School of Health Sciences, University of Surrey, Guildford, Surrey, UK.
Kent, Surrey and Sussex Air Ambulance, Redhill, UK.
Scand J Trauma Resusc Emerg Med. 2024 Jan 26;32(1):7. doi: 10.1186/s13049-024-01179-0.
Use of bystander video livestreaming from scene to Emergency Medical Services (EMS) is becoming increasingly common to aid decision making about the resources required. Possible benefits include earlier, more appropriate dispatch and clinical and financial gains, but evidence is sparse.
A feasibility randomised controlled trial with an embedded process evaluation and exploratory economic evaluation where working shifts during six trial weeks were randomised 1:1 to use video livestreaming during eligible trauma incidents (using GoodSAM Instant-On-Scene) or standard care only. Pre-defined progression criteria were: (1) ≥ 70% callers (bystanders) with smartphones agreeing and able to activate live stream; (2) ≥ 50% requests to activate resulting in footage being viewed; (3) Helicopter Emergency Medical Services (HEMS) stand-down rate reducing by ≥ 10% as a result of live footage; (4) no evidence of psychological harm in callers or staff/dispatchers. Observational sub-studies included (i) an inner-city EMS who routinely use video livestreaming to explore acceptability in a diverse population; and (ii) staff wellbeing in an EMS not using video livestreaming for comparison to the trial site.
Sixty-two shifts were randomised, including 240 incidents (132 control; 108 intervention). Livestreaming was successful in 53 incidents in the intervention arm. Patient recruitment (to determine appropriateness of dispatch), and caller recruitment (to measure potential harm) were low (58/269, 22% of patients; 4/244, 2% of callers). Two progression criteria were met: (1) 86% of callers with smartphones agreed and were able to activate livestreaming; (2) 85% of requests to activate livestreaming resulted in footage being obtained; and two were indeterminate due to insufficient data: (3) 2/6 (33%) HEMS stand down due to livestreaming; (4) no evidence of psychological harm from survey, observations or interviews, but insufficient survey data from callers or comparison EMS site to be confident. Language barriers and older age were reported in interviews as potential challenges to video livestreaming by dispatchers in the inner-city EMS.
Progression to a definitive RCT is supported by these findings. Bystander video livestreaming from scene is feasible to implement, acceptable to both 999 callers and dispatchers, and may aid dispatch decision-making. Further assessment of unintended consequences, benefits and harm is required.
ISRCTN 11449333 (22 March 2022). https://www.isrctn.com/ISRCTN11449333.
旁观者视频直播从现场到紧急医疗服务（EMS）的使用越来越普遍，有助于辅助决策所需的资源。可能的好处包括更早、更合适的派遣以及临床和经济上的收益，但证据很少。
这是一项可行性随机对照试验，嵌入了一个过程评估和探索性经济评估，其中在六个试验周期间，工作班次被随机分为 1:1，在符合条件的创伤事件期间使用视频直播（使用 GoodSAM Instant-On-Scene）或仅使用标准护理。预先定义的进展标准为：（1）≥70%有智能手机的呼叫者（旁观者）同意并能够激活实时流媒体；（2）≥50%的激活请求导致获得视频；（3）由于实时视频，直升机紧急医疗服务（HEMS）的待命率降低≥10%；（4）呼叫者或工作人员/调度员没有证据表明存在心理伤害。观察性子研究包括：（i）一个市中心的 EMS，他们常规使用视频直播来探索在不同人群中的可接受性；（ii）在不使用视频直播的 EMS 中评估工作人员的幸福感，以与试验现场进行比较。
共有 62 班次被随机分配，包括 240 起事件（132 例对照组；108 例干预组）。在干预组的 53 起事件中，视频直播成功。患者招募（以确定派遣的适当性）和呼叫者招募（以衡量潜在伤害）的参与率较低（269 名患者中的 58 名，占 22%；244 名呼叫者中的 4 名，占 2%）。有两个标准得到满足：（1）86%的有智能手机的呼叫者同意并能够激活直播；（2）85%的激活直播请求导致获得视频；由于数据不足，另外两个标准不确定：（3）由于直播，2/6（33%）HEMS 待命；（4）没有证据表明调查、观察或访谈存在心理伤害，但由于呼叫者或比较 EMS 站点的调查数据不足，无法确定。在采访中，调度员报告语言障碍和年龄较大是在市中心 EMS 中进行视频直播的潜在挑战。
这些发现支持向确定性 RCT 推进。从现场到旁观者的视频直播是可行的，既可以接受 999 呼叫者，也可以接受调度员，并且可能有助于调度决策。需要进一步评估意外后果、收益和伤害。
ISRCTN 83430052（2022 年 3 月 22 日）。https://www.isrctn.com/ISRCTN83430052。
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