Telemedicine in Italian mountain area: the e-Res@mont project

A teleconsultation system was developed as part of the of e-Rés@mont (European Interreg Alcotra) project, aimed to improve the healthcare for mountain inhabitants and tourists. Accessing a Web system, through a tablet equipped with a mobile 3G/4G connection, trained nurses from remote shelters of north-west Italian mountain area (between 1544 and 3500 m) can send multimedia data (physiological parameters, electrocardiogram, echography, etc.) to the hospital (Aosta, Italy) where a doctor determined a diagnosis. This system provided an ad hoc videoconference built using the most recent technologies with autoadapting videoband. When connection was not available, a decision support system, on an off-line app, provides scores and suggestions to the nurse to evaluate the severity, to dispense emergency aids, and to call rescue services when needed. When the connection turned available, locally stored data were sent to the hospital. On the basis of acquired information, the presence of acute mountain sickness was also automatically assessed. A total of 702 teleconsultations were performed during last summer and winter. The system fully performed the functions it was designed for in mountain areas: all data were correctly received at the hospital and teleconsultations allowed specialist checks. The average diagnosis time was 42 minutes: 333 white, 356 yellow, and 13 red severity; moreover, in 12 cases, this system avoided inappropriate helicopter rescue intervention. Our mountain teleconsultation system was effective in improving people emergency treatments, allowing proper diagnoses and reducing waiting time. Further studies are needed to establish the effectiveness of this system in a high-altitude setting (>3500 m).