Situated Action in Pre-Hospital Critical Care Dispatch: Identifying where and how Algorithmic Assistance might be useful in the daily work of specialist Emergency Medical Dispatchers

Abstract

This study uses ethnographic immersion and observation as contextual inquiry to understand situated action at an Emergency Medical Dispatch critical care hub. The work is a response to the urgent need to recruit context-specific knowledge and participation into design that helps to narrow the AI Chasm - the gap between the promise of Artificial Intelligence (AI) systems and what they deliver for clinicians and their patients. The work of a pre-hospital critical care team's dispatch process is described and analysed to reveal both the structure of the workflow and the different cognitive demands it makes on staff tasked with dispatch decision-making. Elements of attention, communication and focus between the humans, as they carry out this work, are drawn out in order to understand the work-as-done and identify the many dependencies in the process. The motivation is to establish where AI support might be useful and to discover what challenges there could be in designing appropriate algorithmic assistance. We ask whether, where and how the design and implementation of an AI system might be considered. The ultimate objective is to improve the decision process itself to the benefit of clinicians and patients. The study identifies three key steps in the situated workflow and details how decision-makers negotiate each one as emergency calls follow complex routes between them. We find compelling evidence that the first of these decision steps constitutes the most promising candidate for unobtrusive assistance that could be safe and effective in improving both clinician workload and clinical outcomes.