Is it feasible to conduct a future randomised control trial (RCT) to assess the clinical and cost effectiveness of using GoodSAM live video streaming to improve targeting of emergency medical resources?
Major trauma is a leading cause of serious morbidity and mortality. Prompt, pre-hospital medical treatment following a traumatic incident can prevent death and improve patient outcome, thus timely and effective dispatch of appropriate emergency medical resources is critical. Dispatch prioritisation currently relies mostly on verbal phone information from incidents. It is estimated that up to half of air, and a quarter of road ambulance deployments, are inappropriate and use of live video has been recommended to improve appropriateness of triage and dispatch, but we lack evidence to support its use. GoodSAM is freely available software that supports rapid streaming of live footage (that is not recorded) to dispatchers using callers’ smartphone cameras, without the need for a pre-loaded app.
Consequently, the research question is:
Is it feasible to conduct a future randomised control trial (RCT) to assess the clinical and cost effectiveness of using GoodSAM live video streaming to improve targeting of emergency medical resources?
This feasibility RCT will be conducted within SECAmb to determine if and how the clinical and cost effectiveness of using GoodSAM can be evaluated in a future definitive RCT. An observational sub-study will also be undertaken within London Ambulance Service (LAS) to assess acceptability of GoodSAM in an inner city emergency operations centre (EOC).
All 999 calls involving trauma triaged as high priority and all those screened by Helicopter Emergency Medical Services (HEMS) dispatchers will be randomised within the study. This will be undertaken during six observation weeks (42 days; 84 shifts) where randomisation will be 1:1 by working shifts either to intervention or standard care. Standard care involves usual ambulance dispatch protocol with a 999-caller using a telephone (voice only) and the dispatcher using the NHS Pathways ambulance dispatch tool. Intervention involves dispatch incorporating the use of GoodSAM live streaming via the caller’s phone. Calls allocated to intervention will initially follow the standard NHS Pathways dispatch protocol until the ambulance dispatch prioritisation has been determined by the call handler. An ambulance will be dispatched as normal, without delay. GoodSAM video streaming will then take place and additional ambulance resource allocation may be adjusted following this, though the initial single road ambulance response will remain unaffected.
The primary outcome will be a decision regarding the feasibility of undertaking a definitive RCT based primarily on meeting clearly defined progression criteria.
The secondary outcomes will include speed of appropriate emergency services dispatch, stand-down rate, missed jobs, and requests for further ambulance resources from scene. Additionally, 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. Interviews and a survey with members of the public and staff who did and did not use GoodSAM will be used to evaluate this.
For further information: http://www.surrey.ac.uk/SEEITstudy