Abstract P190: Teleconsultation Does Not Prolong Time Intervals in a Simulated Prehospital Cardiac Emergency Scenario
BACKGROUND: Time is one of the most important factors influencing patient outcome in EMS. Telemedical assistance (TMA) from an experienced physician to the scene including real-time data transmission (monitoring, audible and visual information) is technically feasible. Communication between the EMS team and a consulting physician is an additional task and might prolong the prehospital time - apart from the potential beneficial impact on treatment. Against the background of implementing TMA within the research project “Med-on-@ix” a simulation study has been conducted to investigate whether TMA has an impact on time intervals.
METHOD: Overall 87 subjects, resp. 29 EMS teams (1 EMS physician and 2 paramedics) had to run through a standardized scenario of STEMI using a high-fidelity patient simulator. After randomization 15 EMS teams got TMA and 14 EMS teams worked alone on scene (control). The scenario consisted of a patient presenting typical cardiac symptoms, a 12-lead ECG showing STEMI and after 8 min a sudden instable ventricular tachycardia (VT) with hypotension and nausea. The scenario was finished after 12 min. Two independent investigators analyzed videotaped scenarios on basis of defined scoring items. Wilcoxon-test was used to compare time intervals.
RESULTS: Only in the control group (n=14) one team did not diagnose the STEMI. Time interval from scenario start to STEMI diagnosis: 306s±100s (TMA, n=15) vs. 278s±86s (control, n=13), p=0.3940. Only in the control group 5/14 teams did not contact a cathlab. Time interval from scenario start to information of cathlab: 349s±101s (TMA, n=15) vs. 338s±76s (control, n=9), p=0.6763. Administration of drugs for analgosedation prior to shock: 15/15 (TMA) vs. 10/14 (control). Button pressed for synchronization before delivery of shock: 14/15 (TMA) vs. 6/13 (control). Only in the control group one team did not deliver a shock. Time interval from onset of VT to delivery of a shock: 155s±41s (TMA, n=15) vs. 132s±79s (control, n=13), p=0.3448.
DISCUSSION: Important time intervals are not prolonged by using TMA for EMS teams in a simulated scenario. With rising telemedicine technologies TMA has the potential to improve patient safety and quality of treatment in a prehospital setting and should be further evaluated.