Department of Surgery, University of Massachusetts Chan Medical School, Baystate Medical Center, Worcester, MA.
Department of Emergency Medicine, University of Massachusetts Chan Medical School, Baystate Medical Center, Worcester, MA.
Air Med J. 2023 Mar-Apr;42(2):105-109. doi: 10.1016/j.amj.2022.12.008. Epub 2023 Jan 16.
There are currently no reports on whether telementoring for extended focused assessment with sonography for trauma (eFAST) improves critical care transport providers' performance in prehospital settings. Our objective was to determine the impact of teleguidance on eFAST performance and quantify workload experience.
Eight trauma injury modules were selected on simulated patients. Critical care transport (CCT) providers were tasked to complete one independent and one emergency physician-telementored eFAST. The time to completion and the percent of correct findings were obtained. Participants completed the NASA Task Load Index after each iteration to assess workload.
Eight independent and 8 telementored eFASTs were completed. The mean times to complete the independent and telementored eFAST were 5 minutes 16 seconds (95% confidence interval [CI], 3 minutes 32 seconds, 6 minutes 59 seconds) and 8 minutes 27 seconds (95% CI, 5 minutes 14 seconds, 11 minutes 39 seconds), respectively (P = .06). The percentage of correctly identified injuries for the independent versus the teleguided eFAST was 65% versus 92.5% (P = .01). The CCT providers experienced higher mental (P = .004), temporal (P = .01), and effort (P = .004) demands; greater frustration (P = .001); and subjective lower performance (P = .003) during independent trials. The emergency physician experienced higher mental (P = .001), temporal (P = .02), effort (P = .005), and frustration (P = .001) demands than the CCT members.
The teleguided eFAST yielded higher accuracy than the independent eFAST. The CCT providers relied on teleguidance of the remote physician when performing the eFAST. Teleguidance may improve the accuracy of ultrasounds performed by prehospital personnel in real-life scenarios.
目前尚无关于远程指导创伤超声重点评估（eFAST）是否能提高重症监护转运人员在院前环境中表现的报告。我们的目的是确定远程指导对 eFAST 表现的影响，并量化工作量体验。
在模拟患者中选择了 8 个创伤损伤模块。重症监护转运（CCT）提供者的任务是独立完成一次和一次由急诊医师远程指导的 eFAST。记录完成时间和正确发现的百分比。参与者在每次迭代后完成 NASA 任务负荷指数评估来评估工作量。
完成了 8 次独立和 8 次远程指导的 eFAST。独立和远程指导的 eFAST 的平均完成时间分别为 5 分 16 秒（95%置信区间 [CI]：3 分 32 秒，6 分 59 秒）和 8 分 27 秒（95%CI：5 分 14 秒，11 分 39 秒）（P=0.06）。独立的与远程指导的 eFAST 正确识别损伤的百分比分别为 65%和 92.5%（P=0.01）。CCT 提供者在独立试验中经历了更高的心理（P=0.004）、时间（P=0.01）和努力（P=0.004）需求；更大的挫折感（P=0.001）；以及主观上较低的表现（P=0.003）。急诊医师的心理（P=0.001）、时间（P=0.02）、努力（P=0.005）和挫折感（P=0.001）需求均高于 CCT 成员。
远程指导的 eFAST 比独立的 eFAST 具有更高的准确性。CCT 提供者在进行 eFAST 时依赖远程医生的指导。远程指导可能会提高院前人员在实际场景中进行超声检查的准确性。
