Track1 session5 Telemedical support in EMS: 5 years of routine experience with a holistic system Stefan Beckers
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Technology, telehealth, and more appropriately aligned patient navigation can help emergency medical services to be more efficient. Also, how can we get better use of Automatic External Defibrillators (AEDs) using new technologies? How can we inform citizens about where to find an AED and how to use it? You will hear from experts on these matters in this session. Chair: Dieter Nuessler, Vice President, EENA
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Track1 session5 Telemedical support in EMS: 5 years of routine experience with a holistic system Stefan Beckers
- 1. TELEMEDICINE IN EMS 5 YEARS IN ROUTINE USE Dipl.-Ing. Jürgen Wolff Dr. Stefan Beckers, MD, PhD, MME, FERC Chief Fire Department Medical Director EMS City of Aachen, Germany
- 2. RESPONSIBILITIES TELEMEDICINE IN EMS ▪Client – Emergency Medical Service ▪Operator – Telemedical support system ▪Research Support Dept. of Anaesthesiology
- 3. HISTORY OF TELEMEDICAL SUPPORT IN AACHEN 1st Research Project 2007-2010 2nd Research Project 2010-2013 Integration in structure plan of EMS Planning of implementation Political decision 19.03.2014 Start 01.04.2014 with 4 ambulances and 12 hrs tele-support - Training of EMS personnel 24hrs service from 01.07.14 with 6 ambulances 03/2015: 11 equipped ambulances – implementation phase completed
- 4. EMS OF CITY OF AACHEN 2 EMS physician units 17 (12+5) telemedically equipped ambulances (type C ambulance) 1 tele-EMS physician
- 5. Tele-EMS-physician centre Telemedically equipped ambulances 2) real-time vital data 1) audiocommunication mobile communication unit 3) checklist-based documentation Operator: P3 telehealthcare GmbH 3G 2G peeqBOX 4G 4) photo 5) video TELEMEDICAL SUPPORT SYSTEM
- 7. AMBULANCE Antennas In-Car Communication Unit Video-cam Printer Parallel use: 4 mobile provider via In-car Communication Unit TELEMEDICAL SUPPORT SYSTEM
- 11. TELE-EMS-MISSIONS TELEMEDICAL SUPPORT SYSTEM Advantages . . . ▪ immediate availability of expertise ▪ Parallel, short delayed support possible ▪ Reduced retention time of the Ø duration of mission: 18 min (vs. 53 min NEF) Ø call duration: 9.5 min ▪ Contact by rescue team on site ▪ Anamnesis, diagnosis & delegation of therapy ▪ Pre-information in the target hospital
- 12. TELEMEDICAL SUPPORT SYSTEM CITY OF AACHEN STATUS QUO ▪17 telemedically equipped ambulances ▪1 Support-Center in dispatch-center Aachen 24h/7d ➢Qualification: at least 5. year anesthesia resident, pre-hospital emergency physician, at least 500 missions “on-street” ➢Clarification of all interhospital transports (approx. 2,500 / year) for the dispatch center
- 13. FIRST SUPRA-REGIONAL TELEMEDICAL NETWORK Basic openness & expandability of the network Standardized quality within the network regional specific SOP´s 1 Tele-Physician (24h) 24 Ambulances in 3 EMS-areas since 03/2017 since 03/2018
- 14. Areas of Missions Secondary missions Primary missions Primary Secondary Advice to dispatch center conventional Tele-EMS > 4 YEARS EXPERIENCE – ABOUT 13.000 PATIENTS 404 Ambulance Ambulance + Tele Ambulance + NEF
- 15. NUMBER OF TELE-SUPPORTED MISSIONS
- 16. TECHNICAL PERFORMANCE 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% GPS Video Pictures 12-Lead-ECG Vital data Voice GPS Video Pictures 12-Lead-ECG Vital data Voice No malfunctions 4498 1861 2055 2169 4194 4327 Some malfunctions, quality not affected 147 159 88 76 512 634 Malfunctions, quality reduced 15 26 31 42 105 128 Malfunctions, transmission impossible 53 70 72 87 100 45 No malfunctions Some malfunctions, quality not affected Malfunctions, quality reduced Malfunctions, transmission impossible
- 17. NUMBERS | DATA CATEGORIES OF TELEMEDICALLY MISSION 90,05% 4,65% 1,75% 2,23% 1,32% ALS-ambulance + tele-EMS physician (without EMS physician on scene) EMS physician alerted during teleconsultation teleconsultation initiated while EMS physician was already alerted teleconsultation for the EMS physician or handover from the EMS physician to the tele-EMS physician for transport not specified Support of EMS physician, handover to telemedical support reduction of time interval to medical therapy + improvement of patient safety due to real-time observation by tele-EMS physician
- 18. Diagnosis % Trauma 15% Stroke 14% Acute Pain-Situation (non-traumatic) 11% ACS NSTEMI STEMI 7% Hypertension 7% Acute Abdomen 6% Syncope 5% Data 4. Q 2018 NUMBERS | DATA PRIMARY MISSIONS
- 19. CHECKLIST-BASED SOFTWARE-SUPPORT EXAMPLE STROKE TELEMEDICAL SUPPORT SYSTEM
- 20. QUALITY OF CARE EXAMPLE STROKE ▪ Software-based SOP for stroke-specific information crucial for in-hospital treatment ▪ Use (electronic) checklist ▪ Compliance with guidelines for acute stroke Measure / Parameter % correct Prehospital blood pressure management 93% Docu premedication (lysis contraindications) 97% Docu pre-existing conditions (lysis contraindications) 97% Acquisition of existing allergies 92% Recording symptom onset / time window 92%
- 21. NUMBERS | DATA % WITH EMS-PHYSICIANS Germany
- 22. REGELVERSORGUNG SEIT 04/2014 Status Quo ▪13.422 telemedically supported missions: 01.04.2014 – 31.12.2018 − emergency missions (90%) & interhospital transfers (10%) ▪in apr. 85% of supported missions a regular EMS physician would have been necessary, if no telemedical support would be available − ca. 72% delegation medication − ca. 23% delegation opioids ROUTINE CARE since 04/2014 More quality . . . ▪ direct availability of emergency medical expertise ▪ Shortening therapy-free interval ▪ Increased patient safety through medical supervision ▪ Medical delegation instead of emergency skills ▪ Better documentation quality increases transparency ▪ Above-average guideline adherence
- 23. ROUTINE CARE since 04/2014 Status Quo ▪13.422 telemedically supported missions: 01.04.2014 – 31.12.2018 − emergency missions (90%) & interhospital transfers (10%) ▪in apr. 85% of supported missions a regular EMS physician would have been necessary, if no telemedical support would be available − ca. 72% delegation medication − ca. 23% delegation opioids More efficiency . . . ▪Higher availability of physicians (NEF / RTH) ▪More efficient use of emergency physicians possible ▪Reduction EMS-Physicians rate by more than 50% possible ▪supra-regional applicability successfully implemented
- 24. The key is not to predict the but to prepare for it! Perikles, 500-429 v. Chr.
- 25. THANK YOU VERY MUCH FOR YOUR ATTENTION Dr. Stefan Beckers, MD, PhD, MME, F.E.R.C. Chief Medical Director City of Aachen AELR@mail.aachen.de
- 26. original live vital data of the patient CASE-REPORT
- 27. ➢call from ambulance due to mild chest pain ➢12-lead-ECG transmission: STEMI ➢instable patient➔ additional alarm of EMS physician, but all EMS physician units were busy in neighboring community ➢delegation of Aspirin, Heparin, Nitroglycerin, Morphine & Ondansetrone to paramedics on-scene ➢arrival of EMS-physician-Unit after 22 min ➢patient was transferred from 3rd floor to ambulance at this time point ➢reduction of therapy-free interval: 22 minutes ➢arrival at cardiac cath lab 34 minutes after ambulance arrival CASE-REPORT