A Mobile Computing Intervention for On-­Scene Reporting of Motor Vehicle Crash Trauma

Background: Trauma is the leading cause of death for patients between 1-44 years old and the fifth leading source of mortality in the United States [1]. The most common mechanism contributing to trauma injury is motor vehicle crashes (MVC). MVC’s account for approximately 42,000 fatalities per year [2], of which 60% (70% for Minnesota alone) are on rural roads. Timely and effective emergency medical services (EMS), is an important strategy for reducing the likelihood of death, disability and economic consequences of MVC’s. However, critical information gaps exist between the time when an incident is reported and when the patient receives definitive care at an emergency department (ED) or trauma center [3]. For example, prior studies have shown that only 49% of EMS agencies report collecting electronic data at the patient’s side [3], and verbal handoffs occur for only 44% of EMS patients [4]. Objectives: Existing communication methods between EMS and ED were assessed and a new alternative mobile computing centric strategy was designed, developed, and implemented. A design science research (DSR) approach was employed to design a solution according to the needs of two different core user groups – EMS and ED staff. The design goals were to improve trauma communications, emergency medical decision-making, and patient medical outcomes. The system, CrashHelp, consists of a mobile smartphone equipped with an application where EMS staff (paramedics, EMT’s) can securely capture pictures, digital audio recordings, video, patient and incident data and send it securely to the ED. Data collected includes patient name, gender, date of birth, origin of incident, mechanism of injury, trauma level, interventions, and protocol driven trauma specific data including the Glasgow coma scale (GCS), the highest heart rate, and the lowest blood pressure. Methods: An exploratory field test was conducted in rural Minnesota to assess usage and practitioner perceptions of usefulness. Staging scenarios were conducted at Tri-County Hospital (T-CH) in Wadena, MN, to model crash, response, information obtained and transmitted to the ED. Group discussions were conducted with EMS and ED staff to validate the trauma scenarios, determine trauma use cases, and implement the system. A three-month live pilot test was then conducted. Eleven real MVC trauma runs were selected and used for evaluating the system for its perceived impact on trauma communications, emergency medical decision-making, and medical outcomes. A total of 11 participants at T-CH were interviewed including four paramedics, six charge nurses, and one physician. Results: Key findings include improved trauma information collection by on-scene EMS personnel; improved trauma communication between pre-hospital transport and hospital organizations (ED/Trauma Centers); and improved hospital resource utilization by hospital personnel. Conclusion: The pilot provided an initial exploratory assessment and proof of concept that such a system could aid in improving the timeliness, completeness, accuracy, and richness of a trauma report from EMS to the ED/Trauma Centers. Additional research is needed to further determine the clinical value of using asynchronous data communications for point-of-care decisions; understanding the secondary use of data and value for clinical quality improvement and trauma audits; and integrating the data into hospital systems. [1] Peitzman, A. B., Fabian, T. C., Rhodes, M., Yealy, D. M. and Schwab, C. W. The trauma manual: trauma and acute care surgery. Lippincott Williams & Wilkins, 2012. [2] Peterson, J. A. Medical-Related Causes of Death in the United States. ACSM's Health & Fitness Journal, 17, 3 2013), 44 10.1249/FIT.1240b1013e3182905d3182912. [3] Schooley, B., Murad, A., Abed, Y. and Horan, T. A mHealth System for Patient Handover in Emergency Medical Services. [4] Benner, J. P., Hilton, J., Carr, G., Robbins, K., Schutt, R. C., Borloz, M. P., Alibertis, K., Sojka, B., Hudson, K., Haugh, D. and Brady, W. Information transfer from prehospital to ED health care providers. The American Journal of Emergency Medicine, 26, 2 2008), 233-235. []