Brief report
Video assessment of trauma response: Adherence to ATLS protocols

This project is dedicated to the memory of a valued Emergency Medicine colleague, William Holladay Spivey, MD, without whose efforts the video system used for this study would not exist.
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Abstract

A novel strategy using videotape recordings of initial trauma resuscitations was incorporated into the quality assurance program at a level 1 trauma center. Described are the process of taping the resuscitations, the multidisciplinary nature of the resuscitation team, the security measures taken to assure patient confidentiality, and the review process involved. The videotape review process was incorporated into a multidisciplinary educational trauma conference. The videotapes were used to evaluate the adherence to Advanced Trauma Life Support (ATLS) resuscitation protocols. Resident performance in six aspects of the ATLS resuscitation process were specifically highlighted on each videotape and graded for adherence to preestablished standards. The videotape process allowed an unbiased, indisputable accurate documentation of the sequential application of the protocols of evaluation and resuscitation espoused in the ATLS course. We found 23% overall deviation from ATLS resuscitation principles, with at least one aspect of the resuscitation deviating from expected ATLS performance in 64% of the patients. In addition to documenting adherence to ATLS principles, this study illustrated the impact of the videotape review process on the education of eight senior residents in surgery.

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    In one of the earliest studies of this technology, Hoyt et al. found that implementation of a video review curriculum resulted in a 17% resuscitation time reduction and increased team adherence to protocols.30 Video review has been used to evaluate adherence to Advanced Trauma Life Support principles and to detect errors in team organization and protocol implementation.31,32 Trauma video review technology has emerged and will continue to be an important educational and performance improvement tool in trauma resuscitation.33

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    One camera is above the patient's head and shows an entire view of the patient and the second is in the back of the room and oversees the entire trauma team. Previous studies have shown that errors during trauma evaluations are best identified using video review because of the potential recall bias associated with other forms of analysis, such as medical record review.3,11,12 We reviewed videos to determine the occurrence and timing of prearrival and primary and secondary survey task completion.

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