PP17 Verbalisation of plans during out-of-hospital cardiac arrest resuscitation. Issue 1 (14th January 2019) - Marzuki, Ernisa
Abstract : Background: Planning and communication are pivotal in achieving team goals. Studies have shown that teams with effective planning and sharing of mental models display better performance in resuscitation. The Advanced Life Support (ALS) algorithm serves as an overall script regarding specific stages during resuscitation, but it does not explicitly specify how tasks should be delegated or synchronised. Team members therefore need to rely on ongoing, context-specific shared plans for effective team coordination. Methods: In our research, we explore paramedic resuscitation teams' verbal communication from a discourse-analytic perspective. We analysed out-of-hospital cardiac arrest (OHCA) resuscitation videos, recorded using body cameras in the field, for plan verbalisation patterns and possible association with successful or unsuccessful outcomes. For the current study, the first five minutes of 10 OHCA resuscitations were transcribed and annotated using a bespoke coding scheme. We focused on how paramedics use language to coordinate their goals and manage the transitions between stages of the OHCA treatment process, and whether this is associated with the deployment of the mechanical compression device, AutoPulse. Results: All 10 videos showed similar patterns of plan verbalisation in the first five minutes. The amount of verbalised plans took up nearly half the spoken utterances of all teams, suggesting that paramedics actively shared plans with their team members. Early in the resuscitation, paramedics tended to concentrate on immediate, single-task goals (e.g. moving patient to ideal position) rather than long-term, multi-task goals (e.g. accessing airway). We found little communication of the team leader's overall mental model or script. Instead, plans were shared moment by moment. Based on the 10 videos, the timing of AutoPulse deployment seemed unaffected by the way plans were shared. Conclusion: This study enriches our understanding of real-life planning and sharing of mental models during resuscitation. Through these, we can contribute to the betterment of professional interaction in this critical domain.