Audiovisual Consults by Paramedics to Reduce Hospital Transport After Low-Urgency Calls: Randomized Controlled Trial

Abstract

Introduction: The effect and subjective perception of audiovisual consults (AVCs) by paramedics with a distant physician in prehospital emergency care (PHEC) remain unexplained, especially in low-urgency calls. Objectives: The primary objective of the study was to evaluate the effect of AVCs by paramedics with a base physician on the rate of patients treated on site without the need of hospital transfer. The co-primary safety outcome was the frequency of repeated ambulance trips within 48 hours to the same patient. Secondary objective was the qualitative analysis of perception of the AVCs. Methods: During a six-week period, the dispatching center of Karlovy Vary Emergency Medical Service (EMS) randomized low-urgency events from a rural area (n = 791) to receive either a mandatory phone-call consult (PHONE), AVC (VIDEO), or performed by the paramedic crew in a routine manner, when phone-call consultation is for paramedic crew optional (CONTROL). Secondarily, the qualitative analysis of subjective perception of AVCs compared to consultation over the phone by the paramedic and consulting physician was performed. Results: Per-protocol analysis (PPA) was performed (CONTROL, n = 258; PHONE, n = 193; and VIDEO, n = 192) in addition to the intention-to-treat (ITT) analysis. Patients (PPA) in both mandatory consulted groups were twice as likely to be treated and left on site compared to the CONTROL (PHONE: OR = 2.07; 95% CI, 1.19 to 3.58; P = 0.01 or VIDEO: OR = 2.01; 95% CI, 1.15 to 3.49; P = .01). Repeated trips to patients treated and left on site in 48 hours occurred in three (8.6%) of 35 cases in the PHONE group and in eight (23.5%) of 34 cases in the VIDEO group. Conclusions: The AVCs of the emergency physician by paramedics was not superior to the mandatory conventional phone call in increasing the proportion of patients treated and left at home after a low-urgency call. The AVC improved the subjective feelings of safety by physicians, but not the satisfaction of patients or paramedics, and may lead to an increased need of repeated trips.

Contribution of Live Video to Physicians’ Remote Assessment of Suspected COVID-19 Patients in an Emergency Medical Communication Centre: A Retrospective Study and Web-Based Survey

“…As in the Danish study, the causes of failure or difficulties were mainly related to the users’ handling of the smartphones or non-receipt/difficulty in accessing the SMS URL link. As with all published studies on the subject [ 17 , 27 , 28 , 30 ], acceptance of the video was excellent by both callers and physicians and was also considered easy to use.…”

“…However, this study does not prove an advantage of live video, as there was no control group for this subgroup. Furthermore, another study concluded in the COVID-19 context that the use of live video by emergency physicians was not superior to the use of the telephone alone [ 28 ]. Nevertheless, it seems that nurses/paramedics have difficulty in making an adequate “no transport” decision when they are sent to the patient [ 29 ].…”

Contribution of Live Video to Physicians’ Remote Assessment of Suspected COVID19 Patients in an Emergency Medical Communication Centre: A Retrospective Study and Web-Based Survey

“…However, this study does not prove an advantage of live video, as there was no control group for this subgroup. Furthermore, another study concluded in COVID19 context that the use of live video by emergency physicians was not superior to the use of the telephone alone [28]. Nevertheless, it seems that nurses/paramedics have difficulty in making an adequate "no transport" decision when they are sent to the patient [29].…”

Evaluating the utility of telehealth in emergency medicine

“…Examples of virtual forward triage services that have been evaluated include small studies in the rural Czech Republic 6 and Denmark 7 demonstrated ‘treated and left on site’ rates of 16% and 29%, respectively, with mandated audio‐visual consult with emergency physicians. In the case of the Czech study, being treated and left at the scene following consultation was associated with a large proportion (19.6%) requiring repeat ambulance callout within 48 h.…”