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A Telemedicine Case Series for Acute Medical Emergencies in Greenland: A Model for Austere Environments.

Background: Greenland is a vast country, with immense geographical distances and often extreme weather conditions. Specialized health care is limited to larger cities, and qualified medical care is not always immediately available in rural areas. Telemedicine infrastructure is available throughout the country. Purpose: The purpose of this study was to identify the role of telemedicine in the diagnosis and treatment of acute medical emergencies in remote settlements. Materials and Methods: All medical emergencies were screened from 2015 to 2016 in remote settlements of the Avannaa Health Region in Northwest Greenland, and cases in which telemedicine was utilized were identified. Results: Three illustrative cases were identified. Diagnoses were severe asthma, bilateral pneumonia, and heart failure. All three patients were accurately diagnosed through a telemedical consultation, and early treatment was initiated. In two out of three patients, acute medical evacuation by air ambulance was avoided, and the third patient was stabilized by the time an air ambulance arrived. Conclusions: Telemedicine allows for the accurate diagnosis of acute medical emergencies in remote settlements of Greenland and facilitates timely initiation of treatment. This may reduce morbidity and mortality of acute medical illness. In addition, telemedicine may aid in the clinical decision-making on whether or not to arrange for medical evacuation. Avoiding unnecessary medical evacuations reduces cost and risk to air ambulance crews. In addition, telemedicine allows for close monitoring of the patient until the air ambulance arrives. Telemedicine also ensures diagnostic and treatment options when medical evacuation is impossible due to extreme weather conditions. From a global perspective, telemedicine may increase the availability and quality of health care in remote areas and reduce health inequalities between remote and urban areas.