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

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 4 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.

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