Taylor Cath, Ollis Lucie, Lyon Richard, Williams Julia, Skene Simon S, Bennett Kate, Munro Scott, Mortimer Craig, Glover Matthew, Holah Janet, Maben Jill, Magnusson Carin, Cooke Rachael, Gage Heather, Cropley Mark
School of Health Sciences, University of Surrey, Guildford, Surrey, UK.
Kent, Surrey & Sussex Air Ambulance, Redhill, UK.
Health Soc Care Deliv Res. 2025 May 28:1-38. doi: 10.3310/EUFS2314.
The use of bystander video livestreaming from scene in emergency medical services is becoming increasingly common to inform decisions about the resources and support required. Possible benefits include clinical and financial gains, but evidence is sparse. We aimed to investigate the feasibility of conducting a definitive randomised controlled trial of its use in major trauma incidents.
To obtain data required to design a subsequent randomised controlled trial. To test trial processes. To embed a process evaluation.
A feasibility randomised controlled trial with embedded process and economic evaluations where working shifts ( = 62) in 6 trial weeks were randomised 1 : 1 to video livestreaming or standard care only; and two observational substudies: (1) assessment of acceptability in a diverse inner-city emergency medical service that routinely uses video livestreaming; and (2) assessment of staff well-being in an emergency medical service that does not use livestreaming (for comparison to the trial site). Qualitative data collection included observations (286 hours) and interviews with staff ( = 25) and bystander callers ( = 2).
A pre-hospital emergency medical service in South-East England, with follow-up in associated major trauma centres and trauma units; substudies in (1) London and (2) East of England emergency medical services.
(1) Patients involved in trauma incidents ( = 269); (2) bystander callers ( = 11); and (3) ambulance service staff ( = 67).
Video livestreaming using GoodSAM's Instant-On-Scene.
Progression to a definitive randomised controlled trial based on four pre-defined criteria and consideration of qualitative data: (1) ≥ 70% bystanders with smartphones agreeing and able to activate livestreaming; (2) ≥ 50% requests to activate livestreaming resulting in footage being viewed; (3) helicopter emergency medical services stand-down rate reducing by ≥ 10% due to livestreaming; and (4) no evidence of psychological harm to bystanders or staff caused by livestreaming.
Sixty-two shifts were randomised, contributing 240 eligible incidents (132 control; 108 intervention). In a further three shifts, we randomised by individual call, which contributed four eligible incidents (two control; two intervention), thereby totalling 244 incidents involving 269 patients. Video livestreaming was successful in 53 incidents in the intervention arm. Patient recruitment (to access medical records to assess appropriateness of dispatch) and bystander recruitment (to measure potential harm) were both low (58/269, 22% of patients, 4/244, 2% of bystanders). Two progression criteria were met: (1) 86% of bystanders with smartphones agreed and were able to activate livestreaming; (2) 85% of requests to activate livestreaming resulted in viewed footage; and two were indeterminate due to insufficient data: (3) 2/6 (33%) stand-down due to livestreaming; and (4) no evidence of psychological harm from survey, observations or interviews. In substudy (i), dispatch staff reported that non/limited English language and older age may present barriers to video livestreaming.
Poor recruitment of patients and bystanders limited assessment of appropriateness of dispatch decisions and potential psychological harm.
Video livestreaming is feasible to implement, acceptable to both bystanders and dispatchers, and may aid dispatch decision-making, but further assessment of benefits and harm is required.
Findings support the design and conduct of a future multicentre study taking account of different triage systems and dispatch personnel, potentially using an alternative to a randomised controlled trial due to rapid uptake of video livestreaming in this setting.
This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130811.
在紧急医疗服务中，利用现场旁观者视频直播来为所需资源和支持的决策提供信息正变得越来越普遍。可能的益处包括临床和经济收益，但相关证据较少。我们旨在研究在重大创伤事件中对其开展确定性随机对照试验的可行性。
获取设计后续随机对照试验所需的数据。测试试验流程。纳入一项过程评估。
一项可行性随机对照试验，嵌入过程和经济评估，将6个试验周的工作班次（=62个）按1∶1随机分配至视频直播组或仅标准护理组；还有两项观察性子研究：（1）在常规使用视频直播的多元化市中心紧急医疗服务中评估可接受性；（2）在不使用直播的紧急医疗服务中评估工作人员的幸福感（以便与试验地点进行比较）。定性数据收集包括观察（286小时）以及对工作人员（=25名）和旁观者来电者（=2名）的访谈。
英格兰东南部的院前紧急医疗服务机构，在相关的主要创伤中心和创伤科室进行随访；子研究分别在（1）伦敦和（2）英格兰东部的紧急医疗服务机构开展。
（1）创伤事件中的患者（=269名）；（2）旁观者来电者（=11名）；（3）救护车服务工作人员（=67名）。
使用GoodSAM的即时现场视频直播。
根据四个预先定义的标准并考虑定性数据，确定是否推进到确定性随机对照试验：（1）≥70%持有智能手机的旁观者同意并能够激活直播；（2）≥50%激活直播的请求能产生可供查看的视频片段；（3）由于直播，直升机紧急医疗服务的待命率降低≥10%；（4）没有证据表明直播对旁观者或工作人员造成心理伤害。
随机分配了62个班次，产生240起符合条件的事件（132起对照；108起干预）。在另外三个班次中，我们按单个呼叫进行随机分配，产生了4起符合条件的事件（2起对照；2起干预），从而共有244起涉及269名患者的事件。干预组中有53起事件的视频直播成功。患者招募（以获取病历评估派遣的适当性）和旁观者招募（以衡量潜在危害）都很低（58/269，22%的患者，4/244，2%的旁观者）。满足了两个推进标准：（1）86%持有智能手机的旁观者同意并能够激活直播；（2）85%激活直播的请求能产生可供查看的视频片段；另外两个因数据不足而不确定：（3）因直播导致2/6（33%）的待命取消；（4）调查、观察或访谈均未发现心理伤害的证据。在子研究（i）中，派遣工作人员报告说，英语水平有限或不懂英语以及年龄较大可能是视频直播的障碍。
患者和旁观者招募不佳，限制了对派遣决策适当性和潜在心理伤害的评估。
视频直播实施可行，旁观者和调度员均可接受，可能有助于派遣决策，但需要进一步评估其益处和危害。
研究结果支持未来开展多中心研究，考虑不同的分诊系统和派遣人员，鉴于视频直播在这种情况下的迅速采用，可能使用随机对照试验以外的方法。
本摘要展示了由英国国家健康与照护研究中心（NIHR）健康与社会照护提供研究计划资助的独立研究，资助编号为NIHR130811。
