title: Comparison of physician staffed emergency teams with paramedic teams assisted by telemedicine--a randomized, controlled simulation study.
abstract: OBJECTIVE
  Emergency medical services (EMSs) vary considerably. While some are physician staffed, most systems are run by paramedics. The objective of this randomized, controlled simulation study was to compare the emergency care between physician staffed EMS teams (control group) and paramedic teams that were supported telemedically by an EMS physician (telemedicine group).
  
  
  METHODS
  Overall 16 teams (1 EMS physician, 2 paramedics) were randomized to the control group or the telemedicine group. Telemedical functionalities included two-way audio communication, transmission of vital data (numerical values and curves) and video streaming from the scenario room to the remotely located EMS physician. After a run-in scenario all teams completed four standardized scenarios, in which no highly invasive procedures (e.g. thoracic drain) were required, two using high-fidelity simulation (burn trauma, intoxication) and two using standardized patients (renal colic, barotrauma). All scenarios were videotaped and analyzed by two investigators using predefined scoring items.
  
  
  RESULTS
  Non case-specific items (31 vs. 31 scenarios): obtaining of 'symptoms', 'past medical history' and 'events' were carried out comparably, but in the telemedicine group 'allergies' (17 vs. 28, OR 7.69, CI 2.1-27.9, p=0.002) and 'medications' (17 vs. 27, OR 5.55, CI 1.7-18.0, p=0.004) were inquired more frequently. No significant differences were found regarding the case-specific items and in both groups no potentially dangerous mistreatments were observed.
  
  
  CONCLUSIONS
  Telemedically assisted paramedic care was feasible and at least not inferior compared to standard EMS teams with a physician on-scene in these scenarios.
authors: Section Emergency Medical Care, Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Germany.
authors: Daniel
authors: D
authors: Rörtgen
authors: Sebastian
authors: S
authors: Bergrath
authors: Rolf
authors: R
authors: Rossaint
authors: Stefan K
authors: SK
authors: Beckers
authors: Harold
authors: H
authors: Fischermann
authors: In-Sik
authors: IS
authors: Na
authors: David
authors: D
authors: Peters
authors: Christina
authors: C
authors: Fitzner
authors: Max
authors: M
authors: Skorning
mesh_terms: D000488:Allied Health Personnel / Q000600:supply & distribution*; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital; D005858:Germany; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration*; D016544:Patient Simulation; D010820:Physicians / Q000600:supply & distribution*; D011787:Quality of Health Care; D017216:Telemedicine; D000078329:Workforce