Feasibility of AmbulanCe-Based Telemedicine (FACT) study: safety, feasibility and reliability of third generation in-ambulance telemedicine

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Figure 1. The PreSSUB 3.0 system.

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).

Figure 2. Flow diagram of the FACT study.

Figure 3. Box-and whisker plots demonstrating bandwidth per prehospital teleconsultation.

Box-and whisker plots demonstrating mean (A) and maximal (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 * (P<0.05) or with ** (P<0.001).

Figure 4. Map of Brussels indicating connectivity during prehospital telemedicine consultations.

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 (A) and outside office hours (B).