Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 2, 2019
Open Peer Review Period: Jun 5, 2019 - Jun 25, 2019
Date Accepted: Jul 21, 2019
(closed for review but you can still tweet)
Utilisation, safety, and technical performance of a worldwide unique telemedicine system for prehospital emergency care: An analysis of 6,265 teleconsultations during the initial three operational years
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 utilisation, 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 three 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 6,265 patients were analysed. The number of teleconsultations increased during the run-in period of four quarters towards 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 < 0.01). Only six of 6,265 patients (0.1%; 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 emergency medical service is a frequently used, safe and technically reliable system to provide medical care for emergency patients without an EMS physician physically present. Non-inferiority of the tele-EMS physician compared to an on-site EMS physician needs to be demonstrated in a randomised trial.
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