Framing trauma leaders’ request in emergency care interactions

A multimodal analysis using eye-tracking glasses


  • Keiko Tsuchiya Yokohama City University
  • Frank Coffey University of Nottingham/Nottingham Trent University
  • Andrew Mackenzie Nottingham Trent University
  • Sarah Atkins Aston University
  • Malgorzata Chalupnik University of Nottingham
  • Stephen Timmons University of Nottingham
  • Alison Whitfield University of Nottingham
  • Mike Vernon Nottingham Trent University
  • David Crundall Nottingham Trent University



emergency care interaction, eye-tracking, frame, healthcare simulation, multimodality, request


A team leader’s request is a crucial factor for successful team interaction to ensure patient safety in emergency care. This study examines how team leaders accomplish and frame immediate requests through language use and corresponding eye-movement patterns in emergency care simulation, focusing on when the team is led by a senior doctor (SD) and when it is led by a junior doctor (JD). The team included two foundation doctors, who are in their first two years in medical practice, two emergency department (ED) nurses and one ED expert. They were recorded undertaking separate simulated operations on a simulated patient, and the team leader wore eye-tracking glasses. Interactional linguistic and multimodal analyses of video, audio and eye-movement data revealed that SD made immediate requests to the team members with multimodal emphasis – i.e., gazed at the recipients and addressed them verbally, especially when asking for recipients’ actions – while JD often used only gaze in requesting such actions. Although our study has limitations in terms of the small size of the data, the findings nevertheless highlight that the leader’s requesting was framed and ascribed in the continuum from a question to an instruction through co-construction of joint action with recipients in the social interaction.

Author Biographies

Keiko Tsuchiya, Yokohama City University

Keiko Tsuchiya is an Associate Professor at the School of International Liberal Arts, Yokohama City University. She is currently leading the EYE WORK project (JSPS 17KT0062), which aims to investigate multimodal emergency care interaction. Her research interests also include language education in Japan, i.e., ELF (English as a Lingua Franca) and CLIL (Content and Language Integrated Learning).

Frank Coffey, University of Nottingham/Nottingham Trent University

Frank Coffey is Honorary Professor in Urgent and Emergency Care at Nottingham Trent University at the University of Nottingham. He is Head of Service at the Emergency Department and Director of DREEAM (Department of Research and Education in Emergency Medicine, Acute Medicine and Major Trauma), Nottingham University Hospitals NHS Trust. He has a special interest in the field of Simulation Based Education.

Andrew Mackenzie, Nottingham Trent University

Andrew Mackenzie is a Lecturer at Nottingham Trent University. His research explores the visual processes involved in tasks, attempts to understand the visual and attentional mechanisms and develops diagnostic/training tools to assess/develop skill. He has recently co-authored ‘Creating a hazard-based training and assessment tool for emergency response drivers’ (2020, Accident Analysis and Prevention).

Sarah Atkins, Aston University

Sarah Atkins is a Research Fellow at Aston Institute for Forensic Linguistics, Aston University. Her research investigates language and professional communication. She has conducted research on the linguistic features of simulation with a range of professional groups, including GPs and emergency care providers. Her work has a strong emphasis on applying findings in practice.

Malgorzata Chalupnik, University of Nottingham

Malgorzata Chalupnik is a Teaching Associate in Linguistics and Professional Communication and Director of the Centre for Research in Applied Linguistics (CRAL) at the University of Nottingham. Her expertise is in professional communication, discourse analysis and pragmatics.

Stephen Timmons, University of Nottingham

Stephen Timmons is Professor of Healthcare Innovation at the Centre for Health Innovation, Leadership and Learning, Nottingham University Business School. He previously worked as an NHS manager. His main research interests are in the implementation of innovations in healthcare, sociology of technology and sociology of the professions.

Alison Whitfield, University of Nottingham

Alison Whitfield is an Emergency Nurse Practitioner and a Clinical Educator in Emergency Medicine at the Emergency Department in Nottingham University Hospital NHS Trust and DREEAM (Department of Research and Education in Emergency Medicine, Acute Medicine and Major Trauma). Her research interests include emergency care simulation and professional development of simulated patients.

Mike Vernon, Nottingham Trent University

Mike Vernon is a Lecturer in Psychology at Nottingham Trent University. He previously worked as a Data Manager. He has conducted psycholinguisticsbased research investigating how the planning scope of typewriting is mediated by inner speech and the availability of stored motor codes. His additional research interests are in visual attention, transport psychology and motor control.

David Crundall, Nottingham Trent University

David Crundall is Professor of Psychology at Nottingham Trent University. He does research in applied cognitive psychology, eye movements and attention, and situation awareness in natural situations. His current research focuses on diverse topics including road safety, virtual reality, lifeguarding and sports.


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How to Cite

Tsuchiya, K., Coffey, F., Mackenzie, A., Atkins, S., Chalupnik, M., Timmons, S., Whitfield, A., Vernon, M., & Crundall, D. (2021). Framing trauma leaders’ request in emergency care interactions: A multimodal analysis using eye-tracking glasses. Communication and Medicine, 17(1), 47–63.