As video communications infrastructures and telemedicine technology constantly improve, the opportunities to expand telemedicine into new fields are multiplying rapidly. One such area, mobile health (mHealth), refers to the application of telemedicine technologies in areas beyond the four walls of a hospital or clinic—in other words, medicine on-the-go. For instance, EMS telemedicine (Emergency Medical Services) integrates telemedicine into ambulances so that paramedics can contact a specialist at the hospital for an initial assessment, diagnosis, and treatment plan—even before arriving at the emergency department (ED). This capability offers the potential to save crucial minutes for patients like stroke victims, for whom the drug of choice—tissue plasminogen activator (tPA)—must be administered within a certain time frame to be effective and life-saving. Indeed, a recent meta-analysis of over 6,600 patients treated with tPA found a strong correlation between EMS telemedicine availability in the ambulance and decreased times from symptom onset to treatment. However, the technology can only be useful if the operator can wield it effectively; how do paramedics value and use mHealth?
A 2017 survey, published in the Journal of Emergency Medical Services, questioned 100 paramedics about the use of EMS telemedicine as well as any concerns with audio, video, and equipment functionalities. The results revealed that less than half of the respondents were even aware that EMS telemedicine had already been implemented in some regions. When asked whether they felt that mHealth in ambulances could improve pre-hospital diagnosis, destination decisions, and patient satisfaction, the vast majority of subjects either agreed with these statements or were neutral.
When it came to the hardware aspect of EMS telemedicine, however, paramedics were less enthusiastic. Their uneasiness centered on technology and care delivery; nearly two-thirds of the respondents worried about connection issues, background noise, and interference with normal care. Factors relating to the physical equipment used in mHealth were less problematic; one-third of the paramedics reported concerns over loss, damage, and ease of use during patient transport.
When presented with different scenarios, the survey respondents were asked whether they believe EMS telemedicine would be most beneficial. Half of the paramedics felt strongly that mHealth would be beneficial for unclear acute stroke diagnoses or ST-segment elevation myocardial infarction (STEMI); for other situations that merited a more clear diagnosis without the aid of mHealth, only one-third of the paramedics believed that the technology could prove useful.
All of these findings indicate that in general, paramedics are interested in EMS telemedicine for time-sensitive conditions such as trauma, stroke, and STEMI. The ability to diagnose a patient en route to the hospital offers the option of redirecting the patient to another, more appropriate facility for his/her particular needs, such as a comprehensive stroke center. In addition, paramedics seem to appreciate the availability of a second opinion that can reduce the time to treatment, improve information forwarded to the hospital, and determine the best hospital for that patient.
To learn more about paramedics’ perspectives on EMS telemedicine, visit the Journal of Emergency Medical Services here.