From hearing to seeing

Use of video streaming during medical emergency calls between caller and dispatcher

Abstract

The Emergency Medical Communication Centres (EMCCs) are one of the first links in the chain of survival in Norway. The dispatchers who work in the EMCCs answer medical emergency calls from the public, allocate resources and coordinates communication between prehospital resources and other professions and health institutions. They assess patients, perform triage, and prioritise resources among others. Several concepts are important for how calls unfold and for how the dispatchers perform their tasks: dispatcher’s situation awareness, decision making, and the communicative relationship between dispatcher and caller. Traditionally the dispatchers perform their tasks without any visual aid. During the recent years, video streaming as an additional communication tool has been introduced in Norwegian EMCCs. When the dispatcher activates video streaming during the call, the dispatcher can see the situation through the caller’s smart phone camera. Some research had been conducted on video streaming when we started this project, which mainly focused on out-of-hospital cardiac arrest and cardiopulmonary resuscitation. Little other scientific knowledge existed however on such use of video streaming when it was implemented. The aim of this thesis is therefore to demonstrate implications of video streaming as an additional communication tool during medical emergency calls. We have employed both qualitative and quantitative methods to answer the thesis’ aim. Two of the studies explore the perspectives of the user groups, callers and dispatchers. We conducted focus group interviews with the dispatchers, and semi-structured single interviews with the callers. In the third study we conducted a prospective observational study to investigate whether dispatchers more often recognised that the injured patient had a need for first aid when using video streaming during the call. In addition, we investigated whether video streaming could influence quality of bystander first aid. The fourth study in this thesis is a validation study, which validates a tool used for data collection in the observational study. Several of the dispatchers described that they had experienced their perception of the situation to change after having activated video streaming, and that they often felt more reassured. Some however worried about time length of the calls. Many of the callers interviewed described an increased sense of safety knowing that the dispatchers could see the situation. Some felt more stressed when having to film in an emergency situation, and some reflected on parallels to filming and the issue of posting videos in social media. As for the study investigating potential effects, the odds for the dispatcher to recognise a need for bystander first aid was five times higher when using video streaming during the call. We found no effect on bystander first aid quality. This thesis demonstrates that video streaming has several important implications for medical emergency calls. Video streaming can contribute to enhance dispatchers’ situational awareness and lead to more correct decision making, thus improving patient treatment. This is supported by the findings in study I and III. Study I and II shows that video streaming also may improve communication between caller and dispatcher, by the callers experiencing increased sense of safety and dispatchers improving use of empathy as a tool. It is important for dispatchers to consider for each call whether video streaming is the best option. The use of video streaming is likely to increase in the future along with organizational changes. Video streaming seemingly has several positive implications on calls, but we highlight the importance of basic communication techniques when interacting with the caller. Improvements of systems and tools used in the EMCCs such as video streaming will mean improvement of patient treatment and safety. Further research should be conducted to gain more knowledge about how to make the best use of video streaming during medical emergency calls.