968 TELEMEDICINE and e-HEALTH NOVEMBER 2008 DOI: 10.1089/tmj.2008.0117 TELEHEALTH WHITE PAPERS: A ROADMAP FOR THE FUTURE Applications Scott Simmons, M.S., 1 Dale Alverson, M.D., 2 Ronald Poropatich, M.D., 3 Joe D’Iorio, 4 Mary DeVany, 5 and Charles R. Doarn, M.B.A. 6 1 University of Miami TeleHealth, Miller School of Medicine, Miami, Florida. 2 University of New Mexico, Albuquerque, New Mexico. 3 Telemedicine and Advanced Technology Research Center, Ft. Detrick, Maryland. 4 TANDBERG, Boston, Massachusetts. 5 Avera Health, Sioux Falls, South Dakota. 6 Center for Surgical Innovation, Department of Surgery, University of Cincinnati, Cincinnati, Ohio. Abstract There are myriad telehealth applications for natural or anthropogenic disaster response. Telehealth technologies and methods have been demonstrated in a variety of real and simulated disasters. Telehealth is a force multiplier, providing medical and public health expertise at a distance, minimizing the logistic and safety issues associated with on-site care provision. Telehealth provides a virtual surge capacity, enabling physicians and other health professionals from around the world to assist overwhelmed local health and medical personnel with the increased demand for services postdisaster. There are several categories of telehealth applications in disaster response, including ambulatory/primary care, specialty consultation, remote monitor- ing, and triage, medical logistics, and transportation coordination. External expertise would be connected via existing telehealth networks in the disaster area or specially deployed telehealth systems in shel- ters or on-scene. This paper addresses the role of telehealth in disaster response and recommends a roadmap for its widespread use in pre- paring for and responding to natural and anthropogenic disasters. Key words: disaster medicine, extreme environments, telehealth, telemedicine, policy Introduction ver the last decade, there have been several examples of large-scale disasters with multiple etiologies—from the anthropogenic (e.g., 9/11, Madrid, and London terrorist attacks) to the natural (e.g., Indonesian tsunami, hurricane Katrina). A common thread in all of these disaster events is their sig- nificant acute and long-term impact on human health and healthcare delivery systems. There are many acute and chronic disaster-related health effects. Primary injuries are those caused by the disaster event and are dependent on the nature of the disaster. Disasters that cause major structural damage to buildings, whether caused by wind, water, earthquake, or explosion, often result in trau- matic injury from structural failure. Structural damage can also gen- erate fires and exposure to high-voltage electricity that can result in burns and other associated illness and injury. Inhalational lung inju- ries resulting from explosions or fires are especially complicated and difficult to treat. Secondary illness and injury threats are numerous and wide-ranging. Exposure to contaminated air, water, and sewage, mold, animal bites, and stings can have deleterious effects. Injuries can be sustained during rescue, cleanup, and recovery. Disasters are also associated with mental health consequences, including depres- sion, anxiety, and post-traumatic stress. Dealing with these health effects is further complicated in a disaster-compromised healthcare system and public infrastructure that is overwhelmed by the surge in demand, damaged, or destroyed. The classic medical response to disasters in the United States is to supplement the local emergency medical response systems with med- ical personnel and materiel resources from external sources, includ- ing neighboring communities, humanitarian assistance organizations (e.g., American Red Cross), and the state and Federal government. A complex system of incident command directs the request, activation, and coordination of these supplemental assets. Volunteer healthcare professionals often provide additional assistance. All of these adjunct personnel require logistical support resources associated with their on-site presence, such as food, water, shelter, and security. Applying Telehealth in Natural and Anthropogenic Disasters O