Emergency Telemedicine System Research Articles

81 Implementing a Telehealth System in Baja California, Mexico to Address COVID-19 Pandemic

This paper describes the development and deployment of a rapid response emergency telemedicine system to address the coronavirus pandemic in the State of Baja California, Mexico by coordinating government agencies, private technology companies, public universities, a private academic center and volunteer resources to deliver an enhanced level of care. Government and industry have well-established procedures supported by resources to respond to disasters, whether natural or man-made. Disasters, however widespread, typically have circumferential boundaries within which responses are managed.

Improved technical performance of a multifunctional prehospital telemedicine system between the research phase and the routine use phase – an observational study

Introduction Telemedical concepts in emergency medical services (EMS) lead to improved process times and patient outcomes, but their technical performance has thus far been insufficient; nevertheless, the concept was transferred into EMS routine care in Aachen, Germany. This study evaluated the system’s technical performance and compared it to a precursor system. Methods The telemedicine system was implemented on seven ambulances and a teleconsultation centre staffed with experienced EMS physicians was established in April 2014. Telemedical applications included mobile vital data, 12-lead, picture transmission and video streaming from inside the ambulances. The tele-EMS physician filled in a questionnaire regarding the technical performance of the applications, background noise and assessed clinical values of the transmitted pictures and videos after each mission between 15 May 2014–15 October 2014. Results Teleconsultation was established during 539 emergency cases. In 83% of the cases (n = 447), only the paramedics and the tele-EMS physician were involved. Transmission success rates ranged from 98% (audio connection) to 93% (12-lead electrocardiogram (ECG) transmission). All functionalities, except video transmission, were significantly better than the pilot project (p < 0.05). Severe background noise was detected to a lesser extent (p = 0.0004) and the clinical value of the pictures and videos were considered significantly more valuable. Discussion The multifunctional system is now sufficient for routine use and is the most reliable mobile emergency telemedicine system compared to other published projects. Dropouts were due to user errors and network coverage problems. These findings enable widespread use of this system in the future, reducing the critical time intervals until medical therapy is started.

Design of a real-time emergency telemedicine system for remote medical diagnosis

In routine clinical practice of emergency care, it is very difficult to perform diagnostic procedures during ambulance transport. This can lead to a delay in the patient's diagnosis and, consequently, in the patient's treatment until arrival at the hospital. Although this situation does not imply notable risk in the majority of pathologies, in anticoagulated patients, this delay can be fatal. In this study, a system is discussed that would minimise the response time before the medical administration of anti-haemorrhagic or antithrombotic treatments that would mitigate or even eliminate the dramatic consequences of the progression of intracranial haemorrhage. The aim of this study is to design a real-time emergency telemedicine system for remote medical diagnosis and to demonstrate that it is possible to perform haematological tests in an ambulance in terms of an international normalised ratio (INR) using wireless transmission, accurately and in real-time, to the referral hospital. The main and novel component of our system is a hybrid network that enables secure long-distance communication from an ambulance. The results of the tests in the ambulance are such that there were no significant differences between the values obtained from the samples analysed during travel in the ambulance and those analysed in the laboratory. Transmitting this information immediately to the hospital may involve administering early treatment during the transfer as prescribed by the medical staff that have access to both the data and to the patient's clinical history. In conclusion, the telemedicine system designed for real-time emergencies opens new perspectives for remote medical diagnosis.

Abstract W P294: Integration of TeleStroke into an Established Telemedicine System

Background and Purpose: Most acute stroke patients first present to the emergency department. Emergency personnel are often encouraged to maintain a low threshold for stroke activations to capture all potential candidates for early treatment options. However, a national shortage of neurologists has placed a strain on the stroke specialists providing oversight for all these activations. Our stroke team faced a situation in which there were a limited number of neurologists and consistent coverage was not possible to satisfy primary stroke center qualifications. We report on the development of a hybrid system in which neurology oversight was provided by telemedicine consultation for times in which our neurologists were not available. Methods: Telestroke services were integrated into an established telemedicine system already servicing 17 EDs for general emergency consultations. The system has been in operation for ten years seeing over 425,000 patients with a technical failure rate of 0.00025%. In this protocol, the client ED is considered an extension of the ED of the comprehensive stroke center and activations are simultaneously initiated at both the telemedicine and consultant sites to engage the stroke specialists. After activation, the neurologist is video-conferenced into the telemedicine consultation by way of a personal ipad. Neuroimages are available to the neurologist at the telemedicine consulting site by cloud technology. Results: This telemedicine system is experienced in remotely assisting in stroke management. There is a first line triage of stroke patients by emergency physicians at a comprehensive stroke center with input from a stroke neurologist. If the case requires a neurointerventionalist then rapid transport to the comprehensive stroke center is facilitated by having routed the consultation through an emergency telemedicine system. By integrating with an established system, the telestroke service was operational within 45 days of the agreement. Conclusions: By using this innovative hybrid approach which utilizes a combination of both local neurologists and telemedicine consultations we were able to meet the coverage requirements for stroke center certification.

A wireless emergency telemedicine system for patients monitoring and diagnosis.

Recently, remote healthcare systems have received increasing attention in the last decade, explaining why intelligent systems with physiology signal monitoring for e-health care are an emerging area of development. Therefore, this study adopts a system which includes continuous collection and evaluation of multiple vital signs, long-term healthcare, and a cellular connection to a medical center in emergency case and it transfers all acquired raw data by the internet in normal case. The proposed system can continuously acquire four different physiological signs, for example, ECG, SpO2, temperature, and blood pressure and further relayed them to an intelligent data analysis scheme to diagnose abnormal pulses for exploring potential chronic diseases. The proposed system also has a friendly web-based interface for medical staff to observe immediate pulse signals for remote treatment. Once abnormal event happened or the request to real-time display vital signs is confirmed, all physiological signs will be immediately transmitted to remote medical server through both cellular networks and internet. Also data can be transmitted to a family member's mobile phone or doctor's phone through GPRS. A prototype of such system has been successfully developed and implemented, which will offer high standard of healthcare with a major reduction in cost for our society.

Preliminary evaluation of the use of a CDMA-based emergency telemedicine system

We have conducted a preliminary evaluation of the use of a code division multiple access (CDMA)-based emergency telemedicine system to be used by emergency rescuers providing first-aid treatment for patients. The prototype system included five instrumentation modules for measuring non-invasive arterial blood pressure (NIBP), arterial oxygen saturation (SpO(2)), six-channel electrocardiogram (ECG), blood glucose concentration and body temperature. The patient data were transferred to a doctor's PC through CDMA and TCP/IP networks using an embedded personal digital assistant (PDA) phone. Performance tests in the laboratory showed that the system provided reliable values with error ranges within +/-1% for heart rate, +/-5 mmHg for NIBP, +/-2% for SpO(2) and +/-1% for glucose. The feasibility of the prototype system was then evaluated with 15 real emergency patients on Jeju Island over a two-month period. Measured data were transmitted from a moving ambulance to the emergency medical centre without significant CDMA connection loss or transmission errors. The average transfer time was 8 min. Four emergency doctors and 11 rescuers completed a questionnaire. There were favourable reviews from the users.

Emergency Telemedicine Statewide System As Basis for Cost-Analysis Study

Study Objectives: Telemedicine and various communications technologies have been applied to provide medical care to patients in rural communities, prison systems, and homecare. In the US healthcare system, there is increasing pressure from payers for the system to provide cost effective medical care. There is a growing body of literature that attempts to prove the cost effectiveness and benefits of telemedicine. However, many authors have suggested that these cost-benefit analyses are flawed and incomplete. Major questions remain on this topic because the reliability of the results are clouded by small sample size, lack of a clear hypothesis, lack of a clear perspective from which the analysis was undertaken, questions about the appropriateness of the analyzed costs and benefits, and lack of appropriate analytical technique. The objective of this study is to evaluate a statewide emergency telemedicine system for its ability to provide a basis for a cost effectiveness study.

Real-time emergency telemedicine system: prototype design and functional evaluation.

In this paper, an emergency telemedicine system was designed for the transmission of real-time multimedia for remote consultation, including radiological images, patient records, video-conferencing, full-quality video, ECG, BP, respiration, temperature, SpO(2), systolic and diastolic pressures and heart rate. The standardized, modular, software-based design architecture, without resorting to external hardware compression boards, enables the low-cost implementation of the telemedicine system, using the unified, systematic and compact integration of multimedia on general personal computers. Experimental tests on local networks analyze the technical aspects of designed systems, and inter-hospital experiments demonstrate its clinical usefulness.

Design of Mobile Emergency Telemedicine System Based on CDMA2000 1X-EVDO

The medical service with a high data rate can be supported in mobile emergency telemedicine system by development of cellular communications networks. In Korea, the commercial service of CDMA2000 1X-EVDO is provided since 2002. In this paper, we designed the system that transfers biological signal and video signal information of patients simultaneously based on this communication network environment. In CDMA2000 1X-EVDO, the maximum backward speed is observed to be 153.6Kbps. Several field tests are performed using commercial CDMA2000 1XEVDO to realize the emergency telemedicine system fitted to feature of CDMA2000 1X-EVDO. With the designed system, we could transmit biological signals and MPEG4 images of spatial resolution 640x480 simultaneously. We set up the system in an ambulance and tested it on the road.

Effect of wavelet compression on data transmission in a multipurpose wireless telemedicine system.

We have developed a novel emergency telemedicine system which allows the transmission of physiological data (electrocardiogram, oximetry, blood pressure and temperature) and still images of the patient. The transmission is performed through wireless links using either GSM mobile phones or satellite. Because of the low bandwidth available through these links, data compression is required to allow realtime transmission of electrocardiographic (ECG) data. A new integrated design approach for an optimal zonal wavelet compression (OZWC) method was implemented for the ECG data. The performance of the mobile system with compressed ECG data segments was evaluated in terms of the percentage root-mean-square difference and visual inspection. The optimum wavelet algorithm achieved a maximum compression ratio of 18:1 with low distortion.

A novel emergency telemedicine system based on wireless communication technology--AMBULANCE.

Recent studies conclude that early and specialized prehospital management contributes to emergency case survival. We have developed a portable medical device that allows telediagnosis, long distance support, and teleconsultation of mobile healthcare providers by expert physicians. The device allows the transmission of vital biosignals and still images of the patient from the emergency site to the consultation site using the GSM mobile telephony network. The device can telematically "bring" an expert specialist doctor at the site of the medical emergency, allow him/her to evaluate patient data, and issue directions to the emergency personnel on treatment procedures until the patient is brought to be hospital. Legal reasons mandated the inclusion at the consultation site of a multimedia database able to store and manage the data collected by the system. The performance of the system has been validated in four different countries using a controlled medical protocol and a set of 100 patients per country treated has been collected and analyzed.