Methods Inf Med 2018; 57(05/06): 231-242
DOI: 10.1055/s-0039-1681089
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Prehospital Telemedical Emergency Management of Severely Injured Trauma Patients

A Systematic Review
Patrick A. Eder
1  Zentrum für Telemedizin Bad Kissingen, Bad Kissingen, Germany
,
Birgit Reime
2  Faculty of Health Safety Society, Furtwangen University, Furtwangen, Germany
,
Thomas Wurmb
3  Department of Anaesthesiology, Section of Emergency and Disaster Medicine, University Hospital Würzburg, Würzburg, Germany
,
Uwe Kippnich
4  Bavarian Red Cross, Munich, Germany
,
Layal Shammas
1  Zentrum für Telemedizin Bad Kissingen, Bad Kissingen, Germany
,
Asarnusch Rashid
1  Zentrum für Telemedizin Bad Kissingen, Bad Kissingen, Germany
› Author Affiliations
Further Information

Publication History

03 January 2018

02 June 2018

Publication Date:
15 March 2019 (online)

Summary

Background Trauma is a global burden. Emergency medical services (EMS) provide care for individuals who have serious injuries or suffered a major trauma.

Objective This paper provides a comprehensive overview of telemedicine applications in prehospital trauma care.

Methods We conducted a systematic review according to PRISMA guidelines. We identified articles by electronic database search (PubMed, EMBASE, the Cochrane Library, CINAHL, SpringerLink, LIVIVO, DARE, IEEE Xplore, Google Scholar and ScienceDirect) using keywords related to prehospital settings, ambulance, telemedicine and trauma. Search terms and inclusion criteria were specified a priori by the PICOS template and revised throughout a configurative approach iteratively, to outline the complexity and variety of different telemedical concepts.

Results A final sample of 15 records was systematically selected. Most interventions were piloted and/or evaluated in Germany for trauma victims in prehospital settings. Six studies were simulated scenarios. Telemedical assistance (TMA) via real-time telemetry systems (RTS), enabling video and audio conferencing between EMS by tele-emergency physicians (TEP) were associated with a higher treatment quality and a shorter time-to-treatment in invasive procedures. By initiating in-hospital preparations based on telemedical prehospital notification (TPN), loss of information during the clinical handover was reduced and in-hospital protocols were activated with high accuracy. Remotely guided ultrasound (Tele-Ultrasound) by TEP showed an overall high diagnostic accuracy in simulations. Technical solutions were reliable, seemed practical and auspicious.

Conclusion The review indicates that TMA and TPN are accompanying telemedical concepts in out-of-hospital trauma care. Well-designed populated studies are needed to fully assess the effect of telemedicine in acute trauma care. Therefore, evidence regarding the effectiveness of telemedicine in prehospital setting for trauma patients is still limited.

Authors' Contribution

PE, BR, UK and AR initially planned the systematic review (SR). PE and BR conducted the SR. UK and LS initially planned and reviewed the emergency medicine background from a EMS perspective. PE and BR repeated electronic database research. AR, PE and LS performed a review of included studies. All included studies are analyzed by consensus. BR, TW, AR and PE were the major contributors in writing the manuscript. All authors edited and revised the manuscript.