Objectives & Background The European Commission funded LiveCity Project e-health research involved a multidisciplinary team including telecommunication engineers, network engineers, hardware and software engineers, paramedics, nurses, doctors and research scientists. The intention had been to use off the shelf hardware and open access software to establish an internet based audiovisual communication over a 3 G network between the communication hub in the Emergency Department and the site of the emergency. It was intended to assess the feasibility of providing pre-hospital telemedicine and to assess it's clinical impact.

Methods The 289 control patients were recruited in the Emergency Department by a member of the research team whilst the 34 patients in the intervention arm who underwent a telemedicine consultation were recruited by a researcher who accompanied the ambulance to the site of the emergency. The quality of audio-visual communication was monitored throughout each of the 34 patient's pre-hospital telecommunication consultations. The impact of the telemedical interaction on patient care was assessed.

Results The deployment of the wearable device in the field was associated with a number of significant challenges Including server and network issues associated with a failure to establish a link or loss of signal. The hardware evidenced issues with battery failure in the camera or hard drive, over heating of the hard drive, damage to the dongle, tearing of the back packs, breaks at connection points to the hard drive. There was an issue of delay between the audio feed and the video feed and a delay created by the encryption of both. There was freezing of images, pixilation of images, degradation of sound quality, loss of signal with movement. There was looping of the audio signal. In 33 of 34 patients the telemedical consultation was compromised by technological challenges but it was possible to obtain clinically useful information.

Conclusion Bespoke wearable hardware and software need to be developed for telemedicine in the pre-hospital environment.A 3 G network does not reliably support continuous uninterrupted audio-visual telemedicine in the pre-hospital setting. Paramedics infrequently require medical oversight but when they do it needs to work first time every time.