Clinical trial NCT05742412: Dispatch of Emergency Call Using Video Streaming Compared With Traditional Telephone Communication
Official title: Criteria-based Ambulance Management - Video Indexation VS Standard Indexation On Non-selected Emergency Calls
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Emergency Medical Dispatch Centre
Video Streaming
Emergency Call
Prehospital Emergency Medical Services
Keywords: Emergency Medical Services
Emergency Medical Service Communication Systems
Audiovisual aid
Lead sponsor: Central Denmark Region
Sponsor class: OTHER
First posted: 2023-02-24
Enrollment: 20539
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Cluster Randomised Clinical Trials
Primary purpose: DIAGNOSTIC

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.

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

Primary outcomes:
measure: The frequency of dispatches with the highest level of urgency (A-responses)
timeFrame: Continuously stored during the study period (4 months). Data collection from study termination.
Secondary outcomes:
measure: The frequency of dispatches with the levels of urgency A, B, C, D and E
timeFrame: Continuously stored during the study period (4 months). Data collection from study termination.
measure: Mortality, 30-day
timeFrame: Data collection 30 days after study termination (31st of May 2023)
measure: Number of participants where the levels of urgency are identical when comparing the ambulance to and from the scene
timeFrame: Continuously stored during the study period (4 months). Data collection from study termination.
measure: Length of stay at hospital
timeFrame: Data collection 90 days after study termination or until last patient discharged or dead
measure: The number of participants needing an ICU admission at hospital
timeFrame: Continuously stored during the study period (4 months). Data collection from study termination.
measure: Number of emergency calls where the dispatched level of urgency is changed during the call
timeFrame: Continuously stored during the study period (4 months). Data collection from study termination.
measure: Number of emergency calls where the allocated resources is changed during the call
timeFrame: Continuously stored during the study period (4 months). Data collection from study termination.
measure: Number of participants readmitted to hospital within 24 hours after a dispatch without hospital admission (lowest level of urgency - response level E)
timeFrame: 24-hours after study termination
measure: Duration of emergency medical calls
timeFrame: Continuously stored during the study period (4 months). Data collection from study termination.
measure: Time from emergency call to dispatch
timeFrame: Continuously stored during the study period (4 months). Data collection from study termination.
measure: On-scene time
timeFrame: Continuously stored during the study period (4 months). Data collection from study termination.
Other outcomes:
measure: Number of participants with return-of-spontaneous circulation (ROSC) after cardiac arrest
timeFrame: Continuously stored during the study period (4 months). Data collection from study termination.
measure: 90 days neurological outcome after cardiac arrest measured by the cerebral performance scale (CPC)
timeFrame: Data collection 90 days after study termination (31st of July 2023)
measure: 90 days neurological outcome after cardiac arrest measured by the modified Rankin Scale (mRS)
timeFrame: Data collection 90 days after study termination (31st of July 2023)
measure: Number of patients with Stroke or TIA identified by the EMS dispatcher in the EMDC
timeFrame: Continuously stored during the study period (4 months). Data collection from study termination.
measure: Rate of revascularization treatment (intravenous thrombolysis and/or endovascular treatment (EVT)) among patients with acute ischemic stroke
timeFrame: Continuously stored during the study period (4 months). Data collection from study termination.
measure: Primary admission to a hospital offering acute stroke treatment
timeFrame: Continuously stored during the study period (4 months). Data collection from study termination.
measure: Onset-to-treatment times for patients with acute ischemic stroke treated with i.v. thrombolysis and onset-to-groin-puncture for patients treated with EVT.
timeFrame: Continuously stored during the study period (4 months). Data collection from study termination.
measure: Lowest level of urgency (response level E) among children (< 15 years of age)
timeFrame: Continuously stored during the study period (4 months). Data collection from study termination.
measure: Re-admissions among children (< 15 years of age) to hospital within 24 hours from a prior emergency call dispatched with lowest level of urgency (response level E)
timeFrame: Continuously stored during the study period (4 months). Data collection from study termination.
measure: All levels of urgency (response level A, B, C, D and E) among children (< 15 years of age)
timeFrame: Continuously stored during the study period (4 months). Data collection from study termination.
Locations:
city: Aarhus N
country: Denmark
facility: Prehospital Emegency Medical Service, Central Denmark Region, Denmark
state: Central Denmark Region
Study officials:
affiliation: Prehospital Emergency Medical Service, Central Denmark Region, Denmark
name: Martin F Gude, MD
role: PRINCIPAL_INVESTIGATOR
References: