Cognitive Factors in Emergency Medical Services

Authored by: Evan McHughes Palmer

Human Factors and Ergonomics of Prehospital Emergency Care

Print publication date:  March  2017
Online publication date:  March  2017

Print ISBN: 9781482242515
eBook ISBN: 9781315280172
Adobe ISBN:


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A call comes in from a dispatch to the emergency medical services (EMS) post: “57-year-old female, unconscious.” The paramedics jump in the truck, leave the station, and head into traffic with lights on and the sirens blaring. The driver negotiates traffic as quickly as possible, sometimes driving on the left side of the road, sometimes on the right, proceeding through red lights while vigilantly scanning to make sure traffic is yielding to the ambulance. The partner pulls up the dispatch information, reads a description of the situation, and then switches over to a map to help navigate to the call location. Upon arriving at the scene, the paramedics are met at the door by the patient?s husband, who leads the team up to the second floor bedroom. By this time, the fire department?s first responders are also on the scene and five emergency personnel crowd into the small bedroom with the husband. The patient is not unconscious after all, but is lethargic and unable to rise from the bed. Her skin is cold and clammy to the touch, her heart rate is less than 50 beats per minute, and she reports feeling nauseous and faint. The lead paramedic on this call starts asking her questions. “What have you eaten today? How much have you had to drink? Are you on any medications?” Through the line of questioning, a picture starts to emerge about the situation. The paramedic is concerned about the slow heart rate, but the patient assures him that her heart rate is always slow. The team administers antinausea medication by estimating the weight of the patient and choosing the right dose after performing complicated mental calculations, taking into consideration her age and comorbidities that may affect the medication?s safety. The medication dosage is cross-checked between the team members to make sure that they have calculated the dosage correctly. The team also starts to administer intravenous (IV) fluid since they have determined that one of the patient?s problems is that she is severely dehydrated. After a few minutes, the patient is well enough to stand and is loaded into a chairlift for transport down the stairs and out to the ambulance. She gets out of the stair chair and onto the stretcher under her own power. On the way to the emergency room, the paramedic in the back with the patient continues to administer fluids and gives another round of antinausea medications, again after calculating the correct dosage. He hooks up a 12-lead electrocardiograph (EKG) to the patient to assess for myocardial ischemia or injury as a step in his process of confirming or disconfirming his suspected diagnostic hypothesis. He switches between entering patient information into a laptop, radioing ahead to the emergency room, and keeping up a dialogue with the patient to better understand her medical situation. Once at the hospital, the patient is transferred to the emergency department staff and the paramedic recaps all that he learned about the medical situation and the aid he provided up to that point. Finally, with the call over, the paramedics restock the truck and prepare for their next call.

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