Many published studies [1] have shown that early and specialized pre-hospital management of emergency casescontributes to the patient’s survival. Especially in cases of serious head injuries, spinal cord or internal organs trauma, the way that injured persons are treated and transported is crucial. Most emergency cases are due to car crash accidents and to coronary artery diseases. Statistics for car accidents in USA and Europe prove that many thousands of people loose their lives and many more drivers or passengers are severely injured. Studies performed in Greece, a country with a very high death rate due to car crashes, proved that most of the fatalinjuries in accidents were injured far away from anycompetent healthcare institution, thus resulting in long response times.
Furthermore, in the London, UK, area half of the casualties require at least 2 hours to reach adequate hospital care, 79% of victims of accidents in rural roads dieon the scene, another 11% during transportation [2]. Some of these cases had a 50% chance of survival, if adequate pre-hospital care existed. Heart disease is another common example of high death rates in emergency cases, since two thirds of all patients die before reaching the central hospital. In a study performed in the UK [3] it is shown that among patients above 55 years old, who die from cardiac arrest, 91% do so outside a hospital unit, due to a lack of immediate treatment. Thecomponents of delay in administering the appropriate therapy [4] are: The patient’s failure to recognize the seriousness of his symptoms and seek emergency care, •Pre-hospital evaluation and transport time, •Time required for diagnosis and initiation of treatment in the hospital Also, many studies have proven that a rapid response time in pre-hospital actions concerning emergency heart deceases, decreases mortality and improves patient outcome[5] – [13]. This paper presents a new telemedicine system enabling ambulance staff, rescue people, emergency paramedics, or general practitioners, to collaborate in order to face pre-hospital patient treatment. It is known that, usually, the ambulance staff has not the required advanced theoretical knowledge and experience to handle emergency situations. Moreover, it is not certified to provide medical care without a medical expert advice. On the other hand, expert physicians such as cardiologists, neurosurgeons, orthopedics cannot participate in ambulance staff for financial or practical reasons Using this system, the above restrictions are coming through by means of an electronic collaboration scheme that is established between the ambulance staff and the experts of a medical unit. This scheme provides the appropriate tolls for the acquisition, transfer, demonstration and evaluation of diverse patient vital signs, such as electrocardiogram (ECG), blood oxygen saturation (SPO2), temperature, blood pressure etc. as well as patient pictures. Moreover, by means of wireless communications tools the experts can advise the ambulance staff to perform theappropriate actions in order to face any emergency case. Hence, the valuable pre-hospital transport time is turned to advantage to diagnose and evaluate the patient’s situation en route, and the pre-hospital phase of transport is transformed into a pre-hospital phase of treatment. In the cases of accidents, the introduced system facilitates the collaboration of the trauma center with the police and the fire brigade since all involved vehicles employs the common electronic collaboration scheme. The proposed system resulted by a project tuned by the European Union under the INNACT-RWG R&D programAction 3.1. Its implementation based on the integration of many technologies such as Geographical Information Systems (GIS), Global Positioning Systems (GPS), wireless LAN (IEEE 802.11), and GSM telephony.
During a two-month pilot period of system operation wetried to find out the system reliability. Of the 55 patients, only 20 cases were marked to have pre-hospital notification. The system utilization results –data of only 36,4% of the patients were recorded by the telemedicine system and transmitted to the reception center- was not the expected. This may be due to the small number of ambulancesequipped with the telemedicine health care system. Another possible reason is that not all patients had health problems serious enough to require the use of the telemedicine systems’ resources. Respecting the time for the vital sign acquisition, transmission and interpretation, Figure 5 shows the average time. Depending on the patient’s state, patient’s cooperation, and vehicle speed, a paramedic needs about 3 min to connect all the needed sensors for 12-lead ECG, SPO2, Temp, and NiBP acquisition. A mean time of 40 sec was required for the mobile connection establishment and the vital sign transmission to the reception center. The average time for transportation was 20 min. Therefore, the ambulance was arrived to the hospital 16 min and 20 sec after the vital sign transmission. Doctors need approximately 12 min to make the ECG interpretation and the other vital sign evaluation. Thus, the diagnosis for the transported cases could have been made 4 min and 20 sec before the patient’s arrival to the hospital. During the above time a preparation could proceed. Thinking of the connection and transmission through the GSM network, tables 1 and 2 shows the results. In Table 1,we can find out how successful the mobile connection was. 16 of 20 cases were successful on the first attempt. A second or third attempt was required in 4 and 2 cases respectively. Table 2 shows how successful the transmission was. In atotal of 20 cases, 17 cases were transmitted on the first attempt, 2 were interrupted and retransmitted one time and 1 was interrupted more then one times. The most common reason for the transmission failure was the low signal levelin some geographical areas, the overloaded mobile service network around the referring area, and in some cases, thebad topological situations. The devices’ advantage was that in both cases (no connection with the first trial or interruption during the data transmission), we had no data loss, because all of the collected data from the system startup till the transmission is stored locally in the mobile unit, in order for a complete medical report to be available every time. The directions to the paramedics were provided with bi-directional voice communication using a separate GSM connection. This solution was selected for two major reasons. With the separate voice communication, the maximum bandwidth was available for medical data transmission, allowing faster interpretation and reply from the control center. Also, for additional reasons such as security, freedom of movement in high risk rescues, e.t.c. vocal communication must be always available. Click here