Material and Methods
The island of Tilos (Greece) has been chosen as the operative site of the "Tim-Tem" project. The local authorities take part in it under the guidance of the only medical doctor available on the island. The University of Pisa Italy (Dept. of Surgery, Post-graduate School of Emergency Surgery) represents the scientific and organisational site of the project. Tilos is a rocky Mediterraneains land( Dodecanneso) with a surface of 64 Km2 . It has two main villages, Megalochorio and Livadia (Harbour)which are 7 Km apart from each one another; both villages host military garrisons(with about 50 soldiers). From Livadia Harbour ferry boats sail regularly to Rodos(hospital centre; covering distance in 4h), Nissiros, Cos( hospital centre), Athens(high-quality medical specialities). In summertime the island also offers connections via hydrofoils. The bay of S. Antonio has a little harbour, which offers quick connections to the island of Cos. Tilos has its own heliport, which is open night and day. Mean flight times are: 20 min. to Rodos; 20 min. to Cos, 90 min. to Athens. The island has about 250-300 inhabitants and in tourist seasons the number amounts to 1000(with peaks of 2000 tourists in the period of July-August). The island physician and a nurse are responsible for the only medical aid on the island- that of Megalochorio and Livadia and they also provide to drug distribution. Currently, the great majority of emergencies are treated either in Rodos Hospital or in Athens Hospital. In the period of October-December 1997 and during the first months of 1998 a campaign has been held in Tilos in order to encourage the population to cooperate to the collection of clinical data. This information campaign has been carried out by the authorities of the island, who explained to the inhabitants the possible advantages of their collaboration to the project. In April - May 1998, during a three weeks period four physicians from the Department of Surgery of Pisa University visited Tilos implementing the Phase1 of the project. The screening of the population included: collection of anagraphical
data, clinical history, physical examination, blood pressure evaluation, ECG, neck, breast and abdomen sonography, and if necessary, doppler and color doppler sonography. ECG was performed with Cardiovox Device (Cardiovox P12 Aerotel LTD, Israel.) : this is a portable device that allows a twelve derivations ECG. Recorded ECG were immediately transmitted by phone to the remote Centre(CentroDiagnosticoItaliano lu Milano Italy) where a cardiologist furnished an immediate report by phone, sending by Fax the printed ECG. Sonography was performed using one fixed and one portable sonographic sevice, Fixed device was an echo color doppler (AU3 partner, Esaote Biomedica, Genua, Italy) with cardiologic software and the availability of three probes (3.5 MHz convex, 7.5-t0 MHz linear, 7.5 MHz transrectal) The portable device (SSD 500 Aloka) was equipped with a 3.5M Hz convex and a 1.5 MHz linear probe. In case of doubt in the interpretation the images, stored with the software present on the sonographic devices, were send by email, using sharewere softwares, to a senior sonographer in Pisa. All inhabitans data and the most relevant images have been inserted in a computerised database to be employed in case the resident gets involved in a serious emergency case. We started abasic computer training of medical and paramendical personnel; we started also a basic training of the physician on the use of sonographic devices.
Teleconsult, when needed, was performed with the remote centre (University of Pisa and CDI Milano) using phone, fax, videoconference, internet and email to transmit the images : the remote center is able to perform consult for all specialties(Medicine, Surgery, Radiology, Cardiology, Dermatology, etc...) Dermatological and radiological images were captured and inserted on line using a digital camera. The main limits to the transmission of data and of the images were represented by the absence on the island of ISDN phoneline.

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