title: The effectiveness of video-telemedicine for screening of patients requesting emergency air medical transport (EAMT).
abstract: BACKGROUND
  Demand for emergency air medical transport (EAMT) services have increased in recent years. However, the high costs of these services have raised questions on the benefit to patient outcomes. In this study, we evaluate the effectiveness of video-telemedicine for the preflight screening of patients for air medical transports.
  
  
  METHODS
  A prospective cohort study. Medical records of patients transported from the Penghu Islands to Taiwan were retrospectively collected from November 1999 to October 2002 (stage 1). In addition, we collected medical records of patients who were preflight-screened by physicians using video Web cameras from November 1, 2002 through August 30, 2003 (stage 2). The intervention in stage 2 included a set of protocols and screening criteria for EAMT implemented by the National Aeromedical Consultation Center (NACC). In stage 1, there were no standardized protocols or screening guidelines for EAMT. The EAMT system before implementing preflight screening and telemedicine was mostly based on patient's requests and their health condition determined by the treating medical officers (TMO).
  
  
  RESULTS
  A total of 822 transfers were included in this study. Patient demographic backgrounds in the two groups were similar on gender, age, disease classification, and types of illnesses. Patients in stage 2 were significantly older than those in stage 1. In a comparison of flight frequencies between the two stages, the results revealed a 36.2% reduction of EAMT applications in stage 2. The flight approval rate was 91.2%. The intervention in stage 2 also presented a significant reduction in cross-zone transport (16.1% to 0.1% to the northern Taiwan region). Within-zone transfers increased from 74.9% to 88.3%. Cost analysis showed that physician triage in stage 2 resulted in a total annual savings on EAMTs of US 448,986 dollars.
  
  
  CONCLUSIONS
  This study demonstrates the physician-assisted preflight screening using video-telemedicine significantly reduced the frequency of unnecessary air medical transports and consequently led to reduced costs. Video-telemedicine can be an essential tool to support physicians in decision-making for patient screening.
authors.affiliation: Institute of Injury Prevention and Control, Department of Neurological Surgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan. shtsai@tmu.edu.tw
authors.forename: Shin-Han
authors.initials: SH
authors.lastname: Tsai
authors.forename: Jess
authors.initials: J
authors.lastname: Kraus
authors.forename: Hsueh-Ru
authors.initials: HR
authors.lastname: Wu
authors.forename: Wan-Lin
authors.initials: WL
authors.lastname: Chen
authors.forename: Ming-Fu
authors.initials: MF
authors.lastname: Chiang
authors.forename: Li-Hua
authors.initials: LH
authors.lastname: Lu
authors.forename: Chia-En
authors.initials: CE
authors.lastname: Chang
authors.forename: Wen-Ta
authors.initials: WT
authors.lastname: Chiu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017732:Air Ambulances / Q000191:economics; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020407:Internet; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013624:Taiwan; D017216:Telemedicine; D014218:Triage