TRAUMA QUALITY IMPROVEMENT
Using Trauma Video Review to Assess EMS Handoff and Trauma Team Non-Technical Skills
Published on
December 22, 2021
Prehospital Emergency Care
Overview
The study examined the handoff communication between emergency medical services (EMS) personnel and trauma teams during high-acuity patient resuscitations. Analyzing three months of video recordings from trauma activations with an Injury Severity Score (ISS) of 15 or higher, the researchers assessed handoff quality using the MIST framework, focusing on completeness, efficiency, interruptions, and timeliness. Results indicated that while handoffs were generally efficient, with a median duration of 62 seconds and a completeness score of 11 out of 20, they were often interrupted—primarily by verbal communication from the trauma team. Notably, trauma teams scoring in the top quartile for non-technical skills (T-NOTECHS) demonstrated significantly higher MIST completeness scores, highlighting a correlation between effective EMS handoffs and trauma team performance.
The findings suggest that enhancing the structure and attention to EMS handoffs could lead to better non-technical performance in trauma settings. By utilizing trauma video review (TVR), the study emphasizes the potential to identify and modify behaviors that improve communication and coordination during critical care scenarios, ultimately benefiting patient outcomes.
Results
Researchers 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.
