Introduction: Effective teamwork has been shown to optimize patient safety. However, researchcentered on the critical inputs, processes, and outcomes of team effectiveness in emergency medicalservices (EMS) has only recently begun to emerge. We conducted a theory-driven qualitative studyof teamwork processes—the interdependent actions that convert inputs to outputs—by frontline EMSpersonnel in order to provide a model for use in EMS education and research.

Methods: We purposively sampled participants from an EMS agency in Houston, TX. Full-timeemployees with a valid emergency medical technician license were eligible. Using semi-structuredformat, we queried respondents on task/team functions and enablers/obstacles of teamwork in EMS.Phone interviews were recorded and transcribed. Using a thematic analytic approach, we combinedcodes into candidate themes through an iterative process. Analytic memos during coding and analysisidentified potential themes, which were reviewed/refined and then compared against a model ofteamwork processes in emergency medicine.

Results: We reached saturation once 32 respondents completed interviews. Among participants, 30(94%) were male; the median experience was 15 years. The data demonstrated general support forthe framework. Teamwork processes were clustered into four domains: planning; action; reflection;and interpersonal processes. Additionally, we identified six emergent concepts during open coding:leadership; crew familiarity; team cohesion; interpersonal trust; shared mental models; and proceduralknowledge.

Conclusion: In this thematic analysis, we outlined a new framework of EMS teamwork processes todescribe the procedures that EMS operators employ to convert individual inputs into team performanceoutputs. The revised framework may be useful in both EMS education and research to empiricallyevaluate the key planning, action, reflection, and interpersonal processes that are critical to teamworkeffectiveness in EMS.