Effect of tele-support on attention levels of emergency medical technicians during simulated out-of-hospital cardiac arrest.

Telemedicine in the form of a provider-to-provider telemedical application, in which an expert supports the medical team at the patient’s location with medical and non-technical skills is slowly being introduced in preclinical emergency medicine. While the benefit of a tele-team leader could be demonstrated for simulated neonatal resuscitation scenarios, the effect of tele-support for emergency medical technicians (EMTs) on their attention, cognitive load, workload, and performance in case of an out-of-hospital cardiac arrest (OHCA) in adult patients is still unknown. As the impact of tele-support in OHCA is rarely investigated, this study aims to evaluate the effect of tele-team leadership during cardiopulmonary resuscitation (CPR) on EMTs’ attention, workload, and performance. Forty-three teams performed two simulated OHCA scenarios (one with and one without tele-support) in a randomized order, while wearing eye-tracking glasses (Tobii Pro 3.0). Each team consisted of three persons, of which two were EMTs (team leader and team member) and one confederate from the study team. Tele-support was provided by an experienced emergency physician using Corpuls Mission. The primary outcome was visual attention spend to four predefined areas of interest (AOI), including the patient, medical equipment, monitor, and other staff. Performance of advanced life support and cognitive load were evaluated using time-to-event data and the National Aeronautics and Space Administration Task Load Index, respectively. Tele-support significantly improved visual attention among team leaders, as indicated by a significant condition × AOI interaction (F = 4.88, P = 0.006). Team leaders with tele-support attended more often to the equipment (P = 0.008) and less often to other staff (P = 0.017). Furthermore, they spent less time focusing outside of the task-relevant AOIs (P = 0.002). For team members, the tele-support condition did not significantly change their visual attention. There was no significant difference between conditions for the times to start chest compressions, administration of adrenaline, defibrillation, ventilation, intubation, and the consideration of reversible causes. However, there was a significant difference of whether reversible causes were considered. Without tele-support, as many as 10 teams (26.3%) did not consider reversible causes in the scenario whereas only 2 teams (5.3%) did so when tele-support was provided (P = 0.008). Tele-support significantly improved team leaders’ visual attention during simulated OHCA, while having a positive impact on the resuscitation performance by increasing guideline adherence. Tele-support was viewed positively by a majority of study participants.