Research on medical teams constantly recognise the crucial value of communication. Studies
on various medical teams, such as surgery and trauma, provide evidence for how
communication either affects or is affected by a range of outcomes and variables.
Nevertheless, much of this work has focused on in-hospital communication. Less is known
about the patterns of communication amongst medical practitioners in high-stakes
emergency care outside of the hospital. This thesis presents an investigation of dialogue
during pre-hospital resuscitations when paramedics are responding to out-of-hospital
cardiac arrest (OHCA).
A bespoke dialogue annotation system, called the Dialogue Annotation for Resuscitation
coding scheme (DARe), is developed for this purpose. DARe is used to annotate four
simulated and 40 real-life OHCA resuscitation attempts by paramedics who are based in
Edinburgh, Scotland. We examine (1) the distributions of communicative functions and
subject matters (threads); (2) specific statements used by team members to align
themselves; (3) the prevalence and forms of mitigated directives; (4) the verbal manners of
planning; (5) the occurrence of closed-loop communication and other structures of verbal
communication loops; and (6) the prevalence of socioemotionally-related utterances. For
the real-life resuscitation dialogues, the study additionally investigates (7) the correlations
between the distributions of the dialogue patterns with the assessed performance of
resuscitation team leaders and with the time taken to successfully deploy a mechanical chest
compression device (AutoPulse).
Analysis for the simulation dialogues was performed from the start of simulation until the
end or near the end of the procedure, whilst analysis for the real-life dialogues concentrated
on the first five minutes. Despite this difference in timing, the results showed that simulated
and real-life OHCA dialogues comprised similarly high frequencies of statements, directives,
acceptances, and acknowledgments. Both simulated and real-life dialogues also contained
sociolinguistic influences from the linguistic context that these were derived from, i.e.
Scottish English.
In considering the threads across both settings, the largest proportion of threads revolved
around planning and execution of tasks, followed by threads on patient history and related
instrument/equipment. Dialogues during real-life OHCA resuscitations differed from the
simulated resuscitations in the additional presence of two communicative techniques,
namely Alerters (used to attract hearer’s attention) and Affective performatives (used to
convey affective or socioemotional statements). Additionally, real-life resuscitation dialogues
contained a larger proportion of threads pertaining to patient positioning due to the use of
the AutoPulse.
Resuscitation team members often used a statement structure called State-awareness to
align themselves with one another in terms of their current state or task. Directives were
frequently mitigated, with strategies ranging from simple use of softeners (e.g. please) to
less straightforward directive structures (e.g. suggestion). Plans were verbalised in temporal
clusters, i.e. distinguishable in terms of the immediacy of the task to be performed. Few
verbal affective behaviours (e.g. humour, gratitude, compliments) were observed. Team
members also used very few exchanges that resembled the standard, three-level closed-loop
communication structure typically required from professionals in other high-stakes dialogue
environments.
Correlation analyses revealed that the frequencies of both the communicative functions and
threads were associated with the performance scores of resuscitation team leaders. Teams
led by higher rated leaders (the ideal score group) showed higher proportions of Alerters,
Affective performatives, State-awareness, and Plan of action in their dialogues compared to
teams led by lower rated leaders (the low score group). There were also variations in the
concentrations of chest compressions, patient history, and rhythm threads in the two
groups, indicating that both discussed the same threads but at different junctures of the
procedure. Meanwhile, the time taken to deploy the AutoPulse was positively correlated
with the communicative function Acknowledge and the threads Patient history and
Movement other than patient, and negatively correlated with the communicative function
Open-option and the threads Ventilation and Airway access.
Based on these results, several potential measures for optimising OHCA resuscitation are
proposed: the use of sewn-on name badges for paramedics; shorter time dedicated for the
extraction of patient history; verbal reports of vital points throughout the procedure; the use
of non or less mitigated directives; and standardisation of resuscitation phrases. Each
suggestion is also discussed in terms of anticipated challenges and possible solutions.
The results presented in this thesis provide grounds for further research on the features of
pre-hospital resuscitation dialogues. DARe has been demonstrated to be useful in
discriminating linguistic patterns, suggesting that dialogue annotation analysis can be utilised
to further investigate this area and ultimately contribute to resuscitation performance