Tehnaz P Boyle, Derrick Chu, Ijeoma M Okafor, Lauren Cronin, Caitlin Farrell, Stephanie Stapleton, Ron Medzon, Barbara M Walsh, Howard Cabral, Erik Wang, Mari-Lynn Drainoni, Vinay Nadkarni, Carlos A Camargo, James A Feldman
In simulations, teleconsultation for pediatric EMS transports was acceptable and feasible with minor technical modifications. Implementation should balance physician workload and clarify roles through training. Future trials should evaluate patient outcomes.
BACKGROUND: Before a trial testing prehospital teleconsultation for children, we studied acceptability, feasibility, and workload after integrating teleconsultation into Emergency Medical Service (EMS) workflows.
METHODS: We randomized paramedic-physician teams to teleconsultation (audio/video call, intervention) or usual care (audio call, control) for three simulated pediatric transports using mixed methods. Paramedic dyads provided in-ambulance simulated care while remote pediatric emergency physicians offered real-time consultation. In the intervention group, we used the Telehealth Usability Questionnaire to measure acceptability [primary; Total Usability Score (TUS), maximum = 7] and feasibility [secondary; Interaction Quality Score (IQS)]; and interviews for Technology Acceptance Model themes. Between groups, we calculated descriptive statistics and compared connection success and workload.
RESULTS: Twenty-four teams (12/group) completed 72 simulated transports. Intervention paramedics attempted physician contact in 94% (34/36) of transports versus 47% (17/36) in control; 92% connected in ≤2 attempts. In the intervention group, mean TUS was 5.6 (95% CI 5.2, 6.0) for physicians and 5.8 (95% CI 5.5, 6.0) for paramedics; mean IQS was 5.2 (95% CI 4.6, 6.0) and 5.9 (95% CI 5.4, 6.3) respectively. Intervention paramedics reported similar workload to controls (p = 0.26) but less frustration (p = 0.03); physicians experienced higher workload (p = 0.01). Interviews identified improved communication and physician involvement, alongside uncertainty about physician roles and impact on paramedic autonomy. Video quality was adequate, but concerns about real-world audio and broadband reliability remained.
CONCLUSIONS: In simulations, teleconsultation for pediatric EMS transports was acceptable and feasible with minor technical modifications. Implementation should balance physician workload and clarify roles through training. Future trials should evaluate patient outcomes.