{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:14:55Z","timestamp":1790295295409,"version":"4.1.0"},"reference-count":47,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2019,8,1]],"date-time":"2019-08-01T00:00:00Z","timestamp":1564617600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Telemedicine and e-Health"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Tension pneumothorax is a frequent cause of potentially preventable death. Tube thoracostomy (TT) can obviate death but is invasive and fraught with complications even in experienced hands. We assessed the utility of a remote international virtual network (RIVN) of specialized mentors to remotely guide military medical technicians (medics) using wireless informatics.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">\n                        Medics were randomized to insert TT in training mannequins (TraumaMan; Abacus ALS, Meadowbrook, Australia) supervised by RIVN or not. The RIVN consisted of trauma surgeons in Canada and Australia and a senior medic in Ohio. Medics wore a helmet-mounted wireless camera with laser pointer to confirm anatomy and two-way voice communication using commercial software (Skype\n                        <jats:sup>\u00ae<\/jats:sup>\n                        ). Performance was measured through objective task completion (pass\/fail) regarding safety during the procedure, proper location, and secure anchoring of the tube, in addition to remote mentor opinion and subjective debrief.\n                      <\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Fourteen medics attempted TT, seven mentored and seven not. The RIVN was functional and surgeons on either side of the globe had real-time communication with the mentees. TT placement was considered safe, successful, and secure in 100% of mentored (<\/jats:italic>\n                      n\n                      <jats:italic toggle=\"yes\">\u2009=\u20097) procedures, although two (29%) received corrective remote guidance. All (100%) of the unmentored attempted and adequately secured the TT and were safe. However, only 71% (<\/jats:italic>\n                      n\n                      <jats:italic toggle=\"yes\">\u2009=\u20095) completed the task successfully (<\/jats:italic>\n                      p\n                      <jats:italic toggle=\"yes\">\u2009=\u20090.46). Participating medics subjectively felt remote telementoring (RTM) increased self-confidence (strong agreement mean 5\/5\u2009\u00b1\u20090); confidence to perform field TT (agreement (4\/5\u2009\u00b1\u20091); and decreased anxiety (strong agreement 5\/5\u2009\u00b1\u20091). Subjectively, the remote mentors felt in 100% of the mentored procedures that \u201cyes\u201d they were able to assist the medics (1.86\u2009\u00b1\u20090.38), and in 71% (<\/jats:italic>\n                      n\n                      <jats:italic toggle=\"yes\">\u2009=\u20095) felt \u201cyes\u201d they made TT safer (2.29\u2009\u00b1\u20090.49).<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">RTM descriptively increased the success of TT placement and allowed for real-time troubleshooting from thousands of kilometers with a redundant capability. RTM was subjectively associated with high levels of satisfaction and self-reported self-confidence. Continued controlled and critical evaluation and refinement of telemedical techniques should continue. Trial Registration: ID ISRCTN\/77929274.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/tmj.2018.0138","type":"journal-article","created":{"date-parts":[[2018,9,17]],"date-time":"2018-09-17T12:43:14Z","timestamp":1537188194000},"page":"730-739","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":19,"title":["Transoceanic Telementoring of Tube Thoracostomy Insertion: A Randomized Controlled Trial of Telementored Versus Unmentored Insertion of Tube Thoracostomy by Military Medical Technicians"],"prefix":"10.1177","volume":"25","author":[{"given":"Andrew W.","family":"Kirkpatrick","sequence":"first","affiliation":[{"name":"Regional Trauma Services, University of Calgary, Calgary, Canada."},{"name":"Canadian Forces Medical Services, Ottawa, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica L.","family":"McKee","sequence":"additional","affiliation":[{"name":"Regional Trauma Services, University of Calgary, Calgary, Canada."},{"name":"Canadian Forces Medical Services, Ottawa, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itamar","family":"Netzer","sequence":"additional","affiliation":[{"name":"Israeli Defence Force Medical Corp, Haifa, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul B.","family":"McBeth","sequence":"additional","affiliation":[{"name":"Regional Trauma Services, University of Calgary, Calgary, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"D'Amours","sequence":"additional","affiliation":[{"name":"Liverpool Hospital, Liverpool, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Kock","sequence":"additional","affiliation":[{"name":"Canadian Forces Medical Services, Ottawa, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Dobron","sequence":"additional","affiliation":[{"name":"Israeli Defence Force Medical Corp, Haifa, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad G.","family":"Ball","sequence":"additional","affiliation":[{"name":"Regional Trauma Services, University of Calgary, Calgary, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elon","family":"Glassberg","sequence":"additional","affiliation":[{"name":"Israeli Defence Force Medical Corp, Haifa, Israel."},{"name":"Faculty of Medicine, Bar-Ilan University, Safed, Israel."},{"name":"The Uniformed Services University of the Health Sciences, Bethesda, Maryland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"For the Damage Control Surgery in Austere Environments Research Group (DCSAERG)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,8,1]]},"reference":[{"key":"e_1_3_4_2_2","volume-title":"Advanced trauma life support course for doctors","author":"American College of Surgeons","unstructured":"American College of Surgeons. 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