The treatment of the acutely ill patients represents a severe problem in each country: this fact is particularly true in all those regions that appear geographically isolated, and in which medical aids are reachable only with great difficulties: these sites are called 'Arural areas'. In most cases, not only the treatment of severe acute diseases represents a problem, but also the treatment of chronic diseases or of minor diseases that require in most instances the transfer of the patient. The most important factors to evaluate are : the knowledge of high risk patients, a good system of dispatching and of transport of
patients and a system of telemedicine that allows both the possibility of guiding the treatment of the acute patient and the possibility of helping in the treatment of other, not severe, pathologies. The aim of this work is to improve the care of people living on islands and islands, creating a model exportable to other rural areas. The project, applied to the island of Tilos (Greece), is divided in three phases.

Phase1 : clinical and ecographic mapping of the local population;

Phase2 : Access to "Dispatch System";

Phase3 : Tele-medicine.

Phase1 : .Characteristics and responsibilities of "Tim-Tem" partners. Procedures for the transmission and recording of data. Filing of clinical data. Organisational "pre-phase". Operative phase: Screening of the population( clinical, sonographic, cardiologic). Training of the medical personnel on the island. Transmission of data via fax, email, Internet, Teleconsultation(preliminary phase). Deadline June 1998
Phase2 : "Dispatch System": implementation of a dispatch center and a dispatch system in collaboration with the hospital of the country, The System is already available and applicable by using multiple files on a computerised programme  modulated answer/question system). Dealing with emergencies, also directs us to the most appropriate medical treatment,(giving us the best timing for it) . It can be employed by para-medical personnel as well. Training is necessary. It allows us to avoid high costs and over-use of helicopters. In this phase the implementation of an operative plan for Disaster First Aid is provided. Deadline is December 1998
Phase3 : Operative Tele-medicine. Areas of application depending on the needs really observed and on the means available on the island. The most difficult factor is represented by the training of the personnel of the island. Up to now the only Hardwares available on the island have been the computers of our group. In an early phase the definitive organization of a system of teleconsule with transmission of data and fixed image is provided:in a later phase the transmission of images in real time, also from the field in case of trauma, is provided. Deadline December 1999.
This paper is a preliminary report of the results obtained during the first phase of the project and carried out on Tilos island
Dodecannese Greek

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