Improving an Interprofessional Shared Mental Model and Mutual Understanding Within the Early Links of the Chain of...

The concept of the "chain of survival" emphasizes a series of critical steps that collectively improve outcomes for patients experiencing cardiac arrest. In practice, these links - dispatchers, emergency medical services (EMS), and emergency department (ED) physicians - often function independently but require integration and collaboration to provide the highest care for our patients. The current study aims to establish an interprofessional shared mental model to improve out-of-hospital cardiac arrest outcomes. Basic life support (BLS) needs assessments were administered to dispatchers, fire-based EMS crews, and emergency medicine (EM) resident physicians. After the assessments were administered, a focus group was scheduled and performed with dispatch, EMS crews, and EM resident physicians. Once all focus groups were completed and transcribed, a thematic analysis was performed by hand by four researchers to identify the main themes of each focus group. Themes were then compared between the three groups to find commonalities and differences. After establishing common themes, an educational activity was developed and implemented to establish a shared mental model of the chain of survival. The educational activity included EMS crews, EM resident physicians, and EM attending physicians. An interprofessional debrief was then conducted with EM residents, attending physicians, and EMS crews. A total of 78 individuals completed the needs assessment and participated in focus groups (dispatchers: n = 5; EMS: n = 60; EM residents: n = 13). Thematic analysis of transcribed focus group sessions revealed unique and overlapping challenges across groups, including communication barriers, emotional impact, and environmental limitations. Shared strengths included a mutual understanding of the importance of high-quality cardiopulmonary resuscitation (CPR) and mechanical CPR device utility. Post-curriculum survey responses from 53 EMS participants indicated strong support for the intervention: 71.7% "strongly agreed" that the activity was beneficial, and 75.5% believed it would positively affect daily operations. Creating a shared mental model through role-specific assessment, interprofessional education, and simulation can bridge gaps in the chain of survival. Improved mutual understanding among dispatchers, EMS personnel, and ED physicians may enhance team coordination and ultimately improve outcomes in cardiac arrest management.