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Research
Open Access

Paramedic to trauma team verbal handover optimization — a complex interaction

Shaun Cowan, Patrick Murphy, Michael Kim, Brett Mador, Eddie Chang, Alison Kabaroff, Emerson North, Cheryl Cameron, Kevin Verhoeff and Sandy Widder
CAN J SURG May 24, 2023 66 (3) E290-E297; DOI: https://doi.org/10.1503/cjs.013622
Shaun Cowan
From the Department of Surgery, University of Alberta, Edmonton, Alb. (Cowan, Kim, Mador, Verhoeff, Widder); the Department of Surgery, Indiana University, Indianapolis, Indianna (Murphy); the Department of Critical Care, University of Alberta, Edmonton, Alb. (Cowan, Kim, Widder); the Department of Emergency Medicine, University of Alberta, Edmonton, Alb. (Chang, Kabaroff); the Alberta Emergency Medical Services, Alberta Health Services, Edmonton, Alb. (Cameron); and the Shock Trauma Air Rescue Society, Alberta, Edmonton, Alb. (Cowan, North)
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Patrick Murphy
From the Department of Surgery, University of Alberta, Edmonton, Alb. (Cowan, Kim, Mador, Verhoeff, Widder); the Department of Surgery, Indiana University, Indianapolis, Indianna (Murphy); the Department of Critical Care, University of Alberta, Edmonton, Alb. (Cowan, Kim, Widder); the Department of Emergency Medicine, University of Alberta, Edmonton, Alb. (Chang, Kabaroff); the Alberta Emergency Medical Services, Alberta Health Services, Edmonton, Alb. (Cameron); and the Shock Trauma Air Rescue Society, Alberta, Edmonton, Alb. (Cowan, North)
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Michael Kim
From the Department of Surgery, University of Alberta, Edmonton, Alb. (Cowan, Kim, Mador, Verhoeff, Widder); the Department of Surgery, Indiana University, Indianapolis, Indianna (Murphy); the Department of Critical Care, University of Alberta, Edmonton, Alb. (Cowan, Kim, Widder); the Department of Emergency Medicine, University of Alberta, Edmonton, Alb. (Chang, Kabaroff); the Alberta Emergency Medical Services, Alberta Health Services, Edmonton, Alb. (Cameron); and the Shock Trauma Air Rescue Society, Alberta, Edmonton, Alb. (Cowan, North)
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Brett Mador
From the Department of Surgery, University of Alberta, Edmonton, Alb. (Cowan, Kim, Mador, Verhoeff, Widder); the Department of Surgery, Indiana University, Indianapolis, Indianna (Murphy); the Department of Critical Care, University of Alberta, Edmonton, Alb. (Cowan, Kim, Widder); the Department of Emergency Medicine, University of Alberta, Edmonton, Alb. (Chang, Kabaroff); the Alberta Emergency Medical Services, Alberta Health Services, Edmonton, Alb. (Cameron); and the Shock Trauma Air Rescue Society, Alberta, Edmonton, Alb. (Cowan, North)
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Eddie Chang
From the Department of Surgery, University of Alberta, Edmonton, Alb. (Cowan, Kim, Mador, Verhoeff, Widder); the Department of Surgery, Indiana University, Indianapolis, Indianna (Murphy); the Department of Critical Care, University of Alberta, Edmonton, Alb. (Cowan, Kim, Widder); the Department of Emergency Medicine, University of Alberta, Edmonton, Alb. (Chang, Kabaroff); the Alberta Emergency Medical Services, Alberta Health Services, Edmonton, Alb. (Cameron); and the Shock Trauma Air Rescue Society, Alberta, Edmonton, Alb. (Cowan, North)
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Alison Kabaroff
From the Department of Surgery, University of Alberta, Edmonton, Alb. (Cowan, Kim, Mador, Verhoeff, Widder); the Department of Surgery, Indiana University, Indianapolis, Indianna (Murphy); the Department of Critical Care, University of Alberta, Edmonton, Alb. (Cowan, Kim, Widder); the Department of Emergency Medicine, University of Alberta, Edmonton, Alb. (Chang, Kabaroff); the Alberta Emergency Medical Services, Alberta Health Services, Edmonton, Alb. (Cameron); and the Shock Trauma Air Rescue Society, Alberta, Edmonton, Alb. (Cowan, North)
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Emerson North
From the Department of Surgery, University of Alberta, Edmonton, Alb. (Cowan, Kim, Mador, Verhoeff, Widder); the Department of Surgery, Indiana University, Indianapolis, Indianna (Murphy); the Department of Critical Care, University of Alberta, Edmonton, Alb. (Cowan, Kim, Widder); the Department of Emergency Medicine, University of Alberta, Edmonton, Alb. (Chang, Kabaroff); the Alberta Emergency Medical Services, Alberta Health Services, Edmonton, Alb. (Cameron); and the Shock Trauma Air Rescue Society, Alberta, Edmonton, Alb. (Cowan, North)
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Cheryl Cameron
From the Department of Surgery, University of Alberta, Edmonton, Alb. (Cowan, Kim, Mador, Verhoeff, Widder); the Department of Surgery, Indiana University, Indianapolis, Indianna (Murphy); the Department of Critical Care, University of Alberta, Edmonton, Alb. (Cowan, Kim, Widder); the Department of Emergency Medicine, University of Alberta, Edmonton, Alb. (Chang, Kabaroff); the Alberta Emergency Medical Services, Alberta Health Services, Edmonton, Alb. (Cameron); and the Shock Trauma Air Rescue Society, Alberta, Edmonton, Alb. (Cowan, North)
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Kevin Verhoeff
From the Department of Surgery, University of Alberta, Edmonton, Alb. (Cowan, Kim, Mador, Verhoeff, Widder); the Department of Surgery, Indiana University, Indianapolis, Indianna (Murphy); the Department of Critical Care, University of Alberta, Edmonton, Alb. (Cowan, Kim, Widder); the Department of Emergency Medicine, University of Alberta, Edmonton, Alb. (Chang, Kabaroff); the Alberta Emergency Medical Services, Alberta Health Services, Edmonton, Alb. (Cameron); and the Shock Trauma Air Rescue Society, Alberta, Edmonton, Alb. (Cowan, North)
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Sandy Widder
From the Department of Surgery, University of Alberta, Edmonton, Alb. (Cowan, Kim, Mador, Verhoeff, Widder); the Department of Surgery, Indiana University, Indianapolis, Indianna (Murphy); the Department of Critical Care, University of Alberta, Edmonton, Alb. (Cowan, Kim, Widder); the Department of Emergency Medicine, University of Alberta, Edmonton, Alb. (Chang, Kabaroff); the Alberta Emergency Medical Services, Alberta Health Services, Edmonton, Alb. (Cameron); and the Shock Trauma Air Rescue Society, Alberta, Edmonton, Alb. (Cowan, North)
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Article Figures & Tables

Figures

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  • Fig. 1
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    Fig. 1

    Scenario progression from scene to hospital trauma bay handoff. ATLS = Advanced Trauma Life Support; EMS = emergency medical services; TTL = trauma team leader.

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    Fig. 2

    Trauma simulation flow by study group and progression, for control and intervention groups.

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    Fig. 3

    Thematic analysis codes (themes) and sub-codes from comments by emergency medical services (EMS) providers, trauma team members and expert reviewers within the study. TTL = trauma team leader.

Tables

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    Table 1

    EMS provider level and experience, and total handoff duration by study group

    FactorValue
    Total providers, n13
     Primary care paramedic, n (%)4 (31)
     Advanced care paramedic, n (%)9 (69 )
    Years of experience, median (IQR), yr14.5 (10–18)
     Primary care paramedic3 (2–6.5)
     Advanced care paramedic16 (14–19)
    Handoff elapsed times, mean ± SD, s
     Total71 ± 24
     Control group75 ± 25
     ISOBAR group66 ± 26
     IMIST group65 ± 20
    p value0.65
    • EMS = emergency medical services; IQR = interquartile range; SD = standard deviation.

    • View popup
    Table 2

    Video evaluator scoring results for handoff content checklist

    ContentControl groupISOBAR handoffIMIST handoffTotalp value
    n (%)98 (53.8)42 (23.1)42 (23.1)182 (100.0)–
    Introduction (0,1,2*), median (IQR)
     Stability statement1 (1–1)1 (0.5–1)1 (0–2)1 (0–1)0.23
     Demographic intro2 (1.25–2)2 (2–2)2 (1–2)2 (1–2)0.65
     Time of injury stated1 (0–1)1 (0–1)1 (0–1)1 (0–1)0.75
    Clinical assessment (0,1,2*), median (IQR)
     Critical injuries noted2 (2–2)2 (2–2)2 (2–2)2 (2–2)0.51
     Minor injuries omitted2 (0–2)1 (0–2)2 (0–2)2 (0–2)0.54
     ABC status noted2 (1–2)2 (1–2)2 (1–2)2 (1–2)0.82
     Initial vitals stated1 (1–2)1 (1–2)1 (1–2)1 (1–2)0.95
     Arrival vitals stated2 (1–2)1 (1–2)2 (1–2)2 (1–2)0.02
     Critical events noted2 (2–2)2 (2–2)2 (2–2)2 (2–2)0.66
    Interventions (0,1,2*), median (IQR)
     C-spine noted2 (1–2)2 (0–2)2 (1–2)2 (1–2)0.28
     All major interventions noted2 (2–2)2 (2–2)2 (2–2)2 (2–2)0.93
     Vascular access identified2 (1–2)2 (1–2)2 (0.5–2)2 (1–2)0.73
     Fluid totals2 (0–2)1 (1–2)2 (1–2)2 (1–2)0.22
     Opiate totals2 (2–2)2 (2–2)2 (0–2)2 (1–2)0.78
    • ABC = airway, breathing, circulation; IQR = interquartile range.

    • ↵* 0 = No; 1 = Incomplete; 2 = Complete.

    • View popup
    Table 3

    Video evaluator scoring results for handoff content checklist

    Overall impression and content evaluationControl groupISOBAR handoffIMIST handoffTotalp value
    n (%)98 (53.8)42 (23.1)42 (23.1)182 (100.0)–
    Overall impression score1–10, median (IQR)7 (5.75–8)7 (4–8)7 (5–8)7 (5–8)0.29
    Content evaluation1–5, median (IQR)
     Establishes attention to begin handoff4 (3.75–4)4 (3.5–4)4 (3–5)4 (3–5)0.16
     Mechanism of injury is described concisely4 (4–4)4 (3–4.5)4 (3.5–5)4 (3–5)0.12
     Clearly established clinical trajectory during transport3 (3–4)4 (2–4)4 (2.5–5)3 (2.5–4)0.53
     Head to toe format of injury summary is provided concisely4 (3–4)4 (2–4)4 (3–4)4 (3–4)0.67
     Interventions followed a logical order (ABCDE)4 (3–4)4 (2–4)4 (3–4)4 (2–4)0.98
     Handoff follows a clear format4 (3–4)4 (2–4)4 (2.5–4)4 (2–4)0.70
     Handoff is delivered in a clear and confident manner4 (3–4)4 (3–4.5)4 (3–5)4 (3–4)0.56
    • IQR = interquartile range.

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Canadian Journal of Surgery: 66 (3)
CAN J SURG
Vol. 66, Issue 3
24 Mar 2023
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Paramedic to trauma team verbal handover optimization — a complex interaction
Shaun Cowan, Patrick Murphy, Michael Kim, Brett Mador, Eddie Chang, Alison Kabaroff, Emerson North, Cheryl Cameron, Kevin Verhoeff, Sandy Widder
CAN J SURG May 2023, 66 (3) E290-E297; DOI: 10.1503/cjs.013622

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Paramedic to trauma team verbal handover optimization — a complex interaction
Shaun Cowan, Patrick Murphy, Michael Kim, Brett Mador, Eddie Chang, Alison Kabaroff, Emerson North, Cheryl Cameron, Kevin Verhoeff, Sandy Widder
CAN J SURG May 2023, 66 (3) E290-E297; DOI: 10.1503/cjs.013622
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