Photography Tele-Transmission By Regular Ambulance Staff For The Management Of Mild Trauma Injury – The Nicephore Randomised-Controlled Trial

Abstract

Background:.Handling emergency calls in French emergency medical call centres (EMCCs) can be challenging considering the frequent lack of relevant information. Tele-transmission devices use in regular ambulance seems like a good solution to bring the EMCC physician a more accurate assessment of the scene, in particular for mild trauma injury (MTI). We measured the impact of ambulance staff tele-transmitted photographies on prehospital dispatching optimisation for patients calling the EMCC with MTI.Methods: We conducted a prospective, single-centre, randomised-controlled trial comparing two groups of patients calling the EMCC with MTI who did or did not benefit from photography tele-transmission by ambulance staff. The primary outcome was the proportion of patients referred away from the nearest hospital (left at home for outpatient care; referred to a higher level hospital; handled by a medical intensive care ambulance for advanced pre-hospital care) used as a marker of better orientation.Results:.Between 29 April 2019 and 21 July 2020, 165 patients were randomised and 152 analysed. Photography tele-transmission resulted in better patient dispatching (24/73 [33%] patients in the intervention group vs 9/79 [11%] patients in the control group, OR 3.80 [1.63 – 8.90]; p = 0.03), without increasing the proportion of patients initially left at home for outpatient care and visiting an ED within 10 days for secondary trauma-related care (1/14 [7%] vs 1/4 [25%], OR 0.25 [0.01-24.1]; p = 0.41). The proportion of patients unnecessarily referred to an ED was 7% [4/59 patients] in the intervention group vs 16% [12/75 patients] in the control group (OR 0.38 [0.09-1.36]; p = 0.10).Conclusion: Photographies tele-transmission by regular ambulance staff improves the dispatching of patients calling French EMCCs with MTI.Trial registration: The study is registered with Clinicaltrials.gov (NCT04034797).