P3.H152: Feasibility of Conducting an Mhealth trial in a Pre-Hospital Setting: Findings from a Low-Resource Country

Background: Telemedicine has been proven as a successful tool for pediatricians requiring real time assistance in low-income countries and can be inculcated in prehospital setup. Our aim is to test the feasibility of linking ambulances that transport acutely ill children to a pediatric tele-emergency physician using telemedicine in a low resource setting.

Methods: We conducted a pilot cluster-randomized trial. Our study population included Children ( < 14 years of age) transported by ambulances, Emergency Medical Technicians (EMTs), and Telemedicine Physicians (TMPs). We selected ten ambulances and assigned them equally to intervention and control arms. Intervention arm ambulances were equipped with real-time, audiovisual communication between EMTs and TMPs using: 1- VoIP phone, 2- Headphones, 3- Tablet, 4- Internet router. 5- A 360-degree rotation camera with zoom-in features. All EMTs and TMPs were trained for appropriate equipment use, patient enrollment, and consent process. Based on Medical Priority Dispatch system (MPDS), we enrolled low acuity patients followed by high acuity patients. Our outcomes of interest were 1- Rate of successful call completion, 2- Rate of consent refusals, 3- Liman audiovisual score of ≤3, 4- Rate of interactions deemed safe, 5-System usability survey (SUS), and 6- Rate of completed Pediatric Early Warning Score (PEWS) calculated at two instances i.e., PEWS-1 in ambulance, and PEWS-2 immediately after transport.

Results: We approached a total of 166 parents, out of which 151 (91%) consented to participate. Of these, 73 were assigned to intervention group and 78 to control group. The average age of enrolled patients was 2.5 years (30 ± 43 months), with a range from 1 day to 12 years. As per triage distribution, 35.7% of patients were categorized as low-acuity and 64.3% as high-acuity. These cases were 68% hospital-to-hospital transfers and 32% were either picked up from home, school, or scene of illness. 96% of calls were successfully completed with a Liman score of ≤3 in 87% cases. 76.2% of interactions were deemed safe, followed by 23.8% as neutral and none as unsafe. 91% of TMPs and EMTs responded positively to SUS for use of telemedicine. PEWS-1 was successfully calculated for 100% and PEWS-2 was calculated for 86% patients, respectively.

Conclusion: In conclusion, prehospital mhealth trial is feasible in Pakistan and can be successfully implemented in similar low-resource settings.