This paper describes the role of temporal information in emergency medical teamwork and how time-based features can be designed to support the temporal awareness of clinicians in this fast-paced and dynamic environment. Engagement in iterative design activities with clinicians over the course of two years revealed a strong need for time-based features and mechanisms, including timestamps for tasks based on absolute time and automatic stopclocks measuring time by counting up since task performance. We describe in detail the aspects of temporal awareness central to clinicians' awareness needs and then provide examples of how we addressed these needs through the design of a shared information display. As an outcome of this process, we define four types of time representation techniques to facilitate the design of time-based features: (1) timestamps based on absolute time, (2) timestamps relative to the process start time, (3) time since task performance, and (4) time until the next required task.

In this paper, we describe how we developed an information display prototype for trauma resuscitation teams based on design ideas and feedback from clinicians. Our approach is grounded in participatory design, emphasizing the importance of gaining long-term commitment from clinicians in system development. Through a series of participatory design workshops, heuristic evaluation, and simulated resuscitation sessions, we identified the main information features to include on our display. Our results focus on how we balanced the design tensions that emerged when addressing the ad hoc, hierarchical, and multidisciplinary nature of trauma teamwork. We discuss the implications of balancing role-based differences for each information feature, as well as two major design tensions: process-based vs. state-based designs and role-based vs. team-based displays.

The purpose of this study was to understand how vital signs monitors support teamwork during trauma resuscitation -- the fast-paced and information-rich process of stabilizing critically injured patients. We analyzed 12 videos of simulated resuscitations to characterize trauma team monitor use. To structure our observations, we adopted the feedback loop concept. Our results showed that the monitor was used frequently, especially by team leaders and anesthesiologists. We identified three patterns of monitor use: (i) periods with a low frequency of short looks (glances) to maintain overall process awareness; (ii) periods with a medium frequency of long looks (scrutiny) to monitor trends in patient status; and (iii) peaks with a high frequency of glances to maintain attention on both the patient and monitor during critical tasks. Approximately 75% of looks were 3 seconds or shorter, but many looks (25%) ranged between 3 and 26 seconds. Our results have implications for improving displays by presenting the status of the patient's physiological systems and team activities.

We examine decision-making tasks and information sources during fast-paced, high-risk medical events, such as trauma resuscitation. Interviews with surgical team leaders and ED physicians reveal several environmental aspects that make decision making difficult, including diagnostic tradeoffs, missing and unreliable information, and managing multiple patients simultaneously. We discuss the implications of these findings for the design of wall displays to support decision making in time-critical medical settings.