Trauma Video Review: A Valuable Resource: In Reply

Abstract

In Reply.—Upperman et al make some important observations regarding the use and role of video recording in trauma resuscitation education. It is disappointing indeed that the use of video recording is on the decline in the United States, seemingly as a result of medicolegal concerns and resource issues.1 In contrast, although in December 2001 amended health privacy legislation was enacted in Australia to enhance issues of patient confidentiality, our hospital ethics committee and legal counsel were satisfied with the utility and appropriateness of video recording and approved this project. However, in Australia, video recording is not a routine part of resuscitation review, and medicolegal concerns have contributed to the lack of widespread use. We support the more widespread use of this medium, which provides vital audit information not otherwise available and can detect up to 5 times the errors that medical chart review will find.2Regarding changes made to our trauma team, these were not instituted until after the video-recording project was finished, and the published data refer to the time when a surgical team member was the trauma team leader. Issues of leadership and communication are still present, but there is no longer the confusion of roles when the designated leader is not present at the time of patient arrival.Our trauma team has defined membership and preassigned roles. The trauma paging system at the time required immediate attendance by all members. The videotapes were reviewed by the study personnel but not the treating team, and information from the review was communicated to the team members. It is accepted that best practice from an educational point would involve self-appraisal by team members3; this is planned for our hospital, but resource issues have limited the implementation.The communication issues highlighted by Upperman et al are vitally important to the function of any team. The video recording allows clear and irrefutable information on the team leaders’ instructions and the other members’ responses. We did not specifically analyze this but looked for clear leadership and interaction between the team members and the leader. This could be seen as a limitation of our study, but it provided valuable information that lack of clear team leadership was associated with poor communication in all cases.Our study identified resource issues as a major limiting factor to the ongoing use of video recording as an audit tool. The integration of patient notes to monitor recording of vital signs and video into a single electronic program that can be viewed simultaneously is being developed to allow more timely access to all the necessary data.We join with Upperman et al and encourage trauma centers to continue to use video recording to audit trauma resuscitation management. We believe that patient confidentiality issues are surmountable and that electronic interfaces will minimize the resource requirements.