Emergency medical services streaming enabled evaluation in trauma: the SEE-IT trial

A ‘trauma incident’ is when someone suffers serious injuries that may be life changing, cause death or a long-term disability. Trauma incidents are the biggest killer of people aged under 45 in the UK: most often road traffic accidents. Following a trauma incident, most people will be taken to a hospital emergency department by an ambulance that has responded to a 999 call. Ambulances usually attend an incident by road, but in serious cases, an air ambulance (helicopter) may be sent. The aim is to get the patient to the best hospital to treat their injuries without delay to improve their chances of survival, recovery from their injuries and minimise chances of long-term problems.

When a 999 call is made, the person in the ambulance service who answers (the dispatcher) usually asks the caller to describe what they can see and how serious the injuries appear. This is so the dispatcher can decide how urgently, and what type, of help is required (e.g. what ambulance support to send and whether a helicopter is needed). The caller may give incomplete or wrong information so sometimes too few or too many ambulances are sent. This can delay getting the right help to patients or mean that ambulances are not available for others who need them. It is also costly for the NHS if ambulances or helicopters are sent when not needed.

We want to test whether using live streaming from the scene of an accident helps with decisions about dispatch. We will use a system called GoodSAM that allows the dispatcher to send a link in a text message to the smartphone of 999 callers. When the caller clicks on the link it uses the camera in their phone to send live images to the dispatcher (without recording it). This lets the dispatcher see what is happening at the scene, rather than just being told by the caller. This might help the dispatcher make quicker and more accurate decisions about which and how many ambulances to send, so that patients get the best help in the fastest possible time.

In this feasibility study, we will ask one ambulance dispatch centre to test using live streaming for six weeks spread out over six months (to cover different periods when trauma incidents are higher/lower), so we can check how well it works in practice. We will count the number of calls when video might help the dispatcher decide what ambulances to send. We will check that the link works, and the dispatcher can see the images. After an incident is over, our researchers will look at the reports and assess if the right number and type of ambulances were sent to the scene. We will do this for incidents when GoodSAM was used, and when it was not (control group). This will help us to understand if film footage helped dispatchers send the right ambulances and support.

We will learn if members of the public are willing to allow their camera to be used and if dispatchers find it useful. An important part of this initial study will be to find out whether using live streaming upsets members of the public or dispatchers in any way. We will do this through interviews and a survey with members of the public and staff who did and did not use GoodSAM. Sources of support will be provided. We will also explore these issues in a second ambulance service located in a city so we can see if GoodSAM works in a similar way in an area where callers may not have English as their first language, for example.

This study will help us plan a larger study that will explore more fully the possible benefits of using live streaming for trauma incidents. A panel of lay people will be set up to work with the research team throughout the project to make sure the views of patients and the public are fully represented.

Research Question: Is it feasible to conduct a future randomised controlled trial (RCT) to assess the clinical and cost effectiveness of using GoodSAM live video streaming to improve targeting of emergency medical resources?

A randomised controlled trial is a study design that allows us to compare an intervention (in this case, the use of live streaming) with “standard care” by randomly deciding whether it is used or not (like a flip of a coin).

Aims and objectives: The overall aim of this research is to assess the feasibility of implementing and evaluating live streaming in a future RCT.

The objectives are:

1. To obtain data required to inform the design of a subsequent RCT (that is, the number of incidents that occur in the periods of the study; whether there is any indication that using live streaming might improve the speed of making the right dispatch decisions; and whether it is possible to collect the data we would need to examine the costs associated with using/not using live streaming).
2. To test trial and study processes including randomisation and data collection methods.
3. To conduct a nested process evaluation (a study focused on how/why something works or not) to test the acceptability and feasibility of using live streaming (via GoodSAM) from provider and public perspectives (for example, acceptability and feasibility of delivering training to staff, whether the live streaming works at night, in areas without 4G coverage, and to assess the risk of psychological harm to callers and/or dispatch staff).