Situation Assessment and Decision Making Strategies of Emergency Medical Services Physicians in Routine and Non-Routine Situations

Sedlár, Martin

doi:10.21909/sp.2017.02.735

Cited by 5 publications

(7 citation statements)

References 22 publications

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“…A patient who needs urgent treatment facilitates decisions concerning immediate transportation, while a patient who does not need urgent treatment may cause EMS clinicians to reduce their work pace and be more analytical in their clinical reasoning. This may lead an EMS clinician to decide not to convey a patient to hospital [32, 33, 43, 44, 49, 55, 58].…”

Section: Resultsmentioning

confidence: 99%

“…During this procedure, additional hypotheses may be produced, based on new findings and assessments. In addition, EMS clinicians sometimes do a mental simulation of the options considered to weigh and evaluate all possible consequences [32, 36–39, 55, 58–60]. The number of hypotheses depends on the situation and on the experience of the EMS clinicians in assessing patients.…”

Section: Resultsmentioning

confidence: 99%

“…The number of hypotheses depends on the situation and on the experience of the EMS clinicians in assessing patients. More experience provided a higher specificity in patient hypotheses [32, 37–39, 42, 55]. A lack of experience of specific diagnoses sometimes resulted in a feeling among clinicians of being ready to act but not being confident in the situation [32].…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Clinical reasoning in the emergency medical services: an integrative review

Andersson

Söderholm

Sundström

et al. 2019

Scand J Trauma Resusc Emerg Med

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Clinical reasoning is the process of gathering and understanding information conducted by clinicians in the emergency medical services (EMS) so as to make informed decisions. Research on clinical reasoning spans several disciplines, but a comprehensive view of the process is lacking. To our knowledge, no review of clinical reasoning in the EMS has been conducted. Aim The aim was to investigate the nature, deployment, and factors influencing EMS clinicians’ clinical reasoning by means of a review. Method Data was collected through searches in electronic databases, networking among research teams, colleagues and friends, “grey literature,” and through ancestry searches. A total of 38 articles were deemed eligible for inclusion and were analyzed using descriptive thematic analysis. The analysis resulted in an overarching finding - namely, the importance for EMS clinicians to adjust for perceived control in unpredictable situations. Within this finding, 3 themes emerged in terms of EMS clinicians’ clinical reasoning: (1) maintaining a holistic view of the patient; (2) keeping an open mind; and (3) improving through criticism. Seven subthemes subsequently emerged from these three themes. Results This review showed that EMS clinicians’ clinical reasoning begins with the information that they are given about a patient. Based on this information, clinicians calculate the best route to the patient and which equipment to use, and they also assess potential risks. They need to be constantly aware of what is happening on the scene and with the patient and strive to control the situation. This striving also enables EMS clinicians to work safely and effectively in relation to the patient, their relatives, other clinicians, associated organizations, and the wider community. A lack of contextually appropriate guidelines results in the need for creativity and forces EMS clinicians to use “workarounds” to solve issues beyond the scope of the guidelines available. In addition, they often lack organizational support and fear repercussions such as litigation, unemployment, or blame by their EMS or healthcare organization or by patients and relatives. Conclusion Clinical reasoning is influenced by several factors. Further research is needed to determine which influencing factors can be addressed through interventions to minimize their impact on patient outcomes. Electronic supplementary material The online version of this article (10.1186/s13049-019-0646-y) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical reasoning in the emergency medical services: an integrative review

Andersson

Söderholm

Sundström

et al. 2019

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

show abstract

“…The longer time was due to a longer fixation duration rather than a large fixation count. members should not neglect information from patients' significant others [39,48,49,55]. They can be valuable sources of information to manage the emergency situation to a satisfying conclusion.…”

Section: Situation Awarenessmentioning

confidence: 99%

“…More observable are markers such as seeking medical advice initiating treatment [47], seeking input on various transport-related issues with all relevant parties [44], and objectively evaluating and discussing clinical and other relevant considerations with team members [44,56] to arrive at a suitable course of action [51]. These communication interactions occur more frequently in non-routine situations since courses of actions are already known in routine situations [49,60].…”

Section: Generating and Considering Optionsmentioning

confidence: 99%

Cognitive skills of emergency medical services crew members: a literature review

Sedlár

2020

BMC Emerg Med

Self Cite

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Background: Situation awareness and decision making, listed in non-technical skills taxonomies, are critical for effective and safe performance in high-risk professions. These cognitive skills and their behavioral markers have been studied less in emergency medical services (EMS) crew members. This paper aims to review the existing literature and identify important aspects and behavioral markers of situation awareness and decision making in EMS crew membersthose who work in the role of prehospital emergency care providersand to synthesize findings as a basis for developing a rating and training tool. Method: The search for relevant articles was conducted using electronic databases, reference lists of relevant reviews and included articles and personal collection of articles. The selection process based on the PRISMA statement yielded a total of 30 articles that met the eligibility criteria. Their findings were qualitatively synthesized using the structured approach, informed by the already known structure: situation awareness and its elements (gathering information, interpreting information, anticipating future states), decision making and its elements (generating and considering options, selecting and implementing an option, reviewing outcome/decision). Moreover, the element of maintaining standards also emerged as highly relevant for cognitive skills. Results: This review found an increased research interest in the non-technical cognitive skills of EMS crew members. The majority of included articles' research designs were qualitative, then mixed, Delphi, and quantitative. It revealed several specifics of cognitive skills, such as EMS crew members need to holistically assess a wide range of cues and information, to make various health-and safety-related decisions and take EMS standards into account. However, there was only a limited number of observable markers of cognitive skills, such as acts and verbalizations, that could be considered as examples of good behavior. In addition, findings indicate a lack of articles focused on mass-casualty incidents and the interconnection of cognitive skills with other non-technical and medical skills. Conclusion: Further research is needed to get a more comprehensive view of behavioral markers of cognitive skills and to develop a rating and training tool to improve EMS crew members' cognitive performance.

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Prior Participation in Simulation Events Is Associated With Insimulation Team Performance Among Emergency Medical Services Professionals

Gurňáková

Gröpel

2019

Sim Healthcare

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The below simulation cases were introduced in the 19th International EMS Competition "RALLYE REJVÍZ" which was held in Kouty nad Desnou (Czech Republic) on May 27-31, 2015. The cases were designed by experienced EMS instructors and modelled just as close to actual situations as possible. Each case was performed in a corresponding natural environment (e.g., in forest, at school, in a pub) in Kouty nad Desnou and surrounding communities; trained actors served as patients. Firefighters and the police with their standard equipment were also present in the case they were part of the simulation scenario. Before the competition, EMS crews received a schedule and a map with the locations where the scenes were set. The crews used their own ambulances (fully equipped) for transportation between the scenes. In the main competition, the results of which are reported in this study, the daily tasks were completed on May 29, 2015, and the night tasks in the night from May 29 to 30. Description of the tasks is presented below. Detailed scoring system for each task is presented in Supplemental Digital Content 2. Reproduced with permission from http://rallye-rejviz.com/rallye-rejviz-2015/ BRAVE MAN Case Summary: A biker (man, 25 years) has bumped into tree branches during a downhill ride through the forest and fallen from bike; he has massive hemorrhage from the right side of the neck and from the front area right side of the chest. He has helmet, lies on his left side, is pale, has wet skin, is conscious, answers with latency, is oriented, and dyspneic. Pharmacological anamnesis: negative; allergological anamnesis: NSAID; personal history: negative. Assessment: GCS 4-5-6; SpO2 88%; glycaemia 20.2 mmol/l (363.6 mg/dl); BP 90/50 mmHg; peripheral pulses 120/min; weak radial pulse; capillary refill time 4s; RR 24/min; normal neurological status; breaking contused wound on the right side of the neck with massive bleeding from the vena jugularis externa; deviation of trachea to the left; penetrating injury in right front axillar line in the 3th-4th intercostal space; breath sounds are normal on the left, they are absent on the right; begin subcutaneous emphysema and hyperresonance by percussion; abdomen negative; pelvis fixed; legs without edema; abrasions on the legs and arms.Objectives: Assess the scene; demonstrate a safe approach; take the patient's history (incl. allergological anamnesis); perform a thorough clinical examination; AcBCDE approach; stop bleeding from the v. jugularis externa l. dx.; take off the helmet; put a neck collar; treat the pneumothorax l. dx. by semipermeable dressing or chest drain; treat the evolving hemorrhagic shock and pain; direct the patient to the trauma center optimally by helicopter rescue; recognition of diabetes mellitus. INSTRUCTION FOR PERSONNELEmergency Dispatch Center has received an emergency call from a woman: A man, 25 years old, has fallen from MTB bike in the forest, massive hemorrhage from the neck and the chest, he is conscious, further details not known. Your task:• Assess the scene ...

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Situation Assessment and Decision Making Strategies of Emergency Medical Services Physicians in Routine and Non-Routine Situations

Cited by 5 publications

References 22 publications

Clinical reasoning in the emergency medical services: an integrative review

Clinical reasoning in the emergency medical services: an integrative review

Cognitive skills of emergency medical services crew members: a literature review

Prior Participation in Simulation Events Is Associated With Insimulation Team Performance Among Emergency Medical Services Professionals

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