Addressing Teamwork Delays during Life-Saving Interventions through an Activity Theory-Informed Analysis

Hemorrhage, or severe blood loss due to injury, is a leading cause of preventable deaths after injury. This study uses and extends activity theory to understand the dynamics of team-based hemorrhage control during trauma resuscitation and to explore potential computerized mechanisms to support this time- and safety-critical process. We reviewed videos of 25 resuscitation cases and analyzed hemorrhage control activities using nine activity theory prompts, including a new prompt-speech intention-a critical but underexplored dimension of teamwork in prior activity theory analyses. Through this process, we identified the most common delay-causing activities and developed routine and non-routine activity models for each. A comparison of these models showed that variations from the routine models emerged due to changes in the division of labor, instruments, community, and speech intentions. We contribute to research on designing socio-technical systems by (1) identifying needs and opportunities for computerized support that address delays in complex medical teamwork and (2) examining how an intervention changes an activity model. We also show how adding detailed speech data aids in identifying contradictions between elements in an activity model.