Criteria-based Ambulance Management - Video Indexation VS Standard Indexation On Non-selected Emergency Calls
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 20,539
- 试验地点
- 2
- 主要终点
- The frequency of dispatches with the highest level of urgency (A-responses)
研究概览
简要总结
In the Emergency Medical Dispatch Center, all EMS dispatchers were divided into one of two clusters with 11 EMS dispatchers in each cluster. Because of few clusters, a matched-pair (MP) design was used based on the average proportion of the dispatched level of urgency (highest level of urgency used as primary matching criteria), years of employment and the average duration of emergency calls in a 3-months period (1st of January 2022 - 31st of March 2022) before the implementation of video streaming. Newly employed personnel where matching was not possible were randomly assigned to one of the two clusters. Prior to the study period, video streaming was gradually implemented in the intervention group during a 6-months period (1st of July 2022 - 31st of December 2022).
Using a cluster randomized setup, the aim was to investigate differences in the management of emergency calls (dispatches) when emergency medical service (EMS) dispatchers use video streaming compared with telephone-only (audio-only) communication. All emergency calls will be randomly distributed between the two clusters.
详细描述
In Denmark, all emergency medical calls are answered by a nurse- or paramedic trained in dispatching emergencies. The EMS dispatcher determines the level of urgency and the type and number of resources to be allocated (e.g., ambulance, physician-manned vehicle and/or physician-manned helicopter (HEMS). The decision-making process is supported by a standardized national criteria-based dispatch tool called Danish Index for Emergency Care (DI). DI is a tool that classifies the patient's main complaint into different symptom groups (chapters) to determine the level of urgency required and which resources to allocate.
As standard, emergency calls are based on telephone-only (audio-only) communication, which might limit the understanding of a complex clinical presentation.
Previous studies suggest that a visualized clinical presentation could aid the EMS dispatchers in their decision-making and dispatch.
The decision on implementing video streaming has been made by the management board of the Prehospital Emergency Medical Services, Central Denmark Region, Denmark. It has been decided to implement video streaming gradually to allow for this cluster randomized study. Because video streaming is a deemed part of the standard operating procedure (SOP), ethical approval from our local ethical committee is waived. After the study period, video streaming will be implemented in the current control group as the decision to use video streaming as SOP has already been decided.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Diagnostic
- 盲法
- Single (Participant)
盲法说明
The emergency caller (patient or bystander) is initially masked to the intervention (video or telephone communication) when initiating the call to the Emergency Medical Dispatch Center (EMDC). Emergency calls are randomly answered by an EMS Dispatcher using either video or telephone (audio-only) communication.
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Emergency call to the EMS dispatcher in the EMDC
- •EMS dispatcher employed in the total study period
- •EMS dispatchers with a completed training period (6 weeks total) at the start of the study period
排除标准
- •Emergency calls directed to an EMDC physician or technical logistical personnel not using the criteria-based dispatch tool
- •non-emergency calls (health care provider requested prehospital transports)
- •EMS dispatcher not employed in the total study period
- •EMS dispatchers without a completed training period (6 weeks total) at the start of the study period
结局指标
主要结局
The frequency of dispatches with the highest level of urgency (A-responses)
时间窗: Continuously stored during the study period (4 months). Data collection from study termination.
Defined by the dispatch code generated by the computer-aided dispatch software Logis and stored in the EMDC database
次要结局
- The frequency of dispatches with the levels of urgency A, B, C, D and E(Continuously stored during the study period (4 months). Data collection from study termination.)
- Mortality, 30-day(Data collection 30 days after study termination (31st of May 2023))
- Duration of emergency medical calls(Continuously stored during the study period (4 months). Data collection from study termination.)
- Length of stay at hospital(Data collection 90 days after study termination or until last patient discharged or dead)
- The number of participants needing an ICU admission at hospital(Continuously stored during the study period (4 months). Data collection from study termination.)
- Number of emergency calls where the allocated resources is changed during the call(Continuously stored during the study period (4 months). Data collection from study termination.)
- Number of participants where the levels of urgency are identical when comparing the ambulance to and from the scene(Continuously stored during the study period (4 months). Data collection from study termination.)
- Number of emergency calls where the dispatched level of urgency is changed during the call(Continuously stored during the study period (4 months). Data collection from study termination.)
- Number of participants readmitted to hospital within 24 hours after a dispatch without hospital admission (lowest level of urgency - response level E)(24-hours after study termination)
- On-scene time(Continuously stored during the study period (4 months). Data collection from study termination.)
- Time from emergency call to dispatch(Continuously stored during the study period (4 months). Data collection from study termination.)