Marie-Thérèse Schneiders

Technical and organisational feasibility of a multifunctional telemedicine system in an emergency medical service – an observational study

We evaluated the technical and organisational feasibility of a multifunctional telemedicine system in an emergency medical service (EMS) from the users perspective. The telemedicine system was designed to transmit vital signs data and 12-lead-ECG data, send still pictures and allow voice communication and video transmission from an ambulance. The data were sent to a teleconsultation centre staffed with EMS physicians (tele-EMS physician). The system was used in 157 EMS missions. The applications were used successfully on 80% of missions for real-time vital signs transmission and on 97% for video transmission. The quality of the transmitted still images (n = 64) was: 23% excellent, 50% good, 17% moderate, 9% rather poor and 0% unusable. The quality of the video streaming (n = 36) was: 33% excellent, 56% good, 6% moderate, 6% rather poor and 0% unusable. The tele-EMS physician was able to assist the EMS team in several cases and provided the preliminary information for the hospital in nearly all missions. Use of the telemedical system in EMS is feasible and the quality of the transmitted images and video was satisfactory. However, technical reliability and availability need to be improved prior to routine use.

Implementation phase of a multicentre prehospital telemedicine system to support paramedics: feasibility and possible limitations

BackgroundLegal regulations often limit the medical care that paramedics can provide. Telemedical solutions could overcome these limitations by remotely providing expert support. Therefore, a mobile telemedicine system to support paramedics was developed. During the implementation phase of this system in four German emergency medical services (EMS), the feasibility and possible limitations of this system were evaluated.MethodsAfter obtaining ethical approval and providing a structured training program for all medical professionals, the system was implemented on three paramedic-staffed ambulances on August 1st, 2012. Two more ambulances were included subsequently during this month. The paramedics could initiate a consultation with EMS physicians at a teleconsultation centre. Telemedical functionalities included audio communication, real-time vital data transmission, 12-lead electrocardiogram, picture transmission on demand, and video streaming from a camera embedded into the ceiling of each ambulance. After each consultation, telephone-based debriefings were conducted. Data were retrieved from the documentation protocols of the teleconsultation centre and the EMS.ResultsDuring a one month period, teleconsultations were conducted during 35 (11.8%) of 296 emergency missions with a mean duration of 24.9 min (SD 12.5). Trauma, acute coronary syndromes, and circulatory emergencies represented 20 (57%) of the consultation cases. Diagnostic support was provided in 34 (97%) cases, and the administration of 50 individual medications, including opioids, was delegated by the teleconsultation centre to the paramedics in 21 (60%) missions (range: 1–7 per mission). No medical complications or negative interpersonal effects were reported. All applications functioned as expected except in one case in which the connection failed due to the lack of a viable mobile network.ConclusionThe feasibility of the telemedical approach was demonstrated. Teleconsultation enabled early initiation of treatments by paramedics operating under the real-time medical direction. Teleconsultation can be used to provide advanced care until the patient is under a physician’s care; moreover, it can be used to support the paramedics who work alone to provide treatment in non-life-threatening cases. Non-availability of mobile networks may be a relevant limitation. A larger prospective controlled trial is needed to evaluate the rate of complications and outcome effects.

An Introduction to a Transnational Volunteer Notification System Providing Cardiopulmonary Resuscitation for Victims Suffering a Sudden Cardiac Arrest

While it is always desirable in an emergency to get treatment as soon as possible, there are emergencies that need immediate treatment. In case of Sudden Cardiac Arrest an untreated time interval of only a few minutes usually means the victims’ death. Given the delay between an incoming emergency call and the arrival of the emergency medical services at the scene, it is necessary to find an alternative way to provide immediate first aid treatment. One approach for this is the implementation of a Volunteer Notification System – involving laypersons and medically trained volunteers into the emergency medical service, by notifying those potential helpers who can arrive at the scene fast enough to provide the urgently needed measures.

A Multifunctional Telemedicine System for Pre-hospital Emergency Medical Services

The paper presents the design and architecture of a multifunctional telemedicine system for real-time teleconsultation in pre-hospital emergency medical services (EMS). The application of telemedicine has shown to improve patient treatment quality and efficiency in various settings. Still, its use by pre-hospital EMS is lacking. Current technical, normative standards do not provide a sufficient framework in order to design a multifunctional telemedicine system for teleconsultation in pre-hospital EMS. Starting with a use-case driven requirements analysis, a telemedicine system usable in this setting is designed, realized and currently in use for evaluation by selected German EMS departments. This system uses commercial off-the-shelf medical devices, custom devices for communication and an individual system architecture, integrating the heterogeneous components as required by the defined use-cases.

User Acceptance as a Key to Success for the Implementation of a Telematic Support System in German Emergency Medical Services

The German research project Med-on-@ix aims at optimising the efficiency and quality of preclinical emergency health care by introducing a telematic rescue assistance system into the emergency system. The Emergency Medical Services (EMS) will be supported on site by the virtual presence of a specialised physician in a remote Competence Centre. The transmission of vital parameters, auscultation signs and video material from the emergency site to the Competence Centre by a telematic support system enables a better and quicker treatment – especially in the 14,3% of emergency cases, in which the manual skills of a physician are not necessary on site [GHM03].

A Joint Organizational and Technical Development of a Telematic Rescue Assistance System for German Emergency Medical Services

The German research project Med-on-@ix aims at optimizing the efficiency and quality of preclinical emergency health care by introducing a Telematic Rescue Assistance Systems into the Emergency Medical Services. Paramedics and emergency physicians will be supported on site by a specialized physician in a remote Competence Centre. During the last three years, an interdisciplinary project team of emergency physicians, university scientists and developers supported by industrial enterprises developed a telematic system supporting the emergency care. The Telematic Rescue Assistance Systems provides the real time transmission of voice communication, vital parameters, pictures and videos from any emergency site using mobile radio networks. Both the technical development of the Telematic Rescue Assistance System and the organizational implementation into the regular operations of the Emergency Medical Services constitute the central pillars of the research project. Beside the technical requirements, the user centered requirement management applied within Med-on-@ix identified the necessary organizational changes to realize the introduction of the telematic system into Emergency Medical Services. This paper traces the joint organizational and technical development of the Telematic Rescue Assistance Systems based on a consistent user involvement into the development process. Simulation studies have been used to identify the main challenges regarding the implementation process. Exploring the impact of the system on the working process, organizational changes have been worked out, aiming at the design of a successful implementation process.

The Telemedical Rescue Assistance System "TemRas" - Development, First Results and Impact

Abstract German emergency medical services (EMS) face the challenge of ensuring high-quality emergency care against a background of continuously increasing numbers of emergency missions, resource shortages concomitant with greatly increased arrival times, particularly in rural areas. Because German EMS physicians are at maximum capacity, an immediate response is not always possible, and thus delays in commencing advanced life support measures sometimes occur. In such scenarios, paramedics start the initial treatment until the EMS physician arrives. The delayed availability of a physician can defer the decision process of the paramedics and thus postpone the start of the patient’s essential treatment, which is particularly dangerous during the care of cardiovascular emergencies. Therefore, the project Telemedical Rescue Assistance System (TemRas) has developed an innovative concept to improve quality of emergency care. The objective is to introduce so-called tele-EMS physicians providing remote medical support for the emergency team on site by transmitting audio and video data as well as vital signs and 12-lead-ECG from the emergency site to a teleconsultation center. In this article, the development process as well as the first results of the evaluation phase and the impact for further use of telemedicine in EMS are presented.

Modular Software Architecture Approach for a Telematic Rescue Assistance System

German emergency medical services are in need of new solutions to their care system in order to cope with raising mission numbers and a reduction of available physicians for emergency care. As countermeasure to this development the research project TemRas investigates the introduction of a Telematic Rescue Assistance System. Supported by this system, physicians located in a teleconsultation center advise multiple paramedics teams during their emergency missions. Usage of this system must be unobtrusive for the supported paramedics in order to enable optimal patient care. The proposed software architecture addresses this by enabling a seamless integration of existing medical devices and their communication protocols for real-time data transmission between emergency scene and teleconsultation center. To ease the integration of the resulting heterogeneous application infrastructure in the teleconsultation center, a message bus is introduced which provides a qualified integration point for such environments.

Determination of the Relevant First Aiders within a Volunteer Notification System

During a sudden cardiac arrest (SCA), an untreated time interval of only a few minutes usually means the victims’ death. While professional emergency medical services (EMS) are working on shortening the time needed for arriving on scene, there are parameters that limit potential performance increases regarding this topic; e.g. current traffic, the travel distance and the delay between an incoming emergency call and the march out of the professional helpers. Given this premise, it is necessary to find alternative ways for providing immediate first aid treatment to victims suffering SCA. One approach is the implementation of a Volunteer Notification System (VNS) – integrating laypersons and medically trained volunteers into the EMS, by notifying those potential helpers who are, at the time of incident, close to the scene. Whereas the term “close” is suitable for describing the general concept of a VNS, a social valuable system implementation requires an algorithm that analyses and determines which volunteers are to be alarmed. False or unnecessary notifications might have a negative effect on the user acceptance or system performance, whereas not alarming potential helpers who are actually close enough can greatly decrease the system’s value. While the actual distance is an important parameter to be considered, it does not necessarily determine the time of arrival at the scene. Due to possible obstacles, the beeline calculation obviously does not offer a suitable background for estimating the traveling time; but even considering up-to-date roadmap material in order to calculate the shortest way does not provide sufficient information without some assumptions. Thus, the type of movement, the physical performance of a volunteer and the traffic situation directly influence those calculations. Furthermore, limiting the relevant decision parameters to merely distance seems inadequate and secondary criteria apply; e.g. medical expertise, knowledge of the area or general engagement. In addition to giving a brief overview to the “EMuRgency” project, this paper will introduce the main criteria for determining the relevant volunteers within an ongoing emergency scenario.

Telenotarzt auf dem Prüfstand Evaluation des Projekts Med-on-@ix aus Sicht der Rettungsassistenten

Hintergrund Die konsequente Nutzerorientierung in der Entwicklung des Telemedizinischen Rettungsassistenzsystems (TRAS) ist zentrale Strategie des Projekts Med-on-@ix. Zur optimalen Einpassung des Systems in die Arbeitsablaufe des Rettungsdienstes erfolgte in allen Projektphasen ein konsequenter Dialog mit den Nutzergruppen. Diese Studie befasst sich mit der Evaluation des Systems durch die Aachener Rettungsassistenten im Anschluss an eine 10-monatige Praxisphase.