Impact of tele-medicine on eFAST performance and workload by critical care transport personnel
Margaret Siu, MD1, Marissa Matto, MD1, Jeffrey Dan, MD2, Jason Cohen, DO, FACEP, FCCM3,4, Yamuna Carey, MD1,5, Reginald Alouidor, MD, FACS1,5, Kristina Kramer, MD1,4, Tovy Haber Kamine, MD, FACS1,5,6
1Department of Surgery, University of Massachusetts Chan Medical School, Baystate Medical Center, Springfield, MA; 2Department of Emergency Medicine, University of Massachusetts Chan Medical School, Baystate Medical Center, Springfield, MA; 3Boston MedFlight, Bedford, MA; 4Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA; 5Division of Trauma, Acute Care Surgery and Surgical Critical Care, University of Massachusetts Chan Medical School, Baystate Medical Center, Springfield, MA; 6Department of Healthcare Policy and Population Science, University of Massachusetts Chan Medical School, Springfield, MA
Background: There are few reports on how eFAST tele-mentoring may improve critical care transport providers capabilities in performing eFAST in prehospital settings. We aimed to determine the impact of tele-guidance on eFAST performance and quantify workload experienced in performing and tele-mentoring eFAST.
Methods: Simulated trauma patients and eight trauma scenarios were used. Critical care transport (CCT) providers were given two trauma scenarios, and tasked to complete one independent and one ED physician (EP) tele-guided eFAST. Time required to complete eFAST and percent of correctly identified findings were obtained for each iteration. All participants were asked to complete the NASA Task Load Index survey to assess workload.
Results: 8 CCT providers were enrolled. Mean (95% CI) time to complete independent and tele-guided eFAST were 516 (332, 659) and 827 (514, 1139), respectively, p=0.06. Correctly identified injuries for independent vs. tele-guided was 65% vs. 92.5%, p=0.01. Compared to tele-guided eFAST, CCT providers experienced higher mental (p=0.004), temporal (p=0.01), and effort (p=0.004) demands, greater frustration (p=0.001), and subjective lower performance (p=0.003) during independent trials. EP experienced higher mental (p=0.001), temporal (p=0.02), effort (p=0.005), and frustration (p=0.001) demands than CCT members.
Conclusion: EP tele-guided eFAST yields higher accuracy than independent eFAST. CCT providers relied heavily on the tele-guidance of the remote physician when performing eFAST. Tele-guidance may improve accuracy of ultrasounds performed by prehospital personnel in real life scenarios.
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