Background: Still picture transmission was performed using a telemedicine system in an Emergency Medical\r\nService (EMS) during a prospective, controlled trial. In this ancillary, retrospective study the quality and content of\r\nthe transmitted pictures and the possible influences of this application on prehospital time requirements were\r\ninvestigated.\r\nMethods: A digital camera was used with a telemedicine system enabling encrypted audio and data transmission\r\nbetween an ambulance and a remotely located physician. By default, images were compressed (jpeg, 640 x 480\r\npixels). On occasion, this compression was deactivated (3648 x 2736 pixels). Two independent investigators\r\nassessed all transmitted pictures according to predefined criteria. In cases of different ratings, a third investigator\r\nhad final decision competence. Patient characteristics and time intervals were extracted from the EMS protocol\r\nsheets and dispatch centre reports.\r\nResults: Overall 314 pictures (mean 2.77 Ã?± 2.42 pictures/mission) were transmitted during 113 missions (group 1).\r\nPictures were not taken for 151 missions (group 2). Regarding picture quality, the content of 240 (76.4%) pictures\r\nwas clearly identifiable; 45 (14.3%) pictures were considered ââ?¬Å?limited qualityââ?¬Â and 29 (9.2%) pictures were deemed\r\nââ?¬Å?not usefulââ?¬Â due to not/hardly identifiable content. For pictures with file compression (n = 84 missions) and without\r\n(n = 17 missions), the content was clearly identifiable in 74% and 97% of the pictures, respectively (p = 0.003).\r\nMedical reports (n = 98, 32.8%), medication lists (n = 49, 16.4%) and 12-lead ECGs (n = 28, 9.4%) were most\r\nfrequently photographed. The patient characteristics of group 1 vs. 2 were as follows: median age ââ?¬â?? 72.5 vs.\r\n56.5 years, p = 0.001; frequency of acute coronary syndrome ââ?¬â?? 24/113 vs. 15/151, p = 0.014. The NACA scores and\r\ngender distribution were comparable. Median on-scene times were longer with picture transmission (26 vs. 22 min,\r\np = 0.011), but ambulance arrival to hospital arrival intervals did not differ significantly (35 vs. 33 min, p = 0.054).\r\nConclusions: Picture transmission was used frequently and resulted in an acceptable picture quality, even with\r\ncompressed files. In most cases, previously existing ââ?¬Å?paper dataââ?¬Â was transmitted electronically. This application may\r\noffer an alternative to other modes of ECG transmission. Due to different patient characteristics no conclusions for a\r\nprolonged on-scene time can be drawn. Mobile picture transmission holds important opportunities for clinical\r\nhandover procedures and teleconsultation.
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