Prehospital digital photography and automated image transmission in an emergency medical service - an ancillary retrospective analysis of a prospective controlled trial

Abstract

Background: Still picture transmission was performed using a telemedicine system in an Emergency Medical Service (EMS) during a prospective, controlled trial. In this ancillary, retrospective study the quality and content of the transmitted pictures and the possible influences of this application on prehospital time requirements were investigated.

Methods: A digital camera was used with a telemedicine system enabling encrypted audio and data transmission between an ambulance and a remotely located physician. By default, images were compressed (jpeg, 640 x 480 pixels). On occasion, this compression was deactivated (3648 x 2736 pixels). Two independent investigators assessed all transmitted pictures according to predefined criteria. In cases of different ratings, a third investigator had final decision competence. Patient characteristics and time intervals were extracted from the EMS protocol sheets and dispatch centre reports.

Results: Overall 314 pictures (mean 2.77 ± 2.42 pictures/mission) were transmitted during 113 missions (group 1). Pictures were not taken for 151 missions (group 2). Regarding picture quality, the content of 240 (76.4%) pictures was clearly identifiable; 45 (14.3%) pictures were considered "limited quality" and 29 (9.2%) pictures were deemed "not useful" due to not/hardly identifiable content. For pictures with file compression (n = 84 missions) and without (n = 17 missions), the content was clearly identifiable in 74% and 97% of the pictures, respectively (p = 0.003). Medical reports (n = 98, 32.8%), medication lists (n = 49, 16.4%) and 12-lead ECGs (n = 28, 9.4%) were most frequently photographed. The patient characteristics of group 1 vs. 2 were as follows: median age - 72.5 vs. 56.5 years, p = 0.001; frequency of acute coronary syndrome - 24/113 vs. 15/151, p = 0.014. The NACA scores and gender distribution were comparable. Median on-scene times were longer with picture transmission (26 vs. 22 min, p = 0.011), but ambulance arrival to hospital arrival intervals did not differ significantly (35 vs. 33 min, p = 0.054).

Conclusions: Picture transmission was used frequently and resulted in an acceptable picture quality, even with compressed files. In most cases, previously existing "paper data" was transmitted electronically. This application may offer an alternative to other modes of ECG transmission. Due to different patient characteristics no conclusions for a prolonged on-scene time can be drawn. Mobile picture transmission holds important opportunities for clinical handover procedures and teleconsultation.

Figure 1

Trial Flow. NACA score, National Advisory Committee for Aeronautics Score (seven-ary severity score). ^a: Mission in the Netherlands, EMS station was 7.3 km away from the border. Cross-border assistance between the EMS is governed by contract. ^b: In 4 missions mission related pictures were found, although a malfunction of this application was documented.

Figure 2

Sample pictures. Only pictures without identifiable information are displayed. Patient names and patient related details were obscured. A: Medication list, B: Medication list, C: Medication packages, D: Medical report, E: Medical report, F: Medication list, G: Patient’s detail, H: Medication packages.

Figure 3

Sample 12-lead ECGs. Only ECGs without identifiable personal data are displayed.