Telemedically Supported Analgesia in the Emergency Medical Service

• Rate of complications [ Time Frame: 2 hours ] [ Designated as safety issue: No ]
  Definition of complications: respiratory insufficiency, allergic reaction, circulatory insufficiency
  
  

• Pain level [ Time Frame: average 1 hour ] [ Designated as safety issue: No ]
  Pain level measured with numerical rating scale
  
  
• Incidence of nausea and vomiting [ Time Frame: 2 hours ] [ Designated as safety issue: No ]
  
• Time intervals [ Time Frame: average 1 hour ] [ Designated as safety issue: No ]
  on-scene time, contact to hospital time
  
  
• Medications and dosages [ Time Frame: average 1 hour ] [ Designated as safety issue: No ]
  Evaluation and description of the used medications and dosages
  
  

Six ambulances from five different Emergency Medical Service (EMS) districts are equipped with a portable telemedicine system. In cases of emergencies, where intravenous analgesia is necessary, the paramedics can use this system to contact a so called "tele-EMS physician" after consent of the patient is obtained. The tele-EMS physician has an audio-connection to the EMS team and receives vital parameters (e.g., ECG, pulse oximetry, non-invasive blood pressure) in real-time. The transmission of still pictures - taken with a smartphone - and video streaming from the inside of the ambulance can be carried out, if meaningful. The tele-EMS physician supports the EMS team and can delegate the application of morphine and other analgesics. This can be carried out to bridge the time to the arrival of an EMS physician or in less severe cases without an EMS physician on-scene.

All regular ambulances of the five districts are not allowed to administer analgesics without an physician on-scene. They have to call an Advanced Life Support response unit, staffed with an EMS physician, who carries out all kinds of ALS interventions.

The safety, efficacy and the quality of analgesia should be compared with regular EMS.