Risk Negotiation in Critical Care Teams

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 - specialist teams with extra training, equipment and expertise in treating patients with a critical care need who have suffered a major trauma.

Professor Jo Angouri is working in collaboration with Welsh Ambulance Services University NHS Trust to look at the way decisions in the ambulance control rooms are made, in order to improve the process of getting critical care to the people who need it most.

The challenge

After a 999 call is received for a critically ill or injured patient, a specialist team is dispatched as quickly as possible.

These specialist teams are small and have finite resources, so it is important that they are only sent to emergencies where they are needed. Getting the right information to make this decision in the heat of the moment can be very difficult.

There are 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 (P.A.R.S.E.999).

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 Charitable Trust (WAACT) and the Welsh Ambulance Services NHS Trust (WAST) to undertake research to address these challenges.

The multidisciplinary team has been working on the project more than five years. Their research investigates how critical care teams navigate the complexities of medical emergencies dispatch decision making, and how they collaborate under pressure to deliver critical care whilst making the most efficient use of limited resource.

The study, Landscaping Risk in Medical Emergencies, identified consistent patterns that have been translated into publicly accessible training resources aimed at enhancing pre-hospital care practices.

A key component of this study involved examining 999 calls before and during the pandemic to determine if Covid-19 changed the way that critical care teams respond to emergencies. Professor Angouri explains: “We looked at a selection of all 999 calls where a critical care team is sent to the scene, and we have also studied the policy frameworks of the teams involved in the management of the cases.”

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, the research identifies patterns in how teams assess, manage and respond to risk, while ensuring the provision of life-saving care.”

The findings were translated into resources to inform training programmes, contributing to emergency protocols, and guiding policy development within trauma and critical care. As part of this work, the team developed resources to support healthcare professionals, as well as inform broader policymaking.

These tools are now available to aid trauma teams and emergency workers in enhancing their practices. The tools are based on the team’s research and support training for new and existing staff working in critical care, and ambulance staff working alongside the service.