Telemedicine to a Moving Ambulance Improves Outcome After Trauma in Simulated Patients

Charash, William E.; Caputo, Michael; Clark, Harry; Callas, Peter W.; Rogers, Frederick B.; Crookes, Bruce; Alborg, Monica S.; Ricci, Michael A.

doi:10.1097/ta.0b013e31821e4690

Cited by 32 publications

(24 citation statements)

References 8 publications

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“…Projects with similar goals have been conducted for acute stroke and major trauma; however, their telemedical approaches were only researched using simulation, and the concepts were not transferred into clinical practise [20,21]. Furthermore, these projects were limited to specific emergency situations.…”

Section: Discussionmentioning

confidence: 99%

Implementation phase of a multicentre prehospital telemedicine system to support paramedics: feasibility and possible limitations

Bergrath

Czaplik

Rossaint

et al. 2013

Scand J Trauma Resusc Emerg Med

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BackgroundLegal regulations often limit the medical care that paramedics can provide. Telemedical solutions could overcome these limitations by remotely providing expert support. Therefore, a mobile telemedicine system to support paramedics was developed. During the implementation phase of this system in four German emergency medical services (EMS), the feasibility and possible limitations of this system were evaluated.MethodsAfter obtaining ethical approval and providing a structured training program for all medical professionals, the system was implemented on three paramedic-staffed ambulances on August 1st, 2012. Two more ambulances were included subsequently during this month. The paramedics could initiate a consultation with EMS physicians at a teleconsultation centre. Telemedical functionalities included audio communication, real-time vital data transmission, 12-lead electrocardiogram, picture transmission on demand, and video streaming from a camera embedded into the ceiling of each ambulance. After each consultation, telephone-based debriefings were conducted. Data were retrieved from the documentation protocols of the teleconsultation centre and the EMS.ResultsDuring a one month period, teleconsultations were conducted during 35 (11.8%) of 296 emergency missions with a mean duration of 24.9 min (SD 12.5). Trauma, acute coronary syndromes, and circulatory emergencies represented 20 (57%) of the consultation cases. Diagnostic support was provided in 34 (97%) cases, and the administration of 50 individual medications, including opioids, was delegated by the teleconsultation centre to the paramedics in 21 (60%) missions (range: 1–7 per mission). No medical complications or negative interpersonal effects were reported. All applications functioned as expected except in one case in which the connection failed due to the lack of a viable mobile network.ConclusionThe feasibility of the telemedical approach was demonstrated. Teleconsultation enabled early initiation of treatments by paramedics operating under the real-time medical direction. Teleconsultation can be used to provide advanced care until the patient is under a physician’s care; moreover, it can be used to support the paramedics who work alone to provide treatment in non-life-threatening cases. Non-availability of mobile networks may be a relevant limitation. A larger prospective controlled trial is needed to evaluate the rate of complications and outcome effects.

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Section: Discussionmentioning

confidence: 99%

Implementation phase of a multicentre prehospital telemedicine system to support paramedics: feasibility and possible limitations

Bergrath

Czaplik

Rossaint

et al. 2013

Scand J Trauma Resusc Emerg Med

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“…16,17 To the best of our knowledge, reports on remote ambulanced-based assessment of stroke severity are limited to one project, the mobile TeleBAT. Similar to our study, TeleBAT primarily tested the feasibility of stroke evaluation and assessment of stroke symptoms using a modified NIHSS in an "actor" patient simulation scenario of acute stroke with trained health care professionals.…”

Section: Discussionmentioning

confidence: 99%

Telestroke Ambulances in Prehospital Stroke Management

Liman

Winter

Waldschmidt

et al. 2012

Stroke

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Background and Purpose-Pre-and intrahospital time delays are major concerns in acute stroke care. Telemedicineequipped ambulances may improve time management and identify patients with stroke eligible for thrombolysis by an early prehospital stroke diagnosis. The aims of this study were (1) to develop a telestroke ambulance prototype; (2) to test the reliability of stroke severity assessment; and (3) to evaluate its feasibility in the prehospital emergency setting. Methods-Mobil, real-time audio-video streaming telemedicine devices were implemented into advanced life support ambulances. Feasibility of telestroke ambulances and reliability of the National Institutes of Health Stroke Scale assessment were tested using current wireless cellular communication technology (third generation) in a prehospital stroke scenario. Two stroke actors were trained in simulation of differing right and left middle cerebral artery stroke syndromes. National Institutes of Health Stroke Scale assessment was performed by a hospital-based stroke physician by telemedicine, by an emergency physician guided by telemedicine, and "a posteriori" on the basis of video documentation. Results-In

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“…[3][4][5][6]8,11,13 Our finding of lower physician-related ED medication errors among patients who received telemedicine consultations could be attributed to the specialized training and higher level of experience among the consulting physicians in treating children, which is consistent with other studies evaluating the impact of physician training and experience on patient outcomes. 8,15,[30][31][32][33] Kozer et al, 8 who examined medication errors experienced by children in an ED, found that trainees who do not have sufficient experience in treating children are more likely to commit prescribing errors than attending physicians. 8 Charash et al 30 examined the impact of telemedicine on simulated rural trauma patients in a moving ambulance and found that telemedicine resulted in better assessments, more interventions, and better patient outcomes Telemedicine consultations were associated with significantly fewer physician-related medication errors than telephone consultations, consistent with other intervention studies aimed at preventing medical errors in children.…”

Section: Discussionmentioning

confidence: 99%

“…8,15,[30][31][32][33] Kozer et al, 8 who examined medication errors experienced by children in an ED, found that trainees who do not have sufficient experience in treating children are more likely to commit prescribing errors than attending physicians. 8 Charash et al 30 examined the impact of telemedicine on simulated rural trauma patients in a moving ambulance and found that telemedicine resulted in better assessments, more interventions, and better patient outcomes Telemedicine consultations were associated with significantly fewer physician-related medication errors than telephone consultations, consistent with other intervention studies aimed at preventing medical errors in children. [34][35][36][37] These findings could reflect the fact that patients receiving telemedicine consultations have more involvement of the consulting specialist than patients receiving telephone consultations and the ability of the consulting physicians to see the patient during the consultation.…”

Section: Discussionmentioning

confidence: 99%

Telemedicine Consultations and Medication Errors in Rural Emergency Departments

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Medication errors occur frequently among pediatric patients, particularly those treated in rural emergency departments (EDs). Although telemedicine has been proposed as a potential solution, there are few data supporting its clinical effectiveness and its effect on medication errors. WHAT THIS STUDY ADDS:The use of telemedicine to provide pediatric critical care consultations to rural EDs is associated with less frequent physician-related ED medication errors among seriously ill and injured children. Therefore, this model of care may improve patient safety in rural hospital EDs. abstract OBJECTIVE: To compare the frequency of physician-related medication errors among seriously ill and injured children receiving telemedicine consultations, similar children receiving telephone consultations, and similar children receiving no consultations in rural emergency departments (EDs). METHODS:We conducted retrospective chart reviews on seriously ill and injured children presenting to 8 rural EDs with access to pediatric critical care physicians from an academic children' s hospital. Physician-related ED medication errors were independently identified by 2 pediatric pharmacists by using a previously published instrument. The unit of analysis was medication administered. The association of telemedicine consultations with ED medication errors was modeled by using hierarchical logistic regression adjusting for covariates (age, risk of admission, year of consultation, and hospital) and clustering at the patient level. RESULTS:Among the 234 patients in the study, 73 received telemedicine consultations, 85 received telephone consultations, and 76 received no specialist consultations. Medications for patients who received telemedicine consultations had significantly fewer physician-related errors than medications for patients who received telephone consultations or no consultations (3.4% vs 10.8% and 12.5%, respectively; P , .05). In hierarchical logistic regression analysis, medications for patients who received telemedicine consultations had a lower odds of physician-related errors than medications for patients who received telephone consultations (odds ratio: 0.19, P , .05) or no consultations (odds ratio: 0.13, P , .05).CONCLUSIONS: Pediatric critical care telemedicine consultations were associated with a significantly reduced risk of physician-related ED medication errors among seriously ill and injured children in rural EDs.

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Telemedicine to a Moving Ambulance Improves Outcome After Trauma in Simulated Patients

Abstract: TM to a moving ambulance improved the care of simulated trauma patients. Furthermore, procedurally naïve EMTs were able to perform needle thoracostomy and pericardiocentesis with TM guidance.

Cited by 32 publications

References 8 publications

Implementation phase of a multicentre prehospital telemedicine system to support paramedics: feasibility and possible limitations

Implementation phase of a multicentre prehospital telemedicine system to support paramedics: feasibility and possible limitations

Telestroke Ambulances in Prehospital Stroke Management

Telemedicine Consultations and Medication Errors in Rural Emergency Departments

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