Risk negotiation and decision making in the management of 999 calls

Emergency Medical Dispatch (EMD) systems must provide a rapid, efficient on-site response to medical emergencies and trauma following a 999 call. EMD is directly related to risk assessment. It is the result of a decision-making negotiation process between the caller and clinical teams, coordinated through the Clinical Contact Centre. Although the emergency call and its focal role in risk assessment for EMD is well known, there has been no systematic study of the multi-actor system behind the call that manages the decision to dispatch critical care resources. The COVID-19 pandemic has increased further the complexity of decision-making in relation to critical care deployment. In this paper, we report on the design of an upcoming project that focuses on identifying the specific indicators that function as high-risk trigger points in the 999 call and the way in which they are recontextualised in the subsequent/parallel inter-/intra- team decision-making process. We seek to map the information trajectory of risk negotiation and compare against current dispatch systems and guidelines. We discuss the theoretical approach and methodology that allows the systematic analysis of the ways in which high-acuity decision-making is associated with linguistic choices in the 999 call, and teams’ negotiation of risk in situated interaction. We relate the cross-sectional, qualitative study design to literature and the team’s past projects and argue for the need for improving the way scripted systems register risk. We close the paper with the policy implications of our work.