Telemedicine in Emergency Care - Applications, Benefits, and Challenges

Introduction:

Emergency departments are one of the crucial sections that provide urgent care in the hospital, and their function evaluates the hospital's role. Telemedicine uses communication technology to deliver healthcare services. With the help of telemedicine, it can provide specialized services to overcrowding and rural areas and to paramedics (person who gives emergency services outside the hospital setting) for better management.

What Is Telemedicine?

Telemedicine is a Greek word where tele means wire, medicine means to heal, and together called healing by wire. It is the exchange of information such as evaluation, diagnosis, prevention, treatment, and research of healthcare services with the help of information and communication technologies when distance becomes a critical factor.

What Are the Applications of Telemedicine in Emergency Care?

The application of telemedicine In emergency care includes:

• Use of Telemedicine in Acute Trauma Care: With the help of telemedicine, travel expenses can be reduced, access to specialized consultants can be increased, medical images can be visualized, and continuity of care can be enhanced. With the help of teleconsultation, information can be provided to the paramedics, which they are not normally able to do, and telemedicine pre-notification can provide information about the patient's condition to the hospital care team. Therefore, all these can improve patient care.

• Use of Telemedicine in Case of Stroke and Cardiovascular Disease: Stroke telemedicine (tele-stroke) is the field where healthcare providers treat stroke patients (decreased blood supply to the brain which is a life-threatening situation and can cause long-term disability). With the help of teleconsultation, health care can provide diagnosis and treatment. These can improve the treatment of thrombolytics (drugs that dissolve clots) and stroke-related disabilities. Thrombolytics are given within four hours after experiencing the stroke through an intravenous (IV) route. The use of a tissue thromboplasminogen activator (tPA) within three to four hours is the standard treatment for treating acute ischemic stroke.

• Use of Telemedicine in Noncritical Emergency Situations: These are emergency situations that do not require immediate treatment but do require early hospitalizations, such as a sprained knee, minor burns, skin infections, mild dehydration, or pink eye. This is especially done in rural areas, and teleconsultations are mostly excepted where nurse staff are high in number. With the help of teleconsultation, the patient can be transferred to a major emergency department center where specialists can provide better treatment.

• Use of Telemedicine in Burns Assessment: Analysis with the help of telemedicine can reduce hospital costs and overall mortality. Paramedics, with the help of focused assessment with sonography for trauma (FAST) ultrasound and recognizing the physical signs, can help in improved management of the situation.

• Use of Telemedicine by Ambulance Paramedics: Paramedics in ambulances mostly encounter stroke, trauma, and myocardial infarction (complete stop of blood flow to the heart muscles). Teleconsultations are helpful for the paramedic staff that provides prehospital care with the help of a specialist physician. Teleconsultation also helps in prehospital diagnosis, reduces delays in treatment, and can utilize the equipment and skills from major centers but are cost-effective in rural settings.

• Use of Telemedicine in Psychiatry: Telepsychiatry can help in providing psychological counseling, psychiatric evaluation, patient education, whether individual, family, or group therapy, and medication management. Common psychiatric emergencies are deliberate harm to self or others and suicidal attempts. Teleconsultations help in improving accessibility and reducing the cost of services.

• Use of Telemedicine in Hospital-Based Emergency Care: Teleconsultation helps in diagnosis and treatment, which helps in positive outcomes. Telepresence can help in the on-site performance of a remote physician.

• Use of Telemedical Notification: Telemedical notification can be integrated with the electronic health record (EHR), and reminders can be sent to the patients at the desired time. Therefore this reduces the cost and helps in the effective use of available resources.

• Use of Telemedicine by Less Expensive Care Providers: Less expensive care providers, such as nurses, along with a physician, can provide diagnosis and treatment.

• Use of Tele-Sonography: A nonspecialist sonographer can connect to a specialist by telecommunication, a real-time examination can be done, and the pictures can be sent to the specialist.

• Use of Telemedicine in Primary Care: Teleconsultations help in providing surveillance, monitoring physiological status, vital signs, interpretation of X-rays, and electrocardiogram transmission before transferring the patient to the hospital. It can link two hospital centers and provide better consultation. Apart from this, it can reduce the referral rates to the emergency department in the case of chronic patients.

• Use of Telemedicine in Pediatric Acute Care: Children with traumatic injury or severe illnesses require emergency treatment. Teleconsultation can help in assessing patients, checking medical files and medical images, and monitoring the patient. The use of telemedicine has improved and positive outcomes.

What Are the Benefits of Telemedicine in Emergency Care?

The benefits of telemedicine in emergency care include:

• Reduction of cost services.

• Increased quality of care.

• Decreased rate of patient transfer from rural areas to major centers.

• Decreased mortality rate.

• Decreased rate of patient transfer.

• Decreased time between the first appointment and treatment.

• Better training and practice of medical staff.

• Instant access to specialized staff.

• Reduction in overcrowding in the emergency department.

• On-site diagnosis and treatment.

• Reduction in return visits in case of unnecessary cases.

• Providing better remote care (services outside the hospital setting).

• Prevention of side effects of medicines and their errors.

• Improved management of emergency situations.

What Are the Challenges Faced by Telemedicine in Emergency Care?

The challenges faced by telemedicine in emergency care are:

• Technical difficulties and issues.

• Ethical, legislative, and policy issues.

• Protecting patient confidentiality, security, and privacy.

• Increased consultation time.

• Limited data on technology implementation.

• Lack of cooperation from different departments.

• Decreased skills in the case of rural physicians.

• Pre-existing health systems that are incompatible.

• Increased anxiety in physicians.

• Critical data can be lost.

• Operating the telemedicine and emergency medical fields togetherly.

• Increased work in case of low-staff hospitals.

• Less interest in rural patients participating in telemedicine.

• Extra time to set up the equipment.

• Differences of opinions in diagnosis and management among the physicians.

• Patient support.

• Difficulty in providing health care in rural areas.

• Implementation costs.

• The complexity of cases.

• Difficulty in maintaining the system.

Conclusion:

The application of telemedicine in emergency medicine has vast benefits such as cost-effectiveness, decreased rate of patient transfer, decreased rate of patient transfer, and on-site diagnosis and treatment. But, telemedicine faces challenges such as technical difficulties and issues, critical data can be lost, extra time to set up the equipment, and limited data on technology implementation.