Recovering from Critical Incidents: Evidence from Paramedic Performance

40 Pages Posted: 7 Nov 2018 Last revised: 17 Apr 2020

See all articles by Hessam Bavafa

Hessam Bavafa

University of Wisconsin - Madison - School of Business

Jónas Oddur Jónasson

MIT Sloan School of Management

Date Written: October 15, 2018


Problem Definition: In service operations settings where the difficulty of jobs is unpredictable, workers can encounter critical incidents (CIs)---jobs which are sufficiently disturbing to challenge workers' coping mechanisms. We examine the impact of encountering CIs on subsequent operational performance of workers.

Academic / Practical Relevance: Prior work has examined the effects of CIs on the long-term psychological health of workers. We demonstrate that encountering CIs has a practically meaningful impact on operational performance. We also examine the time-dependency and process-dependency of the effect, and analyze whether it is mitigated by individual characteristics such as age or experience.

Methodology: We use data on 902,002 ambulance activations conducted by paramedics at the London Ambulance Service (LAS). We define CIs as incidents where patients have a high probability of dying at the scene, and examine the impact of such events on the paramedics' performance for the remainder of their shifts. Our outcomes are the completion time of the ambulance activation and each of its five sub-processes. The exogenous assignment of CIs to paramedic crews allows a clean identification of our effect using a shift-level difference-in-differences specification.

Results: Crews who have encountered one prior CI (two prior CIs) spend on average 2.6% (7.5%) more time completing each remaining ambulance activation in the shift. The impact is strongest for the jobs immediately following a CI but persists throughout the shift. The largest effects come from the sub-processes which are least standardized and where paramedics cannot rely on standard operating procedures. The duration effect is larger for teams of older paramedics, but is simultaneously mitigated by experience.

Managerial Implications: Our results show that CIs increase subsequent job duration and that more than one CIs have a compounding, negative effect on operational performance. As a result, managers in settings where performance consistency is key would be advised not to assign new jobs to teams with recent CI experiences.

Keywords: Critical Incidents, Team Performance, Service Operations, Ambulance Operations

Suggested Citation

Bavafa, Hessam and Jónasson, Jónas Oddur, Recovering from Critical Incidents: Evidence from Paramedic Performance (October 15, 2018). Available at SSRN: or

Hessam Bavafa

University of Wisconsin - Madison - School of Business ( email )

975 University Ave
4284C Grainger Hall
Madison, WI 53706
United States

HOME PAGE: http://

Jónas Oddur Jónasson (Contact Author)

MIT Sloan School of Management ( email )

100 Main Street
Cambridge, MA 02142
United States

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