Abstract
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.
Highlights
Almost seven years ago, a telemedicine system was established as an additional component of the city of Aachen’s emergency medical service (EMS)
To minimize selection bias, diversified eligibility criteria were evaluated with independent parameters indicating a possible threat to life, including the National Advisory Committee for Aeronautics (NACA) score, vital signs, and involvement of an onsite EMS physician
When the onsite EMS physician was primarily notified at the same time as the ambulance and already en route, which occurred in 411 cases (9.58%), teleconsultation was conducted either to bridge the interval until the arrival of the onsite EMS physician or to gain a second opinion
Summary
A telemedicine system was established as an additional component of the city of Aachen’s emergency medical service (EMS). 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. 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. Teleconsultation during missions involving patients with life-threatening conditions can significantly improve those patients’ vital signs. I.v. Intravenous LBBB Left bundle branch block NACA National Advisory Committee for Aeronautics RR Respiration rate SOPs Standard operating procedures SpO2 Oxygen saturation STEMI ST-elevation myocardial infarction tele-EMS Telemedical emergency medical service Temp Temperature. The system has been shown to improve several aspects of prehospital patient care It reduces the physicianfree interval by enabling paramedics to access an immediate consultation. Telemedicine systems ensure a higher quality of emergency medical care at an earlier stage
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