Hess Patrick P, Czaplik Michael, Hess Johanna, Schröder Hanna, Beckers Stefan K, Follmann Andreas, Pitsch Mark, Felzen Marc
Department of Anesthesiology, Medical Faculty, RWTH Aachen University, University Hospital RWTH Aachen, Aachen, Germany.
Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.
Front Digit Health. 2025 Apr 30;7:1519619. doi: 10.3389/fdgth.2025.1519619. eCollection 2025.
The emergency medical services (EMS) in Germany are facing several challenges in the near future. Due to the increasing number of emergency missions, the availability of EMS physicians is becoming more limited, resulting in longer response times. To maintain the high quality of EMS, telemedical support systems have shown potential as a valuable complement to the existing system for specific diagnoses. Since 2014, a tele-EMS system has been implemented in Aachen as an integrated telemedical solution alongside standard EMS. Accurate prehospital diagnosis plays a crucial role in ensuring appropriate hospital admission and reducing the time to clinical treatment for time-sensitive conditions. The main TEMS study demonstrated the overall non-inferiority of tele-EMS physicians compared to on-site EMS physicians. This sub-analysis focuses on comparing the diagnostic accuracy between these two groups.
Up to four prehospital diagnoses were selected, coded according to the ICD-10 system, and compared with all admission and discharge diagnoses.
The comparison between diagnoses made by tele-EMS physicians and on-site EMS physicians with admission diagnoses showed no significant difference ( = 0.877). Additionally, no significant differences were found for the diagnoses of stroke ( = 0.385) and epileptic seizure ( = 0.738). However, patients from missions where paramedics decided to consult a tele-EMS physician had significantly longer hospital stays compared to those from missions where an on-site EMS physician was initially dispatched ( < 0.001).
This randomized controlled analysis demonstrated that there is no difference in diagnostic accuracy between on-site EMS physicians and remote tele-EMS physicians. The significantly longer hospital stays for patients treated by tele-EMS physicians suggest that EMS physicians may be called too frequently for non-severe cases.
clinicaltrials.gov, identifier (NCT02617875).
德国的紧急医疗服务（EMS）在不久的将来面临着诸多挑战。由于紧急任务数量不断增加，EMS医生的可获得性变得越来越有限，导致响应时间延长。为了维持EMS的高质量，远程医疗支持系统已显示出作为现有系统对特定诊断的宝贵补充的潜力。自2014年以来，亚琛已实施了一个远程EMS系统，作为与标准EMS并行的综合远程医疗解决方案。准确的院前诊断对于确保适当的医院收治以及减少对时间敏感病症的临床治疗时间起着至关重要的作用。主要的远程紧急医疗服务（TEMS）研究表明，与现场EMS医生相比，远程EMS医生总体上并不逊色。本亚组分析着重比较这两组之间的诊断准确性。
选择多达四项院前诊断，根据国际疾病分类第十版（ICD-10）系统进行编码，并与所有入院和出院诊断进行比较。
远程EMS医生做出的诊断与现场EMS医生做出的诊断与入院诊断之间的比较没有显著差异（=0.877）。此外，中风（=0.385）和癫痫发作（=0.738）的诊断也没有发现显著差异。然而，与最初派遣现场EMS医生的任务中的患者相比，护理人员决定咨询远程EMS医生的任务中的患者住院时间明显更长（<0.001）。
这项随机对照分析表明，现场EMS医生和远程EMS医生之间的诊断准确性没有差异。远程EMS医生治疗的患者住院时间明显更长，这表明对于非严重病例，EMS医生可能被呼叫得过于频繁。
clinicaltrials.gov，标识符（NCT02617875）。
