scholarly journals Utilization, Safety, and Technical Performance of a Telemedicine System for Prehospital Emergency Care: Observational Study (Preprint)

2019 ◽  
Author(s):  
Marc Felzen ◽  
Stefan Kurt Beckers ◽  
Felix Kork ◽  
Frederik Hirsch ◽  
Sebastian Bergrath ◽  
...  
Keyword(s):  
Emergency Service ◽  
Medical Service ◽  
Prehospital Emergency Care ◽  
Reliable System ◽  
Telemedicine System ◽  
System Failures ◽  
Technical Performance ◽  
Voice Communications ◽  
Prehospital Emergency ◽  
The City

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; <italic>P</italic>=.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.

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

10.2196/14907 ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. e14907 ◽  
Author(s):  
Marc Felzen ◽  
Stefan Kurt Beckers ◽  
Felix Kork ◽  
Frederik Hirsch ◽  
Sebastian Bergrath ◽  
...  
Keyword(s):  
Emergency Service ◽  
Medical Service ◽  
Prehospital Emergency Care ◽  
Reliable System ◽  
Telemedicine System ◽  
System Failures ◽  
Technical Performance ◽  
Voice Communications ◽  
Prehospital Emergency ◽  
The City

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.

scholarly journals Tele-EMS physicians improve life-threatening conditions during prehospital emergency missions

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hanna Schröder ◽  
Stefan K. Beckers ◽  
Klaudia Ogrodzki ◽  
Christina Borgs ◽  
Sebastian Ziemann ◽  
...  
Keyword(s):  
Vital Signs ◽  
Improve Patient Care ◽  
Secondary Outcome ◽  
Telemedicine System ◽  
Threatening Condition ◽  
Life Threatening ◽  
Prehospital Emergency ◽  
Drug Doses ◽  
The City

AbstractAlmost seven years ago, a telemedicine system was established as an additional component of the city of Aachen’s emergency medical service (EMS). It allows paramedics to engage in an immediate consultation with an EMS physician at any time. The system is not meant to replace the EMS physician on the scene during life-threatening emergencies. The aim of this study was to analyze teleconsultations during life-threatening missions and evaluate whether they improve patient care. Telemedical EMS (tele-EMS) physician consultations that occurred over the course of four years were evaluated. Missions were classified as involving potentially life-threatening conditions based on at least one of the following criteria: documented patient severity score, life-threatening vital signs, the judgement of the onsite EMS physician involved in the mission, or definite life-threatening diagnoses. The proportion of vital signs indicating that the patient was in a life-threatening condition was analyzed as the primary outcome at the start and end of the tele-EMS consultation. The secondary outcome parameters were the administered drug doses, tracer diagnoses made by the onsite EMS physicians during the missions, and quality of the documentation of the missions. From January 2015 to December 2018, a total of 10,362 tele-EMS consultations occurred; in 4,293 (41.4%) of the missions, the patient was initially in a potentially life-threatening condition. Out of those, a total of 3,441 (80.2%) missions were performed without an EMS physician at the scene. Records of 2,007 patients revealed 2,234 life-threatening vital signs of which 1,465 (65.6%) were remedied during the teleconsultation. Significant improvement was detected for oxygen saturation, hypotonia, tachy- and bradycardia, vigilance states, and hypoglycemia. Teleconsultation during missions involving patients with life-threatening conditions can significantly improve those patients' vital signs. Many potentially life-threatening cases could be handled by a tele-EMS physician as they did not require any invasive interventions that needed to be performed by an onsite EMS physician. Diagnoses of myocardial infarction, cardiac pulmonary edema, or malignant dysrhythmias necessitate the presence of onsite EMS physicians. Even during missions involving patients with life-threatening conditions, teleconsultation was feasible and often accessed by the paramedics.

scholarly journals Which health-related reasons lead to prehospital emergency care and how does subjective emergency status connect to subsequent care?

2021 ◽  
Author(s):  
Silke Piedmont ◽  
Anna Katharina Reinhold ◽  
Jens-Oliver Bock ◽  
Enno Swart ◽  
Bernt-Peter Robra
Keyword(s):  
Health Insurance ◽  
Emergency Care ◽  
Third Party ◽  
Insurance Companies ◽  
Prehospital Emergency Care ◽  
Health Related ◽  
Life Threatening ◽  
Prehospital Emergency ◽  
Health Insurance Companies ◽  
Reported Data

Abstract Objectives/Background In many countries, the use of emergency medical services (EMS) increases steadily each year. At the same time, the percentage of life-threatening complaints decreases. To redesign the system, an assessment and consideration of the patients’ perspectives is helpful. Methods We conducted a paper-based survey of German EMS patients who had at least one case of prehospital emergency care in 2016. Four health insurance companies sent out the questionnaire to 1312 insured persons. We linked the self-reported data of 254 respondents to corresponding claims data provided by their health insurance companies. The analysis focuses a.) how strongly patients tend to call EMS for themselves and others given different health-related scenarios, b.) self-perceived health complaints in their own index case of prehospital emergency care and c.) subjective emergency status in combination with so-called “objective” characteristics of subsequent EMS and inpatient care. We report principal diagnoses of (1) respondents, (2) 57,240 EMS users who are not part of the survey and (3) all 20,063,689 inpatients in German hospitals. Diagnoses for group 1 and 2 only cover the inpatient stay that started on the day of the last EMS use in 2016. Results According to the survey, the threshold to call an ambulance is lower for someone else than for oneself. In 89% of all cases during their own EMS use, a third party called the ambulance. The most common, self-reported complaints were pain (38%), problems with heart and circulation (32%), and loss of consciousness (17%). The majority of respondents indicated that their EMS use was due to an emergency (89%). We could detect no or only weak associations between patients’ subjective urgency and different items for objective care. Conclusion Dispatchers can possibly optimize or reduce the disposition of EMS staff and vehicles if they spoke directly to the patients more often. Nonetheless, there is need for further research on how strongly the patients’ perceived urgency may affect the disposition, rapidness of the service and transport targets.

Multi-Method Vs Single Method Appraisal of Clinical Quality Indicators for the Emergency Medical Services

2020 ◽  
Author(s):  
Ian Howard ◽  
Peter Cameron ◽  
Maaret Castrén ◽  
Lee Wallis ◽  
Veronica Lindström
Keyword(s):  
Group Discussion ◽  
Rank Correlation ◽  
Healthcare Setting ◽  
Prehospital Emergency Care ◽  
Spearman’S Rank Correlation ◽  
Prehospital Emergency ◽  
Single Method ◽  
Multi Method Approach ◽  
The Individual ◽  
Method Approach

ABSTRACT Background Quality Indicator (QI) appraisal protocols are a novel methodology that combines multiple appraisal methods to comprehensively assess the "appropriateness" of QIs for a particular healthcare setting. However, they remain inadequately explored compared to the single appraisal method approach. This paper aimed to describe and test a QI appraisal protocol versus the single method approach, against a series of QIs potentially relevant to the South African Prehospital Emergency Care setting. Methods An appraisal protocol was developed consisting of two categorical-based appraisal methods, combined with the qualitative analysis of the discussion generated during the consensus application of each method. The output of the protocol was assessed and compared with the application and output of each method. Inter-rater reliability of each particular method was evaluated prior to group consensus rating. Variation in the number of non-valid QIs and the proportion of non-valid QIs identified between each method and the protocol were compared and assessed. Results There was mixed IRR of the individual methods. There was similarly low to moderate correlation of the results obtained between the particular methods (Spearman’s rank correlation=0.42,p&lt;0.001). From a series of 104 QIs, 11 non-valid QIs were identified that were shared between the individual methods. A further 19 non-valid QIs were identified and not shared by each method, highlighting the benefits of a multi-method approach. The outcomes were additionally evident in the group discussion analysis, which in and of itself added further input that would not have otherwise been captured by the individual methods alone. Conclusion The utilization of a multi-method appraisal protocol offers multiple benefits, when compared to the single appraisal approach, and can provide the confidence that the outcomes of the appraisal will ensure a strong foundation on which the QI framework can be successfully implemented.

Developing a Lay First Responder Program in Chad: A 12-Month Follow-Up Evaluation of a Rural Prehospital Emergency Care Program

2020 ◽  
Vol 35 (5) ◽  
pp. 546-553 ◽  
Author(s):  
Canaan J. Hancock ◽  
Peter G. Delaney ◽  
Zachary J. Eisner ◽  
Eric Kroner ◽  
Issa Mahamet-Nuur ◽  
...  
Keyword(s):  
Knowledge Acquisition ◽  
Emergency Care ◽  
Prehospital Emergency Care ◽  
Voluntary Participation ◽  
First Responder ◽  
Taxi Drivers ◽  
Post Test ◽  
Prehospital Emergency ◽  
Motorcycle Taxi

AbstractIntroduction:The World Health Organization (WHO; Geneva, Switzerland) recommends lay first responder (LFR) programs as a first step toward establishing formal Emergency Medical Services (EMS) in low- and middle-income countries (LMICs) to address injury. There is a scarcity of research investigating LFR program development in predominantly rural settings of LMICs.Study Objective:A pilot LFR program was launched and assessed over 12 months to investigate the feasibility of leveraging pre-existing transportation providers to scale up prehospital emergency care in rural, low-resource settings of LMICs.Methods:An LFR program was established in rural Chad to evaluate curriculum efficacy, using a validated 15-question pre-/post-test to measure participant knowledge improvement. Pre-/post-test score distributions were compared using a Wilcoxon Signed-Rank test. For test evaluation, each pre-test question was mapped to its corresponding post-test analog and compared using McNemar’s Chi-Squared Test to examine knowledge acquisition on a by-question basis. Longitudinal prehospital care was evaluated with incident reports, while program cost was tracked using a one-way sensitivity analysis. Qualitative follow-up surveys and semi-interviews were conducted at 12 months, with initial participants and randomly sampled motorcycle taxi drivers, and used a constructivist grounded theory approach to understand the factors motivating continued voluntary participation to inform future program continuity. The consolidated criteria for reporting qualitative research (COREQ) checklist was used to guide design, analysis, and reporting the qualitative results.Results:A total of 108 motorcycle taxi participants demonstrated significant knowledge improvement (P <.001) across three of four curricular categories: scene safety, airway and breathing, and bleeding control. Lay first responders treated 71 patients over six months, encountering five deaths, and provided patient transport in 82% of encounters. Lay first responders reported an average confidence score of 8.53/10 (n = 38). In qualitative follow-up surveys and semi-structured interviews, the ability to care for the injured, new knowledge/skills, and the resultant gain in social status and customer acquisition motivated continued involvement as LFRs. Ninety-six percent of untrained, randomly sampled motorcycle taxi drivers reported they would be willing to pay to participate in future training courses.Conclusion:Lay first responder programs appear feasible and cost-effective in rural LMIC settings. Participants demonstrate significant knowledge acquisition, and after 12 months of providing emergency care, report sustained voluntary participation due to social and financial benefits, suggesting sustainability and scalability of LFR programs in low-resource settings.

Psychiatric emergency service in the city of Copenhagen

1991 ◽  
Vol 45 (2) ◽  
pp. 119-127 ◽  
Author(s):  
Joachim Knop ◽  
Ulf Søgaard ◽  
Anne Stub Sørensen ◽  
Vilhelm Schultz ◽  
Ellen Hasselbalch ◽  
...  
Keyword(s):  
Emergency Service ◽  
Psychiatric Emergency ◽  
Psychiatric Emergency Service ◽  
The City

Nurse’s experiences of the caring encounter as single responder in prehospital emergency care

2021 ◽  
Vol 58 ◽  
pp. 101051
Author(s):  
Veronica Vicente ◽  
Lenny Bergqvist ◽  
Moa Kvist ◽  
Rebecka Rubenson Wahlin ◽  
Helena Sjölin
Keyword(s):  
Emergency Care ◽  
Prehospital Emergency Care ◽  
Prehospital Emergency
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