Concepts| Volume 33, ISSUE 2, P224-231, June 2022

Download started.


The Intersection of Telemedicine and Wilderness Care: Past, Present, and Future

Published:April 19, 2022DOI:
      Wilderness medicine and telemedicine seemingly exist at opposite ends of the clinical continuum. However, these 2 specialties share a common history and the literature abounds with examples of successful deployment of telemedicine to resource limited settings. The recent widespread adoption of telemedicine has important ramifications for wilderness providers. Telemedicine is inherently reliant on some sort of technology. There is a wide spectrum of complexity involved, but in general these systems rely on a hardware component, a software component, and a network system to transmit information from place to place. Today, connectivity is nearly ubiquitous through access to cellular networks, Wi-Fi, or communication satellites. However, bandwidth, defined as the amount of data which can be transmitted through a given connection over time, remains a limiting factor for many austere settings. Telemedicine services are typically organized into 4 categories: 1) live/interactive; 2) store and forward; 3) remote patient monitoring; and 4) mHealth. Each of these categories has an applicable wilderness medicine use case which will be reviewed in this paper. Though the regulatory environment remains complex, there is enormous potential for telemedicine to enhance the practice of wilderness medicine. Drones are likely to transform wilderness medicine supply chains by facilitating delivery of food, shelter, and medicines and are able to enhance search and rescue efforts. Remote consultations can be paired with remote patient monitoring technology to deliver highly specialized care to austere environments. Early feasibility studies are promising, but further prospective data will be required to define future best practices for wilderness telemedicine.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Wilderness & Environmental Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sward D.G.
        • Bennett B.L.
        Wilderness medicine.
        World J Emerg Med. 2014; 5: 5-15
        • Freiburger G.
        • Holcomb M.
        • Piper D.
        The STARPAHC collection: part of an archive of the history of telemedicine.
        J Telemed Telecare. 2007; 13: 221-223
        • Doarn C.R.
        • Merrell R.C.
        Spacebridge to Armenia: a look back at its impact on telemedicine in disaster response.
        Telemed J E Health. 2011; 17: 546-552
        • Gilbert B.K.
        • Mitchell M.P.
        • Bengali A.R.
        • Khandheria B.K.
        NASA/DARPA advanced communications technology satellite project for evaluation of telemedicine outreach using next-generation communications satellite technology: Mayo Foundation participation.
        Mayo Clin Proc. 1999; 74: 753-757
        • Garshnek V.
        Applications of space communications technology to critical human needs: rescue, disaster relief, and remote medical assistance.
        Space Commun. 1991; 8: 311-317
        • Weinberg J.
        • Kaddu S.
        • Gabler G.
        • Kovarik C.
        The African teledermatology project: providing access to dermatologic care and education in sub-Saharan Africa.
        Pan Afr Med J. 2009; 3: 16
        • Merrell R.C.
        • Cone S.W.
        • Rafiq A.
        Telemedicine in extreme conditions: disasters, war, remote sites.
        Stud Health Technol Inform. 2008; 131: 99-116
        • Angood P.B.
        • Satava R.
        • Doarn C.
        • Merrell R.
        Telemedicine at the top of the world: the 1998 and 1999 Everest extreme expeditions.
        Telemed J E Health. 2000; 6: 315-325
        • Rayman R.B.
        Telemedicine: military applications.
        Aviat Space Environ Med. 1992; 63: 135-137
        • Pillon S.
        • Todini A.R.
        eHealth in Antarctica: a model ready to be transferred to every-day life.
        Int J Circumpolar Health. 2004; 63: 436-442
        • Woldaregay A.Z.
        • Walderhaug S.
        • Hartvigsen G.
        Telemedicine services for the Arctic: a systematic review.
        JMIR Med Inform. 2017; 5: e16
        • Horneland A.M.
        Maritime telemedicine - where to go and what to do.
        Int Marit Health. 2009; 60: 36-39
        • Harnett B.M.
        • Doarn C.R.
        • Rosen J.
        • Hannaford B.
        • Broderick T.J.
        Evaluation of unmanned airborne vehicles and mobile robotic telesurgery in an extreme environment.
        Telemed J E Health. 2008; 14: 539-544
        • Bhatt K.
        • Pourmand A.
        • Sikka N.
        Targeted applications of unmanned aerial vehicles (drones) in telemedicine.
        Telemed J E Health. 2018; 24: 833-838
        • Karaca Y.
        • Cicek M.
        • Tatli O.
        • Sahin A.
        • Pasli S.
        • Beser M.F.
        • et al.
        The potential use of unmanned aircraft systems (drones) in mountain search and rescue operations.
        Am J Emerg Med. 2018; 36: 583-588
        • Braun J.
        • Gertz S.D.
        • Furer A.
        • Bader T.
        • Frenkel H.
        • Chen J.
        • et al.
        The promising future of drones in prehospital medical care and its application to battlefield medicine.
        J Trauma Acute Care Surg. 2019; 87: 28-34
        • Van Tilburg C.
        First report of using portable unmanned aircraft systems (drones) for search and rescue.
        Wilderness Environ Med. 2017; 28: 116-118
        • McRae J.N.
        • Gay C.J.
        • Nielsen B.M.
        • Hunt A.P.
        Using an unmanned aircraft system (drone) to conduct a complex high altitude search and rescue operation: a case study.
        Wilderness Environ Med. 2019; 30: 287-290
        • Saitoh T.
        • Takahashi Y.
        • Minami H.
        • Nakashima Y.
        • Aramaki S.
        • Mihara Y.
        • et al.
        Real-time breath recognition by movies from a small drone landing on victim’s bodies.
        Sci Rep. 2021; 11: 5042
        • Benziger C.P.
        • Huffman M.D.
        • Sweis R.N.
        • Stone N.J.
        The telehealth ten: a guide for a patient-assisted virtual physical examination.
        Am J Med. 2021; 134: 48-51
        • Weinstein R.S.
        • Krupinski E.A.
        • Doarn C.R.
        Clinical examination component of telemedicine, telehealth, mHealth, and connected health medical practices.
        Med Clin North Am. 2018; 102: 533-544
        • Canepa C.A.
        • Harris N.S.
        Ultrasound in austere environments.
        High Alt Med Biol. 2019; 20: 103-111
        • Otto C.
        • Hamilton D.R.
        • Levine B.D.
        • Hare C.
        • Sargsyan A.E.
        • Altshuler P.
        • et al.
        Into thin air: extreme ultrasound on Mt Everest.
        Wilderness Environ Med. 2009; 20: 283-289
        • Crawford I.
        • Tiruta C.
        • Kirkpatrick A.W.
        • Mitchelson M.
        • Ferguson J.
        Big brother could actually help quite easily: telementored “just-in-time” telesonography of the FAST over a smartphone.
        Ann Emerg Med. 2011; 58: 312-314
        • Otto C.A.
        • Shemenski R.
        • Drudi L.
        Real-time tele-echocardiography: diagnosis and management of a pericardial effusion secondary to pericarditis at an Antarctic research station.
        Telemed J E Health. 2012; 18: 521-524
        • Kao W.F.
        • Huang J.H.
        • Kuo T.B.J.
        • Chang P.L.
        • Chang W.C.
        • Chan K.H.
        • et al.
        Real-time electrocardiogram transmission from Mount Everest during continued ascent.
        PloS One. 2013; 8e66579
        • Bauer J.
        • Moormann D.
        • Strametz R.
        • Groneberg D.A.
        Development of unmanned aerial vehicle (UAV) networks delivering early defibrillation for out-of-hospital cardiac arrests (OHCA) in areas lacking timely access to emergency medical services (EMS) in Germany: a comparative economic study.
        BMJ Open. 2021; 11e043791
        • Amukele T.
        • Ness P.M.
        • Tobian A.A.R.
        • Boyd J.
        • Street J.
        Drone transportation of blood products.
        Transfusion. 2017; 57: 582-588
        • Szawarski P.
        • Hillebrandt D.
        Doctor won’t see you now: changing paradigms in mountain medicine.
        Postgrad Med J. 2018; 94: 182-184
        • Handford C.
        • Thomas O.
        • Imray C.H.E.
        Emerg Med Clin North Am. 2017; 35: 281-299
        • Skolnick A.A.
        Taking telemedicine to the top of the world.
        JAMA. 1998; 279: 816-817
        • Kirkpatrick A.W.
        • McKee J.L.
        • McBeth P.B.
        • Ball C.G.
        • LaPorta A.
        • Broderick T.
        • et al.
        The Damage Control Surgery in Austere Environments Research Group (DCSAERG): a dynamic program to facilitate real-time telementoring/telediagnosis to address exsanguination in extreme and austere environments.
        J Trauma Acute Care Surg. 2017; 83: S156-S163
        • Satava R.
        • Angood P.B.
        • Harnett B.
        • Macedonia C.
        • Merrell R.
        The physiologic cipher at altitude: telemedicine and real-time monitoring of climbers on Mount Everest.
        Telemed J E Health. 2000; 6: 303-313
        • Satava R.M.
        Telemedicine and real-time monitoring of climbers.
        Curr Probl Dermatol. 2003; 32: 141-147
        • Malcolm G.
        • Rilstone S.
        • Sivasubramaniyam S.
        • Jairam C.
        • Chew S.
        • Oliver N.
        • et al.
        Managing diabetes at high altitude: personal experience with support from a multidisciplinary physical activity and diabetes clinic.
        BMJ Open Sport Exerc Med. 2017; 3e000238
        • Nguyen C.
        • Mbuthia J.
        • Dobson C.P.
        Reduction in medical evacuations from Iraq and Syria following introduction of an asynchronous telehealth system.
        Mil Med. 2020; 185: e1693-e1699
        • Natafgi N.
        • Shane D.M.
        • Ullrich F.
        • MacKinney A.C.
        • Bell A.
        • Ward M.M.
        Using tele-emergency to avoid patient transfers in rural emergency departments: an assessment of costs and benefits.
        J Telemed Telecare. 2018; 24: 193-201
        • Penninga L.
        • Lorentzen A.K.
        • Davis C.
        A telemedicine case series for acute medical emergencies in greenland: a model for austere environments.
        Telemed J E Health. 2020; 26: 1066-1070
        • Martin-Gill C.
        • Doyle T.J.
        • Yealy D.M.
        In-flight medical emergencies: a review.
        JAMA. 2018; 320: 2580-2590
        • Sagaro G.G.
        • Amenta F.
        Past, present, and future perspectives of telemedical assistance at sea: a systematic review.
        Int Marit Health. 2020; 71: 97-104
        • Poljak M.
        • Šterbenc A.
        Use of drones in clinical microbiology and infectious diseases: current status, challenges and barriers.
        Clin Microbiol Infect. 2020; 26: 425-430
        • Handford C.
        • Reeves F.
        • Parker P.
        Prospective use of unmanned aerial vehicles for military medical evacuation in future conflicts.
        J R Army Med Corps. 2018; 164: 293-296
        • Hill A.D.
        • Pasik S.D.
        Wilderness medicine education in the time of social distancing and COVID-19.
        AEM Educ Train. 2020; 5: 111-115
        • Hayden E.M.
        • Davis C.
        • Clark S.
        • Joshi A.U.
        • Krupinski E.A.
        • Naik N.
        • et al.
        Telehealth in emergency medicine: a consensus conference to map the intersection of telehealth and emergency medicine.
        Acad Emerg Med. 2021; 28: 1452-1474