In time-critical medical emergencies occurring in remote prehospital environments, reliable broadband connectivity could potentially allow enhanced interaction between ambulance clinicians and hospital-based emergency medical experts, involving transmission of simple audio and video streams as well as physiological monitoring data and ultrasound images. The result could be enhanced decision support outside the hospital leading to better prehospital management (eg surgical management of pneumothorax, thrombolysis decisions, or decisions on whether hospital transfer is required), potentially better decisions about the appropriate destination hospital (eg those offering specialist facilities such as percutaneous vascular intervention or neurosurgery) and more streamlined management on arrival in hospital (eg immediate transfer to a staffed operating theatre). This could potentially result in improved survival, reduced morbidity and consequent reduced health service and social costs. We will conduct a randomised trial of a process where ambulance paramedics manage patients and perform ultrasound scans with remote support from an expert in emergency medicine and point-of-care ultrasound at the receiving hospital. One thousand patients with breathlessness, chest pain, cardiovascular shock, abdominal pain or suspected fractures will be randomly assigned to receive the enhanced communications package including remotely-supported ultrasound scanning, or usual care. The main outcome will be health-related quality of life 6 months later. We will conduct a rigorous economic analysis yielding estimates of cost per quality-adjusted life year. A detailed process analysis will examine implementation of protocols and evaluate which components proved most and least successful. We hope to create a body of evidence to inform future policy on prehospital care.
This abstract was presented at the Innovative Solutions in Remote Healthcare - 'Rethinking Remote' conference, 23-24 May 2016, Inverness, Scotland.