Med-on-@ix: Real-time Tele-Consultation in Emergency Medical Services – Promising or Unnecessary?

Introduction

At present, emergency calls are condensed to certain keywords, such as respiratory distress, and dispatched to both paramedics as well as the EMS-physician. Typically, the ambulance staffed with paramedics is the first on scene and the EMS-physician arrives a few minutes later. In rural areas the arrival period can exceed 30 minutes as there are more ambulance bases than EMS-physician bases. The distances from the bases to the scene are much shorter for ambulances than for the EMS-physician. As a consequence drug free interval vary significantly, depending on whether the emergency is taking place in an urban or rural area. Additionally, the lack of EMS-physicians in times of general shortage of physicians impedes the 24 hours occupation of EMS-physician bases in rural areas (Deutscher Bundestag, 2006) (Behrendt & Schmiedel, 2004).

The Med-on-@ix-project aims at the broad implementation of a telemedical system in EMS enabling support up to a real-time teleconsultation. The basis of the system is a centre of competence with an experienced emergency medical physician (further called Telenotarzt in accordance to the German equivalent for EMS-physician, the Notarzt). Advanced mobile data transmission enables the real time transmission of all vital parameters of a patient and a video live stream from the ambulance and the scene to the competence centre, where the information is visualized on large screens.

He uses specially designed software, including maps, and he has a documentation software as well as databases. The competence centre is responsible for the contact and data transfer to the hospital and the consultation with other institutions (for example family physician, cardiology, poisoning centre, and so forth). Thus, the rescuers on scene can focus on their main task, which is the manual patient care. German paramedics are restricted in their clinical actions due to legal limitations, for example drug therapy at the emergency scene. Therefore, the advantage of this system is, that measures reserved normally only for physicians could be begun on the order of the Telenotarzt until the EMS physician arrives on site. Thus, the treatment free interval may be shortened. In cases where the EMS-physician is not present in the foreseeable future, the Telenotarzt could even replace the EMS physician in part. In most cases it is mainly the expertise and decision-making of the physician that is needed, rather than the practical skills (Gries, Helm & Martin, 2003).

The main aim of this research is to improve the quality of medical care and patient safety while speeding up the whole process. Since 2004, this project has been created by the emergency medicine section at the Department of Anaesthesiology, University Hospital of Aachen. In 2006, the merger of the existing consortium of industry and research was completed. The project Med-on-@ix is funded by the Federal Ministry of Economics and Technology funding programme SimoBIT (secure use of mobile information technology to increase value creation in small business and government)

The main partners in this consortium listed below:

• 1.

  Department of Anaesthesiology at the University Hospital Aachen
EMS-physicians are recruited from the Department of Anaesthesiology
The department operates a simulation centre (AIXTRA) with a “Full-Scale Simulator” to practice various real emergency situations .

• 2.

  Department of Information Management in Mechanical Engineering of the RWTH Aachen University, Germany, (ZLW/IMA)
This department focuses on system integration, customer-driven technology development and design of human-technology interfaces.
Within the Med-on-@ix project, the ZLW / IMA is responsible for the implementation of scenarios, the design of human-technology interfaces, as well as the conduct of simulation studies and their evaluation.

• 3.

  Philips Healthcare, Hamburg
Philips develops and manufactures products for patient monitoring systems for the global market. In the Med-on-@ix project, Philips is involved with the Cardiac & Monitoring Section in Boeblingen and the marketing section in Hamburg.

• 4.

  P3 communications GmbH, Aachen (Telecommunications)
P3 communications includes the telecommunication activities since 1999 of the P3 SOLUTIONS GmbH Consulting Company for Management & Organisation. P3 is now a Europe-wide company which has specialized in the measurement, analysis and optimisation of mobile networks and services. In our project, P3 is responsible for transmission techniques and hardware devices as well as software development.