Coordination of medical and non-medical teams in extreme contexts – COMEXT

- Case study: qualitative data collection, combining participant and non-participant observation of emergency managers' crisis preparedness, semi-structured interviews, focus groups and secondary sources.

In accordance with Charmaz et al. (2014), the data were analysed in two or three coding stages, from contextual coding to theoretical coding. The reliability and validity of the results were assessed according to the guidelines of Lincoln & Guba (1985).

- Questionnaire survey of doctors in charge of the crisis (EMT managers, medical crisis directors).

Our study confirms the importance of preparation and exercises, which must increase in intensity as the exercises progress, creating surprise and placing participants in situations of doubt and destabilisation. They play an essential role in developing a crisis culture within organisations, particularly for coordination between healthcare workers and other professionals. Joint exercises provide a better understanding of each person's role, help participants get to know each other better, and give them an insight into how different managers deal with complex and stressful situations.

The project shows the importance of considering a very wide range of extreme situations, not only those related to specific crises, but also those that overlap and persist. Overlapping crises and multiple crises have a significant impact on team coordination and how to integrate them into preparations. Our study also highlights the normalisation of crises and its consequences for emergency services and hospitals.

The project revealed the central role played by hospitals and their low level of crisis preparedness compared to other pre-hospital actors. Our study shows the importance of relying on medical crisis directors, medical doctors responsible for organising healthcare pathway in crisis situations in hospitals. These individuals play a key role in the crisis response system, beyond exceptional health situations.

This requires:

- reviewing the position of DMC, which was not designed for long-term commitment and its conditions.

- supporting their skills development and professionalisation through specific training and the facilitation of a community of practice.

With the increased terrorist threat, there is a renewed interest in emergency inter-organizations coordination, and in particular between medical and non-medical first responders teams in extreme contexts, notably in multiple terror attacks. We are currently facing a growth in crisis complexity, due to multiple factors that need further investigation. As a consequence, organizations need to change their responses. They tend to increase the number of plans, while trying to preserve some agility for the first responders. The effectiveness of the response heavily relies on the preparation and coordination of the first responders, e.g. the various emergency medical groups, police services, fire brigades.
Within this perspective, the project’s objective is twofold. First, it ambitions to advance knowledge on coordination, sensemaking and learning in extreme contexts. Second, it aims at improving the emergency responses in terms of coordination, training and the learning processes related to the management of extreme crises.
The project will study the coordination of first responders teams (mainly medical emergency groups, police units and fire brigades) in extreme settings and their coordination with second responders (in particular hospitals departments).
In this attempt, the project will:
- Assess the impact of the increasing complexity in extreme situations on the coordination and decision-making of first responders;
- Determine the conditions of effective coordination by identifying the success and failure factors in the organization and coordination of responders to extreme crisis;
- Propose new organizational forms of coordination, recruitment, training and learning modalities.