Monhegan is just not a great place to get sick or hurt, especially in the winter. Located about ten miles out to sea south of Port Clyde, there are only three scheduled boats a week in the off-season to the mainland (weather permitting) and the relatively small population does not have a full time doctor or nurse. Getting off the island for an unplanned medical trip could very well mean a trip by fishing boat or by LifeFlight helicopter. However, through the installation and use of an innovative telemedicine device a new class of emergency medical technicians is being taught in a pilot program on the island, and this same device, with the support of the emergency room staff at nearby Penobscot Bay Medical Center (PBMC), is also able to provide real time, visual physician consultation for cases on the island.
The Monhegan Emergency Rescue Service (MERS) is the first stop for medical care on the island, but this group had recently grown short of members. It was founded by seven original community members, many of whom have gradually retired or moved off-island over the years, until only three members were left. The service was also without a paramedic on the island, which meant that access to several potentially life-saving drugs was restricted. In an effort to breathe new life into the organization, Faryl Wiley, Director of MERS, wanted wanted to have a course taught for island residents, but was faced with the problem of transportation for either an instructor or the students. “This class has been really fantastic for us out here,” says Wiley, “seeing as how it has been not too many years for us going from kerosene lamps to beamed television classes,” although she did note “we are still planning on keeping the kerosene lamps as well.” “Having the first of these units in Maine has been a blessing for us,” she said, “and we are looking forward to having a strong group of EMTs for the future.”
This new emergency medical technician class is being taught under the able instruction of paramedic Luke Church of Union, who himself lived for many years on Monhegan and was in fact the emergency service director on the island. The group of seven future EMTs gathers three evenings a week around a television screen for real time, interactive classes. These classes are beamed from a conference room at Penobscot Bay Medical Center in Rockport, and if all goes well as many as six of these students will be able to contribute to the Monhegan Emergency Rescue Service (MERS) upon graduation May 6. Instructor Church himself took a class on conducting remote education, and has worked closely with the education committee of the state to develop and approve the new course. Nursing classes have been taught using this method in Aroostook County, but this is the first EMT course taught in Maine with this technique. Other Penobscot Bay islands are also equipped with telemedicine devices, and it is hoped that in the future Vinalhaven, North Haven and Islesboro will use this technology for on-site classes as well. “This is a much more cost effective way for the medical crews on the islands to access basic, intermediate and specialty continuing-education training, even if there are just one or two students,” notes Church, “all without leaving the island.” Matinicus and Criehaven do not currently have these units, but have consultation available by telemedicine when the SUNBEAM, the telemedicine-equipped vessel of the Maine Seacoast Mission, is visiting the island.
Many of the students are lobster fishing by day, as Monhegan has Maine’s only dedicated winter-only lobster fishery. Taking classes off the island is really not compatible with work, as a trip off-island in the winter is usually a three-day affair. Acording to Faryl Wiley, Director of MERS, it makes for a long day for many, fishing all day in the exposed waters around the island and then staying awake for classes in the evening. However she notes that this effort has been made much easier by generous community donations of baked goods, left in the classroom each class night. “Having goodies for every session really gives us something to look forward to as we make our way through the winter night to the classroom, and most of all we appreciate the community support it shows for the service,” she says.
The technology making this possible is a two-way closed-circuit television device, transmitting on a dedicated ISDN high-speed phone line. This telemedicine machine is able to communicate with over 50 other similar units located in other rural healthcare facilities and hospitals throughout the state, including one installed in the PBMC emergency room.
Telemedicine uses state-of-the-art technology to allow patients in rural counties to access specialty medical care such as psychiatry, geriatrics, pediatrics, diabetes education and neurology without travel to urban areas. It aims to promote a coordinated health care system through a telecommunications bridge created between health care agencies. Telemedicine units will also be used to facilitate administrative meetings and continuing education for physicians and other providers.
The institution of telemedicine for Maine’s remote communities has long been a goal of state medical directors, and the program is now showing significant real-world benefits. Supporters of telemedicine on Monhegan include the Maine Seacoast Mission, which donated the cable, and Ron Emerson, Director of Institutional Telemedicine of the Regional Medical Center at Lubec (RMCL), who provided the technical assistance for the system. Through its Maine Telemedicine Services, the RMCL, a nonprofit community health center, is actively developing telemedicine, e-health, distance education and interactive video-conferencing solutions for many locations in Maine.
Dr. Chris Michalakes, D.O., of the PBMC Emergency Medicine Department has been a strong supporter of the service, and has made himself available for consultations using the device. Interviews can be conducted face to face, and medical examinations can also be done on-island, as the machine is equipped with a small handheld camera “about the size of a bar of soap,” according to director Wiley, which can be used to closely survey a wound or afflicted area. Stethascopes, otoscopes and dermascopes are also available for use with the unit. Patient records can be accessed, faxed back and forth, and the patient becomes a de-facto admitted patient at PBMC. The device on Monhegan has been used for this consultation application four times since coming on-line six months ago, and has saved at least one trip to the mainland.