The use of body-worn cameras in pre-hospital resuscitation.

INTRODUCTION: Body-worn cameras (BWCs) are commonplace in many workplaces, but rare in the real-time audit of clinical performance in the pre-hospital setting. There are currently no data supporting the use of BWCs as an acceptable tool in clinical audit. Out-of-hospital cardiac arrest (OHCA) is a good candidate for audit - time critical, high stakes and not well observed. While the use of cameras to record such clinical data is demonstrably useful, it could be perceived by front line ambulance staff as intrusive and have a deleterious impact on clinical care. Investigating these potential barriers is important in ensuring that our effort to enhance the early phase of pre-hospital care through video audit does not have negative unintended consequences. METHODS: Since 2012, the Resuscitation Research Group has used BWCs to provide a unique insight into how care is delivered by paramedics attending OHCAs. Paramedics attending arrests as part of the Resuscitation Rapid Response Unit (3RU) second-tier response wear a BWC, and collect real-time footage of these challenging, emotive clinical encounters. This footage has provided a unique medium for the audit of both individual technical task and team-oriented non-technical skills performance. We present the results of a survey in which paramedics share their views on the use of BWCs within their service. RESULTS: A convenience sample of 83 questionnaires was collected. In relation to the primary outcome of the study, 81% (n = 53) of paramedics who responded to the statement, 'the use of BWCs is a positive step for the service', agreed or remained neutral, while only 19% (n = 12) disagreed. CONCLUSION: BWCs, and the supporting infrastructure and feedback processes, are an effective, acceptable and beneficial tool in the audit and analysis of team performance in pre-hospital resuscitation.

How to implement live video recording in the clinical environment: A practical guide for clinical services.

BACKGROUND: The use of video in healthcare is becoming more common, particularly in simulation and educational settings. However, video recording live episodes of clinical care is far less routine. AIM: To provide a practical guide for clinical services to embed live video recording. MATERIALS AND METHODS: Using Kotter's 8-step process for leading change, we provide a 'how to' guide to navigate the challenges required to implement a continuous video-audit system based on our experience of video recording in our emergency department resuscitation rooms. RESULTS: The most significant hurdles in installing continuous video audit in a busy clinical area involve change management rather than equipment. Clinicians are faced with considerable ethical, legal and data protection challenges which are the primary barriers for services that pursue video recording of patient care. DISCUSSION: Existing accounts of video use rarely acknowledge the organisational and cultural dimensions that are key to the success of establishing a video system. This article outlines core implementation issues that need to be addressed if video is to become part of routine care delivery. CONCLUSION: By focussing on issues such as staff acceptability, departmental culture and organisational readiness, we provide a roadmap that can be pragmatically adapted by all clinical environments, locally and internationally, that seek to utilise video recording as an approach to improving clinical care.

Optimising clinical performance during resuscitation using video evaluation.

Video evaluation of resuscitation is becoming increasingly integrated into practice in a number of clinical settings. The purpose of this review article is to examine how video may enhance clinical care during resuscitation. As healthcare and available therapeutic interventions evolve, re-evaluation of accepted paradigms requires data to describe current practice and support change. Analysis of video recordings affords creation of a framework to evaluate individual and team performance and develop unique and tailored strategies to optimise care delivery. While video has been used in a number of non-clinical settings, there has been a recent increase of video systems in the prehospital and other clinical areas. This paper reviews the key opportunities in the emergency department-based resuscitation setting to enhance ergonomics, technical and non-technical skills-at both team and individual level-through video-assisted care performance analysis and feedback.

Introduction of paramedic led Echo in Life Support into the pre-hospital environment: The PUCA study.

OBJECTIVES: Can pre-hospital paramedic responders perform satisfactory pre-hospital Echo in Life Support (ELS) during the 10-s pulse check window, and does pre-hospital ELS adversely affect the delivery of cardiac arrest care. METHODS: Prospective observational study of a cohort of ELS trained paramedics using saved ultrasound clips and wearable camera videos. RESULTS: Between 23rd June 2014 and 31st January 2016, seven Resuscitation Rapid Response Unit (3RU) paramedics attended 45 patients in Lothian suffering out-of-hospital CA where resuscitation was attempted and ELS was available and performed. 80% of first ELS attempts by paramedics produced an adequate view which was excellent/good or satisfactory in 68%. 44% of views were obtained within the 10-s pulse check window with a median time off the chest of 17 (IQR 13-20) seconds. A decision to perform ELS was communicated 67% of the time, and the 10-s pulse check was counted aloud in 60%. A manual pulse check was observed in around a quarter of patients and the rhythm on the monitor was checked 38% of the time. All decision changing scans involved a decision to stop resuscitation. CONCLUSIONS: Paramedics are able to obtain good ELS views in the pre-hospital environment but this may lead to longer hands off the chest time and possibly less pulse and monitor checking than is recommended. Future studies will need to demonstrate either improved outcomes or a benefit from identifying patients in whom further resuscitation and transportation is futile, before ELS is widely adopted in most pre-hospital systems.

Association between ASA grade and complication rate in patients receiving procedural sedation for relocation of dislocated hip prostheses in a UK emergency department.

OBJECTIVE: To determine the association between the American Society of Anesthiologists (ASA) grade and the complication rate of patients receiving procedural sedation for relocation of hip prosthesis in an adult emergency department (ED) in the UK. DESIGN: Retrospective study of registry data from a large UK teaching hospital ED. Consecutive adult patients (aged 16 years and over) in whom ASA grade could be calculated, with an isolated dislocation of a hip prosthesis between 8 September 2006 and 16 April 2010 were included for analyses (n=303). The primary outcome measure was association between ASA and complication rate (any of desaturation <90%; apnoea; vomiting; aspiration; hypotension <90 mm Hg; cardiac arrest). Secondary outcome measures were relationship between ASA grade and procedural success, choice of sedative agent and sedation depth, and complications and choice of sedative agent, arrival time and sedation depth. RESULTS: There was no significant difference between ASA grade and the risk of complication (p=0.800). Moreover, there was no significant difference between ASA grade and procedural success (p=0.284), ASA and choice of sedative agent (p=0.243), or ASA and sedation depth (p=0.48). There was no association between complications and sedative agent (p=0.18), or complications and arrival time (p=0.12). There was a significant difference between sedative depth and complications (p<0.001). CONCLUSIONS: There is no clear association between a patient's physical status (ASA grade) and the risk of complications, chance of procedural success or choice of sedative agent in relocation of hip prostheses. There is a higher rate of complications with higher levels of sedation (p<0.001).

Procedural sedation and analgesia in a large UK Emergency Department: factors associated with complications.

BACKGROUND: The aim of this study was to investigate the delivery of procedural sedation and analgesia (PSA) in an urban teaching hospital Emergency Department (ED) over a 2-year period, and identify factors associated with complications. METHODS: Consecutive ED patients requiring PSA were prospectively enrolled onto the Registry of Emergency Procedural Sedation. Data collected included: patient and procedural characteristics; process times; physiological parameters; agents; sedation depth; and composition of staff team and complications. Multivariable binary logistic regression was used to identify factors associated with an increased risk of complications. RESULTS: 1402 patents required PSA during the study period. 1345 (95.9%) underwent orthopaedic manipulations. 597 (42.6%) received moderate sedation. 401 (28.6%) were sedated to deeper levels. Complications occurred in 49 (3.5%) cases. Deeper levels of sedation and the procedure occurring overnight were identified as risk factors for complications. Procedure type, patient age, grade of doctor and choice of drug were not found to be associated with an increased risk of complications. CONCLUSIONS: Procedural sedation and analgesia by Emergency Physicians is safe and effective; however, complications do happen. Complications are more likely at deeper levels of sedation and at night. Emergency Physicians must have the necessary skills and equipment to deal with such complications when they arise. EDs must be adequately staffed with trained clinicians 24 h a day to provide PSA.