Telemedical Support in Prehospital Emergency Care of Acute Coronary Syndrome

Study Overview
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Brief Summary
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The aim of the study is to investigate the quality of prehospital emergency care in acute coronary syndromes, when paramedics are supported telemedically by an EMS physician.

Detailed Description
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Six ambulances from five different Emergency Medical Service (EMS) districts are equipped with a portable telemedicine system. In cases of suspected acute coronary syndrome (including STEMI), the paramedics can use this system to contact a so called tele-EMS physician after consent of the patient is obtained. The tele-EMS physician has an audio-connection to the EMS team and receives vital parameters (e.g., ECG, pulse oximetry, non-invasive blood pressure) in real-time. Also 12-lead-ECGs can transmitted to the tele-EMS physician. The transmission of still pictures - taken with a smartphone - and video streaming from the inside of the ambulance can be carried out, if meaningful. The tele-EMS physician supports the EMS team in obtaining all relevant medical history, ECG diagnosis, general diagnosis and can delegate the application of medications. This can be carried out to bridge the time to the arrival of an EMS physician or in less severe cases without an EMS physician on-scene. The quality of prehospital care and the possible influences on the initial inhospital phase should be investigated and compared with regular EMS.

Official Title
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Telemedical Support in Prehospital Emergency Care of Acute Coronary Syndromes

Conditions
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Acute Coronary Syndrome

Intervention / Treatment
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* Procedure: Teleconsultation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Suspected acute coronary syndrome Verbal consent for teleconsultation obtained or patient is not able to consent due to the severity of the emergency Exclusion Criteria: Patient refuses consent to teleconsultation No suspected acute coronary syndrome

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Device: Teleconsultation<br>In cases of suspected acute coronary syndrome (including STEMI), if patients give informed consent the paramedics can use this system to contact a so called tele-EMS physician with audio-connection to the EMS team and receives vital parameters (e.g., ECG, pulse oximetry, non-invasive blood pressure) in real-time. Also 12-lead-ECGs can be transmitted to the tele-EMS physician. The transmission of still pictures - taken with a smartphone - and video streaming from the inside of the ambulance can be carried out, if meaningful. The tele-EMS physician supports the EMS team in obtaining all relevant medical history, ECG diagnosis, general diagnosis and can delegate the application of medications. This can be carried out to bridge the time to the arrival of an EMS physician or in less severe cases without an EMS physician on-scene. The quality of prehospital care and the possible influences on the initial inhospital phase should be investigated and compared with regular EMS. | Procedure: Teleconsultation<br>* Teleconsultation of an EMS physician to support the paramedics in acute coronary syndromes<br>|
| No Intervention: Historical Matched Pairs<br>Historical matched pairs were searched from local protocols. During this phase no teleconsultation system was existent. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of prehospital care | Analysis of the quality of the prehospital care on the basis of published guidelines for ACS / STEMI | average 1 hour | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Inhospital time intervals in STEMI | contact to balloon time, arrival to balloon time | up to 12 hours | 
| Rate of secondary transfer for PCI | Rate of secondary transfer to a different facility for PCI | up to 7 days | 
| Troponin-Level | Severity of infarction measured with level of Troponin | 24 hours | 
| Conducted procedures and medications (paramedics) | Amount of guidelines based procedures and medications carried out by paramedics prior to the contact with a physician. | average 1 hour | 
| prehospital time intervals | on-scene time, contact (EMS) to hospital arrival time, transport time | average 1 hour | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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acute coronary syndrome, telemedicine, teleconsultation, emergency medical service