Resilient EMS PSLL: Using a Systems Engineering Approach to Enhance EMS Cognitive Work and Safety for Older Adults During Prehospital Care.

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Project Summary- Prehospital Emergency Medical Services (EMS) are an indispensable component of the US health care system, occupying a crucial role at the intersection of medical care, public health, and public safety. EMS professionals' work is unique, extraordinarily demanding at cognitive and physical levels, and requires highly adaptive, unwaveringly resilient performances. The unpredictable nature of each dispatch, scene setting and patient presentation brings together a myriad of performance shaping factors that often very dynamic and highly variable. Study of `real time' pre-hospital cognitive work, at the individual (EMS professionals) and distributed/ team-based levels (EMS interactions with patients/caregivers, 911 dispatch) is limited despite being fundamental for navigating fluctuating degrees of risk inherent in prehospital emergency care. In response to the need for targeted research in support of overlooked areas of EMS cognitive work, we propose to establish the Resilient_EMS Patient Safety Learning Lab (PSLL), focused on enhancing and supporting safety, quality, and equity within pre-hospital emergency care. This project will focus particularly on prehospital care of older adults (≥ 65 yrs). The Resilient_EMS PSLL is tailored to use systems and human factors engineering approaches to innovate in support of EMS professionals' cognitive work as individuals (e.g., decision making) and in a distributed manner (e.g., sharing mental models). As such, we will conduct a 4- year, multi-site, multi-method field study of geriatric pre-hospital emergency care to achieve 3 specific aims: Aim 1. To identify and define individual and distributed cognitive work system characteristics that impact safety, quality, and equity along the continuum of prehospital resuscitative care (dispatch call transition of care) for older adults presenting with a `potentially critical' chief medical (non- trauma related) complaint (e.g., respiratory distress, acute onset of altered mental status etc.). Aim 2. To co-design with key stakeholders (EMS professionals, patients (older adults)/ caregivers, other professionals) potential solutions to support cognitive work of EMS professionals (individual and team/based levels) required for dynamic resilient performances using `human-centered/ inclusive design' principles and methodologies. Aim 3. To implement and evaluate proposed design/redesign solutions using a multi-pronged approach for improving safety/ quality/ equity along the continuum of resuscitative care for older adults through support and enhancement of EMS professionals' individual and distributed cognitive team-based work. Resilient_EMS PSLL's long term impact will be new insights into the very challenging domain of prehospital care that will aid in creation of innovative and inclusive/ human-centered solutions. Our research team is composed of experts in patient safety, human factors, systems engineering, communication, prehospital care, emergency medicine, geriatrics, nursing, health disparities, and patient/family partners. The study will address several AHRQ priority populations (older adults, low income, racial/ ethnic minorities, rural/inner-city residents, women).