Telemedicine

[fab]

Our station is involved in a study trying to introduce and test the capabilities of Telemedicine in Germany. It's actually a fairly new idea over here since EMS has been pysichian-led for the past 40 years. The data is sent via cellular network only, not digital radio. There are two pysichians available at the dispatch centre, which receive the vitals on our monitor (NiBP, SpO2, live ECG, 12-leads, etCO2), we can send images, they can direct a camera in the back of our ambulance, and of course talk to us via headset. In case the patient is critically ill or severly injured, the ground-based pysician or HEMS would still be dispatched.

Now I'm curious on how you work with Telemedicine and if you do at all. By what means would you send the information? What sort of information do you send? Can you send e.g. 12-leads or are you only able to consult with the doctor? What sort of doctor is that , where is he based (ED or somewhere else)? For what sort of emergency or medication would you call in and does that depend on your level of training? Do you have protocols covering most areas or do you have to call in often? Is the equipment reliable, how is the network or radio coverage? What do you do in case the radio breaks down and a patient needs treatment? Just generally, how are your experiences? Would you prefer working in another system without direct medical control? Are there even systems using independent practitioners in the U.S.?

I understand that there will be a broad range of answers, just give me an idea on how you work with the technology. I've recently watched the first season of Emergency! so that's basically as much as I know I'll also be happy to answer your questions.

Take care

[DFIB]

I have never experienced this in an prehospital setting but have observed surgery observed and directed by a surgeon in a different location. The operation was successful and with the intended results.

I think that direct medical supervision could be good in the sense that patients get a better care. This should not be problematic from a legal standpoint since we already work under medical direction and as an extension of their practice.

The downside that occurs to me, is that it could propitiate the deterioration of critical thinking by prehospital personnel.

It is an interesting concept. I will be very interested in knowing what the results of your pilot program are, assuming that this is a pilot program.

[fab]

yeah, it is a pilot pragram and it's only been running for 4 weeks now, still a year to go... see what happens. I thought that it was still quite common in the States to call a doctor for advice or ask permission for certain interventions. Has it changed or am I just ill-informed? I really thought I could draw from your experience.

I see your point with the critical thinking. So far it has helped improve treatment and sometimes not actually being involved brings a totally different perception or rather view to the scene. If you get my point. You've got to excuse my English, I haven't been abroad for a while so it has suffered a bit

[DFIB]

No worries about your English. I have been trying to learn how to pronounce Rettungassistent since forever.

In the US contacting Medical Direction is a common practice but not by means of video or streaming feed. What you are describing is more like having a Physician in the ambulance with you. Watching and commenting. It seems that you would not so much be his eyes or ears but more so his hands.

So you would consider that it has had a positive effect on patient care?

[fab]

Learning the pronounciation may be obsolete soon. So you call Medical Direction with your phone? Who would that be, is it your Medical Director or just a Doc in the ED or dispatch center? As an EMT what would you have to call him for, say iv access? And as a paramedic, thrombolysis, RSI, antidotes, antiarrhythmics, cardioversion?

I guess it only has positive effects here because invasive procedures are for pysichians only... We use state of emergency laws, iv lines are common for paramedics, glucose, antiemetics, certain cardiac and respiratory drugs, adrenaline, painkillers. I've intubated a few times (GCS <6) and heard of colleagues who've done stuff like needle decompression. You're only allowed to use the ALS procedures when the physichian is on his way or acutally present. So the Doc at the dispatch centrer enables us to treat patients on our own and keeps the number of runs for the ground-based physician low.