Applying Crew Resource Management tools in Emergency Response Driving and patient transport-Finding consensus through a modified Delphi study.

BACKGROUND: Emergency Response Driving (ERD) comprises a significant risk to safety in Emergency Medical Services (EMS). Crew Resource Management (CRM) tools play a major role in securing actions in high-risk procedures. The aim of this study was to find consensus on the important factors to consider when applying CRM tools in ERD and patient transport. METHODS: ERD experts (n = 50) were recruited for a modified three-round Delphi study. Round 1 was based on previous research. The experts evaluated the items as important, neutral, or not important. The predetermined level of consensus was set at ≥ 80%. Answers given to the open-ended questions were analyzed using inductive content analysis. RESULTS: Predetermined consensus was reached on 64 of 86 presented items (74.4 %). The mean values of items reaching consensus varied between 3.81 and 4.86 on a five-point Likert scale. The items where consensus was reached were rated as "important" on a trichotomized scale. CONCLUSION: Multiple important factors to consider when applying CRM tools to ERD and patient transport were highlighted. This study provides valuable information to consider regarding EMS safety improvements. Further scientific research is needed to develop comprehensive recommendations.

Structured communication during emergency response driving: Safety-critical points identified by Finnish emergency response driving experts.

BACKGROUND: Emergency response driving (ERD) is a major occupational risk factor in emergency medical services (EMS). Inadequate communication has been acknowledged as a significant contributing cause for major incidents during ERD. Previous evidence shows that structured communication can promote safety in high-risk procedures, but knowledge in ERD context is lacking. The aim of this study was to examine what are the safety-critical points in ERD that should be secured using structured communication. METHOD: The nominal group technique (NGT) was used for gathering interview material from ERD experts' (n = 11) workshop. In addition, semi-structured thematic interviews were conducted with other ERD experts (n = 15) from five different EMS areas in Finland. The interview material was analyzed using inductive content analysis. RESULTS: Using NGT, 13 safety-critical points in ERD requiring the use of structured communication were identified. As a result of the interviews, two main categories were found: 1) Factors affecting the adaptation of the appropriate speed for the current situation and 2) Factors affecting orientation in a driving event. CONCLUSION: ERD comprises multiple safety-critical points that should be secured using structured communication between ambulance crew members. Pilot and implementation studies exploring the use of structured communication in ERD are needed in the future.

Safety Checklists for Emergency Response Driving and Patient Transport: Experiences from Emergency Medical Services.

BACKGROUND: Emergency response driving (ERD) is considered one of the most significant occupational risk factors affecting both patient and traffic safety in emergency medical services (EMS). The majority of the risk factors in ERD are crew related and could be affected positively with crew resource management (CRM). The aim of this study was to examine how the safety checklists developed for ERD and patient transport are experienced in practical work in EMS by paramedics. METHODS: Safety checklists for ERD and patient transport were developed and then piloted in practical work among 30 paramedics in five different EMS areas around Finland for a two-month period in fall 2019. Afterward, semistructured thematic interviews were performed with the pilot participants, and the material was analyzed using inductive content analysis. RESULTS: Paramedics experienced that use of ERD and patient transport safety checklists improved safety, and deployment of the checklists required systematic planning. Use of the safety checklists was seen as changing the mindset of the ERD drivers to a more safety critical stance and increasing a systematic approach to ERD. Paramedics also stated that when deploying the checklists in EMS, their use should be standardized as a nationwide operating model and that service-dependent fine-tuning is required. CONCLUSION: This study's findings support the use of ERD and patient transport safety checklists in practical work in EMS for promoting safety. In addition to safety checklists, other sections of CRM and its applications to EMS should also be studied.