- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02928705
Quality of Telemedically Guided Prehospital Analgesia
Comparison of Analgesic Treatment Quality Between Prehospital Emergency Care of Telemedically Guided Paramedics and On-scene Physicians - a Retrospective Longitudinal Study
Study Overview
Status
Conditions
Detailed Description
The standard emergency medical service (EMS) in Germany consists of a two-tiered system with ambulances (paramedics) and prehospital EMS physician units. For example, legal conditions restrict opioid-based analgesia to physicians. Based on pre-defined standards regional emergency dispatch centers deploy both kinds of emergency units.
In recent years telemedicine emerged as a complementary system in EMS that may provide remote medical expertise and sustain or even improve quality of medical treatment on-scene. Particularly, based on the results of the projects Med-on-@ix and TemRas (telemedical rescue assistance system), emergency telemedical services were gradually implemented in daily routine of the EMS of the city of Aachen, Germany.
In this retrospective study the quality and adverse events of analgesia by telemedically supported paramedics shall be compared to conventional treatment by on-scene EMS physicians in the EMS of the city of Aachen, Germany.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
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Aachen, Germany, 52074
- University Hospital Aachen
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Initial Numerical Rating Scale ≥ 5 and
- Documented administration of analgesics
Exclusion Criteria:
- Missing consent for telemedical consultation (in teleconsultation group)
- Initial NRS < 5
- Analgesia in non-ST-segment elevation acute coronary syndrome (Non-STEMI-ACS) and ST-elevating myocardial infarction (STEMI)
- Initially unconscious patient
- Inter-hospital transfer missions
- Cases involving both on-scene and telemedical-EMS physicians
Study Plan
How is the study designed?
Design Details
- Observational Models: Case-Control
- Time Perspectives: Retrospective
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
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telemedicine group
physician operated telemedical prehospital analgesia
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Ambulances in the EMS of the city of Aachen are equipped with a portable telemedicine system.
In emergencies requiring intravenous analgesia paramedics can use this system to contact the tele-EMS physician with an audio-connection.
Vital parameters (e.g., ECG, pulse oximetry, non-invasive blood pressure) can be transferred in real-time.
The transmission of still pictures - taken with an official smartphone - and video streaming from the inside of the ambulance are also possible.
The tele-EMS physician supports the paramedics and can delegate the application of morphine and other analgesics based on two predefined algorithms for trauma and non-trauma cases that are displayed on a context-sensitive telemedical documentation system in the teleconsultation center.
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historical control group
prehospital analgesia by on-scene EMS physicians
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This (control) group represents the conventional treatment in German emergency medical service (EMS).
In addition to an ambulance manned with paramedics, a prehospital EMS physician is deployed to conduct analgesic treatment on-scene.
Treatment data for this group are selected from the time period before implementing teleconsultation in routine and therefore represent a historical control group.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Quality of analgesia
Time Frame: Time span of the respective prehospital emergency case treatment; on average a time interval of 30 - 120 minutes for each case.
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Decrease of value on the Numerical Rating Scale (NRS; 0-10).
The NRS is applied at initial contact with the patient and at the end of the mission.
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Time span of the respective prehospital emergency case treatment; on average a time interval of 30 - 120 minutes for each case.
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of adverse events
Time Frame: Time span of the respective prehospital emergency case treatment; on average a time interval of 30 - 120 minutes for each case.
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Respiratory and/or circulatory insufficiency and/or severe allergic reactions
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Time span of the respective prehospital emergency case treatment; on average a time interval of 30 - 120 minutes for each case.
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Administered analgesics and their dosages
Time Frame: Time span of the respective prehospital emergency case treatment; on average a time interval of 30 - 120 minutes for each case.
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Time span of the respective prehospital emergency case treatment; on average a time interval of 30 - 120 minutes for each case.
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Number of patients with documented analgesia related (safety-) parameters (evaluated for each safety parameter separately)
Time Frame: Time span of the respective prehospital emergency case treatment; on average a time interval of 30 - 120 minutes for each case.
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Documentation of analgesia related parameters: heart rate (beats per minute), blood pressure (mmHg), oxygen saturation (0-100%), respiratory rate (respirations per minute), Glasgow coma scale (Numerical values 3 to 15), The above named parameters should be documented by EMS teams at first medical contact and at patient handover in the emergency room. |
Time span of the respective prehospital emergency case treatment; on average a time interval of 30 - 120 minutes for each case.
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Occurrence of nausea and vomiting
Time Frame: Time span of the respective prehospital emergency case treatment; on average a time interval of 30 - 120 minutes for each case.
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Time span of the respective prehospital emergency case treatment; on average a time interval of 30 - 120 minutes for each case.
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Collaborators and Investigators
Sponsor
Investigators
- Study Chair: Rolf Rossaint, Professor, MD, University Hospital RWTH Aachen
- Principal Investigator: Sebastian Bergrath, MD, University Hospital RWTH Aachen
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- Quality of Tele-Analgesia
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
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