Using Trauma Video Review to Assess EMS Handoff and Trauma Team Non-Technical Skills

Madhuri B. Nagaraj, Jessica E. Lowe, Alexander L. Marinica, Brandon Morshedi, S. Marshal Isaacs, Brian L. Miller, Andrew D. Chou, Michael W Cripps, Ryan P. Dumas

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objective: Handoffs by emergency medical services (EMS) personnel suffer from poor structure, inattention, and interruptions. The relationship between the quality of EMS communication and the non-technical performance of trauma teams remains unknown. Methods: We analyzed 3 months of trauma resuscitation videos (highest acuity activations or patients with an Injury Severity Score [ISS] of ≥15). Handoffs were scored using the mechanism-injury-signs-treatment (MIST) framework for completeness (0–20), efficiency (category jumps), interruptions, and timeliness. Trauma team non-technical performance was scored using the Trauma Non-Technical Skills (T-NOTECHS) scale (5–15). Results: We 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. Conclusions: There is a relationship between EMS MIST completeness and high performance of non-technical skill by trauma teams. Trauma video review (TVR) can help identify modifiable behaviors to improve EMS handoff and resuscitation efforts and therefore trauma team performance.

Original languageEnglish (US)
JournalPrehospital Emergency Care
StateAccepted/In press - 2021

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency


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