Feasibility and Efficacy of Ambulance-Based mhealth for Pediatric Emergencies (FEAMER) Trial

项目摘要 在每天死亡的16000名儿童中，有7,000人死于五种急性疾病-肺炎、腹泻、 伤害、脑膜炎和疟疾--主要发生在低收入和中等收入国家。适当的和 对这些儿童进行及时的急诊护理可将此类死亡人数减少约一半。现代急救 护理系统通过由现场护理、紧急医疗服务组成的“生存链”提供护理 (EMS)用于交通、医院急诊科。医疗保健部门的护理和分诊决定 运输过程中的提供者对许多急性白血病患者的最终结果起着至关重要的作用 因此，在大多数高收入国家(高收入国家)，这被认为是一项基本服务。带EMS的 训练有素的工作人员，特别是在照顾危重儿童方面，在LMIC中很少找到。有一种迫切的需要 -在全球范围内，尤其是在LMIC中-用于解决大多数情况下的专业知识/经验差距的解决方案 儿童被送往固定的急救机构的关键时刻和时间。这样的解决方案可以 为每年可能拯救数千名儿童作出贡献。目前，没有任何信息可以证明 移动卫生技术用于指导急病儿童运送过程中护理的可行性和实用性。这个 这项研究的目的是首先评估实施救护车远程会诊的可行性 (ABT)过程(R21)，如果可行，进行临床试验，以确认该方法对 巴基斯坦卡拉奇的短期临床结果(R33)。 我们的具体目标是SA1：评估ABT在急诊护理中的可接受性 孩子们。SA2：确定开展试点整群随机试验的可行性 ABT的儿科早期预警评分(PEWS)。SA3：确定开展集群的可行性-- ABT对儿科预警评分(PEWS)影响的随机试验。如果发现可行，我们将 按照以下R33具体目标进行疗效试验：具体目标4：通过以下方式测试ABT的疗效 测量急病儿童从受伤/患病现场到儿科的长椅变化 急诊科(PEM)使用群组随机设计的具体目标5：发展 在移动健康研究能力方面的当地合作伙伴。

Project Summary Of the 16000 children who die every day, 7000 die because of five acute illnesses – pneumonia, diarrhea, injuries, meningitis, and malaria – largely in in low- and middle-income countries (LMICs). Appropriate and timely acute and emergency care of these children can reduce such deaths by about half. Modern emergency care systems provide care through a “chain of survival” consisting of on-scene care, emergency medical services (EMS) for transportation, and hospital emergency departments. Care and triage decisions by healthcare providers during transportation play a critical role in the eventual outcome of patients from many acute illnesses and are, therefore, considered an essential service in most high-income countries (HICs). EMS with well-trained staff, especially in the care of an acutely ill child, is rarely found in LMICs. There is a critical need – globally, but particularly in LMICs – for solutions that address the expertise/experience gap during the most critical minutes and hours of a child's transport to a fixed emergency care facility. Such solutions can contribute to potentially saving thousands of children every year. Currently, no information exists to prove the feasibility and utility of mobile health technology to guide care during transport of acutely ill children. The purpose of the study is first to assess the feasibility of implementing an ambulance-based teleconsultation (ABT) process (R21) and, if feasible, carry out a clinical trial to confirm the efficacy of the approach on the short-term clinical outcomes (R33) in Karachi, Pakistan. Our specific aims are SA1: To assess the acceptability of ABT for the emergency care of acutely ill children. SA2: To determine the feasibility of carrying out a pilot cluster-randomized trial on the impact of ABT on the Pediatric Early Warning Score (PEWS). SA3: To determine the feasibility of carrying out a cluster- randomized trial on the impact of ABT on the Pediatric Early Warning Score (PEWS). If found feasible, we will conduct an efficacy trial with the following R33 specific aims: Specific Aim 4: To test the efficacy of ABT by measuring a change in the PEWS of acutely ill children from the scene of injury/illness to the pediatric emergency department (PEM) using a cluster-randomized design Specific Aim 5: To develop the capacity of local partners in m-health research capacity.