Video livestreaming from medical emergency callers' smartphones to emergency medical dispatch centres: a scoping review of current uses, opportunities, and challenges.

BACKGROUND: Timely dispatch of appropriate emergency medical services (EMS) resources to the scene of medical incidents, and/or provision of treatment at the scene by bystanders and medical emergency lay callers (referred to as 'callers' in this review) can improve patient outcomes. Currently, in dispatch systems worldwide, prioritisation of dispatch relies mostly on verbal telephone information from callers, but advances in mobile phone technology provide means for sharing video footage. This scoping review aimed to map and identify current uses, opportunities, and challenges for using video livestreaming from callers' smartphones to emergency medical dispatch centres. METHODS: A scoping review of relevant published literature between 2007 and 2023 in the English language, searched within MEDLINE; CINAHL and PsycINFO, was descriptively synthesised, adhering to the PRISMA extension for scoping reviews. RESULTS: Twenty-four articles remained from the initial search of 1,565 articles. Most studies were simulation-based and focused on emergency medical dispatchers' (referred to as 'dispatcher/s' in this review) assisted video cardiopulmonary resuscitation (CPR), predominantly concerned with measuring how video impacts CPR performance. Nine studies were based on real-life practice. Few studies specifically explored experiences of dispatchers or callers. Only three articles explored the impact that using video had on the dispatch of resources. Opportunities offered by video livestreaming included it being: perceived to be useful; easy to use; reassuring for both dispatchers and callers; and informing dispatcher decision-making. Challenges included the potential emotional impact for dispatchers and callers. There were also concerns about potential misuse of video, although there was no evidence that this was occurring. Evidence suggests a need for appropriate training of dispatchers and video-specific dispatch protocols. CONCLUSION: Research is sparse in the context of video livestreaming. Few studies have focussed on the use of video livestreaming outside CPR provision, such as for trauma incidents, which are by their nature time-critical where visual information may offer significant benefit. Further investigation into acceptability and experience of the use of video livestreaming is warranted, to understand the potential psychological impact on dispatchers and callers.

The SEE-IT Trial: emergency medical services Streaming Enabled Evaluation In Trauma: a feasibility randomised controlled trial.

BACKGROUND: Use of bystander video livestreaming from scene to Emergency Medical Services (EMS) is becoming increasingly common to aid decision making about the resources required. Possible benefits include earlier, more appropriate dispatch and clinical and financial gains, but evidence is sparse. METHODS: A feasibility randomised controlled trial with an embedded process evaluation and exploratory economic evaluation where working shifts during six trial weeks were randomised 1:1 to use video livestreaming during eligible trauma incidents (using GoodSAM Instant-On-Scene) or standard care only. Pre-defined progression criteria were: (1) ≥ 70% callers (bystanders) with smartphones agreeing and able to activate live stream; (2) ≥ 50% requests to activate resulting in footage being viewed; (3) Helicopter Emergency Medical Services (HEMS) stand-down rate reducing by ≥ 10% as a result of live footage; (4) no evidence of psychological harm in callers or staff/dispatchers. Observational sub-studies included (i) an inner-city EMS who routinely use video livestreaming to explore acceptability in a diverse population; and (ii) staff wellbeing in an EMS not using video livestreaming for comparison to the trial site. RESULTS: Sixty-two shifts were randomised, including 240 incidents (132 control; 108 intervention). Livestreaming was successful in 53 incidents in the intervention arm. Patient recruitment (to determine appropriateness of dispatch), and caller recruitment (to measure potential harm) were low (58/269, 22% of patients; 4/244, 2% of callers). Two progression criteria were met: (1) 86% of callers with smartphones agreed and were able to activate livestreaming; (2) 85% of requests to activate livestreaming resulted in footage being obtained; and two were indeterminate due to insufficient data: (3) 2/6 (33%) HEMS stand down due to livestreaming; (4) no evidence of psychological harm from survey, observations or interviews, but insufficient survey data from callers or comparison EMS site to be confident. Language barriers and older age were reported in interviews as potential challenges to video livestreaming by dispatchers in the inner-city EMS. CONCLUSIONS: Progression to a definitive RCT is supported by these findings. Bystander video livestreaming from scene is feasible to implement, acceptable to both 999 callers and dispatchers, and may aid dispatch decision-making. Further assessment of unintended consequences, benefits and harm is required. TRIAL REGISTRATION: ISRCTN 11449333 (22 March 2022). https://www.isrctn.com/ISRCTN11449333.

The SEE-IT Trial: emergency medical services Streaming Enabled Evaluation In Trauma: study protocol for an interventional feasibility randomised controlled trial.

INTRODUCTION: Accurate and timely dispatch of emergency medical services (EMS) is vital due to limited resources and patients' risk of mortality and morbidity increasing with time. Currently, most UK emergency operations centres (EOCs) rely on audio calls and accurate descriptions of the incident and patients' injuries from lay 999 callers. If dispatchers in the EOCs could see the scene via live video streaming from the caller's smartphone, this may enhance their decision making and enable quicker and more accurate dispatch of EMS. The main aim of this feasibility randomised controlled trial (RCT) is to assess the feasibility of conducting a definitive RCT to assess the clinical and cost effectiveness of using live streaming to improve targeting of EMS. METHODS AND ANALYSIS: The SEE-IT Trial is a feasibility RCT with a nested process evaluation. The study also has two observational substudies: (1) in an EOC that routinely uses live streaming to assess the acceptability and feasibility of live streaming in a diverse inner-city population and (2) in an EOC that does not currently use live streaming to act as a comparator site regarding the psychological well-being of EOC staff using versus not using live streaming. ETHICS AND DISSEMINATION: The study was approved by the Health Research Authority on 23 March 2022 (ref: 21/LO/0912), which included NHS Confidentiality Advisory Group approval received on 22 March 2022 (ref: 22/CAG/0003). This manuscript refers to V.0.8 of the protocol (7 November 2022). The trial is registered with the ISRCTN (ISRCTN11449333). The first participant was recruited on 18 June 2022.The main output of this feasibility trial will be the knowledge gained to help inform the development of a large multicentre RCT to evaluate the clinical and cost effectiveness of the use of live streaming to aid EMS dispatch for trauma incidents. TRIAL REGISTRATION NUMBER: ISRCTN11449333.

Work-related rumination declines with age but is moderated by gender.

BACKGROUND: Much is known about the physical effects of work and health, but less is known about how older workers unwind mentally from work, and their post-work ruminative thinking. OBJECTIVE: The present study aimed to explore the association between age, gender and two types of work-related rumination: affective rumination, and problem-solving pondering. METHODS: This study utilized a sample of 3991 full-time employees (working 30 or more hours per week), who were stratified into five age bands (18-25, 26-35, 36-45, 46-55, and 56-65 yrs.). RESULTS: Affective rumination was found to significantly decline in the older age groups (46 + yrs.), but this finding was moderated by gender. Males reported lower work-related rumination over the entire age range, but the greatest difference between males and females was observed in the 56-65 age category. The results for problem-solving pondering mirrored those of affective rumination but with the only exception that there was no significant difference in gender between those aged 18-25 years. CONCLUSION: These findings add to our understanding about how workers (between different age groups) mentally switch off from work and highlight the need for interventions to help older workers mentally recover from the effects of work.

Disentangling change across the time and true stability of employees' resilience using latent state model.

There is debate within the literature about whether resilience should be considered a stable character trait or a dynamic, changeable process (state). Two widely used measures to assess resilience are the Connor-Davidson Resilience Scale (CD-RISC) and the Resilience Scale for Adults (RSA). The aim of this study was to evaluate the true stability (invariance) and change across time in resilience captured by these two measures. Using the perspective of Latent State-Trait theory, the aim was to decipher if the CD-RISC and the RSA are more trait-like or more state-like and to address whether true differences in resilience between participants increased (or decreased) across time. In this longitudinal study, UK-based employees (N = 378) completed the CD-RISC (10-item version) and the RSA (33-item version, aggregated and analyzed under six parcels) at three occasions over six months. A latent-state model and latent-state model with indicator specific residual factors were utilized. The analysis suggested that both questionnaires capture trait and state components of resilience. These results contribute to the discussion about how resilience scales are measuring change and stability, and how we define resilience as a more trait-like or state-like phenomena. The findings also highlight the issue of what resilience scales are measuring and whether resilience is a quantifiable construct.

Stress, psychological distress and support in a health care organization during Covid-19: A cross-sectional study.

AIM: The main aim of this study was to understand what health and wellbeing initiatives are helpful for health care workers' stress and psychological distress during the Covid-19 pandemic. BACKGROUND: Health care workers are at increased risk of poor mental health during health emergencies; understanding support required for health care workers is of paramount importance. METHODS: Participants were health care workers at a health and social care organization (N = 159). The study included an online questionnaire including an evaluation of health and wellbeing initiatives and measures of perceived stress and psychological distress. RESULTS: The highest rated resources were counselling, personal protective equipment (PPE) and Covid-19 testing. Those who accessed yoga reported significantly less stress and psychological distress than those who did not access yoga. CONCLUSIONS: Health care workers with higher stress and psychological distress felt less supported by their organization, less listened to and less involved in organizational decisions. IMPLICATIONS FOR NURSING MANAGEMENT: Practical implications are discussed such as forward planning for health emergencies (e.g., PPE supply), accessible Covid-19 testing as well as budgeting for counselling services and exercise classes. In addition, targeted support for those diagnosed with Covid-19 is recommended, alongside involvement of staff members in organizational decisions.

Experiences of transition from children's to adult's healthcare services for young people with a neurodevelopmental condition.

Previous research has highlighted a lack of continuity of care when young people with a neurodevelopmental condition make the transition from children's to adult specialist healthcare services. A lack of planning, consistency, and availability of adult services has been found to lead to; increased anxiety, poor health outcomes, reduced support and some young people not receiving healthcare. The majority of transition research has focused on what health professionals consider important in the transition process, rather than focusing on the experiences of the young people and those closest to them. Our objective was to gather evidence from young people (and their families) who had experienced transition from children's to adult specialist healthcare services through semi-structured interviews. Volunteers were recruited from two London boroughs. All young people were aged between 18 and 25 years with a neurodevelopmental condition (Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder and/or an Intellectual Disability). Overall, we interviewed six young people with support from a family member. Five further family members were interviewed on behalf of the young person. In total, ten semi-structured interviews were transcribed verbatim and analysed using Interpretative Phenomenological Analysis. Four themes emerged from the analysis: (a) Parents as advocates, (b) Availability of adult's specialist health and social care services, (c) Lack of information sharing and (d) Transition as a binary, abrupt change. Our findings suggest the transition experience could be improved by changing service specifications to incorporate assessment and handover across the age range of 16-20 years. Additionally, statutory services should understand and provide the coordination role now offered by parents in transition. We suggest future research could evaluate the feasibility of a patient-owned online information sharing tool with information about relevant services for young people and their families.

Use of a Biofeedback Breathing App to Augment Poststress Physiological Recovery: Randomized Pilot Study.

BACKGROUND: The speed of physiological recovery from stress may be a marker for cardiovascular disease risk. Stress management programs that incorporate guided breathing have been shown to moderate the stress response and augment recovery. OBJECTIVE: The aim of this study was to examine the effectiveness of an app-based brief relaxation intervention (BioBase) for facilitating physiological recovery in individuals exposed to a brief psychological stressor. METHODS: A total of 75 participants (44 women) completed a stressor speech task and were randomly assigned to one of three conditions: control, rumination, or an app-based relaxation breathing (BioBase) conditions. Heart rate variability (HRV) was assessed as a measure of autonomic function at baseline (6 min), during stress (6 min), and during recovery (6 min). RESULTS: There was a significant increase in subjective stress following stress exposure, but the ratings returned to baseline after recovery in all three groups. In addition, there was a significant decrease in vagally mediated HRV in the poststress period. During recovery, the root mean square of successive differences (P<.001), the percentage of successive interbeat (RR) intervals that differ by >50 ms (pNN50; P<.001), and high-frequency (P<.02) HRV were significantly higher in the BioBase breathing condition than the rumination and control conditions. There was no difference in HRV values between the rumination and control conditions during recovery. CONCLUSIONS: App-based relaxed breathing interventions could be effective in reducing cardiovascular disease risk. These results provide additional utility of biofeedback breathing in augmenting physiological recovery from psychological stress.

The association between C-reactive protein, Interleukin-6 and depression among older adults in the community: A systematic review and meta-analysis.

Previous research indicates there may be an association between inflammation and depression in older adults but results are inconsistent. Therefore, the aim of this review was to determine the cross-sectional and longitudinal associations of two inflammatory markers C-reactive protein (CRP) and Interleukin-6 (IL-6) with depression in older adults. We searched five databases for cross-sectional and longitudinal studies reporting an association between CRP or IL-6 with depression among adults sampled from the community aged 50 or older. We found 32 studies (23 cross-sectional, 7 longitudinal, and 2 assessing both cross-sectional and longitudinal associations) that met eligibility criteria. These studies were entered into a random-effects meta-analysis to determine the cross-sectional association and longitudinal direction of association between both IL-6 and CRP with depression. Results indicated a cross-sectional and longitudinal association between both CRP and IL-6 with depression in older adults, with inflammation leading to depression in longitudinal studies rather than depression to inflammation. However, there was notable heterogeneity between studies as results differed based on adjusting for confounders and on how inflammation and depression were measured. These sources of heterogeneity could explain differences in study results.