Using Trauma Video Review to Assess EMS Handoff and Trauma Team Non-Technical Skills

Abstract

Objective

Handoffs by emergency medical services (EMS) personnel suffer from poor structure, inattention, and interruptions. The relationship between the quality of EMS communication and the non-technical performance of trauma teams remains unknown.

Methods

We analyzed 3 months of trauma resuscitation videos (highest acuity activations or patients with an Injury Severity Score [ISS] of ≥15). Handoffs were scored using the mechanism-injury-signs-treatment (MIST) framework for completeness (0–20), efficiency (category jumps), interruptions, and timeliness. Trauma team non-technical performance was scored using the Trauma Non-Technical Skills (T-NOTECHS) scale (5–15).

Results

We analyzed 99 videos. Handoffs lasted a median of 62 seconds [IQR: 43–74], scored 11 [10–13] for completeness, and had 2 [1–3] interruptions. Most interruptions were verbal (85.2%) and caused by the trauma team (64.9%). Most handoffs (92%) were efficient with 2 or fewer jumps. Patient transfer during handoff occurred in 53.5% of the videos; EMS providers giving handoff helped transfer in 69.8% of the Primary surveys began during handoff in 42.4% of the videos. Resuscitation teams who scored in the top-quartile on the T-NOTECHS (>11) had higher MIST scores than teams in lower quartiles (13 [11.25–14.75] vs. 11 [10–13]; p < .01). There were no significant differences in ISS, efficiency, timeliness, or interruptions between top- and lower-quartile groups.

Conclusions

There is a relationship between EMS MIST completeness and high performance of non-technical skill by trauma teams. Trauma video review (TVR) can help identify modifiable behaviors to improve EMS handoff and resuscitation efforts and therefore trauma team performance.

Acknowledgments

We would like to thank the Parkland Memorial Hospital trauma team and the Emergency Medical Service providers that service our patients daily.

Disclosure statement

The authors report no conflict of interest.

Contributions

Madhuri B. Nagaraj: study design, data collection, data analysis, drafting of the manuscript, final approval of the manuscript

Jessica E. Lowe: data collection, data analysis, drafting of the manuscript, final approval of the manuscript

Alexander L. Marinica: study design, data collection, data analysis, drafting of the manuscript, final approval of the manuscript

Brandon B. Morshedi: data analysis, drafting of the manuscript, final approval of the manuscript

S. Marshal Isaacs: data analysis, drafting of the manuscript, final approval of the manuscript

Andrew D. Chou: data analysis, drafting of the manuscript, final approval of the manuscript

Michael W. Cripps: study design, data analysis, drafting of the manuscript, final approval of the manuscript

Ryan P. Dumas: study design, data collection, data analysis, drafting of the manuscript, final approval of the manuscript