Objectives & BackgroundThe LiveCity Project funded by the European Commission included the development of hardware and software and the provision of a telecommunication infrastructure with high-speed internet to allow for an encrypted audio-visual video communication from the site of an emergency to the Emergency Department. Having previously performed a questionnaire based study on telemedicine amongst paramedics we extended our research to examine if Doctors, nurses and patients in the Emergency Department felt it would be beneficial and would want and accept telemedicine in pre-hospital emergency care.MethodsTwo separate seventeen item questionnaires were developed by the research team in consultation with the key stakeholders for patients and staff. Two members of the research team approached doctors, nurses and patients in the Emergency Department to consent them to enrolment in the study. Statistical analysis was performed using SPSS software. The comments and statements from the qualitative data were analysed using simple thematic analysis.Results100% (56) of patients said they would like the technology used if they were in an ambulance and possibly suffering a stroke or a major injury, and 96.3% (54) said they would like it used if they were possibly suffering a heart attack. 83.3% (n=10) of doctors and 89% (n=16) of nurses were in favour of using pre-hospital video platform technology in stroke, Myocardial infarction and major trauma. The potential benefits were felt to be in diagnosis of time-dependent illnesses, time management in the ED, increased hospital preparedness for incoming patients and increased triage efficiency. Nurses and Doctors expressed concern that there may be difficulty operating the technology in situations such as adverse weather conditions, low light levels and in remote areas without network coverage. Concerns regarding potential breaches in patient confidentiality were noted.Conclusion99% of patients, 92% of Doctors and 94% of nurses saw the potential of an audio-visual link from the pre-hospital environment to the Emergency Department. Stakeholder enthusiasm for pre-hospital telemedicine must be met with the technological requirements to provide such a service. As noted by one patient a pre-hospital audio-visual link to the Emergency Department could be a “potentially a life saving service”.

Purpose Significant increases in the volume of preprint articles due to the COVID-19 pandemic, we examined the reliability of preprint articles compared to their peer-reviewed publications. Materials and Methods Preprint articles evaluating experimental studies of select treatment options (anticoagulation, dexamethasone, hydroxychloroquine, remdesivir, and tocilizumab) for COVID-19 in the critically ill, available in a peer-reviewed publication were screened for inclusion within Altmetric (n = 2040). A total of 40 articles met inclusion criteria, with 21 being randomly selected for evaluation. The primary outcome of this evaluation was a change in a study's reported primary outcome or statistical significance between preprint and peer-reviewed articles. Secondary outcomes included changes in primary/secondary outcome effect size and change in study conclusion. Results One article (4.8%, 95% CI 0.12%-23.8%) had a change in the primary outcome. Seven articles (33.3%, 95% CI 14.6%-57.0%) had a change in the primary outcome's effect measure. Five studies (23.8%, 95% CI 8.2%-47.2%) had changes in statistical significance of at least one secondary outcome. Four studies (19.0%, 95% CI 5.4%-41.9%) had a change in study conclusion. Conclusions In preprint articles of COVID-19 treatments, the provided primary outcome is generally reliable, while interpretation of secondary outcomes should be made with caution, while awaiting completion of the peer-review process.

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Objectives & BackgroundThe European Commission funded LiveCity Project e-health research involved a multidisciplinary team including telecommunication engineers, network engineers, hardware and software engineers, paramedics, nurses, doctors and research scientists. The intention had been to use off the shelf hardware and open access software to establish an internet based audiovisual communication over a 3 G network between the communication hub in the Emergency Department and the site of the emergency. It was intended to assess the feasibility of providing pre-hospital telemedicine and to assess it's clinical impact.MethodsThe 289 control patients were recruited in the Emergency Department by a member of the research team whilst the 34 patients in the intervention arm who underwent a telemedicine consultation were recruited by a researcher who accompanied the ambulance to the site of the emergency. The quality of audio-visual communication was monitored throughout each of the 34 patient's pre-hospital telecommunication consultations. The impact of the telemedical interaction on patient care was assessed.ResultsThe deployment of the wearable device in the field was associated with a number of significant challenges Including server and network issues associated with a failure to establish a link or loss of signal. The hardware evidenced issues with battery failure in the camera or hard drive, over heating of the hard drive, damage to the dongle, tearing of the back packs, breaks at connection points to the hard drive. There was an issue of delay between the audio feed and the video feed and a delay created by the encryption of both. There was freezing of images, pixilation of images, degradation of sound quality, loss of signal with movement. There was looping of the audio signal. In 33 of 34 patients the telemedical consultation was compromised by technological challenges but it was possible to obtain clinically useful information.ConclusionBespoke wearable hardware and software need to be developed for telemedicine in the pre-hospital environment.A 3 G network does not reliably support continuous uninterrupted audio-visual telemedicine in the pre-hospital setting. Paramedics infrequently require medical oversight but when they do it needs to work first time every time.