Emergency medical services (EMS) teams are first responders providing urgent medical care to severely ill or injured patients in the field. Despite their criticality, EMS work is one of the very few medical domains with limited technical support. This paper describes a study conducted to examine technology opportunities for supporting EMS data work and decision-making. We transcribed and analyzed 25 simulation videos. Using the distributed cognition framework, we examined EMS teams' work practices that support information acquisition and sharing. Our results showed that EMS teams leveraged various mechanisms (e.g., verbal communication and external cognitive aids) to distribute cognitive labor in managing, collecting, and using patient data. However, we observed a set of prominent challenges in EMS data work, including lack of detailed documentation in real time, situation recall issues, situation awareness problems, and challenges in decision making and communication. Based on the results, we discuss implications for technology opportunities to support rapid information acquisition, integration, and sharing in time-critical, high-risk medical settings.
more »
« less
Characteristics and Challenges of Clinical Documentation in Self-Organized Fast-Paced Medical Work
Clinical documentation is a time-consuming and challenging task, especially in time-critical medical settings. Even with a dedicated scribe person, timely and accurate documentation under time constraints is never easy. In this work, we present a unique type of fast-paced medical team--emergency medical services (EMS)--which has no designated role for documentation while constantly working outside in the field to provide urgent patient care. Through interviews with 13 EMS practitioners, we reveal several interesting and prominent characteristics of EMS documentation practice as well as their associated challenges: EMS practitioners self-organize and collaborate on documentation while in the meantime being both physically and cognitively preoccupied with high-acuity patients, having limited capability to use handheld documentation systems in real-time, and being overwhelmed by strict documentation requirements and regulations. Lastly, we use our findings to discuss both technical and non-technical implications to support timely and collaborative documentation in dynamic medical contexts while accounting for care providers' physical and cognitive constraints in using computing devices.
more »
« less
- Award ID(s):
- 1948292
- PAR ID:
- 10463037
- Date Published:
- Journal Name:
- Proceedings of the ACM on Human-Computer Interaction
- Volume:
- 6
- Issue:
- CSCW2
- ISSN:
- 2573-0142
- Page Range / eLocation ID:
- 1 to 21
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
More Like this
-
-
Designing AI-enabled decision support for fast-paced medical teams remains underexplored. We use Emergency Medical Services (EMS) as a critical use case to examine where AI can, and should not, support time-critical decision-making. We conducted participatory design workshops and formative user evaluations with EMS providers to elicit, prototype, and critique candidate AI application areas for EMS work. Providers identified several promising uses of AI: (1) AI-enabled information retrieval to accelerate access to protocols and medication references; (2) speech-based documentation support to reduce charting burden and generate draft records during care; (3) AI-generated patient “snapshots” that summarize relevant history from prior encounters; and (4) AI-based medication recognition to identify home medications and surface key safety information. In contrast, participants were cautious about clinical reasoning support that could be interpreted as diagnostic assertions, ambient “always-on” monitoring to flag errors or workflow deviations, and voice-based exchanges with AI in front of patients. Across various concepts, providers emphasized key factors critical for AI adoption in EMS, including seamless workflow fit, robustness to noisy environments, transparency, appropriate trust calibration, and the preservation of professional autonomy. We conclude with design implications for responsibly advancing the use of AI technology for EMS decision support.more » « less
-
Emergency medical services (EMS) providers often face significant challenges in their work, including collecting, integrating, and making sense of a variety of information. Despite their criticality, EMS work is one of the very few medical domains with limited technical support. To design and implement effective decision support, it is essential to examine and gain a holistic understanding of the fine-grained process of sensemaking in the field. To that end, we reviewed 25 video recordings of EMS simulations to understand the nuances of EMS sensemaking work, including 1) the types of information and situation that are collected and made sense of in the field; 2) the work practices and temporal patterns of EMS sensemaking work; and 3) the challenges in EMS sensemaking and decision-making process. Based on the results, we discuss implications for technology opportunities to support rapid information acquisition and sensemaking in time-critical, high-risk medical settings such as EMS.more » « less
-
While crew configuration in primary care settings has been studied in terms of its impact on patient outcomes, less is known about how it influences the members' workload experience. This study investigates the workload implications of crew configuration based on members' certification in emergency medical services (EMS). Advanced life support (ALS) ambulance crews are commonly comprised of two paramedics (homogeneous crew) or an emergency medical technician (EMT) and a paramedic (heterogeneous crew). The goals of this study were the following: (1) to investigate differences in workload among members of the same crew, and (2) to use workload assessments to inform crew configuration strategies. We mapped one year of an EMS system's dispatch data to members' workload estimates using the visual, auditory, cognitive, and psychomotor (VACP) approach. We found that lead members (lead paramedics) experience higher workload levels compared to support members (support paramedics or EMTs) in both types of crews. Neither configuration had a consistently lower workload than the other, but differences varied for different shifts and stations. These results informed crew configuration recommendations for stations and shifts in the collaborating system, and in terms of more generalizable variables. A minimum number of staffed crews, half-half shift type (covering both day and night hours), and 30-day frequency of calls with priority P7 most significantly impacted the recommended crew configurations.more » « less
-
Abstract Objective This study aims to investigate key considerations and critical factors that influence the implementation and adoption of smart glasses in fast-paced medical settings such as emergency medical services (EMS). Materials and Methods We employed a sociotechnical theoretical framework and conducted a set of participatory design workshops with 15 EMS providers to elicit their opinions and concerns about using smart glasses in real practice. Results Smart glasses were recognized as a useful tool to improve EMS workflow given their hands-free nature and capability of processing and capturing various patient data. Out of the 8 dimensions of the sociotechnical model, we found that hardware and software, human-computer interface, workflow, and external rules and regulations were cited as the major factors that could influence the adoption of this novel technology. EMS participants highlighted several key requirements for the successful implementation of smart glasses in the EMS context, such as durable devices, easy-to-use and minimal interface design, seamless integration with existing systems and workflow, and secure data management. Discussion Applications of the sociotechnical model allowed us to identify a range of factors, including not only technical aspects, but also social, organizational, and human factors, that impact the implementation and uptake of smart glasses in EMS. Our work informs design implications for smart glass applications to fulfill EMS providers’ needs. Conclusion The successful implementation of smart glasses in EMS and other dynamic healthcare settings needs careful consideration of sociotechnical issues and close collaboration between different stakeholders.more » « less
An official website of the United States government

