Feasibility of telemedicine in civil protection: a prospective observational study during a music festival

doi:10.5847/wjem.j.1920-8642.2025.027

Abstract

Abstract:

BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSION: 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.

Key words: Disaster medicine, Tele-paramedic, Civil protection, Telemedicine, Tele-physician

Anna Müller, Robert Arimond, Janosch Kunczik, Rolf Rossaint, Michael Czaplik, Andreas Follmann. Feasibility of telemedicine in civil protection: a prospective observational study during a music festival[J]. World Journal of Emergency Medicine, 2025, 16(2): 121-128.

Figures/Tables 6

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Table 2.

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Exclusion criteria
General	· Lack of capacity to give consent, presumed consent will not be accepted in this study · Age under 18 years
Symptoms/ diagnoses/ suspected diagnoses for which telemedicine may not be used	· Apnea · Acute respiratory failure · Cardiovascular arrest · ST-elevation myocardial infarction (STEMI) · Unconsciousness (GCS 3) · Status epilepticus · Life-threatening arrhythmia · Polytrauma · Non-manageable symptoms of a mental disorder, existing danger to self or others · Imminent birth
Events for which telemedicine must not be used	· Serious traffic accidents or traffic accidents involving children · Fall from a great height (>3 m) · Gunshot or knife wounds to the head, neck, or torso · Fire with personal injury · High voltage accident · Water accidents (drowning, swimming accidents, ice collapse) · Accidents involving hazardous substances · Rampages, hostage situations, or other situations endangering the lives of emergency personnel · Immediate threat of suicide

Technical aspects	Sacles	Tele-paramedic (n=32)	Tele-physician (n=33)
App stability	Ran smoothly without malfunctions	22 (66.7)	25 (75.8)
	Minor malfunctions that did not affect the quality of use	6 (18.2)	5 (15.2)
	Malfunctions that have affected the quality of use	3 (9.1)	3 (9.1)
	Malfunctions that made use impossible	0	0
	No answer	1 (3.1)	0
Voice connection	Ran smoothly without malfunctions	29 (90.6)	27 (81.8)
	Minor malfunctions that did not affect the quality of use	1 (3.1)	2 (6.1)
	Malfunctions that have affected the quality of use	1 (3.1)	4 (12.1)
	Malfunctions that made use impossible	0	0
	No answer	1 (3.1)	0
One-way video connection	Ran smoothly without malfunctions	17 (53.1)	11 (33.3)
	Minor malfunctions that did not affect the quality of use	1 (3.1)	0
	Malfunctions that have affected the quality of use	0	0
	Malfunctions that made use impossible	0	0
	Not used	13 (40.6)	22 (66.7)
	No answer	1 (3.1)	0
Two-way video connection	Ran smoothly without malfunctions	27 (84.4)	23 (69.7)
	Minor malfunctions that did not affect the quality of use	3 (9.1)	2 (6.1)
	Malfunctions that have affected the quality of use	0	3 (9.1)
	Malfunctions that made use impossible	0	0
	Not used	1 (3.1)	5 (15.1)
	No answer	1 (3.1)	0