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