Employment of Telemedicine in Emergency Medicine

Czaplik, Michael; Bergrath, Sebastian; Rossaint, Rolf; Thelén, Sebastian; Brodziak, Tadeusz; Valentín, B.; Hirsch, F.; Beckers, Stefan; Brokmann, Jörg Christian

doi:10.3414/me13-01-0022

Cited by 48 publications

(9 citation statements)

References 18 publications

(16 reference statements)

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“…In cases of ACS, an established algorithm could be displayed on the workstation to support the tele-EMS physician in guideline-adherent therapy recommendations including the steps needed to diagnose and dose medication as recommended by national and international guidelines. A detailed technical description of the telemedicine system was already described elsewhere [16]. …”

Section: Methodsmentioning

confidence: 99%

Treatment of Acute Coronary Syndrome by Telemedically Supported Paramedics Compared With Physician-Based Treatment: A Prospective, Interventional, Multicenter Trial

Brokmann¹,

Conrad²,

Rossaint³

et al. 2016

J Med Internet Res

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BackgroundPrehospital treatment of acute coronary syndrome (ACS) in German emergency medical services (EMSs) is reserved for EMS physicians due to legal issues.ObjectiveThe objective of this prospective, interventional, multicenter trial was to evaluate the quality of telemedically-delegated therapy and the possible complications in patients with ACS.MethodsAfter approval by the ethics committee and trial registration, a one-year study phase was started in August 2012 with 5 ambulances, telemedically equipped and staffed with paramedics, in 4 German EMS districts. The paramedics could contact an EMS-physician–staffed telemedicine center. After initiation of an audio connection, real-time data transmission was automatically established. If required, 12-lead electrocardiogram (ECG) and still pictures could be sent. Video was streamed from inside each ambulance. All drugs, including opioids, were delegated to the paramedics based on standardized, predefined algorithms. To compare telemedically-delegated medication and treatment in ACS cases with regular EMS missions, a matched pair analysis with historical controls was performed.ResultsTeleconsultation was performed on 150 patients having a cardiovascular emergency. In 39 cases, teleconsultation was started due to suspected ACS. No case had a medical complication. Correct handling of 12-lead ECG was performed equally between the groups (study group, n=38 vs control group, n=39, P>.99). There were no differences in correct handling of intravenous administration of acetylsalicylic acid, heparin, or morphine between both the groups (study group vs control group): acetylsalicylic acid, n=31 vs n=33, P=.73; unfractionated heparin, n=34 vs n=33, P>.99; morphine, n=29 vs n=27, P=.50. The correct handling of oxygen administration was significantly higher in the study group (n=29 vs n=18, P=.007).ConclusionsTelemedical delegation of guideline conform medication and therapy by paramedics in patients with ACS and was found to be feasible and safe. The quality of guideline-adherent therapy was not significantly different in both the groups except for the correct administration of oxygen, which was significantly higher in the study group.Trial RegistrationClinicaltrials.gov NCT01644006; http://clinicaltrials.gov/ct2/show/NCT01644006 (Archived by WebCite at http://www.webcitation.org/6mPam3eDy).

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Section: Methodsmentioning

confidence: 99%

Treatment of Acute Coronary Syndrome by Telemedically Supported Paramedics Compared With Physician-Based Treatment: A Prospective, Interventional, Multicenter Trial

Brokmann¹,

Conrad²,

Rossaint³

et al. 2016

J Med Internet Res

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“…The worldwide unique EMS teleconsultation system in Aachen was optimized and evaluated between 2009 and 2013 in nearly 1000 patient cases. The system appeared functional and was highly appreciated by the paramedics in Aachen [ 27 ]. In the majority of cases it reduced the requirement of EMS physicians and also enabled immediate medical advice to be given by EMS physicians to the paramedics.…”

Section: Discussionmentioning

confidence: 99%

“…All routinely used EMS ambulances in Aachen are equipped and connected to a specific teleconsultation center. This system consists of four sections: the teleconsultation center, a server infrastructure, a fix-mounted in-vehicle PC and a portable autonomous communication device called the “PeeqBOX,” as previously described [ 26 , 27 ].…”

Section: Methodsmentioning

confidence: 99%

Telemedical support for prehospital Emergency Medical Service (TEMS trial): study protocol for a randomized controlled trial

Stevanovic

Beckers

Czaplik

et al. 2017

Trials

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BackgroundIncreasing numbers of emergency calls, shortages of Emergency Medical Service (EMS), physicians, prolonged emergency response times and regionally different quality of treatment by EMS physicians require improvement of this system. Telemedical solutions have been shown to be beneficial in different emergency projects, focused on specific disease patterns. Our previous pilot studies have shown that the implementation of a holistic prehospital EMS teleconsultation system, between paramedics and experienced tele-EMS physicians, is safe and feasible in different emergency situations. We aim to extend the clinical indications for this teleconsultation system. We hypothesize that the use of a tele-EMS physician is noninferior regarding the occurrence of system-induced patient adverse events and superior regarding secondary outcome parameters, such as the quality of guideline-conforming treatment and documentation, when compared to conventional EMS-physician treatment.Methods/designThree thousand and ten patients will be included in this single-center, open-label, randomized controlled, noninferiority trial with two parallel arms. According to the inclusion criteria, all emergency cases involving adult patients who require EMS-physician treatment, excluding life-threatening cases, will be randomly assigned by the EMS dispatching center into two groups. One thousand five hundred and five patients in the control group will be treated by a conventional EMS physician on scene, and 1505 patients in the intervention group will be treated by paramedics who are concurrently instructed by the tele-EMS physicians at the teleconsultation center. The primary outcome measure will include the rate of treatment-specific adverse events in relation to the kind of EMS physician used. The secondary outcome measures will record the specific treatment-associated quality indicators.DiscussionThe evidence underlines the better quality of service using telemedicine networks between medical personnel and medical experts in prehospital emergency care, as well as in other medical areas. The worldwide unique EMS teleconsultation system in Aachen has been optimized and evaluated in pilot studies and subsequently integrated into routine use for a broad spectrum of indications. It has enabled prompt, safe and efficient patient treatment with optimized use of the “resource” EMS physician. There is, however, a lack of evidence as to whether the advantages of the teleconsultation system can be replicated in wider-ranging EMS-physician indications (excluding life-threatening emergency calls).Trial registrationClinicalTrials.gov, identifier: NCT02617875. Registered on 24 November 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1781-2) contains supplementary material, which is available to authorized users.

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“…3,4 Almanya dâhil birçok Avrupa ülkesi, hem EMS hekimlerinin hem de paramediklerin hastane öncesinde acil yanıt verdiği ikili bir sistem kullanmaktadır. 5 Ülkemizde ise son yıllarda hem 'doktorlu ekipler' hem de 'paramedikli, acil tıp teknisyenli ekipler' bulunduğundan her iki modelin de uygulandığı görülmektedir. 6 Sağlık hizmetinde özellikle de acil durumlarda etkili iletişim hayati ve önemlidir.…”

Section: Paramediklerin Danışman Hekimdenunclassified

Paramedic's Asking for Medicine Approval Through Phone from the Consultant

Bayır¹,

Demir²

2019

Turkiye Klinikleri J Health Sci

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Employment of Telemedicine in Emergency Medicine

Cited by 48 publications

References 18 publications

Treatment of Acute Coronary Syndrome by Telemedically Supported Paramedics Compared With Physician-Based Treatment: A Prospective, Interventional, Multicenter Trial

Treatment of Acute Coronary Syndrome by Telemedically Supported Paramedics Compared With Physician-Based Treatment: A Prospective, Interventional, Multicenter Trial

Telemedical support for prehospital Emergency Medical Service (TEMS trial): study protocol for a randomized controlled trial

Paramedic's Asking for Medicine Approval Through Phone from the Consultant

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