National consensus on communication in prehospital trauma care, the DENIM study

Abstract

BackgroundIn the Netherlands prehospital trauma care is provided by emergency medical services (EMS) nurses. This care is extended by Physician staffed Helicopter Emergency Medical Services (P-HEMS) for the more severely injured patient. Prehospital communication is a factor of influence on the identification of these patients and the dispatch of P-HEMS. Though prehospital communication it is often perceived to be incomplete and unstructured. To elucidated factors of influence on prehospital triage and the identification of the severely injured patient a Delphi study was performed.MethodsA three round modified Delphi study was designed to explore concepts amongst experts in prehospital trauma care. P-HEMS physicians/nurses, trauma surgeons, EMS nurses and dispatch center operators where asked to state their opinion regarding identification of the poly trauma patient, trauma patient characteristics, prehospital communication and prehospital handover.ResultsSeventy-one panellist completed all three rounds. For the first round seven cases and 13 theses were presented. From the answers/argumentation the second round was build, in which 68 theses had to be ranked within four principle themes: factors that influence prehospital communication, critical information for proper handover, factors influencing collaboration and how training/education can influence this. Out of these answers the third survey was build, focussing on determining the exact content of a prehospital trauma handover. The majority of the panellists agreed to a set of parameters resulting in a new model of inter-professional hand over regarding prehospital trauma patients.DiscussionExact identification of the poly trauma patient in need of care by P-HEMS is difficult though prehospital communication and the prehospital handover may be improved.ConclusionThe respondents report that prehospital communication needs to be unambiguous to improve trauma care. Consensus was reached on a set of ten parameters that should minimally be handed over with regard to a prehospital trauma patient. This to facilitate prehospital communication between the Dispatch centre, EMS, P-HEMS and the receiving hospital.

Operational experience of the Dutch helicopter emergency medical services (HEMS) during the initial phase of the COVID-19 pandemic: jeopardy on the prehospital care system?

“…Treatment of severely injured patients requires rapid medical intervention. In the Netherlands, the Helicopter Emergency Medical Services (HEMS) and HEMS-ambulance are dispatched to treat severely injured patients [ 1 , 2 ]. Up to 7600 deployments occur annually among four HEMS regions.…”

Health system factors associated with post-trauma mortality at the prehospital care level in Africa: a scoping review

“…The situation is complicated by limited communication facilities and equipment to support and enable facility-based practitioners to swiftly respond to trauma distress calls at the prehospital care level while complimenting lay responder rescue assistance. 61–63 Due to skill and rescue capacity gaps, lay responder rescue and interventions could be contributing to patient mortality and post-trauma complications. Despite lack of evidence to confirm or refute the assumption, lack of critical care skills could heighten risk of avoidable damages and complications.…”

Patient Handover in Emergency Trauma Situations

“…Handover between Learner #1 and Learner #2 will be assessed based on adherence to principles of SBAR (see Appendix A) and the prehospital trauma handover checklist developed by Harmsen et al [7]. Practices such as finding a quiet corner of the room to conduct the handover and using closed-loop communication will also be considered.…”

“…Descriptions of simulation exercises involving emergency trauma situations already exist [6], but they do not incorporate the patient handover component. Also, there is literature related to protocols for creating efficient patient handover in trauma situations [7]. This includes the development of trauma handover checklists developed by medical professionals, but these lists have not yet been integrated into mainstream use.…”