Advancing technologies in clinical medicine: the Yale-Mount Everest telemedicine project.

In the spring of 1999, just before the monsoon descended upon the Himalayas, physician-climbers and scientists brought a novel telemedicine program from the Yale School of Medicine to the remote and harsh environment of the Base Camp of Mount Everest. They implemented and tested new telemedicine technologies in a high-altitude environment well-known to push humans to the limits of their physiologic adaptability. Telemedicine, which "utilizes electronic information and communications technologies to provide and support health care when distance separates the participants" [1] was rigorously evaluated in the Himalayas. The high-altitude environment of Everest Base Camp, at 17,500 feet above sea level, set an ideal stage for evaluating telemedicine's provision of advanced medical care in an isolated and distant location. The atmospheric conditions on the mountain stresses the physiology of climbers considerably in their quest for the summit. Taking into consideration the oxygen cascade from atmosphere to mitochondria, it is truly remarkable that elite climbers can respirate sufficiently to travel at these extremely high-altitudes at all. By quantitatively considering the requisite factors for effective respiration, such as the convective ventilation from atmosphere to alveolus, diffusion across the gasblood barrier, uptake by hemoglobin in pulmonary capillaries, convective flow of oxygenated blood to peripheral capillaries, gas exchange between hemoglobin and tissues, and finally the diffusion of oxygen to mitochondria for utilization in the electron transport system, it has been calculated that at the summit of Mount Everest, a climber breathes oxygen that is very near the absolute lowest partial pressure tolerable for a human [2]. Extreme demands, both physiological and environmental,