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

PLoS One. 2014 Oct 24;9(10):e110043. doi: 10.1371/journal.pone.0110043. eCollection 2014.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Ambulances*
  • Belgium
  • Feasibility Studies
  • Female
  • Geography
  • Hospitals
  • Humans
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Safety*
  • Telemedicine*

Grants and funding

This study was conducted as part of the Prehospital Stroke Study at the Universitair Ziekenhuis Brussel (PreSSUB). The PreSSUB project is supported by the following grants: Grant by the Vrije Universiteit Brussel (www.vub.ac.be) Industrial Research Fund (IOF) for funding of a ‘Proof-of-Concept Project’ for the research project ‘Prehospital Stroke Study at the Universitair ziekenhuis Brussel’ (2013); grant number IOFPOC9/INTGINK70; grant obtained by RB. Grant by the Scientific Fund Willy Gepts (www.vub.ac.be) for the research project ‘Prehospital Stroke Study at the Universitair ziekenhuis Brussel’ (2013); grant number 71045/G145; grant obtained by RB. Grant by the Brussels Institute for Research and Innovation (INNOVIRIS, www.innoviris.be) for the research project 'Prehospital Stroke Study at the Universitair ziekenhuis Brussel - Spin Off in Brussels' (2011–2014); grant number INNOVIRIS/2011SOIB02/KM/MV/VG/LV/2013/1937; grant obtained by RB. All researchers were fully independent from the funders. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.