Abstract
BACKGROUND: Transmission of 12-lead ECG (ECG) to a specialist in acute coronary syndromes (ACS) is beneficial but not routinely integrated into Emergency Medical Services (EMS). Prehospital teleconsultation (TC) with comprehensive data transmission is a new approach. The feasibility and effects on emergency care of ACS were investigated. METHOD: TC was performed between one ambulance and a TC center including real time transmission of voice, ECG, vital data, pictures and video. Standard EMS with ECG transmission via fax served as control. Patients with suspected ACS from May 3 to September 30, 2010 on workdays were included. Primary outcomes: guideline coherent treatment (ECG performance, indicated oxygen and drug administration), time intervals, choice of appropriate facility, quality of prehospital diagnosis and hospital length of stay (LOS). Secondary outcomes: Information content of patient care reporting (PCR), system utilization and technical observations. RESULTS: Overall 939 patients were treated - 289 by the TC ambulance and 650 by standard EMS. Thereof 41 patients in the study group and 67 in the control group met the inclusion criteria. TC vs. control: Baseline data and guideline coherent treatment did not differ. On-scene time was prolonged in non-ST-elevation ACS (26 vs. 19 min, p<0.0001) but not in ST-elevation myocardial infarction (22.5 vs. 20 min, p=0.45). Remaining time intervals, the quality of prehospital diagnosis and LOS showed no difference. Urgent percutaneous coronary intervention (PCI) was performed in 16 (76%) vs. 15 (45%) patients (p=0.047). One (9%) vs. 5 (25%) patients were transferred secondarily from a community hospital for PCI (p=0.38). Information content of PCR improved with TC (p<0.0001). Utilization vs. dysfunction for single applications (%): voice 100 vs. 29; ECG 95 vs. 23; realtime vital data 100 vs. 24; pictures 61 vs. 12; video 35 vs. 14. CONCLUSION: The system is safe, feasible and without impairing effect on relevant time intervals. Treatment with TC was at least equivalent to a high level standard EMS with ECG transmission and led to improved mission documentation. TC holds the potential to optimize patient care, safety and information flow to the hospital. Trials Registration: ISRCTN83270177
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