Forum for Nordic Dermato-Venereology No 3, 2019 Telemedicine

Luit Penninga, Anne Kathrine Lorentzen and Carsten Sauer Mikkelsen – Telemedicine for Frostbite Lesions given to physicians and non-medical professionals in other parts of the world using telemedicine (15). The Utah Health Care Burn Center also provides a telemedical program in frostbite management (http://healthcare.utah. edu/burncenter/frostbite.php) (12). Here, a multidisciplinary approach including surgeons, wound care specialists, physical therapists, nutritionists, pharmacists, and social workers, is used to improve outcomes for frostbite lesions. Telemedicine plays a significant role in health care at An tarctic research stations (16–18). Reports from the Australian, Japanese and British Antarctic research stations describe how telemedicine has evolved over the last 60 years from radio sound-transmissions to advanced store-and-forward image transmissions, and live video transmissions (16–18). These reports also describe the illnesses and diseases occurring at the Antarctic research stations, including frostbite (16–18). Articles from our own group have also reported how tele- medicine and teledermatology is used in Arctic Greenland (4, 19, 20). The regional hospitals in Greenland serve as referral hospitals for local hospitals and rural health clinics, and pro- vide a 24 h telemedical service evaluating electrocardiograms, clinical photographs, otoscopic images, dermatoscopic imag- es, stethoscopic sound files and live video transmissions (4). These modalities help guide the treatment of frostbite lesions presenting at local hospitals and rural clinics (4, 19, 20). New modalities for telemedicine during expeditions are under development (21–23). The primary drive for developing new devices was the catastrophic Everest expedition in 1996, in which 5 climbers lost their lives (21). These devices continu- Fig. 1. Skiing expedition from coast to coast of Svalbard. Food, fuel, tents and equipment was dragged in sledges, and polar bear watch was kept throughout the night. Temperatures reached a low of –30°C during the expedition. Photo: Anne Kathrine Lorentzen. Forum for Nord Derm Ven 2019, Vol. 24, No. 3 ously measure vital signs and other parameters like heart rate, oxygen saturation, skin temperature, core body temperature and lactate levels in the blood. Most devices are wearable, but also pill-like devices designed to be swallowed can measure core body temperature and serum lactate levels (21, 22). These devices constantly transmit data via satellites, and allow for continuous monitoring during extreme expeditions (21, 22). Telemedical information on skin and core body temperature help diagnose frostbite and hypothermia, and increase expe- dition safety. D iscussion The number of people exposed to frostbite and non-freezing cold injuries is increasing. Travel to high altitude, Arctic and Antarctic areas has become more prevalent and an increasing amount of people undertake expeditions into cold and remote areas (4) (Fig. 1). Skiing expeditions in polar areas, and climb- ing the highest mountain peaks in the world, has become more popular and commercially available, increasing the population at risk for frostbite injuries (4) (Figs 2–4). Travel to these remote places means that health care facilities are not easily reachable in case of illness or injury, and medical equipment carried on expeditions is limited. Satellite phones and other communi- cation devices are paramount for expedition safety. In cases of extreme weather making medical evacuation impossible, satellite phones serve as means to telemedical diagnosis, initial stabilization and treatment. This study shows that several teledermatological programs have been developed. These programs allow for global access to expert advice on diagnosis and treatment of frostbite lesions. Fig. 2. Cold exposure on a Greenland expedition. Water vapour in exhaled breath quickly freezes on the mask, hood and eye lashes, and sweat from pulling heavy sledges freezes to ice on the inner linings of outer garments. Icy winds and freezing temperatures combined increases the risk of frostbite injuries significantly. Photo: Anne Kathrine Lorentzen. T heme I ssue : T eledermatology 93

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