Emergency medical services streaming enabled evaluation in trauma: the SEE-IT trial

Background

A ‘trauma incident’ is when someone suffers serious injuries that may be life changing, cause death or a long-term disability. Trauma incidents are the biggest killer of people aged under 45 in the UK: most often road traffic accidents. Following a trauma incident, most people will be taken to a hospital emergency department by an ambulance that has responded to a 999 call. Ambulances usually attend an incident by road, but in serious cases, an air ambulance (helicopter) may be sent. The aim is to get the patient to the best hospital to treat their injuries without delay to improve their chances of survival, recovery from their injuries and minimise chances of long-term problems.

When a 999 call is made, the person in the ambulance service who answers (the call taker) usually asks the caller to describe what they can see and how serious the injuries appear. This is so the dispatcher can decide how urgently, and what type, of help is required (e.g. what ambulance support to send and whether a helicopter is needed). The caller may give incomplete or wrong information so sometimes too few or too many ambulances are sent. This can delay getting the right help to patients or mean that ambulances are not available for others who need them. It is also costly for the NHS if ambulances or helicopters are sent when not needed.

The current study

In this study, we used a system called GoodSAM livestreaming that allowed the dispatchers in the emergency operations centre to send a link in a text message to the smartphone of 999 callers. When the caller clicked on the link, it used the camera on their phone to send live streamed images to the dispatcher (without recording it). This let the dispatcher see what was happening at the scene, rather than just relying on information given by the caller. 

In this feasibility study, one ambulance service emergency operations centre tested the use of livestreaming for trauma incidents that were eligible for inclusion in the trial. For six weeks spread out over six months (to cover different periods when trauma incidents are higher/lower), we evaluated how well it worked in practice. We counted the number of calls when livestreaming helped the dispatchers decide what ambulances to send. We checked how many times the link for livestreaming worked, and how often the dispatchers could see the footage. After each incident was over, our researchers looked at detailed reports and assessed if the right amount and type of ambulances were sent to the scene. We did this for incidents when livestreaming was used, and when it was not (control group). This helped us to understand if livestreaming helped dispatchers send the right ambulances and support.

We learnt about how willing members of the public were in allowing their camera to be used for livestreaming. We also learnt about how useful the dispatchers found the technology. An important part of this initial study was to find out whether use of livestreaming upsets members of the public or dispatchers in any way. We did this through interviews and surveys with members of the public and staff who did and did not use livestreaming. This data was difficult to obtain. We will also explored these issues in a second ambulance service located in a city so we could see if livestreaming works in a similar way in an area where callers may not have English as their first language, for example.

This study will help us plan a larger study that will explore more fully the possible benefits of using livestreaming for trauma incidents. A panel of lay people worked with the research team throughout the project to make sure the views of patients and the public were fully represented.

You can find out more information about our findings further down this page in the 'outputs' section. 

Research Question: 

Is it feasible to conduct a future randomised controlled trial (RCT) to assess the clinical and cost effectiveness of using GoodSAM live video streaming to improve targeting of emergency medical resources?

A randomised controlled trial (RCT) is a study design that allows us to compare an intervention (in this case, the use of live streaming) with “standard care” by randomly deciding whether it is used or not (like a flip of a coin).

Aims and objectives: 

The overall aim of this research was to assess the feasibility of implementing and evaluating live streaming in a future RCT.

The objectives were:

• To obtain data required to inform the design of a subsequent RCT (that is, the number of incidents that occur in the periods of the study; whether there is any indication that using live streaming might improve the speed of making the right dispatch decisions; and whether it is possible to collect the data we would need to examine the costs associated with using/not using live streaming).
• To test trial and study processes including randomisation and data collection methods.
• To conduct a nested process evaluation (a study focused on how/why something works or not) to test the acceptability and feasibility of using live streaming (via GoodSAM) from provider and public perspectives (for example, acceptability and feasibility of delivering training to staff, whether the live streaming works at night, in areas without 4G coverage, and to assess the risk of psychological harm to callers and/or dispatch staff).