Dave Ridings in an ER-Link ambulance circa February 2009. Photo credit: Neil Versel

One of the first attempts at a citywide ambulance-based telemedicine network is offline, a casualty of funding shortfalls.

The city of Tucson, Ariz., has taken ER-Link offline after about $3.8 million in federal grant money ran out. “[There is] no operational funding available to maintain the system,” Tucson Fire Department Assistant Chief Dave Ridings, who heads emergency medical services for the city, explains in an e-mail to MobiHealthNews. “All department budget funding [has been] concentrated in core service functions only.”

Tucson had been the first municipality the nation to set up a WiFi network specifically for mobile teletrauma care. The mesh network, run by the city’s transportation department, covered 227 square miles, reaching 95 percent of the city’s residential population. Tropos Networks set up the mesh in partnership with the city.

Videoconferencing equipment on all 18 city-owned ambulances transmitted over the system to University Medical Center, providing live telemedicine services between the vehicles and the emergency department at the only Level 1 trauma center in southern Arizona.

ER-Link, launched in 2007, allowed emergency and trauma physicians to triage cases remotely, before patients arrived at the hospital. The system did have limitations, notably the range and reliability of WiFi, so consultations generally happened in 20- to 30-second transmissions when the ambulances were not in motion.

Ridings says there are about four or five operational ambulances that are able to connect to ER-Link, but the system is not used much anymore. “Essentially it’s non-operational,” says Mary Ann Matter, director of emergency medical services at UMC.

It costs UMC at least $5,000 to activate a Level 1 trauma team. ER-Link not only helped prevent unnecessary activations, it saved lives by giving trauma specialists the opportunity to make remote preliminary diagnoses and triage decisions.

UMC is where Rep. Gabrielle Giffords (D-Ariz.) and some of the other victims of the January 8 shooting rampage were taken. But the Safeway where the shooting took place, at Oracle and Ina roads, is outside the city limits in an unincorporated part of Pima County, so any Tucson Fire Department ambulances that transported victims would not have been able to conduct telemedicine from the scene.

Matter, a registered nurse, says ER-Link was not activated during that mass emergency.

For now, Tucson Fire Department EMTs still transmit electronic patient care reports over the network, but otherwise the infrastructure sits mostly unused. “There are no current plans to rejuvenate ER-Link unless grant funds are located, either in the transportation or EMS arena,” Ridings says.

He also says that Tucson won’t dismantle the network, even though newer technologies like WiMAX and cellular broadband Internet are more reliable and have longer range than WiFi. “The mesh network is being supported and enhanced by the city and [Department of] Transportation grant funding,” Ridings adds.