Pre-publication history The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-227X/10/1/prepub Acknowledgements We would like to thank all the ED staff at Cooper University Hospital and Christina Tay for their assistance of ICU patients as well as Joseph E Parrillo MD, R Phillip Dellinger MD and Stephen W Trzeciak MD, for their constructive input. Written consent for publication was obtained from the patients.
Time-critical medical emergencies require rapid recognition Inhibitors,research,lifescience,medical of important clinical signs and symptoms in order to diagnose and stabilise

vital functions while treating the patient. Efforts to improve treatment in these settings transcend Inhibitors,research,lifescience,medical individual deeds, and should focus on human factors, actions and interactions in teams [1]. Difficult emergencies may also require teams of specialists not available in rural hospitals. “Virtual teams” can be established during such situations, when team members use interactive communication technology combining picture and sound to stay in touch. Video find protocol conferencing (VC) used for medical emergencies may reduce the number of patients transferred to trauma centers [2-4] and offer a quality of clinical service not previously available [5-7]. This

may reduce discrepancies between urban and rural trauma care [8]. Virtual teams may add complexity [9], disturb work flow and provoke lack of confidence in medical emergencies, hampering Inhibitors,research,lifescience,medical patients treatment. Inhibitors,research,lifescience,medical Thus understanding of human and organisational problems related to communication is needed to assess when accessory communication technologies are useful or harmful [10]. So far, use of VC in emergency medicine have expanded the local team with only one specialist via the video link, and most clinical studies refer to minor Inhibitors,research,lifescience,medical trauma and fairly simple patient conditions. We studied if VC could improve communication and team function

between rural and central emergency hospital teams with several participants at either side of the video link. Searching for evidence beyond measures and numbers [11], we chose a qualitative approach to find strengths and weaknesses of VC when compared to conventional telephone calls during simulated, complex trauma and emergency medicine cases. Methods Participants We adapted a commercial off-the-shelf video conferencing technology to fit medical emergencies between a rural hospital all and an university hospital in a remote arctic area of North-Norway. The rural partner was Longyearbyen Hospital (LYB), located on Spitsbergen, about 1.200 km north of the University Hospital of North Norway (UNN), Tromsø, Norway. The rural hospital has three emergency teams, all included in the study. The teams have three members, a doctor (GP or a surgeon), an operating room (OR) nurse and a nurse anesthetist. Each LYB team was paired with one of three trauma teams at UNN, each with specialists in surgery, neurosurgery, intensive care and emergency medicine.