Skip to Main Content
 

Global Search Box

 
 
 
 

Files

File List


osu1291139651.pdf (7.5 MB)

ETD Abstract Container

Abstract Header

Utilizing Control in Emergency Medical Services: Expertise in Paramedics

Smith, Michael William
http://rave.ohiolink.edu/etdc/view?acc_num=osu1291139651

Abstract Details

2010, Doctor of Philosophy, Ohio State University, Industrial and Systems Engineering.
Paramedics provide pre-hospital care by virtue of demonstrating competency (in terms of knowledge and skills) and following protocols. At the same time, they serve as a major bridge between the hospital where emergency care is provided, and the complex world where a diversity of people, health problems, and environments interact to bring about emergency situations. As such, paramedics must manage complex, ambiguous, and novel situations under dynamic time and resource constraints. Expertise develops to fill in the gap between the protocols and associated competencies on one side, and the demands of the complex world on the other side. The expertise developed by paramedics reflects the nature of the challenges they confront. Given the increasing interdependency between components in the health care system, and the greater breadth and complexity of cases confronting paramedics, it is important to conduct systematic exploration of paramedics’ capabilities in responding to the demands of the complex world. To investigate these issues, a two-phase cognitive systems engineering research study was conducted. The first phase used knowledge elicitation methods with a focus group panel of subject matter experts to clarify the challenges and trends affecting EMS work, and to define specific challenge cases that highlight expert performance in paramedics. The second phase was a staged-world study, incorporating two of these challenge cases into scenarios (a chest pain diagnosis scenario and a multiple patient management scenario). New paramedics (twelve months or less of experience) and very experienced paramedics (identified by supervisors as experts) went through these scenarios in a mixed-fidelity simulation. For the chest pain diagnostic scenario, half of the less experienced paramedics correctly determined that it was not a cardiac issue, but none of them pursued alternate explanations very thoroughly. The more experienced paramedics went beyond standard procedures for determining whether chest pain is a heart attack or not. They explored more alternate explanations, and were more likely than the less experienced paramedics to identify the issue (pulmonary embolism) without additional cues. In the multiple patient scenario, the more experienced paramedics switched focus of attention from one patient to the other more frequently, and used their Emergency Medical Technician (basic level) partner to perform a greater variety of tasks than did the less experienced paramedics. In both scenarios, the expert paramedics were able to modify their approaches to respond to the demands of the situations, whereas the less experienced paramedics were relatively more static in their approaches. These results highlight important aspects of performance that are not captured by traditional concepts of competency, nor by protocols. Furthermore, the adaptive capacities of these experts, and their abilities to employ broader means of control, have implications in the context of distributed care. These facets of expertise enable greater control of patient disposition and utilization of resources in the service of care for that particular patient, and the future capabilities of the paramedic unit.
David Woods, PhD (Advisor)
Philip Smith, PhD (Other)
Sharon Schweikhart, PhD (Other)
251 p.
Educational Evaluation; Health Care; Industrial Engineering
expertise; paramedics; emergency medical services; cognitive systems engineering; knowledge elicitation; staged-world

Recommended Citations

Citations

  • Smith, M. W. (2010). Utilizing Control in Emergency Medical Services: Expertise in Paramedics [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1291139651

    APA Style (7th edition)

  • Smith, Michael. Utilizing Control in Emergency Medical Services: Expertise in Paramedics. 2010. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1291139651.

    MLA Style (8th edition)

  • Smith, Michael. "Utilizing Control in Emergency Medical Services: Expertise in Paramedics." Doctoral dissertation, Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1291139651

    Chicago Manual of Style (17th edition)

osu1291139651
1,195
© 2010, all rights reserved.
This open access ETD is published by The Ohio State University and OhioLINK.