Utilization, Safety, and Technical Performance of a Telemedicine System for Prehospital Emergency Care: Observational Study

Felzen, Marc; Beckers, Stefan; Kork, Felix; Hirsch, F.; Bergrath, Sebastian; Sommer, A.; Brokmann, J.C.; Czaplik, Michael; Rossaint, Rolf

doi:10.2196/14907

Cited by 34 publications

(27 citation statements)

References 32 publications

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“…Therefore, the condition of the mobile network, connection failures, and staff errors are the common limitation of otherwise feasible and easy methods. [18][19][20] Limitations Indeed, the main limitation of this study is its limited generalizability, as the results are very much dependent on the context in which they were obtained: the case mix, level of staff training and competence, setting, and working habits. The main demonstrated benefit of AVC (ie, staff satisfaction with it) might have been subjected to selection bias, as doctors and paramedics outside this study may feel differently about it.…”

Section: Discussionmentioning

confidence: 98%

Audiovisual Consults by Paramedics to Reduce Hospital Transport After Low-Urgency Calls: Randomized Controlled Trial

Sýkora

Renza

Růžička

et al. 2020

Prehosp. Disaster med.

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Introduction: The effect and subjective perception of audiovisual consults (AVCs) by paramedics with a distant physician in prehospital emergency care (PHEC) remain unexplained, especially in low-urgency calls. Objectives: The primary objective of the study was to evaluate the effect of AVCs by paramedics with a base physician on the rate of patients treated on site without the need of hospital transfer. The co-primary safety outcome was the frequency of repeated ambulance trips within 48 hours to the same patient. Secondary objective was the qualitative analysis of perception of the AVCs. Methods: During a six-week period, the dispatching center of Karlovy Vary Emergency Medical Service (EMS) randomized low-urgency events from a rural area (n = 791) to receive either a mandatory phone-call consult (PHONE), AVC (VIDEO), or performed by the paramedic crew in a routine manner, when phone-call consultation is for paramedic crew optional (CONTROL). Secondarily, the qualitative analysis of subjective perception of AVCs compared to consultation over the phone by the paramedic and consulting physician was performed. Results: Per-protocol analysis (PPA) was performed (CONTROL, n = 258; PHONE, n = 193; and VIDEO, n = 192) in addition to the intention-to-treat (ITT) analysis. Patients (PPA) in both mandatory consulted groups were twice as likely to be treated and left on site compared to the CONTROL (PHONE: OR = 2.07; 95% CI, 1.19 to 3.58; P = 0.01 or VIDEO: OR = 2.01; 95% CI, 1.15 to 3.49; P = .01). Repeated trips to patients treated and left on site in 48 hours occurred in three (8.6%) of 35 cases in the PHONE group and in eight (23.5%) of 34 cases in the VIDEO group. Conclusions: The AVCs of the emergency physician by paramedics was not superior to the mandatory conventional phone call in increasing the proportion of patients treated and left at home after a low-urgency call. The AVC improved the subjective feelings of safety by physicians, but not the satisfaction of patients or paramedics, and may lead to an increased need of repeated trips.

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Section: Discussionmentioning

confidence: 98%

Audiovisual Consults by Paramedics to Reduce Hospital Transport After Low-Urgency Calls: Randomized Controlled Trial

Sýkora

Renza

Růžička

et al. 2020

Prehosp. Disaster med.

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“…Every ambulance is equipped with a mobile communication unit attached to the defibrillator monitor (corpuls C 3 ; GS Elektromedizinische Geräte G Stemple, Kaufering, Germany) to enable real-time data transmission of the following components: audio; data on vital signs, including heart rate, blood pressure, oxygen saturation, 6 or 12-lead ECG; photos from the site taken with a smartphone; video streaming from a camera inside the ambulance controlled by the tele-EMS physician; and GPS coordinates of the ambulance to enable location tracking. Details regarding the technical setup of the system can be explored in earlier publications on the system’s technical performance 2 , 4 , 14 .…”

Section: Methodsmentioning

confidence: 99%

“…The operator in the EMS dispatcher center decides to send either only the ambulance or both vehicles in the case of a potentially life-threatening emergency 1 . The implemented telemedicine system enables every paramedic to contact a telemedical EMS (tele-EMS) physician anytime and anywhere 2 – 4 . The system was fully implemented as a complement to the regular 24/7 routine EMS in Aachen in April 2014.…”

Section: Introductionmentioning

confidence: 99%

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

Schröder

Beckers

Ogrodzki³

et al. 2021

Sci Rep

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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.

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“…Telenotfallmedizin scheint als zusätzliche Komponente die Notfallmedizin gewinnbringend zu ergänzen. Der Telenotarzt bietet die Möglichkeit einer häufig genutzten, sicheren und technisch verlässlichen Ressource zur Versorgung von Notfallpatienten [21]. So konnte gezeigt werden, dass die Qualität der Patientenversorgung z.…”

Section: Ressourcen Schonenunclassified

Prähospitale Telenotfallmedizin

Metelmann¹,

Renzing²,

Gräsner³

et al. 2020

Notfallmedizin up2date

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Utilization, Safety, and Technical Performance of a Telemedicine System for Prehospital Emergency Care: Observational Study

Cited by 34 publications

References 32 publications

Audiovisual Consults by Paramedics to Reduce Hospital Transport After Low-Urgency Calls: Randomized Controlled Trial

Audiovisual Consults by Paramedics to Reduce Hospital Transport After Low-Urgency Calls: Randomized Controlled Trial

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

Prähospitale Telenotfallmedizin

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