Trauma: Moving telemed to ambulances improves trauma care

Telemedicine to a moving ambulance can improve the care of trauma patients, according to research published in the July issue of the Journal of Trauma.

William E. Charash, MD, PhD, from the University of Vermont College of Medicine in Burlington, and colleagues evaluated the impact of telemedicine to a moving ambulance on outcomes in simulated trauma patients.

Three trauma scenarios (blunt torso trauma, epigastric stab wound and closed head injury) were created for a human patient simulator. Twenty intermediate emergency medical technicians (EMTs) managed the human patient simulator, in a moving ambulance.

In the telemedicine group, 12 physicians provided consultation. In the non-telemedicine group, EMTs communicated with medical control via radio, as necessary. “We tabulated the fraction of 13 key signs, five pathologic processes, and 12 key interventions that were performed,” the authors wrote. Vital signs and Sao2 were recorded.

Lowest Sao2 (84 vs. 78), lowest systolic blood pressure (70 vs. 53), and highest heart rate (144 vs. 159) were significantly improved in the telemedicine group, the authors found while recognition rates for key signs (0.96 vs. 0.79), processes (0.98 vs. 0.75), and critical interventions (0.92 vs. 0.49) were higher in the telemedicine group.

“EMTs were successfully guided through needle decompression procedures in 22 of 24 cases (zero in the non-telemedicine group),” the authors wrote. EMTs were also able to perform needle thoracostomy and pericardiocentesis with telemedicine guidance, the report added.

“One of the limitations of this study is that the human patient simulator does not simulate actual compression and decompression of air or fluid filled compartments,” Charash and colleagues added. “Thus, all that can be demonstrated is that a correct device was placed in an anatomically correct location, in a correct orientation. The preliminary data, however, is quite encouraging, and invites further investigation.”

Telemedicine guidance of complex airway management, including endotracheal intubation, needle, and open cricothyroidotomy, could also be studied in an in vivo model, the authors concluded.

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