Examining Cognitive Aid Use in Emergency Medical Services

Background: Emergency Medical Service (EMS) clinicians render care in less than ideal environments, and errors occur at high rates. Some cognitive aids (CAs) have been shown to reduce errors and improve adherence to evidence-based practices. However, there have been no widespread studies examining CA use in EMS. The objective of this study was to examine the frequency of CA use by EMS clinicians and which clinicians were using them more frequently during patient care. Methods: A cross-sectional online survey was developed using a modified Delphi method with items examining demographic information and the frequency that 15 selected CAs are used during patient care. A survey link was emailed to 136,093 EMS clinicians across six states (TX, ME, MI, LA, SC, and AR). Descriptive statistics were used to describe frequencies. Kruskal-Wallis was used to assess if use differed among demographic or employment groups, and Spearman correlation was used to examine the relationship between clinician age and CA use. Results: A total of 2,251 respondents were included in the study after meeting the inclusion criteria. Of the 15 CAs examined, the length-based tape was the most used (Med= 3.0, IQR: 1.0 – 4.0). Overall CA use was limited, with a median score of 1.67 (IQR: 1.07 – 2.27). The following groups reported more frequent use of CAs: females (Med= 1.87, IQR: 1.27-2.47), Hispanics (Med= 1.93, IQR: 1.33-2.67), Black/African Americans (Med= 2.00, IQR: 1.20-2.53), air medical clinicians (Med= 2.00, IQR: 1.60-2.40) and clinicians working in military settings (Med= 2.23, IQR: 1.80-2.80). A small negative correlation was identified with age (r = -0.06, p = .005). Conclusions: Overall, CA use in EMS is limited. More effort is needed to increase their use in EMS. This data may provide insight to better target areas of need, improve design, and improve implementation of CAs in EMS.