Examining Cognitive Aid Use in Emergency Medical Services: A Cross-Sectional Survey

Bryan Harmer; Melissa Ivey; John Hoyle, Jr.; Kieran Fogarty

doi:10.56068/JMRQ7592

PDF (Final)

Published: Apr 3, 2024

DOI: https://doi.org/10.56068/JMRQ7592

Keywords:

Cognitive Aids Checklists Pocket Guides Patient Safety Prehospital Human Factors emergency medical services EMS paramedicine

Bryan Harmer, PhD(c), CCP, IC

Western Michigan University School of Medicine

Melissa Ivey, MPH

No Affiliation

John D. Hoyle, Jr. MD

Western Michigan University Homer Stryker, MD School of Medicine

Kieran J. Fogarty, PhD

Western Michigan University

Abstract

Background: Emergency Medical Service (EMS) clinicians render care in less than ideal environments, and errors occur at high rates. Some cognitive aids (CAs) have been shown to reduce errors and improve adherence to evidence-based practices. However, there have been no widespread studies examining CA use in EMS. The objective of this study was to examine the frequency of CA use by EMS clinicians and which clinicians were using them more frequently during patient care.

Methods: A cross-sectional online survey was developed using a modified Delphi method with items examining demographic information and the frequency that 15 selected CAs are used during patient care. A survey link was emailed to 136,093 EMS clinicians across six states (TX, ME, MI, LA, SC, and AR). Descriptive statistics were used to describe frequencies. Kruskal-Wallis was used to assess if use differed among demographic or employment groups, and Spearman correlation was used to examine the relationship between clinician age and CA use.

Results: A total of 2,251 respondents were included in the study after meeting the inclusion criteria. Of the 15 CAs examined, the length-based tape was the most used (Med= 3.0, IQR: 1.0 – 4.0). Overall CA use was limited, with a median score of 1.67 (IQR: 1.07 – 2.27). The following groups reported more frequent use of CAs: females (Med= 1.87, IQR: 1.27-2.47), Hispanics (Med= 1.93, IQR: 1.33-2.67), Black/African Americans (Med= 2.00, IQR: 1.20-2.53), air medical clinicians (Med= 2.00, IQR: 1.60-2.40) and clinicians working in military settings (Med= 2.23, IQR: 1.80-2.80). A small negative correlation was identified with age (r = -0.06, p = .005).

Conclusions: Overall, CA use in EMS is limited. More effort is needed to increase their use in EMS. This data may provide insight to better target areas of need, improve design, and improve implementation of CAs in EMS.

How to Cite

Harmer, B., Ivey, M., Hoyle, Jr. , J., & Fogarty, K. (2024). Examining Cognitive Aid Use in Emergency Medical Services: A Cross-Sectional Survey. International Journal of Paramedicine, (6), 48–61. https://doi.org/10.56068/JMRQ7592

Issue

No. 6 (2024): April - June, 2024

Section

Research Reports

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Author Biographies

Bryan Harmer, PhD(c), CCP, IC, Western Michigan University School of Medicine

Bryan has 20 years of experience in Emergency Medical Services (EMS). He has experience responding as a critical care paramedic in both rural and urban EMS settings. He participated in various EMS committees aimed at improving quality of care, and helped develop several educational programs. In addition to his field experience, he is also an EMS Instructor-Coordinator, and has been involved in EMS education for nearly 15 years. He is currently a full-time Professor and EMS Simulation Coordinator at Lansing Community College (LCC), and clinical faculty at Western Michigan University Homer Stryker M.D. School of Medicine (WMed). While at LCC, he has participated in several committees within the college, national organizations, and at the Michigan Department of Health and Human Services Bureau of EMS and Trauma Preparedness (MDHHS-BETP). He has designed and restructured several curricula including the nationally-recognized Military Medic to Paramedic program. He worked closely with the MDHHS-BETP to develop the first college-based Community Paramedicine program in Michigan. He holds a Masters in Health Professions Education from Michigan State University, and is currently a doctoral candidate at Western Michigan University in the Interdisciplinary Health Sciences program. The focus of Bryan's research is on human factors in patient safety and simulation. He is currently collaborating with the WMed and Michigan Medicine on studies examining pediatric medication errors in EMS.

Melissa Ivey, MPH, No Affiliation

Melissa is a trained epidemiologist with over 14 years of experience in government, international NGO, and private settings. She also serves as a peer reviewer for public health and preparedness journals. She has extensive experience in Quantitative and qualitative research design, implementation, and analysis, descriptive, univariate, and multivariate data analysis including regression modeling, development of research protocols, reports, and presentations for professional and lay audiences, survey design and validation, review of articles for journal publication, dissertation and thesis coaching and editing

John D. Hoyle, Jr. MD, Western Michigan University Homer Stryker, MD School of Medicine

Dr. John D. Hoyle, Jr. is Board Certified in Emergency Medicine, Pediatric Emergency Medicine, Pediatrics and Emergency Medical Services. Dr. Hoyle is the first and thus far, the only physician to obtain these four board certifications in the United States. There are only approximately 3130 physicians in the US that hold 4 board certifications. He is a Professor in the Department of Emergency Medicine and the Department of Pediatric and Adolescent Medicine. He is a graduate of Transylvania University in Lexington, Kentucky with a BA in Biology and Psychology in May 1989. He earned his MD from the University of Kentucky College of Medicine in May 1994. He completed a combined residency in emergency medicine and pediatrics at Methodist Hospital of Indiana, Indiana University School of Medicine in Indianapolis, Indiana in June 1999.

Dr. Hoyle has clinical and research interests in Pediatric Emergency Medicine and Emergency Medical Services. Before coming to Western Michigan University Homer Stryker M.D. School of Medicine, he served as Associate Medical Director for the Pediatric Emergency Department at Helen DeVos Children's Hospital, which involved building a new Pediatric Emergency Department and developing new protocols for sedation and pain management. He also served for 10 years on the Pediatric Emergency Care Applied Research Network (PEACARN) and co-authored many large, definitive pediatric emergency medicine studies, including the PECARN Neuroimaging decision rule. He currently is completing an Emergency Medical Services for Children grant investigating the implementation of a pediatric drug dosing safety system for Emergency Medical Services. He serves as the Associate Medical Director for Pediatrics for the Kalamazoo County EMS system.

Kieran J. Fogarty, PhD, Western Michigan University

Dr. Kieran J. Fogarty is the founding faculty member of Western Michigan University's doctoral program in interdisciplinary health. Fogarty's area of expertise is in interdisciplinary approaches to developing new applied research methods. Fogarty has participated in research collaborations with foundations, governmental and non-profit health care agencies resulting in modifications in the delivery of health care.

Fogarty served as an epidemic intelligence service officer at the Centers for Disease Control and Prevention, where he focused on vaccine delivery issues including a field assignment in Bangladesh with the World Health Organization's Polio eradication program. Previously, he was a senior epidemiologist with the Centers for Disease Control and Prevention, were he worked with public health leaders and governmental agencies on developing HIV/AIDS prevention assessment indicators at the state and national level. He has published in the areas of applied epidemiology, evaluation methodology, integrated surveillance systems, and research methodologies.

References

Arriaga, A. F., Bader, A. M., Wong, J. M., Lipsitz, S. R., Berry, W. R., Ziewacz, J. E., Hepner, D. L., Boorman, D. J., Pozner, C. N., Smink, D. S., & Gawande, A. A. (2013). Simulation-based trial of surgical-crisis checklists. Obstetrical & Gynecological Survey, 68(5), 336–338. https://doi.org/10.1097/01.ogx.0000430375.22369.87

Barimani, B., Ahangar, P., Nandra, R., & Porter, K. (2020). The WHO Surgical Safety Checklist: A Review of Outcomes and Implementation Strategies. Perioperative Care and Operating Room Management, 21, 100117. https://doi.org/10.1016/j.pcorm.2020.100117

Bigham, B. L., Buick, J. E., Brooks, S. C., Morrison, M., Shojania, K. G., & Morrison, L. J. (2012). Patient safety in emergency medical services: A systematic review of the literature. In Prehospital Emergency Care (Vol. 16, Issue 1, pp. 20–35). https://doi.org/10.3109/10903127.2011.621045

Brachten, F., Brünker, F., Frick, N. R. J., Ross, B., & Stieglitz, S. (2020). On the ability of virtual agents to decrease cognitive load: an experimental study. Information Systems and E-Business Management, 18(2), 187–207. https://doi.org/10.1007/s10257-020-00471-7

Brevard County Fire Rescue. (2018). EMS Medical Protocols.

Chen, C., Kan, T., Li, S., Qiu, C., & Gui, L. (2016). Use and implementation of standard operating procedures and checklists in prehospital emergency medicine: a literature review. In American Journal of Emergency Medicine (Vol. 34, Issue 12, pp. 2432–2439). W.B. Saunders. https://doi.org/10.1016/j.ajem.2016.09.057

Cicero, M. X., Adelgais, K., Hoyle, J. D., Lyng, J. W., Harris, M., Moore, B., & Gausche-Hill, M. (2021). Medication Dosing Safety for Pediatric Patients: Recognizing Gaps, Safety Threats, and Best Practices in the Emergency Medical Services Setting. A Position Statement and Resource Document from NAEMSP. Prehospital Emergency Care, 25(2), 294–306. https://doi.org/10.1080/10903127.2020.1794085

Counts, C. R., Benoit, J. L., McClelland, G., DuCanto, J., Weekes, L., Latimer, A., Hagahmed, M., & Guyette, F. X. (2022). Novel Technologies and Techniques for Prehospital Airway Management: An NAEMSP Position Statement and Resource Document. Prehospital Emergency Care, 26(sup1), 129–136. https://doi.org/10.1080/10903127.2021.1992055

Department of Defense. (2017). 2017 demographics profile of the military community.

Derr, P., McEvoy, M., & Tardiff, J. (2021). Emergency & critical care pocket guide acls version (C. Emerton & C. Lavoie, Eds.; 8th ed.). Jones & Bartlett Learning .

Follmann, A., Ohligs, M., Hochhausen, N., Beckers, S. K., Rossaint, R., & Czaplik, M. (2019). Technical Support by Smart Glasses During a Mass Casualty Incident: A Randomized Controlled Simulation Trial on Technically Assisted Triage and Telemedical App Use in Disaster Medicine. Journal of Medical Internet Research, 21(1), e11939. https://doi.org/10.2196/11939

Fowler, J., Beovich, B., & Williams, B. (2018). Improving paramedic confidence with paediatric patients: A scoping review. Australasian Journal of Paramedicine, 15(1). https://doi.org/10.33151/ajp.15.1.559

Gálvez, J. A., Lockman, J. L., Schleelein, L. E., Simpao, A. F., Ahumada, L. M., Wolf, B. A., Shah, M. J., Heitmiller, E., & Rehman, M. (2017). Interactive pediatric emergency checklists to the palm of your hand - How the Pedi Crisis App traveled around the world. Paediatric Anaesthesia, 27(8), 835–840. https://doi.org/10.1111/pan.13173

Hall, C., Robertson, D., Rolfe, M., Pascoe, S., Passey, M. E., & Pit, S. W. (2020). Do cognitive aids reduce error rates in resuscitation team performance? Trial of emergency medicine protocols in simulation training (tempist) in australia. Human Resources for Health, 18(1), 1. https://doi.org/10.1186/s12960-019-0441-x

Hansen, M., Eriksson, C., Mph, B. S., Meckler, G., & Guise, J.-M. (2018). Safety events in pediatric out-of-hospital cardiac arrest. Safety Events in Pediatric Out-of-Hospital Cardiac Arrest, 380–383.

Haynes, A. B., Weiser, T. G., Berry, W. R., Lipsitz, S. R., Breizat, A.-H. S., Dellinger, E. P., Herbosa, T., Joseph, S., Kibatala, P. L., Lapitan, M. C. M., Merry, A. F., Moorthy, K., Reznick, R. K., Taylor, B., & Gawande, A. A. (2009). A surgical safety checklist to reduce morbidity and mortality in a global population. New England Journal of Medicine, 360(5), 491–499. https://doi.org/10.1056/NEJMsa0810119

Hoyle, J. D., Davis, A. T., Putman, K. K., Trytko, J. A., & Fales, W. D. (2012). Medication Dosing Errors in Pediatric Patients Treated by Emergency Medical Services. Prehospital Emergency Care, 16(1), 59–66. https://doi.org/10.3109/10903127.2011.614043

Hoyle, J. D., Ekblad, G., Hover, T., Woodwyk, A., Brandt, R., Fales, B., & Lammers, R. L. (2020). Dosing errors made by paramedics during pediatric patient simulations after implementation of a state-wide pediatric drug dosing reference. Prehospital Emergency Care, 24(2), 204–213. https://doi.org/10.1080/10903127.2019.1619002

Johnson, K. L., Bamer, A. M., Yorkston, K. M., & Amtmann, D. (2009). Use of cognitive aids and other assistive technology by individuals with multiple sclerosis. Disability and Rehabilitation: Assistive Technology, 4(1), 1–8. https://doi.org/10.1080/17483100802239648

Kalz, M., Lenssen, N., Felzen, M., Rossaint, R., Tabuenca, B., Specht, M., & Skorning, M. (2014). Smartphone apps for cardiopulmonary resuscitation training and real incident support: a mixed-methods evaluation study. Journal of Medical Internet Research, 16(3), e89. https://doi.org/10.2196/jmir.2951

Keebler, J. (2017). Human factors and ergonomics of prehospital emergency care (1st ed.). Taylor & Francis.

Krombach, J. W., Edwards, W. A., Marks, J. D., & Radke, O. C. (2015). Checklists and Other Cognitive Aids For Emergency And Routine Anesthesia Care-A Survey on the Perception of Anesthesia Providers From a Large Academic US Institution. Anesthesiology and Pain Medicine, 5(4), e26300. https://doi.org/10.5812/aamp.26300v2

Kuhlmann, S. (2005). Impaired memory retrieval after psychosocial stress in healthy young men. Journal of Neuroscience, 25(11), 2977–2982. https://doi.org/10.1523/JNEUROSCI.5139-04.2005

Lammers, R., Byrwa, M., & Fales, W. (2012). Root causes of errors in a simulated prehospital pediatric emergency. Academic Emergency Medicine, 19(1), 37–47. https://doi.org/10.1111/j.1553-2712.2011.01252.x

Lammers, R. L., Byrwa, M. J., Fales, W. D., & Hale, R. A. (2009). Simulation-based assessment of paramedic pediatric resuscitation skills. Prehospital Emergency Care, 13(3), 345–356. https://doi.org/10.1080/10903120802706161

Michigan Department of Health and Human Services Bureau of EMS, T. & P. (2018, August 24). Michigan Pediatric Cardiac Protocols.

National Association of State EMS Officials. (2022). National Model EMS Clinical Guidelines.

Paramedic Protocol Provider. (n.d.). EMS protocols. Accessed October 1, 2022.

Rappaport, L. D., Brou, L., Givens, T., Mandt, M., Balakas, A., Roswell, K., Kotas, J., & Adelgais, K. M. (2016). Comparison of Errors Using Two Length-Based Tape Systems for Prehospital Care in Children. Prehospital Emergency Care, 20(4), 508–517. https://doi.org/10.3109/10903127.2015.1128027

Rappaport, L. D., Markowitz, G., Hulac, S., & Roosevelt, G. (2022). medication errors in pediatric patients after implementation of a field guide with volume-based dosing. Prehospital Emergency Care, 1–14. https://doi.org/10.1080/10903127.2022.2025962

Sokhanvar, M., Kakemam, E., & Goodarzi, N. (2018). Implementation of the surgical safety checklist in hospitals of Iran; operating room personnel’s attitude, awareness and acceptance. International Journal of Health Care Quality Assurance, 31(6), 609–618. https://doi.org/10.1108/IJHCQA-03-2017-0051

Thomas, L., Donohue-Porter, P., & Stein Fishbein, J. (2017). Impact of interruptions, distractions, and cognitive load on procedure failures and medication administration errors. Journal of Nursing Care Quality, 32(4), 309–317. https://doi.org/10.1097/NCQ.0000000000000256

Thomassen, Ø., Espeland, A., Søfteland, E., Lossius, H. M., Heltne, J. K., & Brattebø, G. (2011). Implementation of checklists in health care; learning from high-reliability organisations. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 19, 53. https://doi.org/10.1186/1757-7241-19-53

Thygerson, S. M., Rassbach, A. R., West, J. H., & Thygerson, A. L. (2013). iPhone Apps for Cardiopulmonary Resuscitation (CPR): A Content Analysis. Journal of Consumer Health On the Internet, 17(3), 241–254. https://doi.org/10.1080/15398285.2013.812912

Walker, D., Moloney, C., SueSee, B., Sharples, R., Blackman, R., Long, D., & Hou, X.-Y. (2022). Factors Influencing Medication Errors in the Prehospital Paramedic Environment: A Mixed Method Systematic Review. Prehospital Emergency Care, 1–18. https://doi.org/10.1080/10903127.2022.2068089

Ward, M. (2017). Nims incident command system field guide (3rd ed.). Jones & Bartlett Learning.

Woods, B., Lang, B., Blayney, C., O’Mahony, L., vander Tuig, A., Rea, T., Carlbom, D., Sayre, M., & King, M. (2019). Medic One Pediatric (MOPed) cards: standardising paramedic paediatric resuscitation. BMJ Open Quality, 8(3), e000534. https://doi.org/10.1136/bmjoq-2018-000534

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