Employment of Telemedicine in Emergency Medicine

OBJECTIVES Demographic change, rising co-morbidity and an increasing number of emergencies are the main challenges that emergency medical services (EMS) in several countries worldwide are facing. In order to improve quality in EMS, highly trained personnel and well-equipped ambulances are essential. However several studies have shown a deficiency in qualified EMS physicians. Telemedicine emerges as a complementary system in EMS that may provide expertise and improve quality of medical treatment on the scene. Hence our aim is to develop and test a specific teleconsultation system. METHODS During the development process several use cases were defined and technically specified by medical experts and engineers in the areas of: system administration, start-up of EMS assistance systems, audio communication, data transfer, routine tele-EMS physician activities and research capabilities. Upon completion, technical field tests were performed under realistic conditions to test system properties such as robustness, feasibility and usability, providing end-to-end measurements. RESULTS Six ambulances were equipped with telemedical facilities based on the results of the requirement analysis and 55 scenarios were tested under realistic conditions in one month. The results indicate that the developed system performed well in terms of usability and robustness. The major challenges were, as expected, mobile communication and data network availability. Third generation networks were only available in 76.4% of the cases. Although 3G (third generation), such as Universal Mobile Telecommunications System (UMTS), provides beneficial conditions for higher bandwidth, system performance for most features was also acceptable under adequate 2G (second generation) test conditions. CONCLUSIONS An innovative concept for the use of telemedicine for medical consultations in EMS was developed. Organisational and technical aspects were considered and practical requirements specified. Since technical feasibility was demonstrated in these technical field tests, the next step would be to prove medical usefulness and technical robustness under real conditions in a clinical trial.

[1]  P. Sefrin,et al.  [The position of the emergency physician in the emergency medical service]. , 2006, AINS. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmertztherapie.

[2]  M. Messelken,et al.  Realistic assessment of the physican-staffed emergency services in Germany , 2006, Der Anaesthesist.

[3]  Robert J Adams,et al.  REACH: Clinical Feasibility of a Rural Telestroke Network , 2005, Stroke.

[4]  T. Luiz,et al.  Verfügbarkeit bodengebundener Notarztstandorte in Rheinland-Pfalz , 2010, Der Anaesthesist.

[5]  F. Rogers,et al.  Telemedicine to a moving ambulance improves outcome after trauma in simulated patients. , 2011, The Journal of trauma.

[6]  Ignacio Foche-Perez,et al.  An open real-time tele-stethoscopy system , 2012, Biomedical engineering online.

[7]  M. Klapholz,et al.  The STAT-MI (ST-Segment Analysis Using Wireless Technology in Acute Myocardial Infarction) trial improves outcomes. , 2011, JACC. Cardiovascular interventions.

[8]  S. Russo,et al.  Paramedic versus emergency physician emergency medical service: role of the anaesthesiologist and the European versus the Anglo-American concept , 2008, Current opinion in anaesthesiology.

[9]  H. Moecke,et al.  The anesthesiologist in prehospital and hospital emergency medicine , 2008, Current Opinion in Anaesthesiology.

[10]  P. Sefrin,et al.  Stellung des Notarztes im Rettungsdienst , 2006 .

[11]  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.

[12]  G. Wagner,et al.  Effect on treatment delay of prehospital teletransmission of 12-lead electrocardiogram to a cardiologist for immediate triage and direct referral of patients with ST-segment elevation acute myocardial infarction to primary percutaneous coronary intervention. , 2008, The American journal of cardiology.

[13]  K. Pfeiffer,et al.  Future Development of Medical Informatics from the Viewpoint of Health Telematics , 2009, Methods of Information in Medicine.

[14]  The First View Concept: introduction of industrial flow techniques into emergency medicine organization , 2012, European journal of emergency medicine : official journal of the European Society for Emergency Medicine.

[15]  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.

[16]  Frederick P Rivara,et al.  Emergency Medical Service (EMS) systems in developed and developing countries. , 2007, Injury.

[17]  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.

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

[19]  Jerry Overton,et al.  Comparing emergency medical service systems--a project of the European Emergency Data (EED) Project. , 2011, Resuscitation.

[20]  U. Bogdahn,et al.  The use of telemedicine in combination with a new stroke-code-box significantly increases t-PA use in rural communities , 2005, Neurocritical care.