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

  • Margaret Siu
    Correspondence
    Address for correspondence: Margaret Siu, MD, UMASS Chan Medical School, Baystate Medical Center, Department of Surgery, 759 Chestnut Street, Springfield, MA 01199.
    Affiliations
    Department of Surgery, University of Massachusetts Chan Medical School, Baystate Medical Center, Worcester, MA
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  • Jeffrey Dan
    Affiliations
    Department of Emergency Medicine, University of Massachusetts Chan Medical School, Baystate Medical Center, Worcester, MA
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  • Jason Cohen
    Affiliations
    Boston MedFlight, Bedford, MA

    Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA
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  • Yamuna Carey
    Affiliations
    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
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  • Reginald Alouidor
    Affiliations
    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
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  • Kristina Kramer
    Affiliations
    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
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  • Tovy Haber Kamine
    Affiliations
    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
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Published:January 16, 2023DOI:https://doi.org/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.
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