Table 3.

Codes and Definitions for Flow Disruptions

Type of flow disruption	Definition
Layout related	Spatial organization or positioning of certain items in the ambulance that hinder the team during their task by blocking their route or impeding visibility. These items include > Furniture or equipment positioning to clear the movement path > Inadequate use of space causing clutter or route blockage > Impeded visibility due to objects obstructing the team's view
Environmental hazards	Incidents involving the interaction of the team with the ambulance environment such as > Slips, trips and/or falls by going over an element on or above the floor > Collison/bumping into people, objects, equipment > Excessive reach needed to access patient, objects, or equipment > Team's interaction with sharp objects and contaminated needles
Interruptions	Incidents not related to the assessment procedure causing distractions for the team during task performance such as > Phone calls or pagers unrelated to the assessment procedure > External personnel who are not a member of the core assessment team > Spilling, dropping, or picking up something from the floor > Searching for missing items > Looking at personal phones
Communication related	Incidents interfering with effective communication between the team members during the assessment procedure in the ambulance, including > Poor communication among the team members that does not achieve its desired goal > Lack of response or confirmation > Confusion and lack of understanding associated with the team communication > Simultaneous communication among team members resulting in miscommunication or repetition of information > Nonessential communication (e.g., sports talk, jokes, personal inquiries) > Environmental noise caused by increasing sound levels in the ambulance
Equipment failure	Incidents where the subject is distracted by malfunctioning or broken equipment during assessment. This includes medical equipment in the ambulance.
Usability related	Subject is distracted by problems associated with telemedicine related equipment: Computers (operating software, programs, and utilities), camera, speaker, pointing devices, monitors.