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Acceptability of ambulance-based telemedicine (ABT) for paediatric emergencies in Karachi, Pakistan
Sheza Hassan1, Kerry Woolfall2, Huba Atiq3
1Department of Emergency Medicine, Weill Cornell Medicine and New York Presbytarian Hospital, New York, NY, USA.
Insights
Telemedicine in ambulances is acceptable for critically ill children. This approach, using audiovisual devices, can improve emergency care access and child survival rates, especially in remote areas.
Area of Science:
- Emergency Medicine
- Telehealth
- Pediatrics
Background:
- Acute childhood illnesses cause millions of deaths globally, often due to delayed diagnosis and treatment.
- Long travel times and care delays in emergency situations can be mitigated through telemedicine.
- Ambulance-based teleconsultation aims to connect remote pediatric emergency physicians with patients in transit.
Purpose of the Study:
- To assess the acceptability of linking ambulances transporting acutely ill children with remote pediatric emergency physicians.
- To explore the feasibility of using simple audiovisual devices for real-time medical consultation during child transport.
Main Methods:
- A qualitative study was conducted using the Theoretical Framework of Acceptability.
- Interviews were held with telemedicine physicians (TMPs) and parents of children requiring ambulance services.
- Focused group discussions were held with emergency medical technicians (EMTs) involved in child transport.
Main Results:
- Participants showed strong support for telemedicine consultations during ambulance transport.
- Telemedicine was perceived to offer prompt intervention, particularly for critically ill children in underserved areas.
- Concerns included privacy, treatment reliability, miscommunication, and parental education, with proposed solutions like joint training and public awareness campaigns.
Conclusions:
- Telemedicine during ambulance transport is deemed acceptable and implementable with proper training for parents, EMTs, and TMPs.
- This intervention shows significant potential for improving the survival rates of critically ill children.
- Addressing identified challenges through education and infrastructure improvements is key to successful implementation.
Introduction:
Globally, half of all 6.2 million deaths in children are caused by acute illnesses which can be prevented if diagnosed and treated in time. We hypothesise that long elapsed travel time and delay in care can be tackled using telemedicine. The objective of this study is to determine the acceptability of linking ambulances that transport acutely ill children to a remote paediatric emergency physician using a simple audiovisual device.
Methods:
We conducted a qualitative study to determine the acceptability of ambulance-based teleconsultation for the emergency care of acutely ill children informed by the Theoretical Framework of Acceptability. We developed semistructured guides using this framework and conducted five interviews with telemedicine physicians (TMPs), 18 interviews with parents of children who recently needed an ambulance and four focused groups with emergency medical technicians (EMTs) who transport children.
Results:
All participants were supportive of using the telemedicine consultation during ambulance transport in the proposed trial as they felt that having access to a video-based physician would offer prompt intervention, particularly for critically ill children in crowded cities and remote regions with scarce resources. Parents believed that ambulance-based telemedicine would enhance their trust in EMTs and reduce their stress. The concerns related to the intervention included parental reluctance in using video cameras due to privacy issues, doubts about doctors' treatment reliability, risk of miscommunication and inadequate parental education. To address these challenges, the groups proposed solutions such as joint training for EMTs and TMPs, educating parents about intervention processes, improving telecommunication infrastructure and promoting public awareness.
Conclusion:
Parents, EMTs and TMPs mutually agreed that the use of telemedicine during ambulance transport can be successfully implemented through proper training and is acceptable in our population. All participants agreed that this intervention holds great potential to improve the survival of critically ill children.
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