Overloaded emergency rooms and emergency services: The Bundestag is today discussing the reform of emergency care. Can emergency doctors connected via video alleviate the shortages?
“Get a second opinion on this,” is what people around the sufferer often say when the dentist wants to extract wisdom teeth or the surgeon prefers the new, modern type of hip operation instead of a tried-and-tested one.
Such interventions can be planned. However, in emergencies such as strokes or accidental injuries that require quick decision-making and action, patients are dependent on the decision of the sole emergency doctor who arrives at the scene of their predicament.
Medical assessment via mobile phone
But that is changing in more and more cities and municipalities: teleemergency doctors are being used more and more often. They are doctors who sit in front of screens in hospitals and are called in during rescue operations to support paramedics who have been specially trained for the system at the scene or to enable the emergency doctor to give a second medical opinion.
All medical data exchange takes place via the mobile phone network. The patient’s vital data, such as blood pressure, is transmitted to the teleemergency doctor via the ECG machine in the ambulance. Video recordings help to assess the medical situation. On this basis, the teleemergency doctor decides which medication needs to be given and what is best to do.
Rescue if the distance is too long
A case evaluated by a team from the RWTH Aachen University Hospital led by Andreas Follmann shows how this actually works and what advantages it can have: A man in a rural area, far from a dense supply network, experienced a racing heart, accompanied by sudden, severe dizziness and nausea. The emergency doctor administers medication to slow down the heart rate. But the remedy doesn’t work, and at the same time it becomes clear that the next specialist clinic can only be reached in 40 minutes. The emergency doctor calls the teleemergency doctor for help.
Based on the transmitted real-time ECG and the emergency doctor’s descriptions, he recognizes that the present case is a life-threatening condition, but that the medication administered by the emergency doctor in this case actually worsens the patient’s condition. The planned transport: too long! Cardiac arrest would most likely result.
The teleemergency doctor instructs the emergency doctor at the scene how to act instead – always with the vital data from the specially equipped ambulance in view. “Because the colleague on site was able to obtain a second opinion and consult the teleemergency doctor, the patient was given targeted therapy that was ultimately able to save his life,” says the case report. “As described, this was only possible through the joint efforts of the emergency doctor on site and the teleemergency doctor remotely.”
Projects in several countries
Experiences like these led to more and more federal states setting up teleemergency doctor projects. The Rhineland-Palatinate Interior Minister Michael Ebling, SPD, has the goal of providing a tele-emergency doctor for every ambulance in Rhineland-Palatinate around the clock by the middle of next year. “Rhineland-Palatinate will be one of the first federal states with nationwide availability of such a system.”
But does setting up a dual structure for emergency care – two doctors for one patient at the same time – fit with reducing costs in the health system?
Does the teleemergency doctor save money?
Teleemergency doctors are used in suspected moderately severe cases, for example if patients’ blood pressure is too high or if the administration of pain medication is necessary. Then you always need a prescription from a doctor who is either on site – or just connected.
If the operation turns out to be more serious, an emergency doctor can still be requested. Proponents of the teleemergency doctor system say that a second opinion via mobile phone could save some patients from unnecessary transport to hospitals and at the same time relieve the burden on emergency rooms.
In fact, the rare emergency doctor spends less useless but costly time in the emergency vehicle and at a single location. Instead, several patients benefit at the same time. Teleemergency doctor Despina Panagiotidis describes in the German Medical Journal: “I am involved in around three to 15 missions per shift, often in several at the same time. So far I have accompanied up to five missions in parallel, so you have to concentrate very much and prioritize depending on the urgency.”
Teleemergency doctors are connected to support paramedics who have been specially trained for the system at the scene or to enable the emergency doctor to provide a second opinion.
Nevertheless: Ruth Hecker, Chairwoman of the Patient Safety Alliance, fundamentally welcomes the initiative to introduce tele-emergency doctors, provided it can be proven that qualified staff are available to operate and support the tele-emergency doctors: “An outstanding example of the successful implementation of this concept is the Aachen University Hospital. She has already proven that with the appropriate technical and personnel equipment, the use of teleemergency doctors can make a valuable contribution to improving patient care.”
Johannes Becker’s experience was similar. He has been one of the tele-emergency doctors at the BG Klinik Ludwigshafen for over a year: “It has been shown that operations with the tele-emergency doctor can be carried out safely. We have not had a single case in which complications arose due to the use of the tele-emergency doctor.”
He has noticed good acceptance from everyone involved so far and the number of emergency doctor calls and unnecessary hospital admissions have been reduced. “The resources saved here are then available for more urgent or serious cases,” says Becker.
Safety factor in rural areas
“There are many countries in which the emergency doctor often needs ten or 15 minutes to arrive at the scene due to the distances. However, depending on how busy the emergency service is, this can also take longer. This is a safety factor for people, especially in rural areas space,” explains Ilias Essaida. He is a consultant for health policy at the social association VdK.
But he also benefits from a different perspective when making this assessment: As a member of the volunteer fire department, he has often seen how the teleemergency doctor can help rescue teams. “It happens again and again that the teleemergency doctor is contacted to assess whether patients will be referred to the family doctor or even taken to a hospital. Or: The patient’s condition is not life-threatening, but acute, and the ambulance crew is considering it Bringing patients to the hospital. What does the teleemergency doctor think about it and which department makes the most sense?
All of this can be clarified excellently by the teleemergency doctor, says Essaida. His conclusion: “This means that people receive a professional assessment more quickly and the emergency paramedics can protect themselves in unclear or complex situations without a lot of time having to pass before an emergency doctor arrives directly at the scene.”
Medical Association: Quality of care must not decrease
The German Medical Association also generally likes teleemergency doctors. However, it is “completely unacceptable” to send qualified emergency paramedics alone into operations without an emergency doctor: “For patients, such a step would mean a loss of quality of care and ultimately a reduction in services,” says a statement on the reform of emergency care, which was published today topic in the Bundestag.
In times in which a shortage of skilled workers does not stop at the emergency doctors’ shift lists, the thought quickly arises: Why let emergency doctors out of the hospital at all when specially trained emergency paramedics can call a tele-emergency doctor at any time?
Clinics with tele-emergency doctors and politicians never tire of emphasizing: The tele-emergency doctor should only supplement, not replace. Maybe it’s a bit like in football: the video referee, the “VAR”, has not replaced his colleague on the pitch. Not yet.
