Clinical handover from emergency medical services to the trauma team: A gap analysis

CJEM ◽  
2020 ◽  
Vol 22 (S2) ◽  
pp. S21-S29
Author(s):  
Arshia P. Javidan ◽  
Avery B. Nathens ◽  
Homer Tien ◽  
Luis T. da Luz
Keyword(s):  
Emergency Medical Services ◽  
Gap Analysis ◽  
Trauma Team ◽  
Trauma Centre ◽  
Medical Services ◽  
Active Listening ◽  
Team Leaders ◽  
Process Measures ◽  
Team Members ◽  
Emergency Medical

ABSTRACTObjectivesThere has been limited evaluation of handover from emergency medical services (EMS) to the trauma team. We sought to characterize these handover practices to identify areas of improvement and determine if handover standardization might be beneficial for trauma team performance.MethodsData were prospectively collected over a nine-week period by a trained observer at a Canadian level one trauma centre. A randomized scheduled was used to capture a representative breadth of handovers. Data collected included outcome measures such as duration of handover, structure of the handover, and information shared, process measures such as questions and interruptions from the trauma team, and perceptions of the handover from nurses, trauma team leaders and EMS according to a bidirectional Likert scale.Results79 formal verbal handovers were observed. Information was often missing regarding airway (present 22%), breathing (54%), medications (59%), and allergies (54%). Handover structure lacked consistency beyond the order of identification and mechanism of injury. Of all questions asked, 35% were questioning previously given information. The majority of handovers (61%) involved parallel conversations between team members while EMS was speaking. There was a statistically significant disparity between the self-evaluation of EMS handovers and the perceived quality determined by nurses and trauma team leaders.ConclusionsWe have identified the need to standardize handover due to poor information content, a lack of structure and active listening, information repetition, and discordant expectations between team members. These data will guide the development of a co-constructed framework integrating the perspectives of all team members.

scholarly journals P079: Clinical handover from emergency medical services to the trauma team: A gap analysis

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S92-S93
Author(s):  
A. Javidan ◽  
A. Nathens ◽  
H. Tien ◽  
L. da Luz
Keyword(s):  
Emergency Medical Services ◽  
Trauma Team ◽  
Trauma Centre ◽  
Medical Services ◽  
Active Listening ◽  
Team Leaders ◽  
Significant Information ◽  
Team Members ◽  
Clinical Handover ◽  
Emergency Medical

Background: Clinical handover between emergency medical services (EMS) and the hospital trauma team can be subject to errors that may negatively affect patient care. Thus far, there has been limited evaluation of the quality of EMS handover. As such, we sought to characterize handover practices from EMS to the trauma team, identify areas for improvement, and determine if there is a need for standardization of current handover practices. Aim Statement: Identify areas for improvement in handover from EMS to the trauma team, specifically examining handover content, structure, and discordances between different team members regarding handover expectations. Measures & Design: Data were prospectively collected over a nine week period by a trained observer at Canada's largest level one trauma centre. A randomized scheduled was used to capture a representative breadth of handovers. Data collected included outcome measures such as duration of handover, structure of the handover, and information shared, process measures such as questions and interruptions from the trauma team, and perceptions of the handover from nurses, trauma team leaders (TTLs) and EMS according to a bidirectional Likert scale. Evaluation/Results: Of 410 trauma team activations, 79 verbal handovers were observed. Information was often missing regarding airway (present 22%), breathing (54%), medications (59%), and allergies (54%). Handover structure lacked consistency beyond the order of identification and mechanism of injury. Only 28% of handovers had a dedicated question and answer period. Of all questions asked, 35% were questioning previously given information. EMS returned to categories of information unprompted in 84% of handovers. The majority of handovers (61%) involved parallel conversations between team members while EMS was speaking, which was associated with a greater number of interrupting questions from the trauma team (3.15 vs. 1.82, p =.001). There was a statistically significant disparity between the self-evaluation of EMS handovers and the perceived quality determined by nurses and trauma team leaders. Discussion/Impact: At our trauma centre, we have identified the need for handover standardization due to poor information content, a lack of structure and active listening, significant information repetition, and discordant expectations between EMS, nurses, and TTLs. We intend to use our results to guide the development of a co-constructed framework integrating the perspectives of all team members on the trauma team.

scholarly journals The Great Belt train accident: the emergency medical services response

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Peter Martin Hansen ◽  
Søren Bruun Jepsen ◽  
Søren Mikkelsen ◽  
Marius Rehn
Keyword(s):  
Emergency Medical Services ◽  
High Speed ◽  
Case Reports ◽  
Trauma Centre ◽  
Medical Services ◽  
Patient Treatment ◽  
Radio Communication ◽  
Potential Threat ◽  
Emergency Medical ◽  
Great Belt

Abstract Background Major incidents (MI) are rare occurrences in Scandinavia. Literature depicting Scandinavian MI management is scarce and case reports and research is called for. In 2019, a trailer falling off a freight train struck a passing high-speed train on the Great Belt Bridge in Denmark, killing eight people instantly and injuring fifteen people. We aim to describe the emergency medical services (EMS) response to this MI and evaluate adherence to guidelines to identify areas of improvement for future MI management. Case presentation Nineteen EMS units were dispatched to the incident site. Ambulances transported fifteen patients to a trauma centre after evacuation. Deceased patients were pronounced life-extinct on-scene. Radio communication was partly compromised, since 38.9% of the radio shifts were not according to the planned radio grid and presented a potential threat to patient outcome and personnel safety. Access to the incident site was challenging and delayed due to traffic congestion and safety issues. Conclusion Despite harsh weather conditions and complex logistics, the availability of EMS units was sufficient and patient treatment and evacuation was uncomplicated. Triage was relevant, but at the physicians’ discretion. Important findings were communication challenges and the consequences of difficult access to the incident site. There is a need for an expansion of capacity in formal education in MI management in Denmark.

scholarly journals Study on patient satisfaction among patients with trauma admitted to trauma centre and emergency medical services ward

2019 ◽  
Vol 6 (4) ◽  
pp. 1219
Author(s):  
Mrutyunjay I. Uppin ◽  
Kapildev K. Hannurkar ◽  
Archana M. Uppin
Keyword(s):  
Patient Satisfaction ◽  
Emergency Medical Services ◽  
Trauma Center ◽  
Road Traffic ◽  
Trauma Centre ◽  
Medical Services ◽  
Research Centre ◽  
Trauma Patients ◽  
Quality Health Care ◽  
Emergency Medical

Background: Patient satisfaction is an important key factor for determining the quality health care and services offered by the emergency departments in the hospital. The objectives of the study were to assess the satisfaction of the trauma patients attending the trauma center with the services provided by the KLES Dr. Prabhakar Kore Hospital and Research Centre, Belagavi, Karnataka.Methods: Fifty trauma patients admitted and treated in trauma center and emergency medical services ward (TCEMS) at KLES Dr. Prabhakar Kore Hospital and Research Centre, Belagavi, over a period of 3 months (from November 2014 till January 2015) were interviewed. After obtaining an informed consent, the required data was collected using a pre-designed and pre-tested questionnaire.Results: Out of the 50 patients interviewed, 86% were males and 14% were females. Out of them 74% were road traffic accident victims. 67.5% of these victims were between the age group of 21 and 50 yrs. The overall satisfaction was good with all the services provided at the center. 80% were satisfied with the care provided by the doctors, 80% with communication by doctors, more than 75% with accessory services, more than 65% with the wait times at various levels and more than 85% satisfaction with amenities in the ward.Conclusions: In conclusion our study revealed that the availability of consultant in triage area, improvements in communication, quick service at the Casualty Pharmacy, reducing the perceived waiting times at various levels and improvement in the ambience of the unit would further enhance the patient satisfaction with TCEMS.

scholarly journals The contribution of helicopter emergency medical services in the pre-hospital care of penetrating torso injuries in a semi-rural setting

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
M. Gavrilovski ◽  
J. E. Griggs ◽  
E. ter Avest ◽  
R. M. Lyon ◽  
Keyword(s):  
Emergency Medical Services ◽  
Rural Areas ◽  
Penetrating Trauma ◽  
Trauma Centre ◽  
Rural Setting ◽  
Medical Services ◽  
Hospital Treatment ◽  
Helicopter Emergency Medical Services ◽  
Emergency Medical ◽  
Major Trauma Centre

Abstract Background Although the merit of pre-hospital critical care teams such as Helicopter Emergency Medical Services (HEMS) has been universally recognized for patients with penetrating torso injuries who present with unstable physiology, the potential merit in patients initially presenting with stable physiology is largely undetermined. The ability to predict the required pre-hospital interventions patients may have important implications for HEMS tasking, especially when transport times to definitive care are prolonged. Methods We performed a retrospective cohort study of patients who sustained a penetrating torso injury and were attended by the Air Ambulance Kent Surrey Sussex (AAKSS) over a 6-year period. Primary outcome was defined as the percentage of patients with penetrating torso injuries requiring HEMS-specific interventions anytime between HEMS arrival and arrival at hospital. Secondary outcomes were the association of individual patient- and injury characteristics with the requirement for HEMS interventions. Results During the study period 363 patients met inclusion criteria. 90% of patients were male with a median age of 30 years. 99% of penetrating trauma incident occurred more than 10-min drive from a Major Trauma Centre (MTC). Presenting GCS was > 13 in 83% of patients. Significant hemodynamic- or ventilatory compromise was present in more than 25% of the patients. Traumatic cardiac arrest was present in 34 patients (9.4%), profound hypotension with SBP < 80 mmHg in 30 (8.3%) and oxygen saturations < 92% in 30 (8.3%). A total of 121 HEMS-specific interventions were performed. Although HEMS-specific interventions were associated with presenting physiology (TCA OR 1.75 [1.41–2.16], SBP < 80 mmHg (OR 1.40 [1.18–1.67] and SpO2 < 92% (OR 1.39 [1.17–1.65], a minority of the patients presented initially with stable physiology but deteriorated on route to hospital and required HEMS interventions (n = 9, 3.3%). Conclusion HEMS teams provide potentially important contribution to the pre-hospital treatment of patients with penetrating torso injuries in rural and semi-rural areas, especially when they present with unstable physiology. A certain degree of over-triage is inevitable in these patients, as it is hard to predict which patients will deteriorate on route to hospital and will need HEMS interventions. The results of this study showing a potentially predictable geographical dispersion of penetrating trauma could inform multi-agency knife crime prevention strategy.

scholarly journals Using Trauma Video Review to Assess Emergency Medical Services Handoff and Trauma Team Non-Technical Skills

2021 ◽  
Vol 233 (5) ◽  
pp. S306-S307
Author(s):  
Madhuri B. Nagaraj ◽  
Jessica E. Lowe ◽  
Alexander L. Marinica ◽  
Brandon B. Morshedi ◽  
Marshal Isaacs ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Trauma Team ◽  
Technical Skills ◽  
Medical Services ◽  
Video Review ◽  
Emergency Medical

Increasing Robot Saliency in Cluttered Visual Displays

2016 ◽  
Vol 60 (1) ◽  
pp. 334-338
Author(s):  
Royce M. Mou ◽  
Electa A. Baker ◽  
Julie A. Adams
Keyword(s):  
Emergency Medical Services ◽  
Team Member ◽  
Hazardous Materials ◽  
Medical Services ◽  
Cognitive Workload ◽  
Team Members ◽  
Additional Information ◽  
Emergency Medical ◽  
Within Subjects ◽  
Complex Events

It has been shown that modulating the saliency of a dense amount of information presented as icons on a map-based interface can reduce cognitive workload and improve user performance. Further, first response teams, particularly those responding to complex events, such as Chemical, Biological, Radiological, Nuclear and Explosive device incidents will incorporate robots into their future teams to assist human team members and collect additional information. The deployment of such robots will require a human team member to supervise and task the various robots associated with the team. As the complexity of an incident increases and the number of responders with different specialties increases, for example Police, Emergency Medical Services, and Hazardous Materials, it will be harder to track the robots associated with a particular team, especially by the human team member responsible for the robots. A new algorithm, the Robot Visualization Algorithm, was developed to improve the saliency of robots for which the human team operator (e.g., Emergency Medical Services) is responsible, while generally minimizing the saliency of the robots from other teams (e.g., Police and Hazardous Materials) that are not relevant to the team operator. The presented Robot Visualization Algorithm makes the other teams’ robots more salient if their activities will impact the operator’s team. The within-subjects evaluation determined that the Robot Visualization Algorithm allowed operators to have a better awareness and lower cognitive workload than a base visualization condition. A number of proposed algorithm refinements are also discussed.

Evaluating the effect of driving distance to the nearest higher level trauma centre on undertriage: a cohort study

2021 ◽  
pp. emermed-2021-211635
Author(s):  
Job F Waalwijk ◽  
Robin D Lokerman ◽  
Rogier van der Sluijs ◽  
Audrey A A Fiddelers ◽  
Luke P H Leenen ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Emergency Medical Services ◽  
Resource Use ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma Centre ◽  
Medical Services ◽  
Trauma Patients ◽  
Emergency Medical ◽  
Critical Resource

BackgroundIt is of great importance that emergency medical services professionals transport trauma patients in need of specialised care to higher level trauma centres to achieve optimal patient outcomes. Possibly, undertriage is more likely to occur in patients with a longer distance to the nearest higher level trauma centre. This study aims to determine the association between driving distance and undertriage.MethodThis prospective cohort study was conducted from January 2015 to December 2017. All trauma patients in need of specialised care that were transported to a trauma centre by emergency medical services professionals from eight ambulance regions in the Netherlands were included. Patients with critical resource use or an Injury Severity Score ≥16 were defined as in need of specialised care. Driving distance was calculated between the scene of injury and the nearest higher level trauma centre. Undertriage was defined as transporting a patient in need of specialised care to a lower level trauma centre. Generalised linear models adjusting for confounders were constructed to determine the association between driving distance to the nearest higher level trauma centre per 1 and 10 km and undertriage. A sensitivity analysis was conducted with a generalised linear model including inverse probability weights.Results6101 patients, of which 4404 patients with critical resource use and 3760 patients with an Injury Severity Score ≥16, were included. The adjusted generalised linear model demonstrated a significant association between a 1 km (OR 1.04; 95% CI 1.04 to 1.05) and 10 kilometre (OR 1.50; 95% CI 1.42 to 1.58) increase in driving distance and undertriage in patients with critical resource use. Also in patients with an Injury Severity Score ≥16, a significant association between driving distance (1 km (OR 1.06; 95% CI 1.06 to 1.07), 10 km (OR 1.83; 95% CI 1.71 to 1.95)) and undertriage was observed.ConclusionPatients in need of specialised care are less likely to be transported to the appropriate trauma centre with increasing driving distance. Our results suggest that emergency medical services professionals incorporate driving distance into their decision making regarding transport destinations, although distance is not included in the triage protocol.

scholarly journals P095: Who, what, where: a critical assessment of helicopter emergency medical services transport and transfer times on patient outcomes at two level 1 trauma centres

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S110-S110
Author(s):  
B. Nolan ◽  
A. Ackery ◽  
H. Tien ◽  
B. Sawadsky ◽  
S. Rizoli ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Emergency Medical Services ◽  
Trauma Centre ◽  
Medical Services ◽  
Trauma Patients ◽  
Helicopter Emergency Medical Services ◽  
Trauma Centres ◽  
Emergency Medical ◽  
Level 1 ◽  
Mode Of Transport

Introduction: Helicopter emergency medical services (HEMS) have become an engrained component of trauma systems to expedite transportation to a trauma centre. Ornge is a provincially run, paramedic-staffed HEMS that is responsible for all air ambulance service within Ontario, Canada. They provide transportation for trauma patients through one of three ways: scene call, modified scene call or interfacility transfer. In this study we report the characteristics of patients transported by each of these methods to two level 1 trauma centres and assess for any impact on morbidity or mortality. Methods: A local trauma registry was used to identify all patients transported to our two trauma centres by HEMS over a 36-month period. Data surrounding patient demographic, arrival characteristics, transport times and in-hospital course were abstracted from the registry. Statistical analysis will be used to compare methods of transport and characterize any association between mode of transport and mortality. Results: From January 1st, 2012 to December 31st, 2014 HEMS transferred a total of 911 patients to our trauma centers with an overall mortality rate of 11%. Of these patients 139 were scene calls with a mortality rate of 8%, 333 were modified scene calls with a mortality rate of 14% and 439 were interfacility transfers with a mortality rate of 10%. Conclusion: Identifying any association between the type of HEMS transport and morbidity and mortality, we may be able to predict those that need more urgent transfer to a trauma centre and find ways to decrease our overall pre-trauma center time.

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