Improving Prehospital Pediatric Emergency Readiness with Telemedicine

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PROJECT SUMMARY Dr. Boyle proposes a 5-year mentored research training program to become an independent clinician investigator leading prehospital pediatric emergency care research. She has a strong background in basic science research and is a board-certified Pediatric Emergency Physician and Assistant Professor of Pediatrics at Boston University. Her current research focuses on testing system-level interventions to improve patient- oriented outcomes of critically ill and injured children. This proposal focuses on teleconsultation as an innovative intervention to improve prehospital treatment of children with acute respiratory emergencies and to facilitate transitions of care to acute care hospitals. Dr. Boyle’s career development plan includes systematic education and mentoring in intervention optimization; the use of simulation as a research tool for early phase intervention testing; clinical trial design and analysis; and training in the ethics of prehospital emergency care research, including emergency exceptions to informed consent and protection of children as human subjects. She has assembled a multidisciplinary expert team to support her on this project, led by primary mentor, James Feldman, MD, MPH, FACEP and co-mentor, Carlos Camargo, MD, DrPH, FACEP. Her training plan includes a combination of formal coursework and workshops, scientific seminars and meetings, and a focused research ethics internship. These will be paired with mentored research studies where she will test the central hypothesis that pediatric teleconsultation (intervention) by Emergency Medical Service (EMS) providers will result in measurably safer care for children with life-threatening respiratory illness as compared to usual care. Dr. Boyle has partnered with local Massachusetts EMS systems and an affiliated pediatric specialty transport system to refine and pilot test the intervention in simulated and real pediatric respiratory emergencies. The specific aims of this career development proposal are to: (1) Identify predictors of stakeholder acceptance of prehospital teleconsultation for children with a mixed methods study; (2) Estimate intervention acceptability, feasibility, and effect size for prehospital team resuscitation performance in simulated pediatric respiratory emergencies using a pilot randomized controlled trial; and (3) Field test acceptability and feasibility of using a mobile video-conferencing platform for remote assessment of children transported by ambulance for respiratory distress. This proposal serves the dual purpose of supporting Dr. Boyle’s transition to independence as a clinician investigator in patient-oriented research, as well as generating important pilot data to estimate clinical effect, provide sample size justification, and establish the acceptability and feasibility of using a teleconsultation platform optimized for prehospital providers to guide future definitive trials of efficacy. If funded, this research will determine whether teleconsultation, a promising intervention to increase access to high quality care in rural and underserved settings, can improve prehospital emergency care for children.