Charash William E, Caputo Michael P, Clark Harry, Callas Peter W, Rogers Frederick B, Crookes Bruce A, Alborg Monica S, Ricci Michael A
University of Vermont College of Medicine, Burlington, VT, USA.
J Trauma. 2011 Jul;71(1):49-54; discussion 55. doi: 10.1097/TA.0b013e31821e4690.
Rural trauma victims often require prolonged transport by s with limited scopes of practice. We evaluated the impact of telemedicine (TM) to a moving ambulance on outcomes in simulated trauma patients.
This is an institutional review board approved, prospective double-blind study. Three trauma scenarios (blunt torso trauma, epigastric stab wound, and closed head injury) were created for a human patient simulator. Intermediate emergency medical technicians (EMTs; n = 20) managed the human patient simulator, in a moving ambulance. In the TM group, physicians (n = 12) provided consultation. In the non-TM group, EMTs communicated with medical control by radio, as necessary. We tabulated the fraction of 13 key signs, 5 pathologic processes, and 12 key interventions that were performed. Vital signs and Sao2 (%) were recorded. Data were compared using the Wilcoxon rank-sum test.
Lowest Sao2 (84 ± 0.7 vs. 78 ± 0), lowest systolic blood pressure (70 ± 1 vs. 53 ± 1), and highest heart rate (144 ± 0.9 vs. 159 ± 0.5) were significantly improved in the TM group (p < 0.001). Recognition rates for key signs (0.96 ± 0.01 vs. 0.79 ± 0.05), processes (0.98 ± 0.02 vs. 0.75 ± 0.05), and critical interventions (0.92 ± 0.02 vs. 0.49 ± 0.03) were higher in the TM group (p < 0.003). EMTs were successfully guided through needle decompression procedures in 22 of 24 cases (zero in the non-TM group).
TM to a moving ambulance improved the care of simulated trauma patients. Furthermore, procedurally naïve EMTs were able to perform needle thoracostomy and pericardiocentesis with TM guidance.
农村创伤患者通常需要由执业范围有限的人员进行长时间转运。我们评估了移动救护车上远程医疗（TM）对模拟创伤患者治疗结果的影响。
这是一项经机构审查委员会批准的前瞻性双盲研究。为人体患者模拟器创建了三种创伤场景（钝性躯干创伤、上腹部刺伤和闭合性颅脑损伤）。中级急救医疗技术人员（EMT；n = 20）在移动救护车上管理人体患者模拟器。在TM组中，医生（n = 12）提供会诊。在非TM组中，EMT根据需要通过无线电与医疗控制中心沟通。我们将所执行的13项关键体征、5种病理过程和12项关键干预措施的比例制成表格。记录生命体征和血氧饱和度（%）。使用Wilcoxon秩和检验比较数据。
TM组的最低血氧饱和度（84±0.7对78±0）、最低收缩压（70±1对53±1）和最高心率（144±0.9对159±0.5）有显著改善（p<0.001）。TM组关键体征（0.96±0.01对0.79±0.05）、病理过程（0.98±0.02对0.75±0.05）和关键干预措施（0.92±0.02对0.49±0.03）的识别率更高（p<0.003）。24例中有22例在TM指导下成功完成了针减压操作（非TM组为零）。
移动救护车上的TM改善了对模拟创伤患者的治疗。此外，经验不足的EMT在TM指导下能够进行胸腔穿刺术和心包穿刺术。
