Can web-based technology save critically ill children?

(This post, the first of three, is adapted from a talk Jeffrey Burns, MD, MPH, gave at IBM’s Impact 2011 Global Conference in April. For the full talk, jump to 44:37 in this video.)

Right now, valuable information is bottlenecked in an old paradigm. Expert training on how to treat children with life-threatening illnesses is available at relatively few hospitals across the world, and access to this training remains anchored to an apprenticeship model – see one, do one, teach one – that’s now nearly 100 years old.

We need to change that paradigm.Several years ago, I had a patient who was critically ill from an infection that was overwhelming her bloodstream. Her vital signs were declining and I was leading a team of what seemed to be at least 20 physicians and nurses in the room. Her mother came up, and she grabbed my right arm, and she said, “Please, do anything to help my daughter.”  And I thought, “We’ve got to do everything we can to save this little girl.”

That little girl, who is alive and well today, gave us hard-earned knowledge. I felt a profound obligation to take the lessons that she has taught us and somehow translate those and extend those forward, so that others don’t have to experience the suffering that she did. But right now that knowledge is effectively bottlenecked within our walls.

Several times a year, I will get calls from around the world when Americans are traveling and their child becomes critically ill. In the last several years I’ve taken care of American children who were ill in Mongolia and in Santiago, Chile.

One day about two years ago, the call was from Guatemala City. A little girl about 5 years old was traveling with her family from California. Ironically she had the same illness. She had an infection traveling throughout her blood system and she was critically ill.

The current paradigm: Medical knowledge transfer is confined within walls. What if we could break those walls down?

She was taken to a cardiovascular clinic in Guatemala City. And I actually knew the surgeon who headed that heart institute. They’re heart surgeons, they’re terrific surgeons, but they’re not expert in taking care of a child who’s got sepsis. So, as we always do, we went into my conference room and we hooked up a crude video link. We tried to transmit the data back and forth, but the data quality was quite poor, and I really couldn’t see the image as well as I would like to.

When my colleague in Guatemala City said, “Dr. Burns, she’s worse, she’s not responding to the therapy,” I realized, “She’s not going make it unless I walk him through something that he hasn’t done before. I’ve got to push him to do something he’s never done.”  And I thought, “I wish I had a better way to transmit this information, the subtlety of what he’s about to do, but I don’t. I’ve just got to walk him through it.” And so I did.

That night I woke up at about 3 a.m., thinking, “I’ve pushed him too far. Something is not right.”

The next morning I was really anxious when the video link came up.  We could barely transmit the data the night before. And I heard my friend say, “Dr. Burns, she’s alive.”

Three years later I see a family looking at me and smiling at me – they seem to know me. I think to myself, “Oh, man, I wish I was better at names! I don’t remember these people!”  And a little girl breaks off and comes running right at me and high-fives me.  I look up and the father says, “This is the little girl you took care of in Guatemala City. Thank you for giving us our daughter back.”

I looked down into her eyes and thought, “My gosh, we did this through the internet.” But almost as quickly, I thought, how many other kids are we not doing this for?

Ten million children under 5 die each year around the world from preventable causes. Can we use web-based technology to save some of them? That’ll be the topic of my next two posts.

Jeffrey P. Burns, MD, MPH, is Chief of the Division of Critical Care Medicine at Children’s Hospital Boston. He established and is the Executive Director of the Children’s Hospital Simulator Program, one of the first hospital based pediatric simulator programs in the United States, and also co-chairs the Children’s Hospital Ethics Committee.