Dr Lucie Ollis

BACKGROUND: Timely dispatch of appropriate emergency resources after traumatic incidents is critical to prevent death and improve outcomes. Dispatch priorities mostly rely on verbal 999-caller information and up to 50% air/25% road ambulance deployments are inappropriate. Video from scene is recommended but lacks evidence. GoodSAM enables video streaming to dispatchers using callers' smartphone cameras. RESEARCH QUESTION: Is it feasible to conduct a future RCT to assess the clinical and cost effectiveness of using GoodSAM to improve targeting of emergency resources? OVERALL AIM: To assess the feasibility of implementing and evaluating GoodSAM in a definitive RCT. OBJECTIVES: 1. To obtain data to design a definitive RCT (e.g. event & screening rates, effect size/precision for outcomes, health economic data) 2. To test trial processes including randomisation and data collection 3. To conduct a process evaluation to test acceptability, feasibility and outcomes of use of GoodSAM from provider and public perspectives (e.g. training, video feasibility and acceptability, psychological harm to callers and/or dispatch staff). DESIGN/SETTING: Feasibility RCT in one Emergency Operations Centre in SE England METHODS: INCLUSION: All 999 calls involving Category 1 or 2 trauma; All calls screened by Helicopter Emergency Medical Services dispatchers involving trauma. EXCLUSION: All emergencies of a suspected medical origin. RANDOMISATION: Calls in 6 observation weeks (42 days; 84 shifts) allocated 1:1 by shift. CONTROL: Standard care NHS Pathways dispatch protocol with a 999-caller (verbal only) INTERVENTION: As per control group until call handler has determined dispatch priority and ambulance dispatched without delay. GoodSAM streaming will then begin (via SMS text link) and ambulance dispatch may be adjusted. PRIMARY OUTCOME: Decision regarding feasibility of undertaking a definitive RCT based on pre-defined criteria (willingness/ability to stream footage, signal of effect; and risk of psychological harm in callers/staff). SECONDARY OUTCOMES: Speed of appropriate emergency dispatch (using time-stamped data from 999 call to appropriate deployment; appropriateness based on expert consensus criteria and using data up to 3 months post-incident), stand-down rate, missed jobs, further resources requested from scene. SAMPLE SIZE: Conservative event rate = 250 trauma incidents (125 allocated to intervention) allowing estimate of true rate within precision of +/-0.75 events/day; and of appropriateness of response with a standard error of <5%. A health economic analysis will be undertaken to inform design of a subsequent full economic evaluation. The process evaluation will include analysis of streaming usage data; observation of control room processes (e.g. fidelity to study protocol); and survey and interviews with staff and 999 callers. A sub-study in an inner-city site will examine acceptability of GoodSAM in a population with greater diversity. ANALYSIS: estimates and confidence intervals of key rates. A framework approach will be used to analyse qualitative data. TIMELINE: 18 months. IMPACT/DISSEMINATION: This study will determine if a subsequent definitive trial is feasible; and produce novel data about psychological harm associated with witnessing/viewing trauma incidents. We will disseminate findings via academic and lay outputs. If effective, GoodSAM could be scaled up nationally/used for other incidents e.g. multi-agency.