Aus der Klinik und Poliklinik für Anästhesiologie, Anästhesie, Intensiv-, Notfall- und Schmerzmedizin (Direktor Univ.- Prof. Dr. med. Klaus Hahnenkamp) der Universitätsmedizin der Ernst-Moritz-Arndt-Universität Greifswald Telemedicine at the Emergency Site – Evaluated by emergency team members in simulated scenarios Inaugural - Dissertation zur Erlangung des akademischen Grades Doktor der Medizin (Dr. med.) der Universitätsmedizin der Ernst-Moritz-Arndt-Universität Greifswald 2015 vorgelegt von Bibiana Metelmann geb. am 13.06.1987 in Berlin Steglitz und Camilla Metelmann geb. am 13.06.1987 in Berlin Steglitz Dekan: Prof. Dr. rer. nat. Max P. Baur 1. Gutachter: Prof. Dr. med. Konrad Meissner 2. Gutachter: Prof. Dr. med. Michael Müller Ort, Raum: Greifswald, Institut für Diagnostische Radiologie und Neuroradiologie Demonstrationsraum F0.23, 1. Bauabschnitt Tag der Disputation: 18.04.2016 Table of Contents 1 Hypothesis and Background ............................................................................... 7 1.1 Hypothesis ........................................................................................................ 7 1.2 EU-Project LiveCity ........................................................................................... 8 1.3 Emergency Use Case of LiveCity Project ......................................................... 8 1.4 Medical Emergency Systems .......................................................................... 10 1.4.1 Medical Emergency Systems worldwide .................................................... 10 1.4.2 Medical Emergency System in Germany ................................................... 11 1.5 Telemedicine .................................................................................................. 14 1.5.1 Concept of Tele-Emergency Doctor ............................................................ 15 1.5.2 Evaluation of different existing concepts of video-communication in emergency medicine ................................................................................................. 18 2 Aim .................................................................................................................... 22 3 Material and Methods ....................................................................................... 23 3.1 Telemedicine core device: the LiveCity camera .............................................. 23 3.2 Emergency site: the Medical Simulation Centre ............................................. 29 3.3 Emergency patient: the Laerdal mannequin Resusci Anne ............................ 31 3.4 Emergency cases: ten scenarios .................................................................... 32 3.4.1 Stroke: with paralysis ..................................................................................... 34 3.4.2 Stroke: with anaesthesia ............................................................................... 34 3.4.3 Myocardial infarction: NSTEMI .................................................................... 35 3.4.4 Myocardial infarction: STEMI ....................................................................... 36 3.4.5 Trauma: tension pneumothorax ................................................................... 37 3.4.6 Trauma: blunt abdominal trauma ................................................................. 38 3.4.7 Rare disease: paracetamol intoxication ...................................................... 39 3.4.8 Rare disease: snake bite............................................................................... 40 3.4.9 Complications during pregnancy: aortocaval compression syndrome .. 41 3.4.10 Complications during pregnancy: preeclampsia ....................................... 41 3.4.11 Training scenario: severe attack of bronchial asthma ............................. 42 3.4.12 Training scenario:acute limb ischemia ....................................................... 43 3.5 Emergency team: emergency doctors and paramedics as propositi ............... 43 3.6 Emergency site procedure: phases and protocol ............................................ 47 3.6.1 Communication via off-the-shelf camera (Phase A) ................................. 49 3.6.2 Communication via“ideal” camera (Phase B) ............................................ 50 3.6.3 Communication via LiveCity camera (Phase C) ........................................ 51 3.7 Emergency site experience: personal appraisal ............................................. 53 3.8 Emergency site experience: professional performance .................................. 53 4 Results .............................................................................................................. 55 4.1 How valid is the emergency site simulated in this project? ............................. 56 4.1.1 Realistic ........................................................................................................... 56 4.1.2 Relevant ........................................................................................................... 56 4.1.3 Take simulation work seriously .................................................................... 57 4.2 How much and what kind of support is needed at the emergency site? ......... 57 4.2.1 Quantity of need ............................................................................................. 57 4.2.2 Quality of need ................................................................................................ 58 4.3 How is a tele-emergency doctor perceived in general? .................................. 58 4.3.1 Helpful .............................................................................................................. 59 4.3.2 Improving the situation .................................................................................. 59 4.3.3 Improving care ................................................................................................ 60 4.4 How do propositi feel during communication via LiveCity camera? ................ 60 4.4.1 Confirming ....................................................................................................... 60 4.4.2 Secure in general ........................................................................................... 61 4.4.3 Legally secure ................................................................................................. 61 4.4.4 Feeling controlled ........................................................................................... 61 4.4.5 Feeling of puppet-on-a-string ....................................................................... 62 4.4.6 Professional identity ....................................................................................... 62 4.4.6 Relationship to patients ................................................................................. 63 4.4.7 Interferer .......................................................................................................... 63 4.4.8 Disrupting......................................................................................................... 64 4.5 What kind of data needs to be transmitted from the emergency site? ............ 64 4.5.1 Transmission of vital signs ............................................................................ 64 4.5.2 Transmission of vital signs and audio connection..................................... 65 4.6 How are the technical aspects of the LiveCity camera evaluated? ................. 65 4.6.1 Adding information ......................................................................................... 66 4.6.2 Adding burden ................................................................................................ 66 4.6.3 Adding weight ................................................................................................. 67 4.6.4 Easy filming ..................................................................................................... 67 4.6.5 Demonstrate everything ................................................................................ 67 4.6.6 Easy on-screen orientation ........................................................................... 68 4.6.7 No vision restriction ........................................................................................ 68 4.6.8 Audio quality .................................................................................................... 69 4.6.9 Tell everything................................................................................................. 69 4.6.10 Easy operating ................................................................................................ 69 4.6.11 Failure-prone .................................................................................................. 70 4.6.12 Deranged communication............................................................................. 70 4.7 How is the concept of a tele-emergency doctor evaluated? ............................ 71 4.7.1 Additional calling ............................................................................................ 71 4.7.2 Faster start of therapy ................................................................................... 72 4.7.3 Useful system ................................................................................................. 72 4.7.4 Commitment .................................................................................................... 74 4.8 Does the tele-emergency doctor improve the