Emergency Medical Services Streaming Enabled Evaluation In Trauma: The SEE-IT Feasibility RCT.

Abstract

Background: The use of bystander video livestreaming from scene in emergency medical services is becoming increasingly common to inform decisions about the resources and support required. Possible benefits include clinical and financial gains, but evidence is sparse. We aimed to investigate the feasibility of conducting a definitive randomised controlled trial of its use in major trauma incidents.

Objectives: To obtain data required to design a subsequent randomised controlled trial. To test trial processes. To embed a process evaluation.

Design: A feasibility randomised controlled trial with embedded process and economic evaluations where working shifts (n = 62) in 6 trial weeks were randomised 1 : 1 to video livestreaming or standard care only; and two observational substudies: (1) assessment of acceptability in a diverse inner-city emergency medical service that routinely uses video livestreaming; and (2) assessment of staff well-being in an emergency medical service that does not use livestreaming (for comparison to the trial site). Qualitative data collection included observations (286 hours) and interviews with staff (n = 25) and bystander callers (n = 2).

Setting: A pre-hospital emergency medical service in South-East England, with follow-up in associated major trauma centres and trauma units; substudies in (1) London and (2) East of England emergency medical services.

Participants: (1) Patients involved in trauma incidents (n = 269); (2) bystander callers (n = 11); and (3) ambulance service staff (n = 67).

Intervention: Video livestreaming using GoodSAM's Instant-On-Scene.

Main outcome measures: Progression to a definitive randomised controlled trial based on four pre-defined criteria and consideration of qualitative data: (1) ≥ 70% bystanders with smartphones agreeing and able to activate livestreaming; (2) ≥ 50% requests to activate livestreaming resulting in footage being viewed; (3) helicopter emergency medical services stand-down rate reducing by ≥ 10% due to livestreaming; and (4) no evidence of psychological harm to bystanders or staff caused by livestreaming.

Results: Sixty-two shifts were randomised, contributing 240 eligible incidents (132 control; 108 intervention). In a further three shifts, we randomised by individual call, which contributed four eligible incidents (two control; two intervention), thereby totalling 244 incidents involving 269 patients. Video livestreaming was successful in 53 incidents in the intervention arm. Patient recruitment (to access medical records to assess appropriateness of dispatch) and bystander recruitment (to measure potential harm) were both low (58/269, 22% of patients, 4/244, 2% of bystanders). Two progression criteria were met: (1) 86% of bystanders with smartphones agreed and were able to activate livestreaming; (2) 85% of requests to activate livestreaming resulted in viewed footage; and two were indeterminate due to insufficient data: (3) 2/6 (33%) stand-down due to livestreaming; and (4) no evidence of psychological harm from survey, observations or interviews. In substudy (i), dispatch staff reported that non/limited English language and older age may present barriers to video livestreaming.

Limitations: Poor recruitment of patients and bystanders limited assessment of appropriateness of dispatch decisions and potential psychological harm.

Conclusions: Video livestreaming is feasible to implement, acceptable to both bystanders and dispatchers, and may aid dispatch decision-making, but further assessment of benefits and harm is required.

Future work: Findings support the design and conduct of a future multicentre study taking account of different triage systems and dispatch personnel, potentially using an alternative to a randomised controlled trial due to rapid uptake of video livestreaming in this setting.

Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130811.