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Dainty K, Debaty G, Waddick J, Vaillancourt C, Malta Hansen C, Olasveengen T, Bray J. Interventions to optimize dispatcher-assisted CPR instructions: A scoping review. Resusc Plus 2024; 19:100715. [PMID: 39135732 PMCID: PMC11318549 DOI: 10.1016/j.resplu.2024.100715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/26/2024] [Accepted: 06/28/2024] [Indexed: 08/15/2024] Open
Abstract
Aim To review and summarize existing literature and knowledge gaps regarding interventions that have been tested to optimize dispatcher-assisted CPR (DA-CPR) instruction protocols for out-of-hospital cardiac arrest (OHCA). Methods This scoping review was undertaken by an International Liaison Committee on Resuscitation (ILCOR) Basic Life Support scoping review team and guided by the ILCOR methodological framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Studies were eligible for inclusion if they were published in peer-reviewed journals and evaluated interventions used to improve DA-CPR. The search was carried out in MEDLINE, EMBASE, Education Resources Information Center (ERIC), PsycINFO, the Cochrane Library, Evidence Based Medicine (EBM) Reviews, and the Campbell Library from 2000 to December 18, 2023. Results After full text review, 31 studies were included in the final review. The interventions reviewed were use of video at the scene (n = 9), changes in terminology about compressions (n = 6), implementation of novel DA-CPR protocols (n = 4), advanced dispatcher training (n = 3), centralization of the dispatch center (n = 2), use of metronome or varied metronome rates (n = 2), change in CPR sequence and compression ratio (n = 1), animated audio-visual recording (n = 1), pre-recorded instructions vs. conversational live instructions (n = 1), inclusion of "undress patient" instructions (n = 1), and specific verbal encouragement (n = 1). Studies ranged in methodology from registry studies to randomized clinical trials with the majority being observational studies of simulated EMS calls for OHCA. Outcomes were highly variable but included rates of bystander CPR, confidence & willingness to perform CPR, time to initiation of bystander CPR, bystander CPR quality (including CPR metrics: chest compression depth and rate; chest compression fraction; full chest recoil, ventilation rate, overall CPR competency), rates of automated external defibrillator (AED) use, return of spontaneous circulation (ROSC) and survival. Overall, all interventions seem to be associated with potential improvement in bystander CPR and CPR metrics. Conclusion There appears to be trends towards improvement on key outcomes however more research is needed. This scoping review highlights the lack of high-quality clinical research on any of the tested interventions to improve DA-CPR. There is insufficient evidence to explore the effectiveness of any of these interventions via systematic review.
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Affiliation(s)
- K.N. Dainty
- North York General Hospital, Toronto Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto Canada
| | - G. Debaty
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
- University of Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000 Grenoble, France
| | - J. Waddick
- North York General Hospital, Toronto Canada
| | - C. Vaillancourt
- Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Canada
| | - C. Malta Hansen
- Copenhagen Emergency Medical Services, Copenhagen University, Denmark
- Department of Cardiology, Gentofte and Herlev Hospital, Copenhagen University, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen University, Denmark
- Department of Clinical Medicine, Copenhagen University, Denmark
| | - T. Olasveengen
- Institute of Clinical Medicine, University of Oslo and Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital, Norway
| | - J. Bray
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - International Liaison Committee on Resuscitation Basic Life Support Task Force
- North York General Hospital, Toronto Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto Canada
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
- University of Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000 Grenoble, France
- Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Canada
- Copenhagen Emergency Medical Services, Copenhagen University, Denmark
- Department of Cardiology, Gentofte and Herlev Hospital, Copenhagen University, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen University, Denmark
- Department of Clinical Medicine, Copenhagen University, Denmark
- Institute of Clinical Medicine, University of Oslo and Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital, Norway
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Röhrs KJ, Audebert H. Pre-Hospital Stroke Care beyond the MSU. Curr Neurol Neurosci Rep 2024; 24:315-322. [PMID: 38907812 PMCID: PMC11258185 DOI: 10.1007/s11910-024-01351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE OF REVIEW Mobile stroke units (MSU) have established a new, evidence-based treatment in prehospital stroke care, endorsed by current international guidelines and can facilitate pre-hospital research efforts. In addition, other novel pre-hospital modalities beyond the MSU are emerging. In this review, we will summarize existing evidence and outline future trajectories of prehospital stroke care & research on and off MSUs. RECENT FINDINGS The proof of MSUs' positive effect on patient outcomes is leading to their increased adoption in emergency medical services of many countries. Nevertheless, prehospital stroke care worldwide largely consists of regular ambulances. Advancements in portable technology for detecting neurocardiovascular diseases, telemedicine, AI and large-scale ultra-early biobanking have the potential to transform prehospital stroke care also beyond the MSU concept. The increasing implementation of telemedicine in emergency medical services is demonstrating beneficial effects in the pre-hospital setting. In synergy with telemedicine the exponential growth of AI-technology is already changing and will likely further transform pre-hospital stroke care in the future. Other promising areas include the development and validation of miniaturized portable devices for the pre-hospital detection of acute stroke. MSUs are enabling large-scale screening for ultra-early blood-based biomarkers, facilitating the differentiation between ischemia, hemorrhage, and stroke mimics. The development of suitable point-of-care tests for such biomarkers holds the potential to advance pre-hospital stroke care outside the MSU-concept. A multimodal approach of AI-supported telemedicine, portable devices and blood-based biomarkers appears to be an increasingly realistic scenario for improving prehospital stroke care in regular ambulances in the future.
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Affiliation(s)
- Kian J Röhrs
- Department of Neurology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Heinrich Audebert
- Department of Neurology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
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Nehme E, Smith K, Jones C, Cox S, Cameron P, Nehme Z. Refining ambulance clinical response models: The impact on ambulance response and emergency department presentations. Emerg Med Australas 2024; 36:609-615. [PMID: 38561320 DOI: 10.1111/1742-6723.14406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 01/21/2024] [Accepted: 03/15/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The ambulance service in Victoria, Australia implemented a revised clinical response model (CRM) in 2016 which was designed to increase the diversion of low-acuity Triple Zero (000) calls to secondary telephone triage and reduce emergency ambulance dispatches. The present study evaluates the influence of the revised CRM on emergency ambulance response times and ED presentations. METHODS A retrospective study of emergency calls for ambulance between 1 January 2015 and 31 December 2018. Ambulance data were linked with ED presentations occurring up to 48 h after contact. Interrupted time series analyses were used to evaluate the impact of the revised CRM. RESULTS A total of 2 365 529 calls were included. The proportion allocated a Code 1 (time-critical, lights/sirens) dispatch decreased from 56.6 to 41.0% after implementation of the revised CRM. The proportion of calls not receiving an emergency ambulance increased from 10.4 to 19.6%. Interrupted time series analyses demonstrated an improvement in Code 1 cases attended within 15 min (Key Performance Indicator). However, for patients with out-of-hospital cardiac arrest or requiring lights and sirens transport to hospital, there was no improvement in response time performance. By the end of the study period, there was also no difference in the proportion of callers presenting to ED when compared with the estimated proportion assuming the revised CRM had not been implemented. CONCLUSION The revised CRM was associated with improved Code 1 response time performance. However, there was no improvement in response times for high acuity patients, and no change in the proportion of callers presenting to ED.
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Affiliation(s)
- Emily Nehme
- Centre for Research & Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
- Department of Research and Innovation, Silverchain, Melbourne, Victoria, Australia
| | - Colin Jones
- Clinical Operations, Ambulance Victoria, Melbourne, Victoria, Australia
| | - Shelley Cox
- Centre for Research & Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The Alfred Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Ziad Nehme
- Centre for Research & Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
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Magnusson C, Ollis L, Munro S, Maben J, Coe A, Fitzgerald O, Taylor C. Video livestreaming from medical emergency callers' smartphones to emergency medical dispatch centres: a scoping review of current uses, opportunities, and challenges. BMC Emerg Med 2024; 24:99. [PMID: 38862922 PMCID: PMC11165798 DOI: 10.1186/s12873-024-01015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/27/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Timely dispatch of appropriate emergency medical services (EMS) resources to the scene of medical incidents, and/or provision of treatment at the scene by bystanders and medical emergency lay callers (referred to as 'callers' in this review) can improve patient outcomes. Currently, in dispatch systems worldwide, prioritisation of dispatch relies mostly on verbal telephone information from callers, but advances in mobile phone technology provide means for sharing video footage. This scoping review aimed to map and identify current uses, opportunities, and challenges for using video livestreaming from callers' smartphones to emergency medical dispatch centres. METHODS A scoping review of relevant published literature between 2007 and 2023 in the English language, searched within MEDLINE; CINAHL and PsycINFO, was descriptively synthesised, adhering to the PRISMA extension for scoping reviews. RESULTS Twenty-four articles remained from the initial search of 1,565 articles. Most studies were simulation-based and focused on emergency medical dispatchers' (referred to as 'dispatcher/s' in this review) assisted video cardiopulmonary resuscitation (CPR), predominantly concerned with measuring how video impacts CPR performance. Nine studies were based on real-life practice. Few studies specifically explored experiences of dispatchers or callers. Only three articles explored the impact that using video had on the dispatch of resources. Opportunities offered by video livestreaming included it being: perceived to be useful; easy to use; reassuring for both dispatchers and callers; and informing dispatcher decision-making. Challenges included the potential emotional impact for dispatchers and callers. There were also concerns about potential misuse of video, although there was no evidence that this was occurring. Evidence suggests a need for appropriate training of dispatchers and video-specific dispatch protocols. CONCLUSION Research is sparse in the context of video livestreaming. Few studies have focussed on the use of video livestreaming outside CPR provision, such as for trauma incidents, which are by their nature time-critical where visual information may offer significant benefit. Further investigation into acceptability and experience of the use of video livestreaming is warranted, to understand the potential psychological impact on dispatchers and callers.
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Affiliation(s)
- Carin Magnusson
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Lucie Ollis
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Scott Munro
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Jill Maben
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Anthony Coe
- South East Coast Ambulance Service NHS Foundation Trust, Crawley, West Sussex, UK
| | - Oliver Fitzgerald
- South East Coast Ambulance Service NHS Foundation Trust, Crawley, West Sussex, UK
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK.
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Plodr M, Chalusova E. Current trends in the management of out of hospital cardiac arrest (OHCA). Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024; 168:105-116. [PMID: 38441422 DOI: 10.5507/bp.2024.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/27/2024] [Indexed: 06/16/2024] Open
Abstract
Sudden cardiac arrest remains a relevant problem with a significant number of deaths worldwide. Although survival rates have more than tripled over the last 20 years (4% in 2001 vs. 14% in 2020), survival rates with good neurological outcomes remain persistently low, representing a major socioeconomic problem. Every minute of delay from patient collapse to start cardiopulmonary resuscitation (CPR) and early defibrillation reduces the chance of survival by approximately 10-12%. Therefore, the time to treatment is a crucial factor in the prognosis of patients with out-of-hospital cardiac arrest (OHCA). Research teams working in the pre-hospital setting are therefore looking for ways to improve the transmission of information from the site of an emergency event and to make it easier for emergency medical dispatch centres (EMDC) to recognise life-threatening conditions with minimal deviation. For emergency unit procedures already at the scene of the event, methods are being sought to efficiently and temporarily replace a non-functioning cardiopulmonary system. In the case of traumatic cardiac arrest (TCA), the focus is mainly on effective affecting non-compressible haemorrhage.
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Affiliation(s)
- Michal Plodr
- Department of Emergency Medicine and Military General Medicine, Military Faculty of Medicine, University of Defence, Hradec Kralove, Czech Republic
- Emergency Medical Services of the Hradec Kralove Region, Hradec Kralove, Czech Republic
| | - Eva Chalusova
- Department of Emergency Medicine and Military General Medicine, Military Faculty of Medicine, University of Defence, Hradec Kralove, Czech Republic
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Idland S, Kramer-Johansen J, Bakke HK, Hagen M, Tønsager K, Platou HCS, Hjortdahl M. Can video streaming improve first aid for injured patients? A prospective observational study from Norway. BMC Emerg Med 2024; 24:89. [PMID: 38807042 PMCID: PMC11131190 DOI: 10.1186/s12873-024-01010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Video streaming in emergency medical communication centers (EMCC) from caller to medical dispatcher has recently been introduced in some countries. Death by trauma is a leading cause of death and injuries are a frequent reason to contact EMCC. We aimed to investigate if video streaming is associated with recognition of a need for first aid during calls regarding injured patients and improve quality of bystander first aid. METHODS A prospective observational study including patients from three health regions in Norway, from November 2021 to February 2023 (registered in clinical trials 10/25/2021, NCT05121649). Cases where video streaming had been used as a supplement during the medical emergency call were compared to cases where video streaming was not used during the call. Patients were included by ambulance personnel on the scene of accident if they met the following criteria: 1. Ambulance personnel arrived at a patient who had an injury, 2. One or more bystanders had been present before their arrival, 3. One or more of the following first aid measures had been performed by bystander or should have been performed: airway management, control of external bleeding, recovery position, and hypothermia prevention. Ambulance personnel assessed quality of first aid performed by bystander, and information concerning use of video streaming and patient need for first aid measures recognized by dispatcher was collected through EMCC audio logs and patient charts. We present descriptive data and results from a logistic regression analysis. RESULTS Data was collected on 113 cases, and dispatchers used video streaming in addition to standard telephone communication in 12/113 (10%) of the cases. The odds for the dispatcher to recognize a need for first aid during a medical emergency call were more than five times higher when video streaming was used compared to no use of video streaming (OR 5.30, 95% CI 1.11-25.44). Overall quality of bystander first aid was rated as "high". The odds ratio for the patient receiving first aid of higher quality were 1.82 (p-value 0.46) when video streaming was used by dispatcher during the call. CONCLUSION Our findings show that video streaming is not frequently used by dispatchers in calls regarding patients with injuries, but that video streaming is associated with improved recognition of patients' first aid needs. We found no statistically significant difference in first aid quality comparing the calls where video streaming as a supplement were used with the calls with audio only.
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Affiliation(s)
- Siri Idland
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway.
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway.
| | - Jo Kramer-Johansen
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Håkon Kvåle Bakke
- Department of Anaesthesia and Critical Care, University Hospital of North Norway, Tromsø, Norway
- Department of Health and Care Sciences, Faculty of Health Science, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Milada Hagen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
| | - Kristin Tønsager
- Air Ambulance Department, Stavanger University Hospital, Pre-hospital Division, Stavanger, Norway
- The Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
| | | | - Magnus Hjortdahl
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
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Harring AKV, Idland S, Dugstad J. When do medical operators choose to use, or not use, video in emergency calls? A case study. BMJ Open Qual 2024; 13:e002751. [PMID: 38772882 PMCID: PMC11110596 DOI: 10.1136/bmjoq-2024-002751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/08/2024] [Indexed: 05/23/2024] Open
Abstract
BackgroundAn evaluation report for a pilot project on the use of video in medical emergency calls between the caller and medical operator indicates that video is only used in 4% of phone calls to the emergency medical communication centre (EMCC). Furthermore, the report found that in half of these cases, the use of video did not alter the assessment made by the medical operator at the EMCC.We aimed to describe the reasons for when and why medical operators choose to use or not use video in emergency calls. METHOD The study was conducted in a Norwegian EMCC, employing a thematic analysis of notes from medical operators responding to emergency calls regarding the use of video. RESULT Informants reported 19 cases where video was used and 46 cases where it was not used. When video was used, three main themes appeared: 'unclear situation or patient condition', 'visible problem' and 'children'. When video was not used the following themes emerged: 'cannot be executed/technical problems', 'does not follow instructions', 'perceived as unnecessary'. Video was mostly used in cases where the medical operators were uncertain about the situation or the patients' conditions. CONCLUSION The results indicate that medical operators were selective in choosing when to use video. In cases where operators employed video, it provided a better understanding of the situation, potentially enhancing the basis for decision-making.
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Affiliation(s)
- Astrid Karina V Harring
- Department for Prehospital Education and Research, Oslo Metropolitan University, Oslo, Norway
| | - Siri Idland
- Department for Prehospital Education and Research, Oslo Metropolitan University, Oslo, Norway
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Janne Dugstad
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Charrin L, Romain-Scelle N, Di-Filippo C, Mercier E, Balen F, Tazarourte K, Benhamed A. Impact of delayed mobile medical team dispatch for respiratory distress calls: a propensity score matched study from a French emergency communication center. Scand J Trauma Resusc Emerg Med 2024; 32:27. [PMID: 38609957 PMCID: PMC11010329 DOI: 10.1186/s13049-024-01201-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Shortness of breath is a common complaint among individuals contacting emergency communication center (EMCCs). In some prehospital system, emergency medical services include an advanced life support (ALS)-capable team. Whether such team should be dispatched during the phone call or delayed until the BLS-capable paramedic team reports from the scene is unclear. We aimed to evaluate the impact of delayed MMT dispatch until receiving the paramedic review compared to immediate dispatch at the time of the call on patient outcomes. METHODS A cross-sectional study conducted in Lyon, France, using data obtained from the departmental EMCC during the period from January to December 2019. We included consecutive calls related to adult patients experiencing acute respiratory distress. Patients from the two groups (immediate mobile medical team (MMT) dispatch or delayed MMT dispatch) were matched on a propensity score, and a conditional weighted logistic regression assessed the adjusted odds ratios (ORs) for each outcome (mortality on days 0, 7 and 30). RESULTS A total of 870 calls (median age 72 [57-84], male 466 53.6%) were sought for analysis [614 (70.6%) "immediate MMT dispatch" and 256 (29.4%) "delayed MMT" groups]. The median time before MMT dispatch was 25.1 min longer in the delayed MMT group (30.7 [26.4-36.1] vs. 5.6 [3.9-8.8] min, p < 0.001). Patients subjected to a delayed MMT intervention were older (median age 78 [66-87] vs. 69 [53-83], p < 0.001) and more frequently highly dependent (16.3% vs. 8.6%, p < 0.001). A higher proportion of patients in the delayed MMT group required bag valve mask ventilation (47.3% vs. 39.1%, p = 0.03), noninvasive ventilation (24.6% vs. 20.0%, p = 0.13), endotracheal intubation (7.0% vs. 4.1%, p = 0.07) and catecholamine infusion (3.9% vs. 1.3%, p = 0.01). After propensity score matching, mortality at day 0 was higher in the delayed MMT group (9.8% vs. 4.2%, p = 0.002). Immediate MMT dispatch at the call was associated with a lower risk of mortality on day 0 (0.60 [0.38;0.82], p < 0.001) day 7 (0.50 [0.27;0.72], p < 0.001) and day 30 (0.56 [0.35;0.78], p < 0.001) CONCLUSIONS: This study suggests that the deployment of an MMT at call in patients in acute respiratory distress may result in decreased short to medium-term mortality compared to a delayed MMT following initial first aid assessment.
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Affiliation(s)
- Léo Charrin
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Université Claude Bernard Lyon 1, 5 Place d'Arsonval, 69437, Lyon, France
| | - Nicolas Romain-Scelle
- Department of Biostatistics and Public Health, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Christian Di-Filippo
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Université Claude Bernard Lyon 1, 5 Place d'Arsonval, 69437, Lyon, France
| | - Eric Mercier
- CHU de Québec-Université Laval Research Centre, Québec, Québec, Canada
| | - Frederic Balen
- Emergency Department, University Hospital of Toulouse, 31059, Toulouse, France
| | - Karim Tazarourte
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Université Claude Bernard Lyon 1, 5 Place d'Arsonval, 69437, Lyon, France
| | - Axel Benhamed
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Université Claude Bernard Lyon 1, 5 Place d'Arsonval, 69437, Lyon, France.
- CHU de Québec-Université Laval Research Centre, Québec, Québec, Canada.
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Taylor C, Ollis L, Lyon RM, Williams J, Skene SS, Bennett K, Glover M, Munro S, Mortimer C. The SEE-IT Trial: emergency medical services Streaming Enabled Evaluation In Trauma: a feasibility randomised controlled trial. Scand J Trauma Resusc Emerg Med 2024; 32:7. [PMID: 38383402 PMCID: PMC10883301 DOI: 10.1186/s13049-024-01179-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/10/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Use of bystander video livestreaming from scene to Emergency Medical Services (EMS) is becoming increasingly common to aid decision making about the resources required. Possible benefits include earlier, more appropriate dispatch and clinical and financial gains, but evidence is sparse. METHODS A feasibility randomised controlled trial with an embedded process evaluation and exploratory economic evaluation where working shifts during six trial weeks were randomised 1:1 to use video livestreaming during eligible trauma incidents (using GoodSAM Instant-On-Scene) or standard care only. Pre-defined progression criteria were: (1) ≥ 70% callers (bystanders) with smartphones agreeing and able to activate live stream; (2) ≥ 50% requests to activate resulting in footage being viewed; (3) Helicopter Emergency Medical Services (HEMS) stand-down rate reducing by ≥ 10% as a result of live footage; (4) no evidence of psychological harm in callers or staff/dispatchers. Observational sub-studies included (i) an inner-city EMS who routinely use video livestreaming to explore acceptability in a diverse population; and (ii) staff wellbeing in an EMS not using video livestreaming for comparison to the trial site. RESULTS Sixty-two shifts were randomised, including 240 incidents (132 control; 108 intervention). Livestreaming was successful in 53 incidents in the intervention arm. Patient recruitment (to determine appropriateness of dispatch), and caller recruitment (to measure potential harm) were low (58/269, 22% of patients; 4/244, 2% of callers). Two progression criteria were met: (1) 86% of callers with smartphones agreed and were able to activate livestreaming; (2) 85% of requests to activate livestreaming resulted in footage being obtained; and two were indeterminate due to insufficient data: (3) 2/6 (33%) HEMS stand down due to livestreaming; (4) no evidence of psychological harm from survey, observations or interviews, but insufficient survey data from callers or comparison EMS site to be confident. Language barriers and older age were reported in interviews as potential challenges to video livestreaming by dispatchers in the inner-city EMS. CONCLUSIONS Progression to a definitive RCT is supported by these findings. Bystander video livestreaming from scene is feasible to implement, acceptable to both 999 callers and dispatchers, and may aid dispatch decision-making. Further assessment of unintended consequences, benefits and harm is required. TRIAL REGISTRATION ISRCTN 11449333 (22 March 2022). https://www.isrctn.com/ISRCTN11449333.
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Affiliation(s)
- Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK.
| | - Lucie Ollis
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Richard M Lyon
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
- Kent, Surrey and Sussex Air Ambulance, Redhill, UK
| | - Julia Williams
- South East Coast Ambulance Service NHS Foundation Trust, Crawley, West Sussex, UK
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Simon S Skene
- Surrey Clinical Trials Unit, University of Surrey, Guildford, UK
| | - Kate Bennett
- Surrey Clinical Trials Unit, University of Surrey, Guildford, UK
| | - Matthew Glover
- Surrey Health Economics Centre, School of Biosciences, University of Surrey, Guildford, UK
| | - Scott Munro
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Craig Mortimer
- South East Coast Ambulance Service NHS Foundation Trust, Crawley, West Sussex, UK
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Hedberg H, Hedberg P, Aléx J, Karlsson S, Haney M. Effects of an advanced first aid course or real-time video communication with ambulance personnel on layperson first response for building-site severe injury events: a simulation study. BMC Emerg Med 2024; 24:2. [PMID: 38185649 PMCID: PMC10773037 DOI: 10.1186/s12873-023-00917-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND The risk of high-energy trauma injuries on construction sites is relatively high. A delayed response time could affect outcomes after severe injury. This study assessed if an advanced first aid course for first aid response for laypersons (employees or apprentices) in the construction industry or real-time video communication and support with ambulance personnel, or neither, together with access to an advanced medical kit, would have an effect on immediate layperson vital responses in a severe injury scenario. METHOD This was a controlled simulation study. Employees or apprentices at a construction site were recruited and randomly allocated into a group with video support or not, and advanced first aid course or not, and where one group had both. The primary outcomes were correct behavior to recognize and manage an occluded airway and correct behavior to stop life-threatening bleeding from a lower extremity injury. Secondary outcomes included head-to-toe assessment performed, placement of a pelvic sling, and application of remote vital signs monitors. RESULTS Ninety participants were included in 10 groups of 3 for each of 4 exposures. One group was tested first as a baseline group, and then later after having done the training course. Live video support was effective in controlling bleeding. A first aid course given beforehand did not seem to be as effective on controlling bleeding. Video support and the first aid course previously given improved the ability of bystanders to manage the airway, the combination of the two being no better than each of the interventions taken in isolation. Course exposure and video support together were not superior to the course by itself or video by itself, except regarding placing the biosensors on the injured after video support. Secondary results showed an association between video support and completing a head-to-toe assessment. Both interventions were associated with applying a pelvic sling. CONCLUSION These findings show that laypersons, here construction industry employees, can be supported to achieve good performance as first responders in a major injury scenario. Prior training, but especially live video support without prior training, improves layperson performance in this setting.
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Affiliation(s)
- Hans Hedberg
- Anesthesiology and Intensive Care Medicine, Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
| | - Pia Hedberg
- Nursing and Surgical and Perioperative Sciences, Center for Disaster Medicine, Umeå University, Umeå, Sweden
| | | | - Sofia Karlsson
- Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Michael Haney
- Anesthesiology and Intensive Care Medicine, Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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Ulvin OE, Skjærseth EÅ, Krüger AJ, Thorsen K, Nordseth T, Haugland H. Can video communication in the emergency medical communication centre improve dispatch precision? A before-after study in Norwegian helicopter emergency medical services. BMJ Open 2023; 13:e077395. [PMID: 37899141 PMCID: PMC10618992 DOI: 10.1136/bmjopen-2023-077395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVES Dispatching helicopter emergency medical services (HEMS) to the patients with the greatest medical or logistical benefit remains challenging. The introduction of video calls (VC) in the emergency medical communication centres (EMCC) could provide additional information for EMCC operators and HEMS physicians when assessing the need for HEMS dispatch. The aim of this study was to evaluate the impact from VC in the EMCC on HEMS dispatch precision. DESIGN An observational before-after study. SETTING The regional EMCC and one HEMS base in Mid-Norway. PARTICIPANTS EMCC operators and HEMS physicians at the EMCC and HEMS base in Trondheim, Norway. INTERVENTION In January 2022, VC became available in emergency calls in Trondheim EMCC. Data were collected from 2020 2021 (pre-intervention) and 2022 (post-intervention). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the proportion of seriously ill or injured HEMS patients, defined as a National Advisory Committee for Aeronautics (NACA) score between 4 and 7. The secondary outcome was the proportion of inappropriate dispatches, defined as missions with neither provision of additional competence nor any logistical contribution based on quality indicators for physician-staffed emergency medical services. RESULTS 811 and 402 HEMS missions with patient contact were included in the pre- and post-intervention group, respectively. The proportion of missions with NACA 4-7 was not significantly changed after the intervention (OR 1.21, 95% CI 0.92 to 1.61, p=0.17). There was no significant change in HEMS alarm times between the pre- and post-intervention groups (7.6 min vs 6.4 min, p=0.15). The proportion of missions with neither medical nor logistical benefit was significantly lower in the post-intervention group (28.4% vs 40.3%, p=0.007). CONCLUSION The results from this study indicate that VC is a promising, feasible and safe tool for EMCC operators in the complex HEMS dispatch process.
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Affiliation(s)
- Ole Erik Ulvin
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-hospital Services, St Olav's University Hospital, Trondheim, Norway
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesia and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - Eivinn Årdal Skjærseth
- Department of Emergency Medicine and Pre-hospital Services, St Olav's University Hospital, Trondheim, Norway
| | - Andreas J Krüger
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-hospital Services, St Olav's University Hospital, Trondheim, Norway
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjetil Thorsen
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Trond Nordseth
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesia and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Helge Haugland
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-hospital Services, St Olav's University Hospital, Trondheim, Norway
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12
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Differences between the dispatch priority assessments of emergency medical dispatchers and emergency medical services: a prospective register-based study in Finland. Scand J Trauma Resusc Emerg Med 2023; 31:8. [PMID: 36797760 PMCID: PMC9936687 DOI: 10.1186/s13049-023-01072-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Responsive and efficient emergency medical services (EMS) require accurate telephone triage. In Finland, such services are provided by Emergency Response Centre Agency (ERC Agency). In 2018, a new Finnish computer-assisted emergency dispatch system was introduced: the Emergency Response Integrated Common Authorities (ERICA). After the introduction of ERICA, the appropriateness of EMS dispatch has not been investigated yet. The study´s objective is to determine the consistency between the priority triage of the emergency medical dispatcher (EMD) and the on-scene priority assessment of the EMS, and whether the priority assessment consistency varied among the dispatch categories. METHODS This was a prospective register-based study. All EMS dispatches registered in the Tampere University Hospital area from 1 August 2021 to 31 August 2021 were analysed. The EMD's mission priority triaged during the emergency call was compared with the on-scene EMS's assessment of the priority, derived from the pre-set criteria. The test performance levels were measured from the crosstabulation of true or false positive and negative values of the priority assessment. Statistical significance was analysed using the chi-square test and the Kruskal-Wallis H test, and p-values < 0.05 were considered significant. RESULTS Of the 6416 EMS dispatches analysed in this study, 36% (2341) were urgent according to the EMD's dispatch priority, and of these, only 29% (688) were urgent according to the EMS criteria. On the other hand, 64% (4075) of the dispatches were non-urgent according to the EMD's dispatch priority, of which 97% (3949) were non-urgent according to the EMS criteria. Moreover, there were differences between the EMD and EMS priority assessments among the dispatch categories (p < 0.001). The overall efficiency was 72%, sensitivity 85%, specificity 71%, positive predictive value 29%, and negative predictive value 97%. CONCLUSION While the EMD recognised the non-urgent dispatches with high consistency with the EMS criteria, most of the EMD's urgent dispatches were not urgent according to the same criteria. This may diminish the availability of the EMS for more urgent missions. Thus, measures are needed to ensure more accurate and therefore, more efficient use of EMS resources in the future.
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Larribau R, Healey B, Chappuis VN, Boussard D, Guiche F, Herren T, Gartner BA, Suppan L. Contribution of Live Video to Physicians' Remote Assessment of Suspected COVID-19 Patients in an Emergency Medical Communication Centre: A Retrospective Study and Web-Based Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3307. [PMID: 36834002 PMCID: PMC9959421 DOI: 10.3390/ijerph20043307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic had a major impact on emergency medical communication centres (EMCC). A live video facility was made available to second-line physicians in an EMCC with a first-line paramedic to receive emergency calls. The objective of this study was to measure the contribution of live video to remote medical triage. The single-centre retrospective study included all telephone assessments of patients with suspected COVID-19 symptoms from 01.04.2020 to 30.04.2021 in Geneva, Switzerland. The organisation of the EMCC and the characteristics of patients who called the two emergency lines (official emergency number and COVID-19 number) with suspected COVID-19 symptoms were described. A prospective web-based survey of physicians was conducted during the same period to measure the indications, limitations and impact of live video on their decisions. A total of 8957 patients were included, and 2157 (48.0%) of the 4493 patients assessed on the official emergency number had dyspnoea, 4045 (90.6%) of 4464 patients assessed on the COVID-19 number had flu-like symptoms and 1798 (20.1%) patients were reassessed remotely by a physician, including 405 (22.5%) with live video, successfully in 315 (77.8%) attempts. The web-based survey (107 forms) showed that physicians used live video to assess mainly the breathing (81.3%) and general condition (78.5%) of patients. They felt that their decision was modified in 75.7% (n = 81) of cases and caught 7 (7.7%) patients in a life-threatening emergency. Medical triage decisions for suspected COVID-19 patients are strongly influenced by the use of live video.
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Affiliation(s)
- Robert Larribau
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211 Geneva, Switzerland
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14
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Idland S, Iversen E, Brattebø G, Kramer-Johansen J, Hjortdahl M. From hearing to seeing: medical dispatchers' experience with use of video streaming in medical emergency calls - a qualitative study. BMJ Open 2022; 12:e063395. [PMID: 36526307 PMCID: PMC9764601 DOI: 10.1136/bmjopen-2022-063395] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Video streaming has recently been introduced as an additional tool for communication between medical dispatchers and caller. Research implies that video streaming may be a useful tool for the dispatchers, but more knowledge is needed. With this study, we wanted to explore how the dispatchers experience using video streaming as an additional tool in medical emergency calls. DESIGN An explorative, qualitative study using semi-structured focus group interviews. SETTING Two emergency medical communications centres in Norway where video streaming recently had been introduced. Interviews were conducted during 24 June 2020 and 26 June 2020. PARTICIPANTS We recruited 25 medical dispatchers, either nurses or emergency medical technicians who worked at the two centres. RESULTS The results are categorised into three themes: (1) change in dispatcher's perception of the patient and the situation, (2) reassurance for the dispatcher and (3) worries about increased time consumption and the possibility of unpleasant images. CONCLUSION The dispatchers experienced that the use of video streaming in medical emergency calls might contribute to a better comprehension of the situation and following more precise resource allocation, as well as greater reassurance for the dispatcher and improved relationship between the dispatcher and the caller. Further research with an aim to measure effects and safety of video streaming during medical emergency calls is needed.
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Affiliation(s)
- Siri Idland
- Bachelor Program in Paramedic Science, Institute of Nursing and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital, Oslo, Norway
| | - Emil Iversen
- Norwegian National Advisory Unit on Emergency Medical Communication (KoKom), Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Guttorm Brattebø
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
- Norwegian National Advisory Unit on Emergency Medical Communication (KoKom) and Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Jo Kramer-Johansen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) and Air Ambulance department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magnus Hjortdahl
- Bachelor Program in Paramedic Science, Institute of Nursing and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
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Video Emergency Calls in Medical Dispatching: A Scoping Review. Prehosp Disaster Med 2022; 37:819-826. [PMID: 36138554 DOI: 10.1017/s1049023x22001297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Video emergency calls (VCs) represent a feasible future trend in medical dispatching. Acceptance among callers and dispatchers seems to be good. Indications, potential problems, limitations, and directions of research of adding a live video from smartphones to an emergency call have not been reviewed outside the context of out-of-hospital cardiac arrest (OHCA). OBJECTIVE The main objective of this study is to examine the scope and nature of research publications on the topic of VC. The secondary goal is to identify research gaps and discuss the potential directions of research efforts of VC. DESIGN Following PRISMA-ScR guidelines, online bibliographic databases PubMed, Web of Science, SCOPUS, Google Scholar, ClinicalTrials.gov, and gray literature were searched from the period of January 1, 2012 through March 1, 2022 in English. Only studies focusing on video transfer via mobile phone to emergency medical dispatch centers (EMDCs) were included. RESULTS Twelve articles were included in the qualitative synthesis and six main themes were identified: (1) cardiopulmonary resuscitation (CPR) guided by VC; (2) indications of VCs; (3) dispatchers' feedback and perception; (4) technical aspects of VCs; (5) callers' acceptance; and (6) confidentiality and legal issues. CONCLUSION Video emergency calls are feasible and seem to be a well-accepted auxiliary method among dispatchers and callers. Some promising clinical results exist, especially for video-assisted CPR. On the other hand, there are still enormous knowledge gaps in the vast majority of implementation aspects of VC into practice.
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Linderoth G, Rosenkrantz O, Lippert F, Østergaard D, Ersbøll AK, Meyhoff CS, Folke F, Christensen HC. Live video from bystanders' smartphones to improve cardiopulmonary resuscitation. Resuscitation 2021; 168:35-43. [PMID: 34509558 DOI: 10.1016/j.resuscitation.2021.08.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 08/19/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
AIM To investigate whether live video streaming from the bystander's smartphone to a medical dispatcher can improve the quality of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA). METHODS After CPR was initiated, live video was added to the communication by the medical dispatcher using smartphone technology. From the video recordings, we subjectively evaluated changes in CPR quality after themedical dispatcher had used live video to dispatcher-assisted CPR (DA-CPR). CPR quality was registered for each bystander and compared with CPR quality after video-instructed DA-CPR. Data were analysed using logistic regression adjusted for bystander's relation to the patient and whether the arrest was witnessed. RESULTS CPR was provided with live video streaming in 52 OHCA calls, with 90 bystanders who performed chest compressions. Hand position was incorrect for 38 bystanders (42.2%) and improved for 23 bystanders (60.5%) after video-instructed DA-CPR. The compression rate was incorrect for 36 bystanders (40.0%) and improved for 27 bystanders (75.0%). Compression depth was incorrect for 57 bystanders (63.3%) and improved for 33 bystanders (57.9%). The adjusted odds ratios for improved CPR after video-instructed DA-CPR were; hand position 5.8 (95% CI: 2.8-12.1), compression rate 7.7 (95% CI: 3.4-17.3), and compression depth 7.1 (95% CI: 3.9-12.9). Hands-off time was reduced for 34 (37.8%) bystanders. CONCLUSIONS Live video streaming from the scene of a cardiac arrest to medical dispatchers is feasible. It allowed an opportunity for dispatchers to coach those providing CPR which was associated with a subjectively evaluated improvement in CPR performance.
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Affiliation(s)
- Gitte Linderoth
- Copenhagen Emergency Medical Services, Copenhagen University Hospital, Copenhagen, Denmark; Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
| | - Oscar Rosenkrantz
- Copenhagen Emergency Medical Services, Copenhagen University Hospital, Copenhagen, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Doris Østergaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation, CAMES, Copenhagen University Hospital - Herlev, Copenhagen, Denmark
| | - Annette K Ersbøll
- National Institute for Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital - Gentofte, Copenhagen, Denmark
| | - Helle C Christensen
- Copenhagen Emergency Medical Services, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Danish Clinical Quality Program (RKKP) ▪ National Clinical Registries, Copenhagen, Denmark
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