Teleconsultation in the mountains: the role of nurses expert in mountain medicine

Introduction and Aim: From June 2017 to March 2018, five trained nurses were involved in the e-Res@mont project to develop a new model of teleconsultation in a remote area. Methods: Nurses were trained in emergency setting and mountain medicine before starting the activity. The tele-consultation took place in five remote locations between 1500 and 3500 m, connected to the doctor through a telematic platform. Communication took place by data transmission, images, or through videoconference. Doctors and nurses chose the validated scales readjusted according to the altitude, defined tools, drugs, and identified a protocol to follow in case of lack of connection. On the basis of symptoms, patients were subjected to clinical evaluation (i.e., vital parameters, pulse oximetry, body mass index, and Lake Louise Score questionnaire); moreover a 12-lead electrocardiogram and lung echo could be performed. Based on the data received, the doctor made diagnosis and gave instructions to the nurse who provided the care. Results: The activity was carried out for 7 months, with 702 visits (male 61%; average age 49 - 17 years). The mean value for vital parameters was different according to altitude. The most treated pathologies were acute mountain sickness 8.0%, headache 4.0%, minor trauma 2.3%, and gastrointestinal disorders 1.3%. In 30 cases, the use of emergency rescue was avoided, specifically in 31% of cases the use of helicopter rescue. The average time of response to the nurse call was 20 minutes. Conclusions: Trained nurses in mountain medicine and telemedicine are crucial: they are link between patients and doctors in the management of critical situation in a mountain environment.