Feasibility of AmbulanCe-Based Telemedicine (FACT) Study:Safety, Feasibility and Reliability of Third Generation Ambulance Telemedicine

Telemedicine is currently mainly applied as an in-hospital service, but this technology also holds potential to improve emergency care in the prehospital arena. We report on the safety, feasibility and reliability of in-ambulance teleconsultation using a telemedicine system of the third generation.A routine ambulance was equipped with a system for real-time bidirectional audio-video communication, automated transmission of vital parameters, glycemia and electronic patient identification. All patients ( ≥ 18 years) transported during emergency missions by a Prehospital Intervention Team of the Universitair Ziekenhuis Brussel were eligible for inclusion. To guarantee mobility and to facilitate 24/7 availability, the teleconsultants used lightweight laptop computers to access a dedicated telemedicine platform, which also provided functionalities for neurological assessment, electronic reporting and prehospital notification of the in-hospital team. Key registrations included any safety issue, mobile connectivity, communication of patient information, audiovisual quality, user-friendliness and accuracy of the prehospital diagnosis.Prehospital teleconsultation was obtained in 41 out of 43 cases (95.3%). The success rates for communication of blood pressure, heart rate, blood oxygen saturation, glycemia, and electronic patient identification were 78.7%, 84.8%, 80.6%, 64.0%, and 84.2%. A preliminary prehospital diagnosis was formulated in 90.2%, with satisfactory agreement with final in-hospital diagnoses. Communication of a prehospital report to the in-hospital team was successful in 94.7% and prenotification of the in-hospital team via SMS in 90.2%. Failures resulted mainly from limited mobile connectivity and to a lesser extent from software, hardware or human error. The user acceptance was high.Ambulance-based telemedicine of the third generation is safe, feasible and reliable but further research and development, especially with regard to high speed broadband access, is needed before this approach can be implemented in daily practice

Development and Pilot Testing of 24/7 In-Ambulance Telemedicine for Acute Stroke:Prehospital Stroke Study at the Universitair Ziekenhuis Brussel-Project

Background: In-ambulance telemedicine is a recently developed and a promising approach to improve emergency care. We implemented the first ever 24/7 in-ambulance telemedicine service for acute stroke. We report on our experiences with the development and pilot testing of the Prehospital Stroke Study at the Universitair Ziekenhuis Brussel (PreSSUB) to facilitate a wider spread of the knowledge regarding this technique. Methods: Successful execution of the project involved the development and validation of a novel stroke scale, design and creation of specific hardware and software solutions, execution of field tests for mobile internet connectivity, design of new care processes and information flows, recurrent training of all professional caregivers involved in acute stroke management, extensive testing on healthy volunteers, organisation of a 24/7 teleconsultation service by trained stroke experts and 24/7 technical support, and resolution of several legal issues. Results: In all, it took 41 months of research and development to confirm the safety, technical feasibility, reliability, and user acceptance of the PreSSUB approach. Stroke-specific key information can be collected safely and reliably before and during ambulance transportation and can adequately be communicated with the inhospital team awaiting the patient. Conclusion: This paper portrays the key steps required and the lessons learned for successful implementation of a 24/7 expert telemedicine service supporting patients with acute stroke during ambulance transportation to the hospital. (C) 2016 S. Karger AG, Base

Prehospital Unassisted Assessment of Stroke Severity Using Telemedicine A Feasibility Study

<p>Background and Purpose We evaluated the feasibility and the reliability of remote stroke severity quantification in the prehospital setting using the Unassisted TeleStroke Scale (UTSS) via a telestroke ambulance system and a fourth-generation mobile network.</p><p>Methods The technical feasibility and the reliability of the UTSS were studied in healthy volunteers mimicking 41 stroke syndromes during ambulance transportation.</p><p>Results Except for 1 issue, high-quality telestroke assessment was feasible in all scenarios. The mean examination time for the UTSS was 3.1 minutes (SD, 0.4). The UTSS showed excellent intrarater and interrater variability (=0.98 and 0.97; P</p><p>Conclusions Remote assessment of stroke severity in fast-moving ambulances using a system dedicated to prehospital telemedicine, 4G technology, and the UTSS is feasible and reliable.</p>

Flow diagram of the FACT study.

<p>Flow diagram of the FACT study.</p

Patient and intervention characteristics.^*

<p>Patient and intervention characteristics.^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0110043#nt101" target="_blank">*</a>}</p

The PreSSUB 3.0 system.

<p>The telemedicine device is securely mounted to the ceiling of the ambulance (A) and allows bidirectional audiovisual communication between the patient and the teleconsultant via integration of a microphone, speakers, a screen and a 360° view camera (B). The teleconsultant has mobile access to the telemedicine platform using a lightweight laptop computer with touch screen, integrated microphone, speakers and a webcam (C).</p

Box-and whisker plots demonstrating bandwidth per prehospital teleconsultation.

<p>Box-and whisker plots demonstrating mean (<b>A</b>) and maximal (<b>B</b>) bandwidth per prehospital teleconsultation for download (from the ambulance to the teleconsultant) and for upload (from the teleconsultant to the ambulance). Hatched boxes represent teleconsultations outside of office hours; white boxes teleconsultations during office hours. Significant differences are indicated with * (<i>P</i><0.05) or with ** (<i>P</i><0.001).</p

Map of Brussels indicating connectivity during prehospital telemedicine consultations.

<p>Map of Brussels indicating the location of the Universitair Ziekenhuis Brussel (H) and the patient locations according to connectivity during prehospital telemedicine consultations (no signal loss: green ambulance; transient signal loss: yellow ambulance; permanent signal loss: red ambulance) during office hours (<b>A</b>) and outside office hours (<b>B</b>).</p

Bandwidth and data transfer during prehospital teleconsultation^*.

<p>Bandwidth and data transfer during prehospital teleconsultation^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0110043#nt104" target="_blank">*</a>}.</p