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

项目摘要-院前紧急医疗服务(EMS)是 美国医疗保健体系，在医疗、公共卫生和公共卫生的交汇点上占据着至关重要的地位 安全。EMS专业人员的工作是独一无二的，在认知和身体层面上要求非常高，而且 需要高度适应性、坚定不移的弹性表现。每次调度的不可预测性， 场景设置和耐心的呈现结合了无数的表演塑造因素，这些因素往往非常 动态的和高度可变的。“实时”院前认知工作的研究，个人(EMS) 专业人员)和分布式/基于团队的级别(EMS与患者/护理人员的互动，911派遣)是 有限，尽管对于导航院前急诊固有的波动的风险程度是基本的 关心。为了回应有针对性的研究的需要，以支持被忽视的EMS认知工作领域，我们 建议建立Resilient_EMS患者安全学习实验室(PSLL)，专注于增强和 支持院前急救的安全性、质量和公平性。这个项目将特别关注 老年人的院前护理(≥65岁)。Resilient_EMS PSLL是为使用系统和人类定制的 支持EMS专业人员个体认知工作的创新要素工程方法 (例如，决策)并且以分布式方式(例如，共享心理模型)。因此，我们将进行4- 老年院前急救多年、多点、多方法实地考察，实现3个具体目标： 目标1.确定和定义影响个体和分布式认知工作系统的特征 院前复苏护理过程中的安全性、质量和公平性(派单呼叫过渡 护理)提供给有潜在危重的主要医疗(与创伤无关)主诉的老年人(例如， 呼吸窘迫、急性精神状态改变等)。目标2.与主要利益相关者共同设计 (EMS专业人员、患者(老年人)/护理人员、其他专业人员)支持的潜在解决方案 动态弹性所需的EMS专业人员(个人和基于团队的级别)的认知工作 采用“以人为本/包容性设计”的原则和方法进行表演。目标3.实施 并使用多管齐下的方法评估建议的设计/重新设计解决方案，以提高安全性/质量/ 通过支持和加强EMS为老年人提供复苏护理的连续过程中的公平 专业人士基于个人和分布式认知团队的工作。Resilient_EMS PSLL的长期影响 将是对非常具有挑战性的院前护理领域的新见解，这将有助于创造创新的 和包容性/以人为中心的解决方案。我们的研究团队由患者安全方面的专家组成， 因素，系统工程，通信，院前护理，急救医学，老年病学，护理， 健康差距，以及患者/家庭伴侣。这项研究将针对AHRQ的几个优先群体(老年人 成人、低收入、种族/少数民族、农村/市中心居民、妇女)。

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).