Utilization, Safety, and Technical Performance of a Telemedicine System for Prehospital Emergency Care: Observational Study

Marc Felzen; Stefan Kurt Beckers; Felix Kork; Frederik Hirsch; Sebastian Bergrath; Anja Sommer; Joerg Christian Brokmann; Michael Czaplik; Rolf Rossaint

doi:10.2196/14907

Utilization, Safety, and Technical Performance of a Telemedicine System for Prehospital Emergency Care: Observational Study

Marc Felzen^*, Stefan Kurt Beckers, Felix Kork, Frederik Hirsch, Sebastian Bergrath, Anja Sommer, Joerg Christian Brokmann, Michael Czaplik, Rolf Rossaint

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: As a consequence of increasing emergency medical service (EMS) missions requiring an EMS physician on site, we had implemented a unique prehospital telemedical emergency service as a new structural component to the conventional physician-based EMS in Germany.

Objective: We sought to assess the utilization, safety, and technical performance of this telemedical emergency service.

Methods: We conducted a retrospective analysis of all primary emergency missions with telemedical consultation of an EMS physician in the City of Aachen (250,000 inhabitants) during the first 3 operational years of our tele-EMS system. Main outcome measures were the number of teleconsultations, number of complications, and number of transmission malfunctions during teleconsultations.

Results: The data of 6265 patients were analyzed. The number of teleconsultations increased during the run-in period of four quarters toward full routine operation from 152 to 420 missions per quarter. When fully operational, around the clock, and providing teleconsultations to 11 mobile ambulances, the number of teleconsultations further increased by 25.9 per quarter (95% CI 9.1-42.6; P=.009). Only 6 of 6265 patients (0.10%; 95% CI 0.04%-0.21%) experienced adverse events, all of them not inherent in the system of teleconsultations. Technical malfunctions of single transmission components occurred from as low as 0.3% (95% CI 0.2%-0.5%) during two-way voice communications to as high as 1.9% (95% CI 1.6%-2.3%) during real-time vital data transmissions. Complete system failures occurred in only 0.3% (95% CI 0.2%-0.6%) of all teleconsultations.

Conclusions: The Aachen prehospital EMS is a frequently used, safe, and technically reliable system to provide medical care for emergency patients without an EMS physician physically present. Noninferiority of the tele-EMS physician compared with an on-site EMS physician needs to be demonstrated in a randomized trial.

Original language	English
Article number	14907
Number of pages	9
Journal	Journal of Medical Internet Research
Volume	21
Issue number	10
DOIs	https://doi.org/10.2196/14907
Publication status	Published - 8 Oct 2019

Keywords

emergency medicine
ambulances
telemedicine
quality of care
eHealth
MEDICAL-SERVICE
PILOT PROJECT
STROKE
TIME
IMPLEMENTATION
THROMBOLYSIS
FEASIBILITY
SUPPORT
TEMPIS
TRIAL

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10.2196/14907Licence: CC BY

Cite this

@article{744695cb782043b1b92d4e411aa2f6fe,

title = "Utilization, Safety, and Technical Performance of a Telemedicine System for Prehospital Emergency Care: Observational Study",

abstract = "Background: As a consequence of increasing emergency medical service (EMS) missions requiring an EMS physician on site, we had implemented a unique prehospital telemedical emergency service as a new structural component to the conventional physician-based EMS in Germany.Objective: We sought to assess the utilization, safety, and technical performance of this telemedical emergency service.Methods: We conducted a retrospective analysis of all primary emergency missions with telemedical consultation of an EMS physician in the City of Aachen (250,000 inhabitants) during the first 3 operational years of our tele-EMS system. Main outcome measures were the number of teleconsultations, number of complications, and number of transmission malfunctions during teleconsultations.Results: The data of 6265 patients were analyzed. The number of teleconsultations increased during the run-in period of four quarters toward full routine operation from 152 to 420 missions per quarter. When fully operational, around the clock, and providing teleconsultations to 11 mobile ambulances, the number of teleconsultations further increased by 25.9 per quarter (95% CI 9.1-42.6; P=.009). Only 6 of 6265 patients (0.10%; 95% CI 0.04%-0.21%) experienced adverse events, all of them not inherent in the system of teleconsultations. Technical malfunctions of single transmission components occurred from as low as 0.3% (95% CI 0.2%-0.5%) during two-way voice communications to as high as 1.9% (95% CI 1.6%-2.3%) during real-time vital data transmissions. Complete system failures occurred in only 0.3% (95% CI 0.2%-0.6%) of all teleconsultations.Conclusions: The Aachen prehospital EMS is a frequently used, safe, and technically reliable system to provide medical care for emergency patients without an EMS physician physically present. Noninferiority of the tele-EMS physician compared with an on-site EMS physician needs to be demonstrated in a randomized trial.",

keywords = "emergency medicine, ambulances, telemedicine, quality of care, eHealth, MEDICAL-SERVICE, PILOT PROJECT, STROKE, TIME, IMPLEMENTATION, THROMBOLYSIS, FEASIBILITY, SUPPORT, TEMPIS, TRIAL",

author = "Marc Felzen and Beckers, {Stefan Kurt} and Felix Kork and Frederik Hirsch and Sebastian Bergrath and Anja Sommer and Brokmann, {Joerg Christian} and Michael Czaplik and Rolf Rossaint",

note = "Publisher Copyright: {\textcopyright} Marc Felzen, Stefan Kurt Beckers, Felix Kork, Frederik Hirsch, Sebastian Bergrath, Anja Sommer, J{\"o}rg Christian Brokmann, Michael Czaplik, Rolf Rossaint.",

year = "2019",

month = oct,

day = "8",

doi = "10.2196/14907",

language = "English",

volume = "21",

journal = "Journal of Medical Internet Research",

issn = "1439-4456",

publisher = "JMIR Publications Inc.",

number = "10",

}

TY - JOUR

T1 - Utilization, Safety, and Technical Performance of a Telemedicine System for Prehospital Emergency Care

T2 - Observational Study

AU - Felzen, Marc

AU - Beckers, Stefan Kurt

AU - Kork, Felix

AU - Hirsch, Frederik

AU - Bergrath, Sebastian

AU - Sommer, Anja

AU - Brokmann, Joerg Christian

AU - Czaplik, Michael

AU - Rossaint, Rolf

N1 - Publisher Copyright: © Marc Felzen, Stefan Kurt Beckers, Felix Kork, Frederik Hirsch, Sebastian Bergrath, Anja Sommer, Jörg Christian Brokmann, Michael Czaplik, Rolf Rossaint.

PY - 2019/10/8

Y1 - 2019/10/8

N2 - Background: As a consequence of increasing emergency medical service (EMS) missions requiring an EMS physician on site, we had implemented a unique prehospital telemedical emergency service as a new structural component to the conventional physician-based EMS in Germany.Objective: We sought to assess the utilization, safety, and technical performance of this telemedical emergency service.Methods: We conducted a retrospective analysis of all primary emergency missions with telemedical consultation of an EMS physician in the City of Aachen (250,000 inhabitants) during the first 3 operational years of our tele-EMS system. Main outcome measures were the number of teleconsultations, number of complications, and number of transmission malfunctions during teleconsultations.Results: The data of 6265 patients were analyzed. The number of teleconsultations increased during the run-in period of four quarters toward full routine operation from 152 to 420 missions per quarter. When fully operational, around the clock, and providing teleconsultations to 11 mobile ambulances, the number of teleconsultations further increased by 25.9 per quarter (95% CI 9.1-42.6; P=.009). Only 6 of 6265 patients (0.10%; 95% CI 0.04%-0.21%) experienced adverse events, all of them not inherent in the system of teleconsultations. Technical malfunctions of single transmission components occurred from as low as 0.3% (95% CI 0.2%-0.5%) during two-way voice communications to as high as 1.9% (95% CI 1.6%-2.3%) during real-time vital data transmissions. Complete system failures occurred in only 0.3% (95% CI 0.2%-0.6%) of all teleconsultations.Conclusions: The Aachen prehospital EMS is a frequently used, safe, and technically reliable system to provide medical care for emergency patients without an EMS physician physically present. Noninferiority of the tele-EMS physician compared with an on-site EMS physician needs to be demonstrated in a randomized trial.

AB - Background: As a consequence of increasing emergency medical service (EMS) missions requiring an EMS physician on site, we had implemented a unique prehospital telemedical emergency service as a new structural component to the conventional physician-based EMS in Germany.Objective: We sought to assess the utilization, safety, and technical performance of this telemedical emergency service.Methods: We conducted a retrospective analysis of all primary emergency missions with telemedical consultation of an EMS physician in the City of Aachen (250,000 inhabitants) during the first 3 operational years of our tele-EMS system. Main outcome measures were the number of teleconsultations, number of complications, and number of transmission malfunctions during teleconsultations.Results: The data of 6265 patients were analyzed. The number of teleconsultations increased during the run-in period of four quarters toward full routine operation from 152 to 420 missions per quarter. When fully operational, around the clock, and providing teleconsultations to 11 mobile ambulances, the number of teleconsultations further increased by 25.9 per quarter (95% CI 9.1-42.6; P=.009). Only 6 of 6265 patients (0.10%; 95% CI 0.04%-0.21%) experienced adverse events, all of them not inherent in the system of teleconsultations. Technical malfunctions of single transmission components occurred from as low as 0.3% (95% CI 0.2%-0.5%) during two-way voice communications to as high as 1.9% (95% CI 1.6%-2.3%) during real-time vital data transmissions. Complete system failures occurred in only 0.3% (95% CI 0.2%-0.6%) of all teleconsultations.Conclusions: The Aachen prehospital EMS is a frequently used, safe, and technically reliable system to provide medical care for emergency patients without an EMS physician physically present. Noninferiority of the tele-EMS physician compared with an on-site EMS physician needs to be demonstrated in a randomized trial.

KW - emergency medicine

KW - ambulances

KW - telemedicine

KW - quality of care

KW - eHealth

KW - MEDICAL-SERVICE

KW - PILOT PROJECT

KW - STROKE

KW - TIME

KW - IMPLEMENTATION

KW - THROMBOLYSIS

KW - FEASIBILITY

KW - SUPPORT

KW - TEMPIS

KW - TRIAL

U2 - 10.2196/14907

DO - 10.2196/14907

M3 - Article

C2 - 31596244

SN - 1439-4456

VL - 21

JO - Journal of Medical Internet Research

JF - Journal of Medical Internet Research

IS - 10

M1 - 14907

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