Complex Decision Making in Emergency Care

Complex Decision Making in Emergency Care

Supporting emergency medical teams to reach critically ill or injured patients

Ambulance services around the UK consist of various emergency care staff, including pre-hospital critical care teams. These are teams with extra training, equipment and expertise for assisting patients who need specialist care.

This case study draws on a programme of interdisciplinary sociolinguistic research co-led by Professor Jo Angouri, addressing a critical societal challenge: improving the decision-making and policy that underpin emergency medical dispatch (EMD). As emergency medical services (EMS) across the UK and globally face increasing pressure from limited human capacity, stretched resources, and rising demand, this research investigates how communication practices and institutional frameworks affect life-critical decisions.

The challenge

EMS in the UK and internationally are under significant pressure due to fiscal challenges, resource constraints, and rising demand for care.

Our programme of work is designed to address real-world gaps and identify opportunities for improving current and future systems and practice. It explores the interactional and institutional processes behind dispatch decisions made by EMS teams in high-stakes, rapidly evolving contexts. These decisions carry significant clinical, individual as well as economic consequences, with misjudgements leading to delays, resource inefficiency, and avoidable patient harm. The research directly responds to calls from health bodies (e.g. DHSC, WHO) for urgent reform of EMD systems.

The dispatching of specialist teams constitutes an under researched area, although it is critically relevant to EMS. These specialist teams are a finite resource and need to be sent to emergencies where they are needed the most. Getting the right information to make this decision in the heat of the moment is a complex process and one of relevance to any organisation that needs to decide when/how to dispatch its most finite resource.

Our work addresses two areas where research is urgently needed:

1. The role of backstage clinical teams in translating the caller/call-taker interaction in their internal risk negotiation.
2. The role of national, regional and organisational policy frameworks, protocols and regulations which directly influence how the different teams and professionals need to negotiate risk vis-a-vis institutional priorities, resource allocation and performance indicators.

Our approach

Professor Jo Angouri, a Sociolinguist and expert in Interaction Analysis at The University of Warwick, is working with colleagues from the University of Bristol, the Emergency Medical Retrieval and Transfer Service (EMRTS), Wales Air Ambulance Charity (WAA) and the Welsh Ambulance Services University NHS Trust (WAST) to undertake research to address these challenges.

A distinctive feature of this research is the application of a methodology for interactional sociolinguistic research, which Professor Angouri has developed over years of interdisciplinary research. This work (for an overview Angouri, et al., 2024) resulted to a model for a language-first, ethnographic approach to understanding clinical interaction, particularly in high-pressure, risk-intensive contexts. The underpinning research provided a strong foundation for engaging directly with ambulance services and for studying decision-making in EMD, a space typically inaccessible by social science research.

By drawing on Angouri’s established methodology, the team is able to study real-time negotiation of risk and communication and translate the results.

A unique component of this programme of work involves examining 999 cases from a system perspective and interdisciplinary angle. Professor Angouri explains: “We work with a sample of 999 full cases where a critical care team is sent to the scene, we have landscaped the system of decision making and key stakeholders involved. We are working on identifying ‘nodes’ where information may be lost and how our research can be translated to support the work of health care professionals.”

Our impact

The team is working to improve the process of getting critical care to the people who need it most.

Professor Angouri continues: “By analysing real-world data and practices from an interdisciplinary angle, the research identifies patterns in how teams assess, manage and respond to risk, while ensuring the provision of life-saving care.”

This programme of work has identified consistent patterns that have been translated into publicly accessible training resources aimed at enhancing pre-hospital care practices as well as policy guidelines. The team’s outputs include:

• Training resources are embedded in national EMD accreditation schemes.
• Health commissioners have adopted outputs for service implementation.
• Public awareness is being raised through campaigns and events. Dedicated materials for a wider audience such as Welsh translated materials and resources for children.
• Operational policy has been developed.
• Stakeholder involvement through governance meetings, training events, and user engagement sessions.
• Academic publications to help support research and development in this sector.