UT Health-San Antonio, Department of Emergency Medicine, San Antonio, Texas.
The University of Texas at Austin, Department of Psychiatry, Austin, Texas.
West J Emerg Med. 2020 Oct 19;21(6):264-271. doi: 10.5811/westjem.2020.7.47238.
Effective teamwork has been shown to optimize patient safety. However, research centered on the critical inputs, processes, and outcomes of team effectiveness in emergency medical services (EMS) has only recently begun to emerge. We conducted a theory-driven qualitative study of teamwork processes-the interdependent actions that convert inputs to outputs-by frontline EMS personnel in order to provide a model for use in EMS education and research.
We purposively sampled participants from an EMS agency in Houston, TX. Full-time employees with a valid emergency medical technician license were eligible. Using semi-structured format, we queried respondents on task/team functions and enablers/obstacles of teamwork in EMS. Phone interviews were recorded and transcribed. Using a thematic analytic approach, we combined codes into candidate themes through an iterative process. Analytic memos during coding and analysis identified potential themes, which were reviewed/refined and then compared against a model of teamwork processes in emergency medicine.
We reached saturation once 32 respondents completed interviews. Among participants, 30 (94%) were male; the median experience was 15 years. The data demonstrated general support for the framework. Teamwork processes were clustered into four domains: planning; action; reflection; and interpersonal processes. Additionally, we identified six emergent concepts during open coding: leadership; crew familiarity; team cohesion; interpersonal trust; shared mental models; and procedural knowledge.
In this thematic analysis, we outlined a new framework of EMS teamwork processes to describe the procedures that EMS operators employ to convert individual inputs into team performance outputs. The revised framework may be useful in both EMS education and research to empirically evaluate the key planning, action, reflection, and interpersonal processes that are critical to teamwork effectiveness in EMS.
有效的团队合作已被证明可以优化患者安全。然而，最近才开始有研究关注急救医疗服务（EMS）中团队有效性的关键投入、过程和结果。我们对一线 EMS 人员的团队合作过程（将投入转化为产出的相互依存的行动）进行了理论驱动的定性研究，以便为 EMS 教育和研究提供一个模型。
我们从休斯顿的一家 EMS 机构有目的地抽取了参与者。具有有效紧急医疗技术员执照的全职员工有资格参加。我们使用半结构化格式询问受访者在 EMS 中的任务/团队职能以及团队合作的促进因素/障碍。电话访谈进行了录音和转录。使用主题分析方法，我们通过迭代过程将代码合并为候选主题。在编码和分析过程中，分析备忘录确定了潜在的主题，这些主题经过审查/完善，然后与急诊医学中的团队合作过程模型进行了比较。
在 32 名受访者完成访谈后，我们达到了饱和。在参与者中，有 30 名（94%）是男性；中位数经验为 15 年。数据普遍支持该框架。团队合作过程分为四个领域：计划；行动；反思；和人际过程。此外，我们在开放式编码过程中确定了六个新出现的概念：领导力；机组人员熟悉度；团队凝聚力；人际信任；共享心理模型；和程序知识。
在这个主题分析中，我们概述了一个新的 EMS 团队合作过程框架，以描述 EMS 操作人员将个人投入转化为团队绩效产出所采用的程序。修订后的框架在 EMS 教育和研究中可能很有用，可以从经验上评估对 EMS 团队有效性至关重要的关键规划、行动、反思和人际过程。
