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CASE STUDY 1

A 7-year-old boy is found unresponsive at the bottom of a swimming pool. Cardiopulmonary resuscitation is initiated by first responders, and the child is rushed to the closest hospital. The internal medicine physician covering the emergency department (ED) at this critical access hospital has limited experience with critically ill children. Upon arrival, the staff continues resuscitation and immediately activates a pediatric tele-emergency consultation. Within a minute, a pediatric emergency medicine physician from the regional pediatric quaternary care center is connected to the bedside with telemedicine, with high-quality audiovisual communications, ready to assist the team. With the expert guidance and teamwork, the resuscitation is successful, and the child is transported to the regional pediatric hospital for definitive care.

CASE STUDY 2

A 4-year-old girl with a history of asthma presents to a community hospital ED in respiratory distress. The physician administers IV steroids and initiates breathing treatments, but it becomes clear that the patient needs hospital admission and close observation. Previously, a child on continuous albuterol would need to be transported several hours to the closest pediatric intensive care unit (ICU), but with a remote monitoring program in place, the child is admitted to the local community hospital with 24/7 monitoring by a pediatric critical care physician. With this collaborative treatment between the bedside team of respiratory therapists, nurses and physicians, and the telemedicine team, the child improves and after 3 days is able to go home. An expensive, risky interfacility transfer was avoided, and the patient received high-quality pediatric care in her home town, which provided good outcomes and patient-and family-centered care.

CASE STUDY 3

A 6-month-old with a diffuse rash presents to a small rural ED. The general emergency medicine physician has seen many rashes, but never one like this. The child is otherwise well appearing, but the physician does not feel comfortable making a diagnosis. Previously, he would have transferred the child 4 hours to the closest pediatric referral center, but with their telemedicine program, she is able to activate a consultation with a pediatric emergency medicine physician. The remote physician takes a full history and performs a physical exam and is able to efficiently diagnose and treat the child without the patient ever leaving their hometown.

INTRODUCTION

Each of these scenarios illustrates how the use of telemedicine by pediatric emergency and critical care clinicians can address disparities in timely access to care, improve clinical outcomes, and reduce health care costs, all while improving the quality of care delivered to children.

According to the 2010 Census, rural areas of the United States are home to nearly 20% of the population. As a result, many children face significant access barriers to important pediatric health services. 1,2 These barriers include geographic challenges for families living in rural communities, a relative shortage and maldistribution of ...

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