Prehospital Telemedical Emergency Management of Severely Injured Trauma Patients

Eder, Patrick Andreas; Reime, Birgit; Wurmb, Thomas; Kippnich, Uwe; Shammas, Layal; Rashid, Asarnusch

doi:10.1055/s-0039-1681089

Cited by 24 publications

(12 citation statements)

References 90 publications

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“…Two narrative synthesis reviews looked at the role of telehealth in the management of trauma patients. 52,53 The more recent review focused specifically on pre-hospital trauma care. 52 The authors identified telemedical assistance by real-time telemetry and telemedical pre-hospital notification as complementary applications of the technology but concluded that evidence of effectiveness in this setting remains limited.…”

Section: Trauma Reviewsmentioning

confidence: 99%

“…55 The use of telehealth in ambulances allows service models based on early initiation of diagnosis and/or treatment by paramedics as well as triage to divert less seriously ill patients away from EDs when clinically appropriate. 52,58,59 However, barriers remain to the widespread adoption of telehealth technology in some settings. Other mitigation interventions, including improved co-ordination between services, 46 are discussed in the relevant sections of Chapter 3 (see Mitigation studies).…”

Section: Implications For Service Deliverymentioning

confidence: 99%

See 1 more Smart Citation

Effects of increased distance to urgent and emergency care facilities resulting from health services reconfiguration: a systematic review

Chambers

Cantrell

Baxter

et al. 2020

Health Serv Deliv Res

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Background Service reconfigurations sometimes increase travel time and/or distance for patients to reach their nearest hospital or other urgent and emergency care facility. Many communities value their local services and perceive that proposed changes could worsen outcomes for patients. Objectives To identify, appraise and synthesise existing research evidence regarding the outcomes and impacts of service reconfigurations that increase the time and/or distance for patients to reach an urgent and emergency care facility. We also aimed to examine the available evidence regarding associations between distance to a facility and outcomes for patients and health services, together with factors that may influence (moderate or mediate) these associations. Data sources We searched seven bibliographic databases in February 2019. The search was supplemented by citation-tracking and reference list checking. A separate search was conducted to identify the current systematic reviews of telehealth to support urgent and emergency care. Methods Brief inclusion and exclusion criteria were as follows: (1) population – adults or children with conditions that required emergency treatment; (2) intervention/comparison – studies comparing outcomes before and after a service reconfiguration, which affects the time/distance to urgent and emergency care or comparing outcomes in groups of people travelling different distances to access urgent and emergency care; (3) outcomes – any patient or health system outcome; (4) setting – the UK and other developed countries with relevant health-care systems; and (5) study design – any. The search results were screened against the inclusion criteria by one reviewer, with a 10% sample screened by a second reviewer. A quality (risk-of-bias) assessment was undertaken using The Joanna Briggs Institute Checklist for Quasi-Experimental Studies. We performed a narrative synthesis of the included studies and assessed the overall strength of evidence using a previously published method. Results We included 44 studies in the review, of which eight originated from the UK. For studies of general urgent and emergency care populations, there was no evidence that reconfiguration that resulted in increased travel time/distance affected mortality rates. By contrast, evidence of increased risk was identified from studies restricted to patients with acute myocardial infarction. Increases in mortality risk were most obvious within the first 1–4 years after reconfiguration. Evidence for other conditions was inconsistent or very limited. In the absence of reconfiguration, evidence mainly from cohort studies indicated that increased travel time or distance is associated with increased mortality risk for the acute myocardial infarction and trauma populations, whereas for obstetric emergencies the evidence was inconsistent. We included 12 systematic reviews of telehealth. Meta-analyses suggested that telehealth technologies can reduce time to treatment for people with stroke and ST elevation myocardial infarction. Limitations Most studies came from non-UK settings and many were at high risk of bias because there was no true control group. Most review processes were carried out by a single reviewer within a constrained time frame. Conclusions We found no evidence that increased distance increases mortality risk for the general population of people requiring urgent and emergency care, although this may not be true for people with acute myocardial infarction or trauma. Increases in mortality risk were most likely in the first few years after reconfiguration. Future work Research is needed to better understand how health systems plan for and adapt to increases in travel time, to quantify impacts on health system outcomes, and to address the uncertainty about how risk increases with distance in circumstances relevant to UK settings. Study registration This study is registered as PROSPERO CRD42019123061. Funding This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 31. See the NIHR Journals Library website for further project information.

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Section: Trauma Reviewsmentioning

confidence: 99%

Section: Implications For Service Deliverymentioning

confidence: 99%

Effects of increased distance to urgent and emergency care facilities resulting from health services reconfiguration: a systematic review

Chambers

Cantrell

Baxter

et al. 2020

Health Serv Deliv Res

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“…Successful telemedical approaches already exist in the preclinical care of severely injured people [ 17 , 18 ]. A national program for telemedicine consultation after neurotrauma could eliminate the need for 68% of patient transfers [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Central COVID-19 Coordination Centers in Germany: Description, Economic Evaluation, and Systematic Review

Schopow¹,

Osterhoff²,

Dercks³

et al. 2021

JMIR Public Health Surveill

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Background During the COVID-19 pandemic, Central COVID-19 Coordination Centers (CCCCs) have been established at several hospitals across Germany with the intention to assist local health care professionals in efficiently referring patients with suspected or confirmed SARS-CoV-2 infection to regional hospitals and therefore to prevent the collapse of local health system structures. In addition, these centers coordinate interhospital transfers of patients with COVID-19 and provide or arrange specialized telemedical consultations. Objective This study describes the establishment and management of a CCCC at a German university hospital. Methods We performed economic analyses (cost, cost-effectiveness, use, and utility) according to the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) criteria. Additionally, we conducted a systematic review to identify publications on similar institutions worldwide. The 2 months with the highest local incidence of COVID-19 cases (December 2020 and January 2021) were considered. Results During this time, 17.3 requests per day were made to the CCCC regarding admission or transfer of patients with COVID-19. The majority of requests were made by emergency medical services (601/1068, 56.3%), patients with an average age of 71.8 (SD 17.2) years were involved, and for 737 of 1068 cases (69%), SARS-CoV-2 had already been detected by a positive polymerase chain reaction test. In 59.8% (639/1068) of the concerned patients, further treatment by a general practitioner or outpatient presentation in a hospital could be initiated after appropriate advice, 27.2% (291/1068) of patients were admitted to normal wards, and 12.9% (138/1068) were directly transmitted to an intensive care unit. The operating costs of the CCCC amounted to more than €52,000 (US $60,031) per month. Of the 334 patients with detected SARS-CoV-2 who were referred via EMS or outpatient physicians, 302 (90.4%) were triaged and announced in advance by the CCCC. No other published economic analysis of COVID-19 coordination or management institutions at hospitals could be found. Conclusions Despite the high cost of the CCCC, we were able to show that it is a beneficial concept to both the providing hospital and the public health system. However, the most important benefits of the CCCC are that it prevents hospitals from being overrun by patients and that it avoids situations in which physicians must weigh one patient’s life against another’s.

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“…This systematic review examined whether clinical decisions are associated with telemedicine use in a prehospital emergency medical setting. To date, feasibility studies, simulated randomized controlled trials [9,26], and systematic reviews [30,32,42] on telemedicine fail to adequately address the role of decision making in patient outcomes. It is difficult to access information on (1) how telemedicine has been implemented and if any protocols exist and (2) measurements of clinical outcomes before versus after telemedicine implementation.…”

Section: Discussionmentioning

confidence: 99%

“…Simulation trials have previously been included in systematic reviews on telemedicine applications in a prehospital setting [30][31][32][33]. This systematic review intended to examine telemedicine use in real-life scenarios to better understand its clinical value and limitations, as it is yet to be embedded into widespread routine use.…”

Section: Study Selectionmentioning

confidence: 99%

Decision Support Capabilities of Telemedicine in Emergency Prehospital Care: Systematic Review (Preprint)

Kim¹,

Groombridge²,

Romero³

et al. 2020

Preprint

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UNSTRUCTURED To systematically review whether the clinical outcomes achieved favours telemedicine decision support for medical interventions during prehospital care. Design: systematic review of peer-reviewed journal articles. Data sources: Searches of seven databases and in relevant reviews. Eligibility criteria: Studies were included that covered telemedicine based on data/information sharing and communication with the objective of support for medical decisions (e.g. diagnosis, treatment, receiving hospital decision) in a prehospital emergency setting. Simulation studies and paediatric populations were excluded. Methods: The procedures in this review followed the PRISMA statement. ROBINS-I was used for the assessment of risk of bias. The results were synthesised based on predefined aspects of medical decisions that are made in a prehospital setting which include diagnostic decision support, receiving facility decisions, and medical directions for treatment. All data extractions were done by at least two reviewers independently. Results: Out of 42 full-text reviews, seven were found eligible. Diagnostic support and medical direction/decision for treatments were often reported. A majority of the articles described the clinical value of having access to remote experts without robust quantitative data. Most telemedicine solutions were evaluated as a feasibility or short-term preliminary study. In general, the results were positive for telemedicine use, however biases, due to confounding factors pre-intervention, and a lack of documentation on quality assurance and protocol for telemedicine activation, makes it difficult to determine the direct effect on patient outcomes. Conclusions: The information-sharing capacity of telemedicine enables access to remote experts to support medical decisions being made at scene or in prolonged field care. The influence of human and technology factors on patient care is poorly understood and documented.

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Prehospital Telemedical Emergency Management of Severely Injured Trauma Patients

Cited by 24 publications

References 90 publications

Effects of increased distance to urgent and emergency care facilities resulting from health services reconfiguration: a systematic review

Effects of increased distance to urgent and emergency care facilities resulting from health services reconfiguration: a systematic review

Central COVID-19 Coordination Centers in Germany: Description, Economic Evaluation, and Systematic Review

Decision Support Capabilities of Telemedicine in Emergency Prehospital Care: Systematic Review (Preprint)

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