title: Treatment of Acute Coronary Syndrome by Telemedically Supported Paramedics Compared With Physician-Based Treatment: A Prospective, Interventional, Multicenter Trial.
abstract: Prehospital treatment of acute coronary syndrome (ACS) in German emergency medical services (EMSs) is reserved for EMS physicians due to legal issues.
  
  
  
  The objective of this prospective, interventional, multicenter trial was to evaluate the quality of telemedically-delegated therapy and the possible complications in patients with ACS.
  
  
  
  After approval by the ethics committee and trial registration, a one-year study phase was started in August 2012 with 5 ambulances, telemedically equipped and staffed with paramedics, in 4 German EMS districts. The paramedics could contact an EMS-physician-staffed telemedicine center. After initiation of an audio connection, real-time data transmission was automatically established. If required, 12-lead electrocardiogram (ECG) and still pictures could be sent. Video was streamed from inside each ambulance. All drugs, including opioids, were delegated to the paramedics based on standardized, predefined algorithms. To compare telemedically-delegated medication and treatment in ACS cases with regular EMS missions, a matched pair analysis with historical controls was performed.
  
  
  
  Teleconsultation was performed on 150 patients having a cardiovascular emergency. In 39 cases, teleconsultation was started due to suspected ACS. No case had a medical complication. Correct handling of 12-lead ECG was performed equally between the groups (study group, n=38 vs control group, n=39, P>.99). There were no differences in correct handling of intravenous administration of acetylsalicylic acid, heparin, or morphine between both the groups (study group vs control group): acetylsalicylic acid, n=31 vs n=33, P=.73; unfractionated heparin, n=34 vs n=33, P>.99; morphine, n=29 vs n=27, P=.50. The correct handling of oxygen administration was significantly higher in the study group (n=29 vs n=18, P=.007).
  
  
  
  Telemedical delegation of guideline conform medication and therapy by paramedics in patients with ACS and was found to be feasible and safe. The quality of guideline-adherent therapy was not significantly different in both the groups except for the correct administration of oxygen, which was significantly higher in the study group.
  
  
  
  Clinicaltrials.gov NCT01644006; http://clinicaltrials.gov/ct2/show/NCT01644006 (Archived by WebCite at http://www.webcitation.org/6mPam3eDy).
authors.affiliation: Emergency Department, Rheinisch-Westfälische Technische Hochschule, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Jörg C
authors.identifier: 0000-0002-1745-6130
authors.initials: JC
authors.lastname: Brokmann
authors.affiliation: Department of Anaesthesiology, Rheinisch-Westfälische Technische Hochschule, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Clemens
authors.identifier: 0000-0002-5887-307X
authors.initials: C
authors.lastname: Conrad
authors.affiliation: Department of Anaesthesiology, Rheinisch-Westfälische Technische Hochschule, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Rolf
authors.identifier: 0000-0001-7587-1693
authors.initials: R
authors.lastname: Rossaint
authors.affiliation: Department of Anaesthesiology, Rheinisch-Westfälische Technische Hochschule, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Sebastian
authors.identifier: 0000-0001-5297-7655
authors.initials: S
authors.lastname: Bergrath
authors.affiliation: Department of Anaesthesiology, Rheinisch-Westfälische Technische Hochschule, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Stefan K
authors.identifier: 0000-0002-2896-7948
authors.initials: SK
authors.lastname: Beckers
authors.affiliation: Department of Medical Statistics, Rheinisch-Westfälische Technische Hochschule, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Miriam
authors.identifier: 0000-0002-0076-1403
authors.initials: M
authors.lastname: Tamm
authors.affiliation: Department of Anaesthesiology, Rheinisch-Westfälische Technische Hochschule, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Michael
authors.identifier: 0000-0002-7118-7728
authors.initials: M
authors.lastname: Czaplik
authors.affiliation: Department of Anaesthesiology, Rheinisch-Westfälische Technische Hochschule, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Frederik
authors.identifier: 0000-0002-5333-7497
authors.initials: F
authors.lastname: Hirsch
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000488:Allied Health Personnel; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D010865:Pilot Projects; D011446:Prospective Studies; D019114:Remote Consultation / Q000379:methods*; D017216:Telemedicine / Q000379:methods*
keywords: acute coronary syndrome; myocardial infarction; prehospital emergency care; telehealth; telemedicine