emeRgEncy diSPatch decisiONs using viDeo consultation (999 R.E.S.P.O.N.D. 2)

Background, aims: Emergency Medical Services (EMS) are under pressure to optimise use of scarce resource while handling a growing number of cases. In the UK the 999 emergency call is the gateway to EMS and the anchor point for making decisions to dispatch Enhanced and Critical Care Teams (ECCTs) to deliver advanced clinical interventions for critically ill patients at the scene of incidents. ECCTs, clinical centres and the public conventionally communicate through audio/written channels which struggle to cope with the complexity and volume of information, hindering the ability of all stakeholders to fully assess the critical situations. In recent years, live video consultation (VC) is increasingly adopted among call-handlers, ECCTs, ambulance clinicians, and/or members of the public to potentially add information to mitigate the shortcomings of audio and written channels. But empirical evidence to underpin its optimal use remains scant. There is a void in understanding how VC affects risk negotiation with professionals who have been socialised and trained to make optimal use of audio/written channels. We argue that current use of VC disrupts set norms and communication practices known and practiced by professionals. Without proper training and guidelines, professionals conduct VC based on intuition and own experience. This complexifies systems’ ability to cope and may increase risk. There is thus an urgent need – reflected in this study’s aims – to evaluate the impact of VC as a complex disruption to current communication practices (based on phone calls) on risk negotiation and ECCTs dispatch so as to support and regulate its use. Main research question: In VC, how are risk and severity indicators in an emergency identified by and brokered amongst on/off-site participants for the dispatch of ECCTs compared to phone calls? Methods, Anticipated impact and dissemination: We adopt a Theory of Change (ToC) approach to provide a set of initatives for improving practice and systems. This is an interdisciplinary and impact-oriented process, with inbuilt designs to co-develop frameworks and interventions with key stakeholders. Outputs will be delivered via three work packages (WPs). WP1 seeks to understand the impact to achieve for using VC in EMS and dispatch of ECCTs. It comprises 1) literature review, 2) Document Analysis of policy procedure and guidance (a qualitative method examining the content and context of documents), and 3) stakeholders engagement – through workshops, focus groups and interviews with ECC and EMS staff and commissioners as well as members of public. WP2 analyses video/audio recordings and textual records of emergency calls with the Interactional Sociolinguistics framework, an established methodology in Social Sciences, for systematically analysing patterns in interaction, with regard to communication practices impacting ‘time to decision’, the ‘quality’ of information exchanged, and the ‘interactional dynamics’ between participants. WP3 works closely with key stakeholders to develop seven output including: a ToC map, tools/frameworks for regulation, training, or auditing, an economic model for VC, and public-facing materials on using VC in EMS. Policymakers and administrators in EMS will be invited to workshops to co-develop, test, then disseminate the outputs to their networks.