Impact of Telemedicine on Extended Focused Assessment With Sonography for Trauma Performance and Workload by Critical Care Transport Personnel

Margaret Siu; Jeffrey Dan; Jason Cohen; Yamuna Carey; Reginald Alouidor; Kristina Kramer; Tovy Haber Kamine

doi:10.1016/j.amj.2022.12.008

Impact of Telemedicine on Extended Focused Assessment With Sonography for Trauma Performance and Workload by Critical Care Transport Personnel

Air Med J. 2023 Mar-Apr;42(2):105-109. doi: 10.1016/j.amj.2022.12.008. Epub 2023 Jan 16.

Authors

Margaret Siu¹, Jeffrey Dan², Jason Cohen³, Yamuna Carey⁴, Reginald Alouidor⁴, Kristina Kramer⁴, Tovy Haber Kamine⁵

Affiliations

¹ Department of Surgery, University of Massachusetts Chan Medical School, Baystate Medical Center, Worcester, MA. Electronic address: Margaret.Siu@baystatehealth.org.
² Department of Emergency Medicine, University of Massachusetts Chan Medical School, Baystate Medical Center, Worcester, MA.
³ Boston MedFlight, Bedford, MA; Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA.
⁴ Department of Surgery, University of Massachusetts Chan Medical School, Baystate Medical Center, Worcester, MA; Division of Trauma, Acute Care Surgery and Surgical Critical Care, University of Massachusetts Chan Medical School, Baystate Medical Center, Worcester, MA.
⁵ Department of Surgery, University of Massachusetts Chan Medical School, Baystate Medical Center, Worcester, MA; Division of Trauma, Acute Care Surgery and Surgical Critical Care, University of Massachusetts Chan Medical School, Baystate Medical Center, Worcester, MA; Department of Healthcare Policy and Population Science, University of Massachusetts Chan Medical School, Worcester, MA.

PMID: 36958873
DOI: 10.1016/j.amj.2022.12.008

Abstract

Introduction: There are currently no reports on whether telementoring for extended focused assessment with sonography for trauma (eFAST) improves critical care transport providers' performance in prehospital settings. Our objective was to determine the impact of teleguidance on eFAST performance and quantify workload experience.

Methods: Eight trauma injury modules were selected on simulated patients. Critical care transport (CCT) providers were tasked to complete one independent and one emergency physician-telementored eFAST. The time to completion and the percent of correct findings were obtained. Participants completed the NASA Task Load Index after each iteration to assess workload.

Results: Eight independent and 8 telementored eFASTs were completed. The mean times to complete the independent and telementored eFAST were 5 minutes 16 seconds (95% confidence interval [CI], 3 minutes 32 seconds, 6 minutes 59 seconds) and 8 minutes 27 seconds (95% CI, 5 minutes 14 seconds, 11 minutes 39 seconds), respectively (P = .06). The percentage of correctly identified injuries for the independent versus the teleguided eFAST was 65% versus 92.5% (P = .01). The CCT providers experienced higher mental (P = .004), temporal (P = .01), and effort (P = .004) demands; greater frustration (P = .001); and subjective lower performance (P = .003) during independent trials. The emergency physician experienced higher mental (P = .001), temporal (P = .02), effort (P = .005), and frustration (P = .001) demands than the CCT members.

Conclusion: The teleguided eFAST yielded higher accuracy than the independent eFAST. The CCT providers relied on teleguidance of the remote physician when performing the eFAST. Teleguidance may improve the accuracy of ultrasounds performed by prehospital personnel in real-life scenarios.

MeSH terms

Focused Assessment with Sonography for Trauma*
Humans
Telemedicine*
Ultrasonography
Workload