title: Telemedicine to a moving ambulance improves outcome after trauma in simulated patients.
abstract: BACKGROUND
  Rural trauma victims often require prolonged transport by s with limited scopes of practice. We evaluated the impact of telemedicine (TM) to a moving ambulance on outcomes in simulated trauma patients.
  
  
  METHODS
  This is an institutional review board approved, prospective double-blind study. Three trauma scenarios (blunt torso trauma, epigastric stab wound, and closed head injury) were created for a human patient simulator. Intermediate emergency medical technicians (EMTs; n = 20) managed the human patient simulator, in a moving ambulance. In the TM group, physicians (n = 12) provided consultation. In the non-TM group, EMTs communicated with medical control by radio, as necessary. We tabulated the fraction of 13 key signs, 5 pathologic processes, and 12 key interventions that were performed. Vital signs and Sao2 (%) were recorded. Data were compared using the Wilcoxon rank-sum test.
  
  
  RESULTS
  Lowest Sao2 (84 ± 0.7 vs. 78 ± 0), lowest systolic blood pressure (70 ± 1 vs. 53 ± 1), and highest heart rate (144 ± 0.9 vs. 159 ± 0.5) were significantly improved in the TM group (p < 0.001). Recognition rates for key signs (0.96 ± 0.01 vs. 0.79 ± 0.05), processes (0.98 ± 0.02 vs. 0.75 ± 0.05), and critical interventions (0.92 ± 0.02 vs. 0.49 ± 0.03) were higher in the TM group (p < 0.003). EMTs were successfully guided through needle decompression procedures in 22 of 24 cases (zero in the non-TM group).
  
  
  CONCLUSIONS
  TM to a moving ambulance improved the care of simulated trauma patients. Furthermore, procedurally naïve EMTs were able to perform needle thoracostomy and pericardiocentesis with TM guidance.
authors.affiliation: University of Vermont College of Medicine, Burlington, VT, USA. bill.charash@vtmednet.org
authors.forename: William E
authors.initials: WE
authors.lastname: Charash
authors.forename: Michael P
authors.initials: MP
authors.lastname: Caputo
authors.forename: Harry
authors.initials: H
authors.lastname: Clark
authors.forename: Peter W
authors.initials: PW
authors.lastname: Callas
authors.forename: Frederick B
authors.initials: FB
authors.lastname: Rogers
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Crookes
authors.forename: Monica S
authors.initials: MS
authors.lastname: Alborg
authors.forename: Michael A
authors.initials: MA
authors.lastname: Ricci
mesh_terms: D000552:Ambulances / Q000600:supply & distribution*; D004311:Double-Blind Method; D004867:Equipment Design; D006801:Humans; D017063:Outcome Assessment, Health Care; D016544:Patient Simulation; D011446:Prospective Studies; D017216:Telemedicine / Q000295:instrumentation*; D014481:United States; D014947:Wounds and Injuries / Q000628:therapy*