Shaving Time & Saving Lives

Paul Llobet is the lone physician at the Margaretville Hospital, which serves about 3,750 area residents near the foothills of New York’s Catskill Mountains. Ten miles away is the all-season Belleayre Ski Resort — a high-tourism attraction with its share of trauma-related skiing, snowmobiling, hiking, and hunting accidents, which also are treated by Margaretville Hospital. “Nothing more dangerous than New Jersey hunters,” Llobet jokes. “ They’ll miss the deer and hit each other.”

It’s no joke, however, that the nearest trauma centers are more than 90 minutes away in Albany and Westchester. So in 2016, when the HealthAlliance hospital affiliated with Westchester Medical Center — complete with its robust infrastructure of teletrauma and teleICU services — Llobet seized the opportunity to promote Margaretville as the “perfect location” for telemedicine. “Now I have 10 different specialists at my fingertips at any given time in an area that you would never be able to get them there,” he says.

What training was required before the program was operational?

It’s mostly training staff how to properly operate the equipment — turning it on, connecting with the Westchester Medical team and troubleshooting — which takes maybe an hour. Then follow up two weeks later with an hour recap. Then every morning during the shift change the staff does a test connect — “Camera’s good, audio’s good, zoom-in and out is good, thank you and see you tomorrow” — for three months. Now it’s autopilot.

Does teletrauma — having teams at separate sites working together — pose any collaborative issues?

No. The immediate knee-jerk response is “This is not going to work. This is a gimmick.” But after they experience one or two scenarios, they’re like, “This was fantastic!” That’s when you get complete buy-in and almost become dependent on it. It’s such an amazing tool; why would you practice medicine without having a full team around you?

What benefits have been realized since teletrauma was implemented?

We’ve saved lives. When you have an auto accident with four victims but only one provider in the ER, now you have additional teams right there to assist, determining whether this patient goes by ambulance or needs to be airlifted. That’s really beneficial. You’re shaving time.

What do rural patients think about telemedicine?

Patients here still tell stories of how their doctors used to visit them at home, and I say, “This isn’t Little House on the Prairie anymore.” We laugh, but they are adapting and appreciate not driving two hours for a follow-up cardiology appointment.

What other teletrauma challenges have you encountered?

Westchester Medical has a command center with specially trained teams of physicians and nurses. But because the network of specialists aren’t all in one room, you need clear communications and logistical and scheduling experts to maximize efficiency. At the other end, we know we cannot schedule when traumas occur, so if trauma teams are already involved in other cases and not immediately available, you just do the best you can until they can help.