Situation awareness in emergency medical dispatch
Introduction
Maintaining awareness of the situation is often key to success, particularly in dynamic situations that demand rapid decision making. Ambulance control—or emergency medical dispatch (EMD), to give it its formal title—is one such work domain. Understanding how situation awareness is developed and maintained can provide guidance for the design of systems that support this crucial perceptual and cognitive activity that sets the stage for decision making. Situation awareness (SA) is a phenomenon originally described by military aviators to refer to being vigilant in observing and drawing inferences from developments around them. We extend the study of SA into the domain of EMD.
EMD is defined as the “reception and management of requests for emergency medical assistance in an emergency medical services (EMS) system” (Clawson and Dernocoeur, 1998). It involves two broad aspects of work: call-taking, where calls for emergency medical assistance are received and prioritized; and controlling, where the most appropriate ambulance is dispatched to the emergency and ambulance resources are optimized in their areas of operations.
Section snippets
Background
As will emerge in the discussion of findings from this study, many different lines of research contribute to our understanding of EMD work. The focus of this paper is on the development and maintenance of Situation Awareness; however, it also relates to work on other forms of awareness and naturalistic decision making. We include a brief review of these topics. Other aspects of the work, such as its social nature (relying heavily on team working and coordination of actions), are also essential
Methodology
The field study reported in this paper involved a number of different methods of investigation, selected to be appropriate to the domain of study, and to provide complementary information to yield a broad understanding of the nature of the work of EMD operators.
- (i)
Initial interviews with senior and key management staff within the organization, including initial visits to the control room and reading corporate documentation on procedures and practices, identified formal current practice and issues
Emergency medical dispatch at an ambulance control centre
The ambulance control centre at which this field study was conducted is considered one of the busiest in the world. It receives at least 3200 emergency calls a day (compared to ‘hundreds’ in other control centres we have visited, or that described by Martin et al. (1997)). It is responsible for controlling about 400 emergency ambulances, 14 smaller fast response units and a helicopter, deployed over 70 ambulance stations distributed over a densely populated urban area of about 1600 km2.
Results and discussion
One key feature of EMD work that emerged from both the observation of routine work and the CDM interviews is that work can be classified broadly into three phases as follows.
- (i)
During routine work, the allocator is dealing with a large number of vehicles and incidents; each takes relatively little of the allocator's time; the primary focus of the allocator's concern is on the deployment of their vehicles, and relatively little attention needs to be paid to any incident once the initial decision
Conclusion
From this study, a number of observations can be made about SA in EMD at this control centre.
- (i)
Decisions are not made in isolation, but within the context of a dynamically changing situation. Awareness of this situation is therefore crucial.
- (ii)
Senior EMD operators practise an ‘information hub’ strategy that allows them to be made aware of changes in the different areas and activities they control.
- (iii)
EMD operators who demonstrate an awareness of SA describe a mental model that consists of a static set
Acknowledgements
We are grateful to the management and many EMD staff who participated in this study. Feedback from referees on an earlier version of this paper was most helpful in guiding restructuring and clarification.
References (36)
- et al.
Effects of Integrated Graphical Displays on Situation Awareness in Anaesthesiology
Cognition, Technology and Work
(2002) A review of the Cocktail Party Effect
Journal of the American Voice I/O Society
(1992)- et al.
Contextual Design
(1998) - Blandford, A., Wong, B.L.W., Connell, I., Green, T., 2002. Multiple viewpoints on computer supported team work: A case...
- Clawson, J.J., Dernocoeur, K.B., 1998. Principles of Emergency Medical Dispatch, 2nd Edition. The National Academy of...
Toward a theory of situation awareness in dynamic systems
Human Factors
(1995)- et al.
Situation awareness in air traffic controlthe picture
- et al.
A comparative survey of the utility of cross-cockpit linkages and autoflight systems’ backfeed to the control inceptors of commercial aircraft
Ergonomics
(1998) - Finkelstein, A., Dowell, J., 1996. A comedy of errors: the London Ambulance Service case study. In: Proceedings of the...
- Gentner, S., Stevens, A.L. (Eds.), 1983. Mental Models. Lawrence Erlbaum, Hillsdale,...
The Presentation of Self in Everyday Life
Use of the critical decision method to elicit expert knowledgea case study in the methodology of cognitive task analysis
Human Factors
Who is flying this plane anyway? What mishaps tell us about crew member role assignment and air crew situation awareness
Human Factors
Mental Models
Overcoming representational errors in complex environments
Human Factors
Cited by (147)
Deep ensemble multitask classification of emergency medical call incidents combining multimodal data improves emergency medical dispatch
2021, Artificial Intelligence in MedicineSurgeons' expertise during critical event in laparoscopic cholecystectomy: An expert-novice comparison using protocol analysis
2020, American Journal of SurgeryIntelligent assistant system as a context-aware decision-making support for the workers of the future
2020, Computers and Industrial EngineeringAn interview analysis of coordination behaviours in Out–of–Hours secondary care
2019, Applied Ergonomics
- 1
Authors are listed alphabetically; both have contributed equally to this paper.
- 2
Present address: Interaction Design Centre, School of Computing Science, Middlesex University, Trent Park, Bramley Road, London N14 4YZ, UK.