a donation, the instruments to some public hospital,and designate some colleague(s) that be our representative, and be responsible of the instruments. Consider the Mobile Neurosurgical Unit (MNU). 5-Later, we could monitor the neurosurgical actions and activities at this country.
  6. 6. Chile EQ 8.8 Richter The same day of my report, this was happening in my country……
  7. 7. Source: What´s happening in some parts of our planet ???
  8. 8. 2010 -Two big earthquakes happened in America Haiti - A country with a very weak social economical situation, and health system not well organized. EQ Magnitude 7.0 - HAITI REGION 2010 January 12 21:53:10 UTC - 04:53:10 PM at epicenter According to official estimates, 222,570 people killed, 300,000 injured, 1.3 million displaced, 97,294 houses destroyed and 188,383 damaged in the Port-au-Prince area and in much of southern Haiti. This includes at least 4 people killed by a local tsunami in the Petit Paradis area near Leogane .
  9. 9. 2010 -Two big earthquakes in America happened Chile - A country with a middle high social economical situation(WDB), and health system well organized. EQ Magnitude 8.8 - OFFSHORE MAULE, CHILE 2010 February 27 06:34:14 UTC - 03:34:14 AM at epicenter. At least 521 people killed, 56 missing, about 12,000 injured, 800,000 displaced and at least 370,000 houses, 4,013 schools, 79 hospitals and 4,200 boats damaged or destroyed by the earthquake and tsunami in the Valparaiso-Concepcion-Temuco area. At least 1.8 million people affected in Araucania, Bio-Bio, Maule, O'Higgins, Region Metropolitana and Valparaiso. The total economic loss in Chile was estimated at 30 billion US dollars. Electricity, telecommunications and water supplies were disrupted and the airports at Concepcion and Santiago had minor damage. The tsunami damaged or destroyed many buildings and roads at Concepcion, Constitucion, Dichato and Pichilemu
  10. 10. TELEMEDICINE TELECOMMUNICATIONS ARE VERY IMPORTANT In emergency situations!!!! and for M.D. this means….
  11. 11. The World Health Organization defined Telemedicine (TM) as the use in the clinic of the medical knowledge, through communication networks when the distance is a determining factor. This definition makes clear the need for the use of advanced technological support for the practice of medicine has no distance limitations for the patient . The technology infrastructure allows to perform the exchange of information between various participants involved in an act of TM and its main objective is to provide multimedia network services (transfer of audio, video, images, data and text) that enable healthcare
  12. 12. Telemedicine can be broken into three main categories: 1- Store-and-forward 2-Remote monitoring 3-Interactive services
  13. 13. Store-and-forward Telemedicine It involves acquiring medical data (like medical images, biosignals etc) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline. It does not require the presence of both parties at the same time. Dermatology (cf: teledermatology),radiology, and pathology are common specialties that are conducive to asynchronous telemedicine. A properly structured Medical Record preferably in electronic form should be a component of this transfer.
  14. 14. Remote Monitoring Also known as self-monitoring or testing, enables medical professionals to monitor a patient remotely using various technological devices. This method is primarily used for managing chronic diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma. These services can provide comparable health outcomes to traditional in-person patient encounters, supply greater satisfaction to patients, and may be cost-effective.
  15. 15. Interactive Telemedicine Services Provide real-time interactions between patient and provider, to include phone conversations, online communication and home visits. Many activities such as history review,physical examination, psychiatric evaluations and ophthalmology assessments can be conducted comparably to those done in traditional face-to-face visits. In addition, “clinician-interactive” telemedicine services may be less costly than in-person clinical visits.
  16. 16. Emergencies in Disasters What is the real situation in Disasters? Isolation Communications fail Prompt action in the devastated places difficult Health cares difficult to perform Traumatic cases increase Also , another pathologies
  17. 17. How we could improve the healthcares during a DISASTER ??? Mainly treating some urgent problems as: 1- Quick communication with the area or region of the Disaster ( Diagnosis of the situation).(Satellital, IP telephony) (Physically by helicopters) 2- Quick access with medical cares, essencialy, for urgent Cases( Trauma). Mobile Emergency Unit (MEU) 3- Treat and compensation of clinical cases in the area affected.(*) 4- Maintain the communication with the general medical doctor ( surgeon), to give more informations and indications from the base hospital.(Telepresence) 5- Triage of the affected cases to the base hospital. (*) SAP <90mmHg HBO 2 sat <90% PaO 2 < 60 mm Hg
  18. 22. My visit to…………………..
  19. 27. Cisco HealthPresence Sites
  20. 28. MEU
  21. 29. Mobile Emergency Unit Mobile Surgical Unit Mobile Neurosurgical Unit
  22. 30. Sensors devices X Ray-CT Scan Operating room Laboratory Robotic op. –Robotized Camera assistance Telepresence
  23. 31. The countries of the world under developing social-economical status must continue to seek ways to meet the basic needs of their populations, through nutrition and sanitation programs, poverty reduction, universal quality education, and economic modernization. At the same time, they must do their part to address global challenges. In such a context, leveraging the opportunities presented by technological change in a globalized economy becomes a necessity for any emerging economy. An important message ……
  24. 32. Neurosurgical Service for Disasters: Telemedicine/Telesurgery & the Mobile Emergency/Neurosurgical Unit (MEU/MNU) Concept (Second Part)
  25. 33. Strategies for developing the Action of the MEU/MNU
  26. 34. Mobile Emergency Unit (MEU) <ul><li>Mobilization to disaster site w/in 24 hours </li></ul><ul><li>Transport by a few transport helicopters </li></ul><ul><ul><li>Chinook Helicopter payload ~ 12,000 kg </li></ul></ul><ul><li>Located w/in ~ 1,000 km of disaster site </li></ul><ul><ul><li>Chinook Helicopter range ~ 1,100 km </li></ul></ul><ul><li>Continuously operating MEU will be ready for deployment at any time </li></ul><ul><li>Ideally 4 sites: Latin America, Africa, Central Asia, Southeast Asia </li></ul>
  27. 35. Mobile Emergency/Neurosurgical Unit (MEU/MNU) <ul><li>Portable basic neurosurgical operating room </li></ul><ul><li>Portable CT, microscope, OR table, lighting </li></ul><ul><li>Generators, water supply, sterilization </li></ul><ul><li>Staff (neurosurgeons/trauma surgeons/ortho-pedic surgeons, anesthesiologists, nursing, maintenance/support) </li></ul>
  28. 36. WFNS MEU/MNU Site Selection <ul><li>Competitive application - similar to site selection for educational courses & meetings </li></ul><ul><li>In conjunction with local neurosurgical unit </li></ul><ul><li>Located where the ongoing service need is great (underserved region) </li></ul><ul><li>Located where tertiary backup available (e.g. by air transport) </li></ul><ul><li>Two years in a given location/country </li></ul>
  29. 37. WFNS MEU/MNU Site Staffing <ul><li>Combination of host country and ‘developed country’ senior neurosurgeons </li></ul><ul><li>Combination of host country and ‘developed country’ in-training neurosurgeons </li></ul><ul><li>Combination of host country and ‘developed country’ support staff (e.g. nursing) </li></ul><ul><li>One month to one year term for all staff </li></ul><ul><li>Maintenance and accommodation provided by host country </li></ul>
  30. 38. WFNS MEU/MNU Site Educational Benefits <ul><li>Curriculum to be developed and certified by WFNS – standardized training </li></ul><ul><li>Residency training credit for both host country and ‘developed country’ residents </li></ul><ul><li>Benefit to host country residents: training w/ resident & faculty from ‘developed country’ </li></ul><ul><li>Benefit to visiting residents: intense clinical experience; appreciation of neurosurgery in ‘under-developed country’ </li></ul>
  31. 39. WFNS MEU/MNU Additional Site Benefits <ul><li>A relatively ‘apolitical’ means by which the WFNS can foster universal neurosurgical standards for training and certification </li></ul><ul><li>The honor of selection as an MEU/MNU site should boost the host country neurosurgical community’s stature with its government, etc </li></ul><ul><li>Junior host country neurosurgeons will gain appreciation & respect for the WFNS mission </li></ul><ul><li>Neurosurgical research platform </li></ul>
  32. 40. WFNS MEU/MNU Additional Organizations <ul><li>Medical/Surgical Societies: </li></ul><ul><ul><li>Trauma Surgeons, Orthopedic Surgeons </li></ul></ul><ul><ul><li>Anesthesiologists </li></ul></ul><ul><ul><li>Surgical Nurses </li></ul></ul><ul><ul><li>Rehabilitation </li></ul></ul><ul><li>International Education Societies: </li></ul><ul><ul><li>FIENS – Found. Intl. Education in Neurol. Surg. </li></ul></ul><ul><li>Medical Disaster Organizations: </li></ul><ul><ul><li>Doctors without Borders </li></ul></ul><ul><ul><li>Civilian & Military Emergency Response </li></ul></ul><ul><li>Junior host country neurosurgeons will gain appreciation & respect for the WFNS mission </li></ul>
  34. 42. USNS Comfort (off of Port-au-Prince 1994); Ship Operating Room; Mobile CT Scanner
  35. 44. Haiti, 1/2010 – US Military Medical Transport Helicopter & Truck
  36. 45. WFNS MEU/MNU The US Military Combat Support Hospital <ul><li>A Combat Support Hospital (CSH ) is a mobile hospital delivered in standard military-owned Demountable Containers (MILVAN) cargo containers and assembled by the staff into a tent hospital to treat wounded soldiers. The hospital is typically between 16 and 256 operational hospital beds. </li></ul><ul><li>The great operational advantage of the DEPMEDS facility is the use of single or double expanding milvans to create hard sided, air conditioned, sterile operating rooms and intensive care facilities, which can produce surgical outcomes similar to that seen in fixed facility hospitals, and do so in an austere environment. Wikipedia </li></ul>
  37. 46. World Federation of Neurosurgical Societies Neurosurgical Service for Disasters MNU Concept Benefits <ul><li>Extended day-to-day association between neurosurgeons from developed and developing countries - camaraderie </li></ul><ul><li>Improvement and standardization of neurosurgical education and training worldwide </li></ul><ul><li>Research platform for neurotrauma as well as clinical interventions utilizing basic neurosurgical techniques </li></ul><ul><li>Improve surgical care for disasters in particular and neurotrauma in general (major Public Health issues) </li></ul><ul><li>Improve neurosurgical demography worldwide </li></ul>