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Author Chun Kit Jacky Chan, Fabian Ling Ngai Tung, Suk Yin Joey HO, Alice Yip |
| Abstract Cardiac arrest survival depends on timely, effective resuscitation, guided by Advanced Cardiac Life Support (ACLS) protocols designed for six-person teams. However, real-world constraints like staffing shortages often force teams to operate with only three members, creating a critical gap between protocol standards and clinical practice. This qualitative study explored the perspectives of experienced ACLS faculty (n=6) to analyze teamwork dynamics, role allocation, and cognitive workload in three-person resuscitations, using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Thematic analysis of semi-structured interviews revealed that role distractions occurred in approximately 80% of scenarios, primarily during high-cognitive-load tasks like rhythm analysis. While standardized protocols provided a shared mental model initially, unexpected events necessitated a difficult shift to explicit problem-solving. Environmental stressors, such as night-shift conditions, amplified cognitive demands. Key findings indicate that successful three-person resuscitation hinges on two factors: strict role specialization to prevent cognitive overload and strong leadership to act as a cognitive buffer, coordinating the system and absorbing complexity. The study concludes that ACLS training should incorporate specific modules on role adherence and leadership for small-team configurations. Future research should combine these qualitative insights with physiological measures, like functional near-infrared spectroscopy (fNIRS), to validate these relationships and develop evidence-based tools tailored for constrained teams. |
