A review of the role of telemedicine in the accident and emergency department.

A literature search was conducted for articles on the role of telemedicine in accident and emergency work. The search yielded 39 relevant papers, which came from 21 independent groups that had used telemedicine in an emergency medicine setting. The articles showed that telemedicine has been applied in a variety of ways from medical advice for paramedics in the disaster setting, to patient follow-up in the fracture clinic. A variety of communications equipment has been tried, including radio links, telephone, email and mobile wireless videoconferencing devices. All such links have been found to transfer information effectively, but success has sometimes been limited by technical failure and by staff lacking confidence in using the systems. Telemedicine has been used widely to support emergency nurse practitioners in minor injury units. Telemedicine has also been suggested as a way for paramedics to communicate with regional coronary care units quickly, hence enabling them to provide pre-hospital thrombolysis in the field when appropriate. The accident and emergency setting is well suited to the application of telemedicine. Larger trials and cost-effectiveness studies are required in this area.