Prehospital Emergency Care of Obstructive Respiratory Emergencies With the Use of Teleconsultation

Overview

The aim of the study is to investigate the quality of prehospital emergency care in acute respiratory emergencies, when paramedics are supported telemedically by an EMS physician.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: N/A
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: July 2013

Detailed Description

Six ambulances from five different Emergency Medical Service (EMS) districts are equipped with a portable telemedicine system. In cases of acute obstructive, respiratory emergencies the paramedics can use this system to contact a so called "tele-EMS physician" after consent of the patient was obtained. The tele-EMS physician has an audio-connection to the EMS team and receives vital parameters (e.g., ECG, pulse oximetry, non-invasive blood pressure) in real-time. The transmission of still pictures (taken with a smartphone), 12-lead-ECGs and video streaming from the inside of the ambulance can also be carried out, if indicated. The tele-EMS physician supports the EMS team in obtaining all relevant medical history, diagnosis and can delegate the application of medications. This can be carried out to bridge the time to the arrival of an EMS physician or in less severe cases without an EMS physician on-scene. The quality of prehospital care and the possible influences on the initial inhospital phase should be investigated and compared with regular EMS.

Interventions

  • Device: Teleconsultation
    • Teleconsultation for the EMS in acute respiratory emergencies

Arms, Groups and Cohorts

  • Experimental: Device: Teleconsultation
    • In cases of acute obstructive, respiratory emergencies if patients give informed consent the paramedics can use this system to contact a so called “tele-EMS physician” who has an audio-connection to the EMS team and receives vital parameters (e.g., ECG, pulse oximetry, non-invasive blood pressure) in real-time. The transmission of still pictures (taken with a smartphone), 12-lead-ECGs and video streaming from the inside of the ambulance can also be carried out, if indicated. The tele-EMS physician supports the EMS team in obtaining all relevant medical history, diagnosis and can delegate the application of medications. This can be carried out to bridge the time to the arrival of an EMS physician or in less severe cases without an EMS physician on-scene. The quality of prehospital care and the possible influences on the initial inhospital phase should be investigated and compared with regular EMS.

Clinical Trial Outcome Measures

Primary Measures

  • Oxygen Saturation
    • Time Frame: average 1 hour
    • Measurement of pulse oximetric oxygen saturation at the timepoint of first contact with a physician (EMS physician OR hospital arrival)

Secondary Measures

  • Quality of emergency care
    • Time Frame: average 1 hour
    • Analysis of the quality of prehospital care on the basis of published guidelines for asthma / COPD.
  • Rate of ventilation
    • Time Frame: average 1 hour
    • Fraction of patients that receive invasive or non-invasive ventilation during the prehospital phase
  • Rate of complications
    • Time Frame: 2 hours
    • Rate of complications due to medications: allergic reaction, heart rhythm problems

Participating in This Clinical Trial

Inclusion Criteria

  • Obstructive, respiratory emergency – Verbal consent for teleconsultation obtained or patient is not able to consent due the severity of the emergency Exclusion Criteria:

  • No respiratory emergency – Refused consent for teleconsultation

Gender Eligibility: All

Minimum Age: N/A

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • RWTH Aachen University
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Rolf Rossaint, Prof. Dr., Study Chair, University Hospital Aachen, Germany, Department of Anesthesiology
    • Jörg C Brokmann, Dr., Principal Investigator, University Hospital Aachen, Germany, Emergency Department

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