title: A Systematic Review of the Implementation Challenges of Telemedicine Systems in Ambulances.
abstract: Telemedicine systems are gaining attention nationwide as a means for providing care in remote areas and allowing a small number of providers to impact a large geographic region. We systematically reviewed the literature to identify the efficacy and implementation challenges of telemedicine systems in ambulances.
  
  
  
  A search for published studies on Web of Science and PubMed was completed. Studies were selected if they included at least a pilot study and they focused on feasibility or implementation of telemedicine systems in ambulances.
  
  
  
  A total of 864 articles were used for title and abstract screening. Full text screening was completed for 102 articles, with 23 being selected for final review. Sixty-one percent of the studies included in the review focused on general emergency care, while 26% focused on stroke care and 13% focused on myocardial infarction care. The reviewed studies found that telemedicine is feasible and effective in decreasing treatment times, report a high diagnosis accuracy rate, show higher rates of positive task completion than in regular ambulances, and demonstrate that stroke evaluation is completed with comparable accuracy to the standard way of delivering care.
  
  
  
  Although this review identified life-saving benefits of telemedicine, it also showed the paucity of the scientifically sound research in its implementation, prompting further studies. Further research is needed to analyze the capabilities and challenges involved in implementing telemedicine in ambulances, especially studies focusing on human-system integration and human factors' considerations in the implementation of telemedicine systems in ambulances, the development of advanced Internet connectivity paradigms, additional applications for triaging, and the implications of ambulance location.
authors.affiliation: 1 Department of Industrial Engineering, Clemson University , Clemson, South Carolina.
authors.forename: Hunter
authors.initials: H
authors.lastname: Rogers
authors.affiliation: 1 Department of Industrial Engineering, Clemson University , Clemson, South Carolina.|2 Department of Civil Engineering, Clemson University , Clemson, South Carolina.|3 Department of Public Health Sciences, Medical University of South Carolina , Charleston, South Carolina.
authors.forename: Kapil Chalil
authors.initials: KC
authors.lastname: Madathil
authors.affiliation: 2 Department of Civil Engineering, Clemson University , Clemson, South Carolina.
authors.forename: Sruthy
authors.initials: S
authors.lastname: Agnisarman
authors.affiliation: 1 Department of Industrial Engineering, Clemson University , Clemson, South Carolina.
authors.forename: Shraddhaa
authors.initials: S
authors.lastname: Narasimha
authors.affiliation: 4 School of Dental Medicine, Southern Illinois University at Edwardsville , Alton, Illinois.
authors.forename: Aparna
authors.initials: A
authors.lastname: Ashok
authors.affiliation: 2 Department of Civil Engineering, Clemson University , Clemson, South Carolina.
authors.forename: Aswathi
authors.initials: A
authors.lastname: Nair
authors.affiliation: 3 Department of Public Health Sciences, Medical University of South Carolina , Charleston, South Carolina.
authors.forename: Brandon M
authors.initials: BM
authors.lastname: Welch
authors.affiliation: 5 South Carolina Telehealth Alliance, Medical University of South Carolina , Charleston, South Carolina.
authors.forename: James T
authors.initials: JT
authors.lastname: McElligott
mesh_terms: D000552:Ambulances / Q000191:economics / Q000458:organization & administration*; D004562:Electrocardiography; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy; D019114:Remote Consultation / Q000191:economics / Q000295:instrumentation* / Q000458:organization & administration* / Q000592:standards; D020521:Stroke / Q000175:diagnosis / Q000628:therapy; D061665:Time-to-Treatment; D055986:Vital Signs
keywords: ambulance; implementation; systematic review; telemedicine