Prehospital digital photography and automated image transmission in an emergency medical service – an ancillary retrospective analysis of a prospective controlled trial

Abstract

BackgroundStill picture transmission was performed using a telemedicine system in an Emergency Medical Service (EMS) during a prospective, controlled trial. In this ancillary, retrospective study the quality and content of the transmitted pictures and the possible influences of this application on prehospital time requirements were investigated.MethodsA digital camera was used with a telemedicine system enabling encrypted audio and data transmission between an ambulance and a remotely located physician. By default, images were compressed (jpeg, 640 x 480 pixels). On occasion, this compression was deactivated (3648 x 2736 pixels). Two independent investigators assessed all transmitted pictures according to predefined criteria. In cases of different ratings, a third investigator had final decision competence. Patient characteristics and time intervals were extracted from the EMS protocol sheets and dispatch centre reports.ResultsOverall 314 pictures (mean 2.77 ± 2.42 pictures/mission) were transmitted during 113 missions (group 1). Pictures were not taken for 151 missions (group 2). Regarding picture quality, the content of 240 (76.4%) pictures was clearly identifiable; 45 (14.3%) pictures were considered “limited quality” and 29 (9.2%) pictures were deemed “not useful” due to not/hardly identifiable content. For pictures with file compression (n = 84 missions) and without (n = 17 missions), the content was clearly identifiable in 74% and 97% of the pictures, respectively (p = 0.003). Medical reports (n = 98, 32.8%), medication lists (n = 49, 16.4%) and 12-lead ECGs (n = 28, 9.4%) were most frequently photographed. The patient characteristics of group 1 vs. 2 were as follows: median age – 72.5 vs. 56.5 years, p = 0.001; frequency of acute coronary syndrome – 24/113 vs. 15/151, p = 0.014. The NACA scores and gender distribution were comparable. Median on-scene times were longer with picture transmission (26 vs. 22 min, p = 0.011), but ambulance arrival to hospital arrival intervals did not differ significantly (35 vs. 33 min, p = 0.054).ConclusionsPicture transmission was used frequently and resulted in an acceptable picture quality, even with compressed files. In most cases, previously existing “paper data” was transmitted electronically. This application may offer an alternative to other modes of ECG transmission. Due to different patient characteristics no conclusions for a prolonged on-scene time can be drawn. Mobile picture transmission holds important opportunities for clinical handover procedures and teleconsultation.

A systematic review of prehospital telehealth utilization

“…Table 1 summarizes the primary data table, including the condition type, geographic region, and method for telehealth delivery. 8–75…”

Impact de la télémédecine sur la régulation d'un malaise

“…La télémédecine en préhospitalier est en plein développement. De plus en plus d'études évaluent sa faisabilité et l'intérêt de sa réalisation au sein des ambulances [6][7][8][9]. Elles ont montré l'intérêt des ECG télétransmis notamment sur la détection plus précoce de SCA de présentation atypique ou dans des milieux plus compliqués d'accès comme dans les centres pénitenciers [9].…”

Making Emergency Care in Rural Areas Fit for Future: Protocol for multi-method and multi-perspective longitudinal analysis and control group study (Preprint)

“…Telemedicine in emergency medical care, such as a TEP system, can contribute to ensuring high-quality medical care in rural areas [31,32]. In emergency services with moving vehicles, however, the standard requirements for telemedicine are much higher than in areas where data transfer solely runs over local networks (eg, over a local area network or Wi-Fi) between physicians in the same field [33][34][35]. Even the technical aspect of data connection via mobile transfer media is challenging in rural areas.…”