title: Improved technical performance of a multifunctional prehospital telemedicine system between the research phase and the routine use phase - an observational study.
abstract: 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.
authors.affiliation: 1 Department of Anaesthesiology, University Hospital RWTH Aachen, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Felzen
authors.affiliation: 2 Emergency Department, University Hospital RWTH Aachen, Germany.
authors.forename: Jörg C
authors.initials: JC
authors.lastname: Brokmann
authors.affiliation: 1 Department of Anaesthesiology, University Hospital RWTH Aachen, Germany.|3 Fire Department and Emergency Medical Service, Germany.
authors.forename: Stefan K
authors.initials: SK
authors.lastname: Beckers
authors.affiliation: 1 Department of Anaesthesiology, University Hospital RWTH Aachen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Czaplik
authors.affiliation: 1 Department of Anaesthesiology, University Hospital RWTH Aachen, Germany.
authors.forename: Frederik
authors.initials: F
authors.lastname: Hirsch
authors.affiliation: 4 Institute of Medical Statistics, University Hospital RWTH Aachen, Germany.
authors.forename: Miriam
authors.initials: M
authors.lastname: Tamm
authors.affiliation: 1 Department of Anaesthesiology, University Hospital RWTH Aachen, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Rossaint
authors.affiliation: 1 Department of Anaesthesiology, University Hospital RWTH Aachen, Germany.|3 Fire Department and Emergency Medical Service, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bergrath
mesh_terms: D000552:Ambulances; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods*; D005858:Germany; D006801:Humans; D033183:Interdisciplinary Communication; D010343:Patient Admission / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000458:organization & administration; D010865:Pilot Projects; D019114:Remote Consultation / Q000379:methods; D017216:Telemedicine / Q000379:methods*
keywords: Telemedicine; ambulance; emergency medical service; teleconsultation; video transmission