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13th September 2021
When members of the public are faced with a medical emergency, such as an injury or an individual collapsing in the street, they contact emergency services and speak with a medical dispatcher for assistance. This is vital for effective triage of a situation and ensures appropriate resource allocation, avoiding any delays for critical conditions. Appropriate triage is extremely important, especially with research showing that over-crowding within emergency departments is associated with a higher level of inpatient mortality. The use of live video from a bystander’s mobile phone could potentially provide dispatchers with more information about the clinical condition of the patient although this topic has poor poorly studied. In fact, its value was seen as an aid to helicopter emergency services in a small UK-based study. In contrast, another study that compared audio and video-assisted cardiopulmonary resuscitation, concluded that there was no survival benefit from video-assistance.
In trying to gather more evidence to ascertain the value of video streaming, a team from the Copenhagen Emergency Medical Services, University of Copenhagen, set out to assess the feasibility and dispatcher’s perceptions and responses after the addition of live video from bystanders making emergency calls. In Denmark, medical dispatchers are trained nurses or paramedics and for the purposes of the study, were able to decide whether or not to utilise live video although it was recommended if the patient was unconscious or potentially had a cardiac arrest. The team collected information on whether the emergency response changed as a result of videoing , e.g., whether an ambulance was dispatched, with or without sirens, if it was deemed non-urgent or if the individual could self-transport to the emergency department. The medical dispatchers were issued with a follow-up questionnaire where they were asked to evaluate the use of live video calls.
A total of 1020 live video calls were attempted and successful in 838 (82.2%) of cases with over half (53.7%) for male patients and a third (33%) were for patients aged 10 to 39 years of age. Live video calls were made for a large number of symptoms including unconscious adults (12.4%), seizures/convulsions (9.1%), accidents (8.6%) and wounds/fractures/minor injuries (7.3%).
There were 637 medical dispatchers who responded to the follow-up questionnaire, of whom, 88.6% stated that the use of video was either “extremely useful” or “very useful”. In addition, dispatchers stated that their assessment of the patient had changed in 51.1% of the live video calls, with 12.9% deemed more critical and 38.2% less critical. This resulted in a change to the emergency response in 27.5% of cases compared to not using live video, such that the odds for changing the emergency response were 58% higher (odds ratio, OR = 1.58, 95% CI 1.30–1.91). Interestingly, in 9.9% of live video calls, the dispatchers reported that seeing the patient enabled them to recognise another problem.
The authors discussed how the use of live video calls was both feasible and of benefit to medical dispatchers, giving them “eyes”, which improved their situational awareness. While this innovation was clearly of value, the authors suggested that a paradigm shift is required to implement these changes because medical dispatchers are currently trained in traditional protocols based on verbal questions and answers.
Linderoth G et al. Live video from bystanders’ smartphones to medical dispatchers in real emergencies. BMC Emerg Med 2021