Objectives: More and more disasters are occurring and there will be an increasing shortage of physicians in the future. Telemedicine could be a solution here to offer medical care despite the lack of physicians in the area of operation. This study analyzes whether telemedicine for lower-qualified paramedics is comparable to conventional disaster medicine. Methods: A simulation study was conducted in which one conventional and two telemedicine groups cared for thermal-traumatically injured in a stressful situation. The telemedicine was conducted on tablets with integrated vital sign monitoring or on smartphones. The physician engagement time, the number of physician contacts, the time for relevant measures and the usage behavior of telemedicine were examined between these groups. Results: One telemedicine group showed significantly fewer patient contacts. This can be attributed to the ongoing consultation in the intervention group with more contacts. There are no significant differences in the relevant measures. Conclusion: Telemedicine is comparable to conventional disaster medicine in civil protection. Due to potential technical failures, it should primarily be used to compensate for the lack of physicians, and training should focus on an exit-strategy in case of a failure of the telemedicine.

The ability to use drones to obtain important vital signs could be very valuable for emergency personnel during mass-casualty incidents. The rapid and robust remote assessment of heart rates could serve as a life-saving decision aid for first-responders. With the flight sensor data of a specialized drone, a pipeline was developed to achieve a robust, non-contact assessment of heart rates through remote photoplethysmography (rPPG). This robust assessment was achieved through adaptive face-aware exposure and comprehensive de-noising of a large number of predicted noise sources. In addition, we performed a proof-of-concept study that involved 18 stationary subjects with clean skin and 36 recordings of their vital signs, using the developed pipeline in outdoor conditions. In this study, we could achieve a single-value heart-rate assessment with an overall root-mean-squared error of 14.3 beats-per-minute, demonstrating the basic feasibility of our approach. However, further research is needed to verify the applicability of our approach in actual disaster situations, where remote photoplethysmography readings could be impacted by other factors, such as blood, dirt, and body positioning.

Using drones to obtain vital signs during mass-casualty incidents can be extremely helpful for first responders. Thanks to technological advancements, vital parameters can now be remotely assessed rapidly and robustly. This motivates the development of an automated unmanned aerial system (UAS) for patient triage, combining methods for the automated detection of respiratory-related movements and automatic classification of body movements and body poses with an already published algorithm for drone-based heart rate estimation. A novel UAS-based triage algorithm using UAS-assessed vital parameters is proposed alongside a robust UAS-based respiratory rate assessment and pose classification algorithm. A pilot concept study involving 15 subjects and 30 vital sign measurements under outdoor conditions shows that with our approach, an overall triage classification accuracy of 89% and an $F_1$ score of 0.94 can be achieved, demonstrating its basic feasibility.

As disasters intensify and professional deficits persist, civil protection is reliant on medical volunteers. With limited physician availability, telemedicine is promising. No system currently empowers lower-qualified paramedics for physician-delegated telemedicine. Existing telemedicine technology unfits for civil protection. This study aimed to evaluate a modified system at a music festival to simulate disaster situations. A tablet-based telemedicine system, integrating vital sign monitoring, was deployed at the “Summerjam” music festival characterized by various medical emergencies. A physician could be contacted via telemedicine or requested onsite. Medical feasibility was rated by patient condition changes, with National Advisory Committee of Aeronautics (NACA) score and Primary Ranking for Initial Orientation in the Rescue service (PRIOR) algorithm for triaging. Technical feasibility was assessed by connection stability, communication, and vital sign transmission. Of 404 treatments, 34 (8.4%) were performed using telemedicine, 49 (12.1%) were carried out with a physician onsite. Telemedicine treatments accounted for 40.9% of all treatment in which a physician was involved. Patient conditions varied up to NACA III (moderate disturbance). A variety of internal medical (76.5%) and surgical (23.5%) conditions were addressed, some of which required invasive measures or application of medication. No patients experienced a deterioration in their condition. Despite technical difficulties, treatment was not significantly impacted, confirming technical feasibility. The study shows that lower-qualified paramedics can effectively use telemedicine for physician-delegated treatment, suggesting potential applicability to civil protection. Nonetheless, further system robustness improvements and research are needed.

Background/Objectives: Physician shortages increasingly challenge the provision of medical care at mass gathering events. Telemedicine may expand the treatment capabilities of Emergency medical technician intermediates (EMT-I), but the extent to which medical procedures are suitable for telemedical delegation and how such a care model might affect hospital transport rates remain unclear. Methods: In this retrospective modelling study, patient records from the 2022 Summerjam Festival were reviewed, and all documented diagnostic and therapeutic measures were extracted for assessment in a modified Delphi process. We then applied the resulting expert consensus on telemedical delegability to the original patient cohort to classify cases by theoretical suitability for telemedical management and to project hospital transport rates under a predefined telemedicine-only scenario. Results: Based on the retrospective application of the final modified Delphi consensus, 385 of 403 cases (95.5%; 95% CI 93.0–97.3%) were classified as theoretically eligible for telemedicine-only management. Overall, 144 of 200 interventions were classified as fully delegable, 48 as suitable for bridging delegation, and 8 as requiring an on-site physician. Under the predefined telemedicine-only scenario, the projected hospital transport rate increased from 6.2% to 9.2%, corresponding to an absolute increase of 3.0 percentage points (95% CI 1.3–5.0%). Conclusions: These findings suggest that telemedicine may substantially expand the theoretical scope of care provided by EMT-Is in mass gathering medicine. The projected increase in hospital transports under the predefined telemedicine-only scenario was partly determined by the assumption that patients requiring bridging or physician-only measures would require hospital transport in the absence of an on-site physician. Hybrid care models combining telemedical physician support with targeted on-site physician availability may therefore warrant prospective evaluation in future mass gathering settings.

Background/Objectives: Disaster medicine is frequently constrained by shortages of highly qualified medical personnel. Telemedicine may extend advanced expertise to less-qualified responders, but previous disaster telemedicine models have predominantly relied on physicians as remote consultants. This study compared patient care outcomes under telemedical support provided by experienced Paramedics with tele-physician support, conventional on-site physician care, and EMT-only care. Methods: A prospective, simulation-based, controlled quasi-experimental study was conducted during a 7.5-h mass casualty exercise in Hamburg, Germany. Seven treatment tents were assigned to four groups: on-site physician (CONT), EMT-only care (IV 1), tele-physician support (IV 2), and tele-Paramedic support (IV 3). Outcomes comprised time to first treatment order, indicated treatments addressed, analgesia management, and patient contact frequency by the most highly qualified team member. Results: A total of 151 simulated patients were included. Time to first treatment order did not differ significantly between groups (p = 0.09). The proportion of indicated treatments addressed differed significantly (p < 0.001), with rates of 56% in CONT, 8% in IV 1, 57% in IV 2, and 51% in IV 3. Analgesia was addressed in 68%, 7%, 59%, and 60% of patients with an indication, respectively (p < 0.001). Increasing pain intensity significantly increased the likelihood of analgesia in CONT, IV 2, and IV 3 but not in IV 1. Recorded patient contact frequencies were descriptively higher in the telemedicine groups, although contacts were operationally defined differently between telemedicine and non-telemedicine models. Conclusions: Tele-physician and tele-Paramedic support showed similar observed performance across selected outcomes to conventional physician-led care and substantially better rates of indicated treatments addressed and analgesia provision than EMT-only care. The findings indicate that experienced Paramedics may represent a valuable additional resource for telemedical disaster response. Larger studies are needed to confirm these results, define the appropriate scope of practice, and evaluate tiered consultation models in which tele-Paramedics provide first-line support and tele-physicians remain available for escalation of complex cases.