title: Teleconsultation in pre-hospital emergency medical services: real-time telemedical support in a prospective controlled simulation study.
abstract: BACKGROUND
  Teleconsultation from the scene of an emergency to an experienced physician including real-time transmission of monitoring, audio and visual information seems to be feasible. In preparation for bringing such a system into practice within the research project "Med-on-@ix", a simulation study has been conducted to investigate whether telemedical assistance (TMA) in Emergency Medical Services (EMS) has an impact on compatibility to guidelines and timing.
  
  
  METHODS
  In a controlled simulation study 29 EMS teams (one EMS physician, two paramedics) ran through standardized scenarios (STEMI: ST-elevation myocardial infarction; MT: major trauma) on high-fidelity patient simulators with defined complications (treatable clearly following guidelines). Team assignments were randomized and each team had to complete one scenario with and another without TMA. Analysis was based on videotaped scenarios using pre-defined scoring items and measured time intervals for each scenario.
  
  
  RESULTS
  Adherence to treatment algorithms improved using TMA. STEMI: cathlab informed (9/14 vs. 15/15; p=0.0169); allergies checked prior to acetylsalicylic acid (5/14 vs. 13/15; p=0.0078); analgosedation prior to cardioversion (10/14 vs. 15/15; p=0.0421); synchronized shock (6/14 vs. 14/15; p=0.0052). MT: adequate medication for intubation (3/15 vs. 10/14; p=0.0092); mean time to inform trauma centre 547 vs. 189 s (p=0.0001). No significant impairment of performance was detected in TMA groups.
  
  
  CONCLUSIONS
  In simulated setting TMA was able to improve treatment and safety without decline in timing. Nevertheless, further research is necessary to optimize the system for medical, organizational and technical reasons prior to the evaluation of this system in routine EMS.
authors: Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, D-52057 Aachen, Germany. mskorning@ukaachen.de
authors: Max
authors: M
authors: Skorning
authors: Sebastian
authors: S
authors: Bergrath
authors: Daniel
authors: D
authors: Rörtgen
authors: Stefan K
authors: SK
authors: Beckers
authors: Jörg C
authors: JC
authors: Brokmann
authors: Benjamin
authors: B
authors: Gillmann
authors: Jöran
authors: J
authors: Herding
authors: Michael
authors: M
authors: Protogerakis
authors: Christina
authors: C
authors: Fitzner
authors: Rolf
authors: R
authors: Rossaint
mesh_terms: D000328:Adult; D000465:Algorithms; D001930:Brain Injuries / Q000628:therapy*; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D016544:Patient Simulation; D011446:Prospective Studies; D011787:Quality of Health Care; D019114:Remote Consultation / Q000379:methods*; D055815:Young Adult