Abstract
Introduction: The current level of information and communication technologies leads to extensive development and research in the use of telemedicine (TM) methods in pre-hospital emergency care (PEC). Objective: To present a summary of news, possibilities, including own experience from the Emergency Medical Service of the Karlovy Vary Region (EMS KV) and possible future directions for the use of TM.
Methods: The recently published papers on this topic were actively searched for in the Pubmed database. However, with regard to their inhomogeneity and fundamental methodological differences, these researched publications were further evaluated without a specific systematic methodology, but only according to the criterion of topicality, relevance or interest for presentation in this summary.
As a part of this review, there are commented the outcomes of technical feasibility implemented at the EMS KV in the years 2016-2019, which aimed to utilize existing, commonly used technologies in the PEC for audiovisual consultations of distant physicians with the paramedics at scene. Results: In some sub-specialisations of the PEC, TM is well used in the world and Czech Republic.
Nowadays, it is possible to rely on a number of data showing better outcomes in patients especially with acute coronary syndrome or stroke. Partial results are available for trauma care.
Audiovisual TM assistance was provided to the paramedics, where the goal was to perform a supervised procedure or action (pericardiacentesis, thoracostomy, intubation, burns, ultrasound examination). However, described promising results have been achieved mainly in simulations and expectations were less fulfilled under normal clinical conditions.
More complicated is the general use of TM in the PEC. An example is the Houston research programme, which is probably the largest so far.
It is based on application of the audiovisual consultations to events with low clinical severity or urgency. In those local conditions, there was a significant reduction in crews "back in service time", mainly due to the physician's consultation and the recommendation of alternative patient transport to an emergency department.
During verifying the technical feasibility of TM in the EMS KV with use of available and currently used technologies (computer and mobile phone), it is suggestive that the dominant direction of the development of TM assistance will be in lower urgency or diagnostic uncertainties. Conclusion: Despite all technical limitations, TM can be considered a sub-discipline that, thanks to its dynamic development, will increasingly penetrate into the work of the PEC, either individually or systematically.
Truly relevant data on patient's outcomes from prospective and randomized studies are currently available, particularly in urgent cardiology and neurology. The general and wide interdisciplinary use of audiovisual consultations or TM assistances is technically easy to implement, but it is still a very unsystematic subject in which research questions, methodology and data collection need to be set for future direction.