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To the Editor: Telemedicine is a promising expansion of health care delivery.¹ Johnston Atoll, a tiny coral archipelago 1300 km southwest of Hawaii, would appear ideally suited for its use. Although Johnston Atoll is a US National Wildlife Refuge, it is better known as a site for chemical weapons storage and destruction, with about 300 military and 900 civilian residents.

The Johnston Atoll health clinic is staffed by primary care physicians, with basic laboratory, electrocardiographic, and plain film radiologic capability but otherwise limited diagnostic services. Persons with illnesses or injuries not manageable at the clinic are evacuated to Hawaii. Urgent evacuations typically require the dispatch of a C-141 military jet aircraft from Hickam Air Force base in Hawaii. The island population averages 10 to 15 urgent evacuations per year, at a cost of approximately US $40,000 per immediate evacuation.

Methods

To prevent unnecessary evacuations, a program to obtain specialist consultation by . . . [Full Text of this Article]

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