Emergency Medicine: Intensive Care and Cyberspace
J Varon, O Wenker
acyberspace, computer resources, emergency medicine, intensive care, internet
J Varon, O Wenker. Emergency Medicine: Intensive Care and Cyberspace. The Internet Journal of Emergency and Intensive Care Medicine. 1996 Volume 1 Number 1.
We live in the information age and that the information super highway (“Cyberspace”) passes by each of our doors every day. Of course, we are referring to computer connectivity, and specifically to the structured collection of resources known as the Internet. Unfortunately, many physicians and other health care providers either do not have an “on ramp” to this super highway or have not learned to use the facilities we do have. Physicians and other health care providers working in emergency departments (ED) or intensive care units (ICU) who begin to explore the Internet will find many uses for this new connectivity.
The Internet is not a new project. Indeed, it began as a Department of Defense networking experiment funded by the Advanced Research Project Agency (ARPA). In 1969, four western academic institutions joined ARPA and other networks connected shortly thereafter. For a long time, the Internet was the bastion of the university researcher and “computer geek” who had a working knowledge of UNIX commands and felt comfortable with computers. This has changed dramatically over the last 5 years. With the increase in popularity of Windows and other graphical operating systems, new “front-ends”(software programs with which the user interacts with the network) have been developed to allow the user to access and explore the Internet without memorizing or even understanding arcane computer syntax.
As you are probably aware of (because you are reading this electronic journal!), 3 distinct components are required for any person trying to connect with the Internet. First, an access provider which permits the physical connection to the network. Second, a computer system with networking software that controls the transmission of the information to and from the Internet connection to the user’s computer terminal. Third, application programs to access and use the services provided by remote computers connected to the Internet. Many academic settings have direct physical connections with the Internet allowing health care providers affiliated with these institutions easy access to the network. Dial-up access using modems and standard telephone lines allow many other people various levels of Internet services. These dial-up connections are mainly limited by the speed with which information may be transmitted over standard telephone lines. With the advent of high speed connections (i.e., ISDN lines and cable connections) these limitations will shortly disappear.
A number of services are available on the Internet. E-mail or electronic mail is probably the most frequently utilized. Text and other data (audio, images, etc.) may be exchanged between connected individuals with very short transfer times by simply addressing the item using an assigned name/address. Commercial computer information services (e.g., America On-Line , CompuServe , Prodigy ) permit their subscribers to send and receive E-mail from Internet mailservers. This service is commonly available at no or minimal cost.
In an extension of the E-mail concept, individuals with common interests may band together in groups in an E-mail club known as a mail list. Through this mechanism, ongoing discussions of topics pertinent to the group may occur. Points of view or queries are sent as E-mail to the mailing list manager. The mailing list manager is a computer system that collects and transmits these E-mail messages to all the subscriber on the mailing list. Common mailing list managers are “LISTSERV” and “MAJORDOMO”. Mail lists may be moderated (in which every message is reviewed by the moderator before it is sent out to the subscribers), or unmoderated. Emergency medicine and intensive care mailing lists exist for the transmission of information and discussions relevant to emergency medicine and intensive care.
Another information source available on the Internet are the so-called “newsgroups”. These collections of messages are very much like a bulletin board and only vary slightly from the mailing lists noted above. Messages are posted and responded to by members of the mailing group. Rather than being E-mailed directly to the members of the group, newsgroup articles must be downloaded from a newserver maintained by the Internet access provider. Thousands of newsgroups exist covering every topic imaginable exist. Unfortunately, the administrator of the local newserver determines which groups are available to their users. Good newsreader software allows one to follow the thread of the discussion based upon subject.
The most rapidly growing information source in the Internet is the World Wide Web (WWW). The distinguishing characteristics of the WWW is its hypertext format (HTML or HTM). The term hypertext refers to a non-linear writing form in which one may follow associated paths through textual documents. Hypertext links to other documents or other sites on the Internet characterize a WWW page. Navigated by the use of a “browser” (a piece of software that typically displays pictures and text), the Web allows the internaut to see still images, download animations and sound, and to even send E-mail to specific addresses. Several very useful emergency medicine, trauma and critical care web pages are in operation. Moreover, several hospitals and university fellowship programs also maintain pages. A world of clinical cases, radiographic images, history of medicine images and other data is available through the WWW.
A particularly useful Internet service is “ftp” or file transfer protocol. This is one of the main ways in which one may retrieve or transmit files between computers connected on the Internet.
More recently, a video conferencing capability for the Internet has been introduced known as “CU-SEEME”. With appropriate hardware and software, one may have a one-on-one conference with another person connected on the Internet, or utilizing a “reflector” broadcast your video image to other interested CU-SEEME users. Many other video conferencing programs are being developed with significant improvements in the quality of video conferencing. Most of these programs, however, require high speed connections. A variety of emergency medicine and intensive care-related sites can be found on the Internet.
What we believe will impact the most our emergency medicine and intensive care practice is the availability of “on-line” publications that allow a user a fast way to find “urgent” information. For example, in the case of poisonings, access to information databases that contain specific antidotes. In addition, on-line publications such as The Internet Journal of Emergency and Intensive Care Medicine or The Internet Journal of Anesthesiology provide up-to-date information, graphical reviews, interactive video conferencing and discussions that can not be accomplished in regular journals. Discussing prognostic indicators over a video conference or multimedia slide presentation at the tip of the users fingers will prove to be invaluable information. No longer, readers will have to wait for 18 months of peer review, typesetting and publishing before they can read new and exciting information. This is now the present and not the future.