Video livestreaming in emergency trauma dispatch: an observational study of technological integration with clinical decision-making in prehospital enhanced care services

Abstract

Background: Emergency Medical Services (EMS) play a critical role as the initial point of contact for patients with trauma injuries, where making timely and accurate dispatch decisions is crucial for determining the speed and effectiveness of the response. Assessing injury severity and the appropriate EMS resources needed based on audio medical emergency number calls (e.g. 999/911/112) alone presents challenges. The prevalence of smartphones among the UK population offers a unique opportunity by enabling callers to send live video feeds to Emergency Operations Centres. This study explores the use of video livestreaming in emergency dispatch of prehospital enhanced care teams to determine how and why it impacts decision-making and situational awareness during trauma incidents and whether this varies by patient/caller, incident or dispatcher characteristics.

Methods: A multimethod qualitative observational study was undertaken comprising 200 h of non-participant ethnographic observation of the use of video livestreaming in routine practice, and 14 semi-structured interviews with staff within two critical care services in London, UK who used the technology. Data collection and analysis were underpinned by naturalistic decision-making models that emphasise the role of situational awareness. Data were analysed and triangulated using the framework method.

Findings: We identified three phases in the decision-making process for use of video livestreaming in emergency dispatch: (i) Evaluation and Determination, (ii) Integration and Observation, and (iii) Resolution and Response. Phase 1 addresses why video livestreaming is used and the patient/caller, incident and dispatcher characteristics and identifying primary drivers and barriers. Phase 2 explores how livestreaming impacts situational awareness, focusing on visual cues such as clinical indicators, mechanisms of injury, and environmental factors. Phase 3 examines the impact on dispatch decision-making and immediate care advice. An overarching theme emphasises the role of dispatchers' clinical experience and expertise in using video livestreaming effectively.

Conclusions: Video livestreaming has the potential to impact situational awareness and decision-making in emergency dispatch, as reported by participants and observed during the study, particularly in response to complex and ambiguous trauma scenarios. The technology's effectiveness depends on dispatcher expertise, caller characteristics, and incident complexity. Further research is needed to evaluate its use across different EMS contexts.

Keywords: Decision-making; Emergency medical services; Ethnography; Interview; Prehospital; Qualitative research; Situational awareness; Smartphone; Trauma; Video.

Fig. 1

Endsley’s Model of situation awareness in dynamic decision making [17]. (Reprinted by Permission of SAGE Publications)

Fig. 2

Conceptual model of the use of video livestreaming in trauma dispatch

Fig. 3

Modes of interrogating emergency medical calls. CAD = Computer Aided Dispatch

Fig. 4

Impact of Livestreaming on decision dispatch decision making (adapted version of threshold decision making model [29])