This was a single-center, retrospective, descriptive study conducted at the EMS of the University Hospital of Martinique during the first wave of the COVID-19 pandemic, between March 10 and May 31, 2020.

The primary objective was to describe the evolving profile of patients managed by the EMS follow-up unit. All patients over 18 years of age monitored by the COVID-19 follow-up unit of EMS of Martinique were included after providing consent at the start of follow-up. Patients who failed to respond to follow-up calls for more than 3 consecutive days were subsequently excluded.

Data were collected from the EMS software (Centaure 15; Nexpublica Switzerland AG), which compiles medical regulation records, and from the COVID-19 patient follow-up application database, which contains all follow-up teleconsultations. All patients included had initially contacted EMS and were triaged by emergency medical operators before being transferred to the follow-up unit. They were then contacted according to predefined protocols:

Patient follow-ups were conducted using a standardized questionnaire within the monitoring app. Collected data included sex, age, city of residence, medical history, polymerase chain reaction (PCR) tests performed, symptoms, follow-up outcome (recovery, hospitalization, or death), anxiety level at the beginning and end of follow-up, and satisfaction at the end of follow-up.

Anxiety level, added later in the process, was assessed using a numeric rating scale based on a Likert scale from 0 (not anxious) to 5 (extremely anxious). Satisfaction level was measured on a numeric scale from 0 (very dissatisfied) to 10 (very satisfied).

Continuous variables were described using means and SDs, while categorical variables were summarized using frequencies and percentages. χ² tests or Student t tests were used to evaluate associations between patients’ medical history and hospitalization status, as well as to assess reductions in anxiety scores before and after the intervention. A significance level of .05 was used.

This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of the University Hospital of Martinique on June 3, 2021 (No. 2021/108), as well as by the French National Commission on Informatics and Liberty. Consent to participate was obtained at the beginning of the follow-up. All data were anonymized prior to analysis and handled in accordance with the General Data Protection Regulation. Participants did not receive any financial compensation for their participation in the study.

Emerging epidemics pose major challenges to health care systems, particularly during periods of health uncertainty [14]. Teleconsultation offers an innovative and effective solution to maintain access to care while reducing the risk of infection [15]. The EMS follow-up teleconsultation unit was urgently established in the context of uncertainty regarding COVID-19 and its evolution. During the first epidemic wave in Martinique, knowledge about the disease was limited, prevention and diagnostic tools were underdeveloped, and public anxiety was high.

The urgency of establishing this system led to the implementation of a straightforward telephone follow-up approach. While videoconferencing is generally recommended for teleconsultations [16], the immediacy of the COVID-19 pandemic’s onset did not allow for the inclusion of a video component. Moreover, a multimedia teleconsultation strategy with integration of vital sign reporting through tracking apps might have provided higher-quality care but could have posed a substantial barrier to adoption, particularly among older or socially vulnerable populations in Martinique [17-20]. Nevertheless, the safety of this system was ensured by an experienced team trained in telephone-based tele-evaluation.

In the context of an emerging epidemic, rapid spread of infection is a major risk. Teleconsultation can help reduce patient movements to high-risk environments such as emergency departments [21]. In our case, it also addressed a new societal factor: the government-mandated lockdown, which complicated transport due to the suspension of public transportation. Teleconsultation additionally ensured regular medical follow-up, particularly for vulnerable patients in isolated areas [22]. Epidemics can disrupt health care infrastructure, leading to shortages of supplies, sudden increases in workload, or the isolation of specific regions. The risk of transmission to health care workers also remains significant, and teleconsultation can help protect this crucial workforce in epidemic contexts.

During uncertain epidemics such as COVID-19 in its early stages, it is essential to rapidly identify suspected cases and provide appropriate recommendations. Teleconsultation serves as an efficient tool for initial remote triage [23]. Physicians can assess symptoms, direct patients to appropriate centers for diagnostic testing or advanced care, and provide remote advice. This early triage helps prevent health care facilities from being overwhelmed and reduces the risk of contamination in clinical settings, thereby preserving the quality of care and the management of severe cases. Teleconsultation allows nonurgent or concerned patients to receive assessments remotely, preserving hospital capacity for critical cases and reducing system strain. In our cohort, most patients completed follow-up at home, whereas hospitalized patients were older and had more comorbidities, consistent with findings from prior studies [24,25].

During rapidly evolving epidemics such as COVID-19, teleconsultation enables agile adaptation of treatments and remote monitoring. Physicians can track symptom progression, adjust prescriptions according to updated medical guidelines, and collect essential patient information. This approach is especially valuable in the early stages of an epidemic, as treatment protocols can evolve quickly with new evidence and clinical experience. A major initial challenge was diagnosis, which relied primarily on clinical assessment due to the limited availability and long turnaround times of PCR testing. Clinical variability, compounded by high public anxiety, justified the follow-up system implemented by the EMS. Anxiety was a major concern during this health crisis [26,27]. Telephone follow-up revealed a significant reduction in patient anxiety, suggesting that teleconsultation services can play a role not only in medical care but also in psychological support during epidemics. Despite the potential for satisfaction bias, the high level of reported patient satisfaction supports the idea that this type of service can benefit emotionally vulnerable populations during health crises.

This study has several limitations. First, its retrospective, single-center design limits the generalizability of the findings, as the teleconsultation system was implemented within the specific geographic and health care context of Martinique. Second, diagnostic confirmation was limited because PCR testing was not widely available during the early phase of the epidemic, and many patients were managed based on suspected infection; nevertheless, similar constraints may be encountered during the emergence of a new infectious disease or during large-scale epidemics. Third, some data, including anxiety levels and satisfaction, were self-reported during telephone calls with a numeric scale and did not use a validated psychological measure, and they may be subject to reporting bias.

In the context of a novel and uncertain epidemic, teleconsultation, as implemented during the COVID-19 pandemic by the EMS at the University Hospital of Martinique, appears to be a valuable tool for addressing public health needs while minimizing transmission risks. It helps ensure continuity of care, optimize patient flow, and provide close individual monitoring, thereby alleviating pressure on health care systems. Although this organization was implemented within a specific geographic, organizational, and health care context, some components, such as the integration of teleconsultation within EMS regulation and the use of remote monitoring to manage selected patients at home, may represent adaptable approaches that could inform preparedness and response strategies during future epidemiological or biological health crises.