Clinical trial NCT05121649: Video-instructed First Aid in Emergency Medical Call Centers
Official title: Video Streaming in Norwegian Emergency Medical Call Centers as a Supplement to Telephone-instructed Bystander First Aid for Injured Patients
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Injuries
Emergencies
Keywords: emergency call center
dispatcher
video
first aid
emergency call
Lead sponsor: Oslo Metropolitan University
Sponsor class: OTHER
Collaborators: name: Vestre Viken Hospital Trust
name: Laerdal Foundation
name: Ostfold Hospital Trust
name: Oslo University Hospital
name: University Hospital of North Norway
name: Helse Stavanger HF
First posted: 2021-11-16
Enrollment: 174
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: OTHER
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patients with injuries who meet the inclusion criteria in the health trusts cooperating as study areas.

Brief summary: Video streaming as an additional tool to telephone was introduced in some Norwegian emergency medical call centers during the spring of 2020. This allows the dispatchers to communicate with the caller through video streaming during emergency calls. Some studies are conducted on this use of video streaming, but further research is needed.

In this study, the investigators have chosen to focus on potential effect from video streaming on bystander first aid for injured patients. The investigators have knowledge from preliminary results that dispatchers often find video streaming useful in emergency calls regarding injuries.

This study will investigate whether the use of video streaming might have an effect on the recognition rate by dispatchers on the need for bystander first aid for injured patients. In addition, the investigators will investigate whether video-instructions from dispatcher can improve bystander first aid quality.

The investigators will be using data collected by ambulance personnel including patients with injuries, as well as data from EMCC journals and audio logs.

Detailed description: Background:

Emergency Medical Communication Centres (EMCCs) in Norway receive more than 400 000 emergency calls every year, resulting in more than 250 000 ambulance dispatches. Emergency calls are answered by nurses or paramedics with special training, who by audio assesses the situation and decides on a response. Video streaming as a supplement to telephone in EMCC was introduced during springtime 2020 in Norway, and is independent of this study. The intended effect was to improve shared situational awareness between caller and operator, and thus improve the triage process. The video solution is live-only, and caller must give consent. Limited scientific evidence for such use exists, and even if video calls seems commonplace in society, the effects and acceptance in EMCCs has mainly been studied in simulated settings. Preliminary results from the early launch of video streaming showed that injured patients was one of the conditions where the dispatchers seemed to find video streaming useful. Previous studies by Bakke et.al investigating bystander first aid for injured patients, showed a potential for dispatchers in EMCCs to recognize more injured patients with the need for bystander first aid.

Aim:

This study focuses on the effect of video streaming in EMCCs on bystander first aid. The investigators aim to investigate whether dispatchers identifies the need for relevant first aid measures more frequently when using video streaming. The study will be conducted in several health trusts in Norway. In health trusts where video streaming not yet has been implemented in the EMCC, the investigators will collect data from period before video streaming is implemented, and after video streaming is implemented. From some health trusts in the study, video streaming already been implemented, and data collection will hence only be conducted for an after-period.

Methods and population size:

The number needed to treat is based on the studies by Bakke et al, as well it is based on one of our outcome goals: an aim for improvement of correctly identification of need for first aid by EMCC operator from 35% to 50%. Bakke et al included 355 cases during 18 months, which was done in a study area with approximately 270.500 inhabitants. For achievement of power of 0,80 and p-value \<0,05 we need each study group to be 169, with the aimed improvement of 15%. Adding an estimate of missing cases of 10%, our study sample size for each group for this outcome measure is estimated to approximately 200 cases. For the outcome goal on quality improvement on first aid, which we aim the effect to be a raise in 20%, there is no aggregated outcome from previous studies to base an improvement on. The investigators therefore base our study sample size on number of cases included in Bakke's study. For this study to reach inclusion of 355 cases and with a study area with 1.150.000 inhabitants, the investigators need four months for each period. In Bakke's study, inclusion criteria were based on ICD-10 from hospital admissions. The investigators are therefore confident that the study will reach a minimum of 355 cases including patients not admitted to hospital as well. Based on these calculations on study sample sizes, the investigators estimate each of the before- and after periods to last 4 months, where cases before video implementation will be compared to calls after, separated by a wash-in period of 1-2 months.

Data collection and analyzes:

Patients will be included by ambulance personnel after the study's inclusion criteria. Ambulance personnel on scene will collect data through an internet-based questionnaire on need for first aid measures and quality of bystander first aid. In addition, data will be collected from EMCC journals and audio logs. This data will contain information on dispatchers recognition of first aid measures, as well as information on prehospital resources and time data. The investigators will also apply for data from the National Trauma Registry. Ambulance personnel participating in the data collection will complete an educational course about the questionnaire. The questionnaire used will be validated in a separate study. Analyzes of primary and secondary outcomes will be executed according to the ITT-principle. Uni- and multivariate regression analysis will be conducted.

Ethics:

The study is assessed by the Regional ethics committee in Norway as outside area of jurisdiction. It is approved by the Norwegian Center for Research Data and the Norwegian Health Directorate.

Eligibility criteria: Inclusion Criteria:

* Patient with an injury,
* One or more bystanders at scene,
* One or more of the following first aid measures have been attempted or should have been attempted: Open airway, bleeding control, recovery position, hypothermia prevention.

Exclusion Criteria:

* The caller is at a different location than the patient
* Patients who are alone on scene and contacted the EMCC themselves

Primary outcomes:
measure: Dispatchers' recognition of relevant first aid measures
timeFrame: Through study completion, an average of 1,5 years
Secondary outcomes:
measure: First aid measures performed by bystander
timeFrame: Through study completion, an average of 1,5 years
measure: Bystander first aid quality
timeFrame: Through study completion, an average of 1,5 years
Other outcomes:
measure: Time delay until activation of first ambulance
timeFrame: Through study completion, an average of 1,5 years
measure: Time delay until need for first aid is recognized by dispatcher
timeFrame: Through study completion, an average of 1,5 years
measure: 30-days mortality for patients included
timeFrame: Through study completion, an average of 1,5 years
Locations:
city: Oslo
country: Norway
facility: University of OsloMet
Study officials:
affiliation: OsloMet
name: Magnus Hjortdahl, PhD
role: PRINCIPAL_INVESTIGATOR
References:
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citation: Bakke HK, Steinvik T, Eidissen SI, Gilbert M, Wisborg T. Bystander first aid in trauma - prevalence and quality: a prospective observational study. Acta Anaesthesiol Scand. 2015 Oct;59(9):1187-93. doi: 10.1111/aas.12561. Epub 2015 Jun 19.
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citation: Yang CW, Wang HC, Chiang WC, Hsu CW, Chang WT, Yen ZS, Ko PC, Ma MH, Chen SC, Chang SC. Interactive video instruction improves the quality of dispatcher-assisted chest compression-only cardiopulmonary resuscitation in simulated cardiac arrests. Crit Care Med. 2009 Feb;37(2):490-5. doi: 10.1097/CCM.0b013e31819573a5.
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