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7000人死于五种急性疾病--肺炎，腹泻， 受伤、脑膜炎和疟疾--主要发生在低收入和中等收入国家。适当和 及时对这些儿童进行急症和紧急护理，可将此类死亡减少约一半。现代应急 护理系统通过“生存链”提供护理，包括现场护理、紧急医疗服务 (EMS)运输和医院急诊部门。医疗保健的护理和分诊决定 运输过程中的供应商在许多急性疾病患者的最终结果中发挥着关键作用， 因此，在大多数高收入国家（HIC）中，这被视为一项基本服务。EMS与 在中低收入国家，很少有训练有素的工作人员，特别是在照顾重病儿童方面。迫切需要 - 在全球范围内，尤其是在中低收入国家， 将儿童运送到固定的紧急护理设施的关键分钟和小时。此类解决方案可以 每年都有可能拯救成千上万的儿童。目前，没有任何信息可以证明 移动的保健技术在运送重症儿童过程中指导护理的可行性和实用性。的 本研究的目的是首先评估实施基于救护车的远程会诊的可行性 (ABT)过程（R21），并在可行的情况下进行临床试验，以确认该方法对 巴基斯坦卡拉奇的短期临床结局（R33）。 我们的具体目标是SA 1：评估ABT用于急性病患者急诊护理的可接受性 孩子SA 2：确定开展一项关于以下因素影响的试点随机分组试验的可行性 儿科早期预警评分（PEWS）。战略顾问3：为了确定开展集群的可行性， 关于ABT对儿科早期预警评分（PEWS）影响的随机试验。如果可行，我们将 进行疗效试验，具体目标如下：具体目标4：通过以下方法测试ABT的疗效： 测量急性病儿童从受伤/患病现场到儿科的PEWS变化 急诊科（PEM）使用分组随机设计具体目标5： 移动医疗研究能力的当地合作伙伴。

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.