Dispatch of Emergency Call Using Video Streaming Compared With Traditional Telephone Communication

Study Overview
=================
Brief Summary
-----------------
In the Emergency Medical Dispatch Center, all EMS dispatchers were divided into one of two clusters with 11 EMS dispatchers in each cluster. Because of few clusters, a matched-pair (MP) design was used based on the average proportion of the dispatched level of urgency (highest level of urgency used as primary matching criteria), years of employment and the average duration of emergency calls in a 3-months period (1st of January 2022 - 31st of March 2022) before the implementation of video streaming. Newly employed personnel where matching was not possible were randomly assigned to one of the two clusters. Prior to the study period, video streaming was gradually implemented in the intervention group during a 6-months period (1st of July 2022 - 31st of December 2022). Using a cluster randomized setup, the aim was to investigate differences in the management of emergency calls (dispatches) when emergency medical service (EMS) dispatchers use video streaming compared with telephone-only (audio-only) communication. All emergency calls will be randomly distributed between the two clusters.

Detailed Description
-----------------
In Denmark, all emergency medical calls are answered by a nurse- or paramedic trained in dispatching emergencies. The EMS dispatcher determines the level of urgency and the type and number of resources to be allocated (e.g., ambulance, physician-manned vehicle and/or physician-manned helicopter (HEMS). The decision-making process is supported by a standardized national criteria-based dispatch tool called Danish Index for Emergency Care (DI). DI is a tool that classifies the patient's main complaint into different symptom groups (chapters) to determine the level of urgency required and which resources to allocate. As standard, emergency calls are based on telephone-only (audio-only) communication, which might limit the understanding of a complex clinical presentation. Previous studies suggest that a visualized clinical presentation could aid the EMS dispatchers in their decision-making and dispatch. The decision on implementing video streaming has been made by the management board of the Prehospital Emergency Medical Services, Central Denmark Region, Denmark. It has been decided to implement video streaming gradually to allow for this cluster randomized study. Because video streaming is a deemed part of the standard operating procedure (SOP), ethical approval from our local ethical committee is waived. After the study period, video streaming will be implemented in the current control group as the decision to use video streaming as SOP has already been decided.

Official Title
-----------------
Criteria-based Ambulance Management - Video Indexation VS Standard Indexation On Non-selected Emergency Calls

Conditions
-----------------
Emergency Medical Dispatch Centre, Video Streaming, Emergency Call, Prehospital Emergency Medical Services

Intervention / Treatment
-----------------
* Device: Video streaming (smartphone camera)
* Device: Telephone (telephone microphone)


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Emergency call to the EMS dispatcher in the EMDC EMS dispatcher employed in the total study period EMS dispatchers with a completed training period (6 weeks total) at the start of the study period Exclusion Criteria: Emergency calls directed to an EMDC physician or technical logistical personnel not using the criteria-based dispatch tool non-emergency calls (health care provider requested prehospital transports) EMS dispatcher not employed in the total study period EMS dispatchers without a completed training period (6 weeks total) at the start of the study period
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Cluster Randomised Clinical Trials
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention Group<br>Intervention group: EMS dispatcher using video-based communication in emergency calls. In the intervention arm, the EMS Dispatchers are requested to use video in all emergency calls during the 4-month study period. | Device: Video streaming (smartphone camera)<br>* Adding video streaming as a technical adjunct to the otherwise audio-based-only communication during emergency medical dispatch<br>|
| Active Comparator: Control Group<br>Control group: EMS dispatcher using telephone-only (audio-only) communication in emergency calls. In the control arm, the EMS Dispatchers continue using standard telephone communication (usual care). | Device: Telephone (telephone microphone)<br>* Usual care: Audio-based-only communication using telephone during emergency medical dispatch<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The frequency of dispatches with the highest level of urgency (A-responses) | Defined by the dispatch code generated by the computer-aided dispatch software Logis and stored in the EMDC database | Continuously stored during the study period (4 months). Data collection from study termination. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The frequency of dispatches with the levels of urgency A, B, C, D and E | Defined by the dispatch code generated by the computer-aided dispatch software Logis and stored in the EMDC database graded in 5 levels. | Continuously stored during the study period (4 months). Data collection from study termination. | 
| Mortality, 30-day | Mortality within 30 days after study inclusion | Data collection 30 days after study termination (31st of May 2023) | 
| Number of participants where the levels of urgency are identical when comparing the ambulance to and from the scene | The number and proportion of participant where the level of urgency dispatched by the EMS dispatcher (determining the speed of the ambulance transport to the scene) is identical to the level of urgency determined by the EMS provider (determining the speed of the ambulance transport to hospital). | Continuously stored during the study period (4 months). Data collection from study termination. | 
| Length of stay at hospital | Time from initial hospital admission to hospital discharge to home or care facility | Data collection 90 days after study termination or until last patient discharged or dead | 
| The number of participants needing an ICU admission at hospital | Number and proportion of patients needing ICU admission during hospital stay | Continuously stored during the study period (4 months). Data collection from study termination. | 
| Number of emergency calls where the dispatched level of urgency is changed during the call | Number and proportion of emergency medical calls, where the EMS dispatcher change the level of urgency during the emergency medical call. | Continuously stored during the study period (4 months). Data collection from study termination. | 
| Number of emergency calls where the allocated resources is changed during the call | Change in allocated resources (e.g., number of ambulances, helicopter, physician manned vehicles etc.) during the emergency call compared with the initially allocated resources. | Continuously stored during the study period (4 months). Data collection from study termination. | 
| Number of participants readmitted to hospital within 24 hours after a dispatch without hospital admission (lowest level of urgency - response level E) | The number and rate of readmission to hospital within 24 hours among emergency medical calls dispatched at lowest level of urgency (response level E) without allocated prehospital resources (patients only provided with an advice from the EMS dispatcher). | 24-hours after study termination | 
| Duration of emergency medical calls | The duration of the total call time in minutes. | Continuously stored during the study period (4 months). Data collection from study termination. | 
| Time from emergency call to dispatch | Time (in minutes) from the start of the emergency medical call to the dispatch (allocated resources with a level of urgency) by EMS dispatcher. | Continuously stored during the study period (4 months). Data collection from study termination. | 
| On-scene time | Time (in minutes) from EMS provider arrival at scene to departure with the patient. | Continuously stored during the study period (4 months). Data collection from study termination. | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Emergency Medical Services, Emergency Medical Service Communication Systems, Audiovisual aid