Randomised controlled study on quality of care using either a telemedical or conventional physician based out-of-hospital emergency system

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In Germany out of all prehospital emergencies 50% are managed by paramedics alone, 50% by additional emergency physicians. This high use of additional physicians occurs in spite of the fact that in only 1/10 of all cases the manual abilities of a physician are needed. Due to the closing down of many emergency care centers, the steady increase of emergency cases and additional shortage of qualified emergency physicians it is especially in rural areas nearly impossible to maintain a short time interval between emergency call and arrival of an emergency physician.Although telemedicine has been proven to be helpful and quality-improving in many Areas of clinical medicine, so far, in the field of prehospital emergency medicine only specific telemedicine components responding to a unique need based on a specific disease (e.g. stroke) were used. To overcome this shortage, we developed a holistic telemedicine system for a broad spectrum of different prehospital emergency cases, which acts synergistically to the existing ground- and air-based rescue systems. This systems consists of hard- and software components (work-station for the tele-emergency physician, server-infrastructure, mobile and in the ambulance integrated transfer unit), which allows for an online and safe transfer of all data (language, vital parameter, images and videostream). After legal clarification, evaluation of the system in two research projects and further technical development this system is used for routine care since April, 1rst 2014. However, at present the system, which is an add-on to the already existing rescue devices, is only used, if in situations planned for paramedics only the need for additional physician treatment occurs. So far, the > 2000 initially paramedics-only planned operations were without adverse events, however, showed a better medical history, treatment and documentation quality. At the same time the physician tied-up period was reduced by 50%.Using a randomized controlled trial design this research grant proposal including 3000 patients aims for comparing the procedure-specific complication rate and quality of care of a prehospital emergency telemedicine physician based system with a conventional emergency physician based system, when excluding certain cases (e.g. multiple trauma and respiratory or cardiac arrest) accounting for about 10% of all emergency cases.Should this RCT demonstrate that under these conditions the telemedicine approach is with respect to complications equivalent to the conventional physician based out-of-hospital emergency system and at the same time leads to an improved quality of care in some aspects, it would allow a restructuring of the German out-of-hospital rescue service. Instead of 50% only about 10% of all emergency cases would be in need of a physically present emergency physician, the other cases in need of a physician could be treated with the help of an emergency telemedicine physician.