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.