gms | German Medical Science

Background: Between 2013 and 2015, each of 279 Level III trauma centers contributing their patient data to the German Trauma Registry, treated on average 13 trauma patients per year [1]. Respectively, on average 43 patients were treated at one of 233 included Level II and 147 patients at one of 124 included Level I trauma centers. Research suggests that patient volume is a positive predictor of survival in severely injured patients (Injury Severity Score ≥ 16) [2]. Accordingly, while a clear cut-off value could not be established, survival rates seem to increase when at least 40 severely injured patients are being treated at a hospital annually. Compared to the US where a tele-trauma pilot project in Tucson, Arizona reported that supporting trauma surgeons of low-volume trauma centers via telemedicine can be lifesaving and cost reducing [3], [4], in Germany telemedical trauma center assistance for the treatment of severely injured patients has neither been implemented nor evaluated yet.

Aim of the study: Aim of the project is to develop a feasible concept for the support of Level II and Level III trauma centers by Level I trauma centers using telemedicine. Thus, the survival outcome for severely injured patients might potentially be increased and a highly qualitative- and specialized trauma care can be widely distributed.

Proposed methods: Basic principles of tele-trauma procedures will be tested in simulated trauma room scenarios at the simulation center of the University Hospital Muenster, Germany. Participating physicians and nursing staff from Level III trauma centers working on training dummies will remotely be assisted by a tele-trauma leader (i.e. trauma surgeon) from a Level I trauma center via teleconsultation. Using wireless Bluetooth headsets connected to smartphones, hands-free communication with the tele-trauma leader, who is located in another room at the simulation center, will be achieved. Furthermore, due to real-time video transmission via mobile telemedicine unit as well as continuous vital data transmission to a telemedical workstation, the remote tele-trauma leader will be able to advise the treating physician.

In simulation studies, the processes of trauma room care will be scientifically evaluated with and without the use of telemedicine. Here, aspects like process quality, adherence to professional medical guidelines, stress of participants etc. will be observed.

Parallel to initial testing, a training program for real-life use of tele-trauma aiming at physicians and nurses, based on modern didactic- and coaching concepts as well as Advanced Trauma Life Support (ATLS^®) principles, will be developed. Next to the interpersonal and care related parts, functional aspects of the tele-trauma equipment and procedural aspects will play a substantial role.

Points for discussion: Similar projects in Germany have shown that legal and data security aspects regarding use of telemedicine in real-life settings involving patients can be dealt with [5], [6]. Nevertheless, these aspects will be addressed in this project as to prepare for real operation. For a widely available tele-trauma program, a network of different volume-sized hospitals, like the Trauma Network of the German Society for Trauma [7], might lay the foundation for future use.

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