Tele-EMS physicians improve life-threatening conditions during prehospital emergency missions

Abstract

Almost seven years ago, a telemedicine system was established as an additional component of the city of Aachen’s emergency medical service (EMS). It allows paramedics to engage in an immediate consultation with an EMS physician at any time. The system is not meant to replace the EMS physician on the scene during life-threatening emergencies. The aim of this study was to analyze teleconsultations during life-threatening missions and evaluate whether they improve patient care. Telemedical EMS (tele-EMS) physician consultations that occurred over the course of four years were evaluated. Missions were classified as involving potentially life-threatening conditions based on at least one of the following criteria: documented patient severity score, life-threatening vital signs, the judgement of the onsite EMS physician involved in the mission, or definite life-threatening diagnoses. The proportion of vital signs indicating that the patient was in a life-threatening condition was analyzed as the primary outcome at the start and end of the tele-EMS consultation. The secondary outcome parameters were the administered drug doses, tracer diagnoses made by the onsite EMS physicians during the missions, and quality of the documentation of the missions. From January 2015 to December 2018, a total of 10,362 tele-EMS consultations occurred; in 4,293 (41.4%) of the missions, the patient was initially in a potentially life-threatening condition. Out of those, a total of 3,441 (80.2%) missions were performed without an EMS physician at the scene. Records of 2,007 patients revealed 2,234 life-threatening vital signs of which 1,465 (65.6%) were remedied during the teleconsultation. Significant improvement was detected for oxygen saturation, hypotonia, tachy- and bradycardia, vigilance states, and hypoglycemia. Teleconsultation during missions involving patients with life-threatening conditions can significantly improve those patients' vital signs. Many potentially life-threatening cases could be handled by a tele-EMS physician as they did not require any invasive interventions that needed to be performed by an onsite EMS physician. Diagnoses of myocardial infarction, cardiac pulmonary edema, or malignant dysrhythmias necessitate the presence of onsite EMS physicians. Even during missions involving patients with life-threatening conditions, teleconsultation was feasible and often accessed by the paramedics.

Telemedicine for emergency patients in pre-hospital care: A scoping review

“…Vital signs are indicators of certain diseases such as infection, respiratory problems, and heart diseases. According to Schröder et al 19 , about two-thirds of patients with life-threatening vital signs can be treated via teleconsultation in the pre-hospital setting, and this is frequently done without the use of invasive procedures. If necessary, advanced airway management such as intubation can be aided with telemedicine using additional devices like Google Glass incorporated with video laryngoscope and two-way audio-visual for expert consultation.…”

“…23 After conducting patients' medical condition and history assessment, physical examination with vital sign monitoring, and other diagnostic procedures, EMS paramedics can either tele-transmit the result to a physician and get notified with text or audio for further advice for diagnosis or therapy 24 , or use audio and video features where they can connect virtually to physicians. [16][17][18][19]22,24,25,27 Catapan et al 33 found that video teleconsultation has numerous benefits. A few of the benefits are the ability to diagnose accurately, similar to face-to-face, the ability to deliver care without moving the patient, and the ability to adapt to current time constraints for health care.…”

“…The implementation of NCD management strategies is essential to the achievement of both the worldwide aim of a 25 percent relative decline in premature deaths due by NCDs by 2025 and the Sustainable Development Goal (SDG) target of a 33 percent drop by 2030 (Table 3). 30 Other emergency conditions discussed in included studies were pain-related diseases (n=1) 22 , pediatric difficult airway (n=1) 23 , and unspecified emergency conditions (n=5) 18,19,21,25,28 .…”

Digitale Systeme zur Unterstützung von präklinischen Notfalleinsätzen

“…Die föderalistische Struktur des deutschen Rettungswesens hat in der Vergangenheit eher die Existenz von "Insellösungen" gefördert als eine flächendeckende, einheitliche und integrierte Digitalisierung und Vernetzung [24]. Das in Literatur und Praxis gängige Verständnis von "Informationstechnik im Rettungsdienst" bezieht sich hierzulande neben der Einsatzdokumentation hauptsächlich auf den Bereich des E-Health und die Realisierung einer telemedizinischen Zuschaltung des Notarztes über audiovisuelle Kommunikation zur Assistenz des Rettungsteams vor Ort ("Telenotarzt") [28,32]. Andere Anwendungsfälle, in denen IKT die Arbeit von Rettungsdienstmitarbeitern und Notärzten im Einsatz wie oben illustriert unterstützen können (sowohl medizinisch als auch organisatorisch), finden bislang eher nachrangig Beachtung.…”

The Pathophysiology and Management of Hemorrhagic Shock in the Polytrauma Patient

“…Furthermore, several potentially life-threatening cases could be handled by a tele-EMS physician as they did not require any invasive interventions that needed to be performed by an onsite EMS physician. Consequently, telemedicine systems establish a higher quality of emergency medical care at an earlier stage [ 88 ].…”