Page 137 - JSOM Fall 2025

Study Collaborators ; Steven G. Schauer, LTC, DO, MS ; Nee- Introduction
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Kofi Mould-Millman, MD, PhD, MSCS 1
Our primary aim was to test the feasibility of using a novel
1 University of Colorado School of Medicine, Aurora, CO field telemedicine platform, provided by OPTAC-X, using a
2 Stellenbosch University, Cape Town, South Africa head-mounted high-resolution camera linked to a satellite
3 Western Cape Government Health and Wellness, Cape Town, communications terminal in a civilian emergency medical ser-
South Africa vices (EMS) system.
Introduction Methods

Traumatic pneumothorax and hemothorax (PHTX) is a com- In this prospective, observational, feasibility pilot trial, Mayo
mon wartime injury that often requires transfer out of theater Clinic paramedics contacted on-call medical control for tele-
to a Role 4 facility for further care. Emergency departments medicine guidance at their discretion when evaluating pa-
(EDs) in South Africa use an innovative protocol to rapidly re- tients from 911 requests. A Mayo Clinic Ambulance Service
habilitate simple PHTX patients. Patients receive chest tubes (MCAS) ambulance was outfitted with a Kymeta U8 Hawk
connected to dry-seal intercostal drains (ICDs) with the ability satellite communications (SATCOM) terminal connected via
to perform autologous transfusions. They have scheduled chest local WiFi to a RealWear Navigator 520 head-mounted cam-
physiotherapy and physical exercise while in ED observation era. We collected general case demographics, physician and
status; oxygen and wall suction are not routinely administered. paramedic survey data, and scene times. Participants rated au-
Here, we evaluate the patient profile, length of stay, and com- dio and video quality using sliding scales, where audio quality
plication rates of this protocol, to explore potential military ranged from 0 (extremely poor, could not hear) to 100 (ex-
applications for preservation of the fighting force in theater. tremely clear, without issues), and video quality ranged from
0 (non-functional) to 100 (high definition, extremely clear).
Methods
Results
This prospective cohort study included adult patients with
PHTX treated in EDs in Western Cape, South Africa, from Paramedics called for medical control on 30 cases. Of the pa-
March to November 2024. Inclusion criteria were unilateral tients involved, 19 were female (63.3%), with a median age
PHTX requiring an ICD, able to ambulate, and managed of 54 years (IQR: 40.5 [35.5–76]; range: 6–89 years) and a
within the ED. Exclusion criteria were massive hemothorax mean age of 54.4 years. Twenty-three patients (80.0%) were
(stat >1L ICD drainage), ICU admission, operating room in- transported, with a median scene time of 19.0 minutes (IQR:
tervention, or death, within 24 hours. 12 [13–25]; range: 8–57 minutes). In 13 cases (43.3%), the
paramedic was dismounted from the vehicle. A two-sided Wil-
Results coxon rank sum test demonstrated that scene time was signifi-
A total of 323 patients were treated with the ICD protocol: cantly longer post-intervention compared to pre- intervention
91% male, median age 30 years, with pneumothorax (44%) (p=.017; Figure 1). Across the 30 cases, cellular data usage
and hemothorax (56%). Injury mechanisms included stab averaged 57.1GB (median 54.2GB), while satellite data us-
(88%), firearm (7%), struck (5%), and motor vehicle collision age averaged 12.9GB (median 10.3GB). Paramedic survey re-
(1%). Median new injury severity score was 10 (IQR 9–17). sponses (n=30) indicated high satisfaction with the technology,
Most patients (302; 94%) received no oxygen. Wall suction reporting a median score of 90 (mean 88.8) for ease of inter-
was initiated in 10% (33 patients). Complications were rare facing with the medical control physician, 100 (mean 90.9) for
(6%) and included superficial ICD site infection (3 patients), audio quality, and 100 (mean 96.2) for comfort wearing the
ICD dislodgement (1 patients), empyema (2 patients), retained headset. Physician survey data (n=24) similarly reflected posi-
hemothorax (5 patients), mechanical ventilation (2 patients), tive feedback, with a median audio quality score of 90 (mean
and chest tube re-insertion (6 patients). There was one in-hos- 83.3) and a video quality score of 90 (mean 84.3).
pital death (0.3%) (empyema/sepsis) and few 30-day readmis-
sions (13; 4%). ICD removal occurred at a median of 3.5 (IQR FIGURE 1 Scene time
2–5) days and length of stay was a median of 4 (IQR 2–5) days. Scene Time, minutes
Median
Discussion Patients Mean (SD) (Q1, Q3)
Pre-intervention 59,899 15.9 (8.5) 14.6 (10.2, 20.0)
Most patients in the protocol were young men with stab
wounds. Few required oxygen or wall suction, complications Post-intervention 23 20.6 (10.8) 19.0 (13.0, 24.5)
were rare, and most discharged within 5 days. (OPTAC-X)
Conclusions
Conclusion
We demonstrated that a novel telemedicine communications
The Western Cape ICD protocol shows promise for PHTX platform functions well in a civilian prehospital clinical setting
management in austere environments. With further research, during both mounted and dismounted care.
this protocol may be considered for use in military settings
where wall suction and oxygen are in limited supply. Hypocalcemia in Trauma: Evaluation of Patient
Characteristics for the Consideration of Prehospital Empiric
Prospective Observational Pilot of a Head Mounted High Calcium Supplementation
Resolution Camera for Civilian Operational Telemedicine Jessica, Oudakker, BA ; Christiaan Rees, MD, PhD ; Jessica
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Christopher S. Russi, DO 1 Wild, PhD ; Hendrick Lategan, MBChB, MMed, MPH ; EpiC
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1 Mayo Clinic, Rochester, MN
2025 SOMSA Abstracts | 135