# Feasibility and Efficacy of Ambulance-Based mhealth for Pediatric Emergencies (FEAMER) Trial

> **NIH NIH R33** · WEILL MEDICAL COLL OF CORNELL UNIV · 2024 · $258,943

## Abstract

Introduction: The overall goal of our research project is to reduce the mortality and morbidity of children with 
acute and emergency illnesses by improving care during ambulance transportation using telemedicine. In the 
R21 phase, we proved the feasibility of conducting an ambulance-based telemedicine cluster randomized trial. 
Specific Aims for the R33 phase: The R21 phase had three aims, while the R33 phase have the following two 
aims, which remain unchanged from our initial proposal.
- SA 4: To test the efficacy of Ambulance Based Teleconsultation (ABT) by measuring a change in the 
Pediatric Early Warning Signs (PEWS) of acutely ill children from the scene of injury/illness to the 
pediatric emergency department (PED) through a cluster-randomized trial. 
- SA 5: To develop the capacity of local partners in m-health research capacity. 
Methodology: SA4 will be a prospective cluster randomized trial with each ambulance serving as a cluster. We 
will use a stratified random sampling design to assign 30 ambulances to receive the ABT setup, while 30 others 
will serve as control clusters. Our primary outcome will be a change in the Pediatric Early Warning Score from 
the scene of illness/injury to the hospital triage/resuscitation room. Our secondary outcomes will be % of 
completed calls, the satisfaction rate of EMTs and Telemedicine Physicians, and the outcome at the end of the 
ED visit. We will work with our existing partners and use the same telemedicine setup as tested in the R21 phase. 
We will use the SIEHS EMTs who were part of the intervention and control ambulances during the R21 phase to 
work with the research team as trainers for the rest of the service. Our minimum required sample size of 600 
(300 each in intervention and control clusters) remains unchanged. The only change in the data collection 
process will be the incorporation of Emergency Department PEWS in the standard electronic medical record by 
the ChildLife Foundation. This will ensure consistent and timely access to PEWS scores during the trial. As tested 
in the R21 phase, we will store identifiable data in a codebook on a password-protected institutional drive 
accessible to the research team only. After both sets of PEWS have been completed and follow-up consent has 
been received, the data will be de-identified and made accessible for analysis. Concurrently, we will share data 
on outcomes with the currently existing Data Safety Monitoring Board at 10%, 25%, 50%, 75%, and 100% levels 
of enrollment. Table 1 summarizes the milestones for SA4. 
For SA5, we will build capacity on telemedicine/telehealth research and will further strengthen expertise in 
emergency care clinical trials in Pakistan. This will be achieved through quarterly webinars, two workshops, and 
one national seminar. Additionally, we plan to support the training of SIEHS ambulance in modern prehospital 
care systems through one study visit to a regional or international center of excellence. 
Ex...

## Key facts

- **NIH application ID:** 11064186
- **Project number:** 4R33HD103049-03
- **Recipient organization:** WEILL MEDICAL COLL OF CORNELL UNIV
- **Principal Investigator:** Junaid Abdul Razzak
- **Activity code:** R33 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $258,943
- **Award type:** 4C
- **Project period:** 2024-07-10 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11064186

## Citation

> US National Institutes of Health, RePORTER application 11064186, Feasibility and Efficacy of Ambulance-Based mhealth for Pediatric Emergencies (FEAMER) Trial (4R33HD103049-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/11064186. Licensed CC0.

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