Dynamic Performance of Emergency Medical Teams as Seen in Responses to Unexpected Clinical Events

Daily clinical work in the emergency department requires a balance between the available resources and the work necessary to save patients’ lives. Emergency medical teams must demonstrate resilience, especially when dealing with unexpected events, by acting flexibly and adaptively to unstable situations. To elucidate the team dynamics responsible for resilience, we examined the performance of emergency medical teams as seen in their responses to a mass casualty incident. In dealing with multiple patients, the team first sought help, and then roughly allocated roles to each member of staff. The team then repeatedly assessed the situation and allocated resources more appropriately. In reassessment and reallocation, each member acted autonomously based on the information obtained while maintaining relationships with other team members. Networks were created and dynamically modified by multi-objective optimisation with information exchange between staff members.This case study revealed that the scalable emergency medical teams, which demonstrated resilient performance in the face of a changing situation by autonomously using limited resources, did not begin through fine adjustment, but instead adapted through coarse approximation, followed by frequent reassessment and reallocation.