Remote Alaska port clinic goes modern with telemedicine

The only clinic in one of the nation's busiest commercial fishing ports is so remote that even conventional telemedicine for emergencies has been impossible for its limited staff - until this week.

Starting Thursday, a new partnership with an Anchorage hospital will virtually beam critical care doctors 800 miles away to the emergency room on Unalaska Island, home to Dutch Harbor.

But instead of transmissions with fiber-optics, which are nowhere near the isolated Alaska island, the team putting together the system is relying on satellite technology in what is believed to be a first in the country for telemedicine.

The clinic, Iliuliuk Family and Health Services, brings to nine the number of providers served by the electronic intensive care unit at Anchorage's Providence Alaska Medical Center.

"We are kind of mix-mashing everything together to try to make this work," Sharon Compton, services manager of the hospital's eICU office, said after a recent demonstration of the Dutch Harbor link.

The new system will provide real-time camera links between emergency doctors and clinic staffers during medical emergencies, such as injuries among the Bering Sea crabbing fleet made famous by the Discovery Channel show "Deadliest Catch."

The idea is to help stabilize patients before transporting them out of town and to help with triage during major events like a ship sinking.

From afar, doctors will be able to view X-rays and patient charts and talk directly with patients on camera instead of consulting with medics by phone and email.

There are some unknowns about how the system will work, with likely slowdowns in satellite reception because of the region's notoriously bad weather.

During the recent demonstration, pre-launch kinks prevented the rolling-cart-mounted camera in Dutch Harbor from being pivoted remotely. But the camera otherwise performed impressively, sending back crystal-clear video of clinic staffers as they chatted with a critical care doctor.

The new service was lauded by Seattle-based crabbing boat owner by Lance Farr, who has been badly hurt twice in his decades of working in the Bering Sea.

Several years ago, he almost severed a finger in a dockside engine accident. He was stabilized at the clinic before being flown to Anchorage for further treatment. In 1996, Farr broke his foot at Dutch Harbor after dropping an engine on it. He spent the night at the clinic under the care of nurses before being flown out the next day.

In hindsight, having his care visually monitored by emergency room specialists would have provided a morale boost, as well as invaluable expertise, Farr said.

"It would be a good thing, I would think, to have a real physician being able to advise the people out there," he said.

The city of Unalaska has just 4,600 year-round residents, but the population swells to 16,000 or more during the region's two main fishing seasons, when boat crews and processing workers flood the town with dozens of languages and cultures. That means more potential for patients, including people who don't speak English.

The clinic averages more than 300 after-hours emergency room visits a year, with about a third of those patients flown elsewhere, often to Anchorage, for more complete treatment.

Fishing-industry emergencies at sea can mean significant delays to appropriate medical treatments when the injured must first be carried by rescue helicopter to Dutch Harbor. Injuries can range from deep cuts and broken bones to back injuries and amputations.

"These guys are pretty tough out here, and they will, you know, continue to fish until they can't get out of bed anymore," said James Novotny, nurse practitioner at the clinic.

The drastically shifting population can put a strain on clinic staffing in this rural setting. So can the inability to afford emergency specialists or much in the way of diagnostic equipment.

Then there's the challenge of living in such a far-flung spot, which makes finding and keeping medical staff difficult, according to clinic medical director, Ann Nora Ehret, an osteopathic doctor who has wanted to tap into telemedicine since joining the staff in 2013. Only recently did the clinic hire a second doctor after the position was vacant for nearly a year.

Adding the long-distance help will be invaluable, Ehret said.

"I think it could be a game changer for recruiting, retention and for the care of the patients," she said. "We are getting the support we need in an austere environment."