Combining Conventional and Telemedicine Medical Services to Reduce the Burden on Emergency Medical Services in Rural Areas: A Retrospective Cohort Study.

Abstract

Objectives: During the COVID-19 pandemic, the number of ambulance calls increased sharply, and ambulances could not be dispatched due to unavailability, especially in rural areas. This study assessed the integration of traditional emergency care systems in rural areas with online medical services from urban areas.

Methods: In this retrospective observational cohort study, patients recovering from mild COVID-19 at home who called an ambulance (November 2022 to January 2023) in Asahikawa, Japan were included. When an emergency call was received, the fire department control center initiated an online medical consultation to ascertain the necessity of ambulance transport while conventionally dispatching an ambulance. We compared chief complaints and patient characteristics between those who were transferred to hospitals and those who were not transferred, considering the time from the beginning of the 1-1-9 call to the start of the online service, and the duration of the online consultation for each group. The statistical significance of the differences between groups was analyzed by the Mann-Whitney U-test for continuous variables and the chi-square test or Fisher's exact test for categorical variables with statistical significance set at p < 0.05.

Results: Among the 136 patients, 73 (53.7%) were transferred to a hospital via ambulance. The median age of the transferred patients was significantly higher, at 83 years (interquartile range (IQR): 57-90), compared with 37 years (IQR: 26-60) for those not transferred (p < 0.001). A significantly higher number of transferred patients had hypoxemia (17, 23.3%; vs. non-transferred, 2, 3.2%; p < 0.001). The time from the start to the end of the online consultation was shorter for the transferred patients (13 min (IQR: 8-20) compared to non-transferred patients (15 min (IQR: 13-22); p < 0.001). There were no significant differences between groups in terms of sex, medical history, other chief complaints, or the time from the start of the 1-1-9 call to the start of the online service.

Conclusions: Online medical services have the potential to optimize medical resource allocation and utilization in rural areas.