Images and Asynchronous File Transfer - Best Practices

Sending information, documentation, files, and particularly images (sometime of other files) related to casualty care before synchronous TC is a best practice because it allows the RE to consider the context of the consultation and to begin organizing thoughts ahead of the TC.

1. Ideally, send images of patients and care context to REs before starting a TC. This helps the remote expert to provide “consultation in context” and avoids recommendations that are discordant with local capabilities. Useful images include:

- Flowsheet and other documentation like the TC script
- Patient wounds
- Imaging – pictures or video of collected imaging studies (ultrasound, x-ray, etc.)
- Whole patient
- Special equipment
- Facility or aid station

2. Image quality is important (Figure 1). Photographs that are less than 500KB are often of insufficient quality to convey information to a remote consultant.

3. Be mindful of patient privacy and operational security (OPSEC):

- Images should be compliant with HIPAA. Do not include personally identifiable information in the image like full face images and unique tattoos unless they are essential for communicating injury or disease state to the remote expert in which case the image must be encrypted before sending. Best practice is to use the GTP to send these images.
- Similarly, do not include images of the environment that could cause a safety issue for the local care team by exposing their location or affiliation or other information that could be used against them (consider, for example, media implications of the image).

4. Note that digital photos may also contain “geotags” which can provide an exact location where it was taken. This feature can be disabled if there are security concerns. The easiest way to do so is to disable location services on your device before taking pictures.