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

BACKGROUND As a consequence of increasing emergency medical service (EMS) missions requiring an EMS physician on site, we had implemented a unique prehospital telemedical emergency service as a new structural component to the conventional physician-based EMS in Germany. OBJECTIVE We sought to assess the utilization, safety, and technical performance of this telemedical emergency service. METHODS We conducted a retrospective analysis of all primary emergency missions with telemedical consultation of an EMS physician in the City of Aachen (250,000 inhabitants) during the first 3 operational years of our tele-EMS system. Main outcome measures were the number of teleconsultations, number of complications, and number of transmission malfunctions during teleconsultations. RESULTS The data of 6265 patients were analyzed. The number of teleconsultations increased during the run-in period of four quarters toward full routine operation from 152 to 420 missions per quarter. When fully operational, around the clock, and providing teleconsultations to 11 mobile ambulances, the number of teleconsultations further increased by 25.9 per quarter (95% CI 9.1-42.6; P=.009). Only 6 of 6265 patients (0.10%; 95% CI 0.04%-0.21%) experienced adverse events, all of them not inherent in the system of teleconsultations. Technical malfunctions of single transmission components occurred from as low as 0.3% (95% CI 0.2%-0.5%) during two-way voice communications to as high as 1.9% (95% CI 1.6%-2.3%) during real-time vital data transmissions. Complete system failures occurred in only 0.3% (95% CI 0.2%-0.6%) of all teleconsultations. CONCLUSIONS The Aachen prehospital EMS is a frequently used, safe, and technically reliable system to provide medical care for emergency patients without an EMS physician physically present. Noninferiority of the tele-EMS physician compared with an on-site EMS physician needs to be demonstrated in a randomized trial.

[1]  M. Ward,et al.  Telemedicine Is Associated with Faster Diagnostic Imaging in Stroke Patients: A Cohort Study. , 2019, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[2]  M. Ward,et al.  Emergency Department Telemedicine Shortens Rural Time-To-Provider and Emergency Department Transfer Times. , 2018, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[3]  R. Rossaint,et al.  Blood pressure management and guideline adherence in hypertensive emergencies and urgencies: A comparison between telemedically supported and conventional out‐of‐hospital care , 2017, Journal of clinical hypertension.

[4]  R. Rossaint,et al.  Quality of analgesia in physician-operated telemedical prehospital emergency care is comparable to physician-based prehospital care - a retrospective longitudinal study , 2017, Scientific Reports.

[5]  R. Rossaint,et al.  Telemedical support for prehospital Emergency Medical Service (TEMS trial): study protocol for a randomized controlled trial , 2017, Trials.

[6]  Michael Czaplik,et al.  Treatment of Acute Coronary Syndrome by Telemedically Supported Paramedics Compared With Physician-Based Treatment: A Prospective, Interventional, Multicenter Trial , 2016, Journal of medical Internet research.

[7]  C. Vandelanotte,et al.  Is preference for mHealth intervention delivery platform associated with delivery platform familiarity? , 2016, BMC Public Health.

[8]  R Rossaint,et al.  Analgesia by telemedically supported paramedics compared with physician‐administered analgesia: A prospective, interventional, multicentre trial , 2016, European journal of pain.

[9]  R. Rossaint,et al.  [Potential and effectiveness of a telemedical rescue assistance system. Prospective observational study on implementation in emergency medicine]. , 2015, Der Anaesthesist.

[10]  T. Molfenter,et al.  Trends in telemedicine use in addiction treatment , 2015, Addiction Science & Clinical Practice.

[11]  Ives Hubloue,et al.  Feasibility of AmbulanCe-Based Telemedicine (FACT) Study: Safety, Feasibility and Reliability of Third Generation In-Ambulance Telemedicine , 2014, PloS one.

[12]  N. Brunetti,et al.  Pre-hospital electrocardiogram triage with tele-cardiology support is associated with shorter time-to-balloon and higher rates of timely reperfusion even in rural areas: data from the Bari- Barletta/Andria/Trani public emergency medical service 118 registry on primary angioplasty in ST-elevation myo , 2014, European heart journal. Acute cardiovascular care.

[13]  Rolf Rossaint,et al.  Feasibility of Prehospital Teleconsultation in Acute Stroke – A Pilot Study in Clinical Routine , 2012, PloS one.

[14]  Rema Raman,et al.  Efficacy of telemedicine for stroke: pooled analysis of the Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) and STRokE DOC Arizona telestroke trials. , 2012, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[15]  Marie-Thérèse Schneiders,et al.  Technical and organisational feasibility of a multifunctional telemedicine system in an emergency medical service – an observational study , 2011, Journal of telemedicine and telecare.

[16]  C. Madler,et al.  [Operational availability of ground-based emergency medical services in Rheinland-Palatinate: state-wide web-based system for collation, display and analysis]. , 2011, Der Anaesthesist.

[17]  M. Schuster,et al.  Duration of mission time in prehospital emergency medicine: effects of emergency severity and physicians level of education , 2010, Emergency Medicine Journal.

[18]  S. Russo,et al.  The Out-of-Hospital Esophageal and Endobronchial Intubations Performed by Emergency Physicians , 2007, Anesthesia and analgesia.

[19]  S. Shaw,et al.  Safety and feasibility of prehospital thrombolysis carried out by paramedics , 2003, BMJ : British Medical Journal.