The Telemedical Rescue Assistance System "TemRas"--development, first results, and impact

German emergency medical services (EMS) face the challenge of ensuring high-quality emergency care against a background of continuously increasing numbers of emergency missions, resource shortages concomitant with greatly increased arrival times, particularly in rural areas. Because German EMS physicians are at maximum capacity, an immediate response is not always possible, and thus delays in commencing advanced life support measures sometimes occur. In such scenarios, paramedics start the initial treatment until the EMS physician arrives. The delayed availability of a physician can defer the decision process of the paramedics and thus postpone the start of the patient's essential treatment, which is particularly dangerous during the care of cardiovascular emergencies. Therefore, the project Telemedical Rescue Assistance System (TemRas) has developed an innovative concept to improve quality of emergency care. The objective is to introduce so-called tele-EMS physicians providing remote medical support for the emergency team on site by transmitting audio and video data as well as vital signs and 12-lead-ECG from the emergency site to a teleconsultation center. In this article, the development process as well as the first results of the evaluation phase and the impact for further use of telemedicine in EMS are presented.