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

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. Chile EQ 8.8 Richter The same day of my report, this was happening in my country……

7. Source: http://neic.cr.usgs.gov/neis/eqlists/eqstats.html What´s happening in some parts of our planet ???

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. 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. TELEMEDICINE TELECOMMUNICATIONS ARE VERY IMPORTANT In emergency situations!!!! and for M.D. this means….

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. Telemedicine can be broken into three main categories: 1- Store-and-forward 2-Remote monitoring 3-Interactive services

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. 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. 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. 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. 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

22. My visit to…………………..

27. Cisco HealthPresence Sites

28. MEU

29. Mobile Emergency Unit Mobile Surgical Unit Mobile Neurosurgical Unit

30. Sensors devices X Ray-CT Scan Operating room Laboratory Robotic op. –Robotized Camera assistance Telepresence

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 ……

32. Neurosurgical Service for Disasters: Telemedicine/Telesurgery & the Mobile Emergency/Neurosurgical Unit (MEU/MNU) Concept (Second Part)

33. Strategies for developing the Action of the MEU/MNU

41. THE HIGHEST TECHNOLOGY

42. USNS Comfort (off of Port-au-Prince 1994); Ship Operating Room; Mobile CT Scanner

44. Haiti, 1/2010 – US Military Medical Transport Helicopter & Truck