title: Unité de Coordination Clinique des Services Préhospitaliers d'Urgence: A clinical telemedicine platform that improves prehospital and community health care for rural citizens.
abstract: Access to health care in Canada's rural areas is a challenge. The Unité de Coordination Clinique des Services Préhospitaliers d'Urgence (UCCSPU) is a telemedicine program designed to improve health care in the Chaudiere-Appalaches and Quebec City regions of Canada. Remote medical services are provided by nurses and by an emergency physician based in a clinical unit at the Alphonse-Desjardins Community Health and Social Services Center. The interventions were developed to meet two objectives. The first is to enhance access to quality health care. To this end, Basic Life Support paramedics and nurses were taught interventions outside of their field of expertise. Prehospital electrocardiograms were used to remotely diagnose ST segment elevation myocardial infarction and to monitor patients who were en route by ambulance to the nearest catheterization facility or emergency department. Basic Life Support paramedics received extended medical authorization that allowed them to provide opioid analgesia via telemedicine physician orders. Nurses from community health centres without physician coverage were able to request medical assistance via a video telemedicine system. The second objective is to optimize medical resources. To this end, remote death certifications were implemented to avoid unnecessary transport of deceased persons to hospitals. This paper presents the telemedicine program and some results.
authors.affiliation: 1 UCCSPU, Centre intégré de santé et de services sociaux de Chaudière-Appalaches (CISSS-CA), (CHAU Hôtel-Dieu de Lévis), Canada.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Bussières
authors.affiliation: 1 UCCSPU, Centre intégré de santé et de services sociaux de Chaudière-Appalaches (CISSS-CA), (CHAU Hôtel-Dieu de Lévis), Canada.
authors.forename: Alain
authors.initials: A
authors.lastname: Tanguay
authors.affiliation: 1 UCCSPU, Centre intégré de santé et de services sociaux de Chaudière-Appalaches (CISSS-CA), (CHAU Hôtel-Dieu de Lévis), Canada.
authors.forename: Denise
authors.initials: D
authors.lastname: Hébert
authors.affiliation: 2 Research Chair in Emergency Medicine, Centre intégré de santé et de services sociaux de Chaudière-Appalaches (CISSS-CA), (CHAU Hôtel-Dieu de Lévis), Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Fleet
mesh_terms: D002170:Canada; D003153:Community Health Services / Q000458:organization & administration*; D003644:Death Certificates; D004632:Emergency Medical Services / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008020:Life Support Care / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration*; D011787:Quality of Health Care / Q000592:standards*; D019035:Rural Health Services / Q000458:organization & administration*; D017216:Telemedicine / Q000379:methods*
keywords: Basic Life Support paramedics; Prehospital; ST segment elevation myocardial infarction; electrocardiogram; emergency medical services; fentanyl; nurse; pain management; remote death certification; rural; telehealth