Quality of analgesia in physician-operated telemedical prehospital emergency care is comparable to physician-based prehospital care - a retrospective longitudinal study

Niklas Lenssen, Andreas Krockauer, Stefan K Beckers, Rolf Rossaint, Frederik Hirsch, Jörg C Brokmann, Sebastian Bergrath, Niklas Lenssen, Andreas Krockauer, Stefan K Beckers, Rolf Rossaint, Frederik Hirsch, Jörg C Brokmann, Sebastian Bergrath

Abstract

Acute pain is a common reason for summoning emergency medical services (EMS). Yet in several countries the law restricts opioid-based analgesia administration to physicians. Telemedical support of paramedics is a novel approach to enable timely treatment under the guidance of a physician. In this retrospective observational study, conducted in the EMS of Aachen, Germany, the analgesic quality and occurrence of adverse events were compared between telemedically-supported paramedics (July-December, 2014) and a historical control group (conventional on-scene EMS physicians; January-March, 2014).

Inclusion criteria: pain (initial numerical rating scale (NRS) ≥5) and/or performed analgesia. Telemedically-assisted analgesia was performed in 149 patients; conventional analgesia in 199 control cases. Teleconsultation vs.

Control: Initial NRS scores were 8.0 ± 1.5 and 8.1 ± 1.7. Complete NRS documentation was carried out in 140/149 vs. 130/199 cases, p < 0.0001. NRS scores were reduced by 4.94 ± 2.01 and 4.84 ± 2.28 (p = 0.5379), leading to mean NRS scores at emergency room arrival of 3.1 ± 1.7 vs. 3.3 ± 1.9 (p = 0.5229). No severe adverse events occurred in either group. Clinically relevant pain reduction was achieved in both groups. Thus, the concept of remote physician-based telemedically-delegated analgesia by paramedics is effective compared to analgesia by on-scene EMS physicians and safe.

Conflict of interest statement

J.C.B. and R.R. are shareholder of the Docs in Clouds GmbH. F.H. is a part-time employed (25%) tele-EMS physician at P3 telehealthcare. All other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Standard operating procedure (SOP) for analgesia in teleconsultation: (a) trauma, (b) non-trauma.
Figure 2
Figure 2
Study flow chart.

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Source: PubMed

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