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Telemedical Direction to Optimize Resource Utilization in a Rural Emergency Medical Services System.

Ramesh Karra1, Amber D Rice1,2, Aileen Hardcastle1

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Telemedicine in rural emergency medical services (EMS) did not increase advanced life support (ALS) transports or on-scene times for chest pain patients. Paramedics and physicians found the telemedicine connection quality to be good.

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Area of Science:

  • Emergency Medicine
  • Health Services Research
  • Telehealth

Background:

  • Telemedicine is underutilized in rural emergency medical services (EMS) systems.
  • Barriers include concerns about increased Advanced Life Support (ALS) transports, extended on-scene times, and connectivity issues.
  • This project aimed to implement and assess telemedicine in rural EMS for chest pain patients, addressing perceived barriers.

Purpose of the Study:

  • To implement a telemedicine system in a rural EMS setting.
  • To assess telemedicine's impact on EMS management of chest pain patients.
  • To evaluate perceived barriers to telemedicine implementation.

Main Methods:

  • Mixed-methods, retrospective review of quality assurance data.
  • Comparison of 12-month pre-implementation and 15-month post-implementation data.
  • Inclusion criteria: chief complaint of chest pain or 12-lead ECG obtained.
  • Primary outcome: ALS transport rate. Secondary outcomes: response times, quality improvement benchmarks.
  • Qualitative data collected on paramedic/EMT and physician perceptions of call quality.

Main Results:

  • Telemedicine pilot project implemented September 2020; 58 successful encounters.
  • Included 38 patients (pre- and post-implementation).
  • ALS transport rate: 42% pre-implementation vs. 45% post-implementation (OR 1.11).
  • Median out-of-service times decreased from 47 to 33 minutes (P=0.07).
  • 64% of paramedics/EMTs and 89% of EMS physicians rated telemedicine call quality as 'good.'

Conclusions:

  • Telehealth platform successfully implemented in rural EMS, connecting paramedics/EMTs with EMS physicians.
  • Telemedicine did not alter ALS transport rates or increase on-scene times.
  • Majority of healthcare providers rated telemedicine connection quality as 'good.'