Performance of the Multidisciplinary Team in Prehospital Care: Challenges and Potentialities in Emergency Care

Copyright © ISRG Publishers. All rights Reserved. DOI: 10.5281/zenodo.17614669 192 ISRG PUBLISHERS Abbreviated Key Title: ISRG J Arts Humanit Soc Sci ISSN: 2583-7672 (Online) Journal homepage: https://isrgpublishers.com/isrgjahss Volume – III Issue -VI (November-December) 2025 Frequency: Bimonthly Performance of the Multidisciplinary Team in Prehospital Care: Challenges and Potentialities in Emergency Care Wagner de Aguiar Raupp1*, Patrícia Cristina Silva Lopes2, Flavio Santos Marques Junior3, Tânia Maria de Oliveira Moreira4, Gerusa Tomaz Faria5, Mauricio Anselmo Alves6, Fernanda Santos Schwarz7, Alessandra Ferreira Mendes Jiticovski8 1, 2, 3, 4, 5, 6, 7, 8 Wagner de Aguiar Raupp Rua Joao Tobias 15 38401066. Affiliation: PHD in Public Health - Universidad de Ciencias Empresariales y Sociales | Received: 03.11.2025 | Accepted: 06.11.2025 | Published: 15.11.2025 *Corresponding author: Wagner de Aguiar Raupp Wagner de Aguiar Raupp Rua Joao Tobias 15 38401066. Affiliation: PHD in Public Health - Universidad de Ciencias Empresariales y Sociales Abstract Prehospital care (PHC) is a crucial stage in emergency management, providing immediate assistance before the patient arrives at the hospital. In Brazil, it is primarily organized through SAMU and SIATE, two services that, despite structural differences, share the goal of ensuring rapid, comprehensive, and humanized care. This study aimed to identify the challenges and potentialities of the multidisciplinary team's performance in PHC. A narrative review of scientific literature published between 2019 and 2024 was conducted. The selected studies address topics such as professional integration, quality of care, and operational barriers in emergency contexts. The findings were categorized into three main areas: team composition, encountered challenges, and observed best practices. Successful strategies identified include the adoption of clinical protocols, interprofessional training, use of digital technologies, and the promotion of humanized care. These practices enhance team cohesion and problem-solving capacity in critical settings. The study concludes that strengthening multidisciplinary work in PHC requires investment in public policies, continuous training, and support structures that ensure safe, ethical, and user-centered care. Keywords: Prehospital care, Emergencies, Multidisciplinary team, Interdisciplinarity, Humanized care. Copyright © ISRG Publishers. All rights Reserved. DOI: 10.5281/zenodo.17614669 193 Introduction Prehospital care (PHC) represents a crucial stage in the management of health emergencies, as it is responsible for providing the initial care to individuals in critical condition before they reach a hospital facility. In Brazil, this type of care is regulated by public policies such as the National Policy on Emergency Care, which serves as a key strategy to ensure timely, comprehensive, and effective access to care in emergency situations (Pereira et al., 2024). The increasing complexity of clinical scenarios related to emergencies—such as traffic accidents, cardiorespiratory arrests, traumatic events, or acute clinical decompensations—demands a coordinated, agile, and efficient response from the teams that make up the PHC system. Within this context, the role of the multidisciplinary team stands out, comprising professionals from various fields, including physicians, nurses, nursing technicians, driver-rescuers, physiotherapists, and psychologists. The coordination of these diverse areas of knowledge and skills is essential to ensure comprehensive, humanized care based on the best available scientific evidence (Silva, Cordeiro & Drummond, 2024; Busatto & Mendes, 2024). However, the integrated performance of these teams faces significant challenges, ranging from structural and organizational limitations to issues related to professional training and interprofessional communication. The specialized literature has shown that such obstacles can compromise the quality and continuity of care. Nevertheless, there has also been notable progress in the adoption of successful collaborative practices and the integration of support technologies, which significantly contribute to improving the effectiveness of field interventions and optimizing the care provided (Rodrigues, da Silva & Galhardo, 2024). In this regard, it is essential to gain a deeper understanding of the main challenges and potentialities shaping the performance of multidisciplinary teams in the field of prehospital care, especially in situations that require immediate response and efficient coordination. Therefore, this study aims to describe the performance of the multidisciplinary team in PHC, identifying its main challenges and highlighting the potentialities involved in enhancing care quality in emergency contexts. Methodology This study is a narrative literature review, a methodological approach that enables the collection and synthesis of available evidence on a specific phenomenon, encompassing studies with different methodological perspectives and promoting a broader understanding of the topic. The research question guiding this review was: What are the challenges and potentialities of the multidisciplinary team’s performance in prehospital care during emergency situations? The search was conducted in the PubMed, SciELO, and LILACS databases, selected for their relevance in the fields of public health, emergencies, and urgent care, as well as for their broad range of scientific publications related to professional practice in prehospital care contexts. Controlled descriptors and free terms were used in Portuguese, English, and Spanish, combined using the Boolean operators AND and OR. Key terms included: ―prehospital care,‖ ―emergencies and urgent care,‖ ―multidisciplinary team,‖ ―health interdisciplinarity,‖ and ―prehospital emergency care.‖ Studies published within the last five years were included if they discussed the performance of multidisciplinary teams in prehospital care services, with an emphasis on operational challenges, knowledge integration, the potential of interdisciplinary care, and the quality of emergency care. Exclusion criteria included duplicate studies, non-systematic reviews, editorials, letters to the editor, experience reports, and works not directly related to multidisciplinary performance in the PHC context. The analysis of the studies was conducted rigorously, considering thematic relevance, methodological quality, and contribution to understanding the main challenges and potentialities of multidisciplinary team performance in prehospital care. The data synthesis enabled the identification of recurring thematic categories, which served as the basis for organizing the results and developing a critical discussion of the selected literature. Results and Discussion The analysis of the selected studies allowed the findings to be organized into three thematic categories, built from a critical reading and synthesis of the available evidence in the literature. These categories reflect the main elements related to the performance of the multidisciplinary team in prehospital care (PHC), particularly in emergency situations, highlighting structural aspects, operational challenges, and care potentialities. Composition and Organization of the Multidisciplinary Team in Prehospital Care The composition of the multidisciplinary team involved in prehospital care reflects the complexity and dynamic nature of urgent and emergency care settings. In Brazil, one of the main frameworks is the Mobile Emergency Care Service (SAMU 192), whose units generally include physicians and/or nurses, nursing technicians, driver-rescuers, and, in specific contexts, other professionals such as physiotherapists, psychologists, and social workers. The presence of each professional depends on the service’s structure, the type of unit deployed—basic or advanced— and the epidemiological and territorial demands of the served region (Diotalevi, 2024; Busatto & Mendes, 2024). In addition to SAMU, the Integrated Trauma and Emergency Care Service (SIATE) also plays a prominent role in Brazil. Initially implemented in the state of Paraná and later replicated in other states and municipalities, SIATE is mainly operated by the Military Fire Department and is primarily focused on trauma care— particularly for victims of traffic accidents, falls, gunshot wounds, stab wounds, and other situations involving immediate physical risk (Diotalevi, 2024). SIATE operates through an integrated regulation center that dispatches mobile units, usually composed of military personnel trained in basic and advanced life support. Unlike SAMU, which is directly linked to the public health system and integrated with the Health Care Network (RAS), SIATE emphasizes a rapid and effective response to traumatic events, focusing on immediate patient rescue and stabilization at the incident site (Souza et al., 2024; Reis & Costa, 2024). Despite notable institutional and operational differences, both SAMU and SIATE are complementary strategies within Brazil’s prehospital care model. Effective coordination between these systems is essential to ensure a fast, cohesive, and effective emergency response. This requires clear communication protocols, Copyright © ISRG Publishers. All rights Reserved. DOI: 10.5281/zenodo.17614669 194 well-defined operational flows, and continuous training for the involved teams (da Silva & Camargos, 2024; de Lima et al., 2024). Physicians and nurses play essential roles in prehospital teams, particularly in initial clinical assessment, therapeutic decisionmaking, and immediate life-saving interventions. Nursing technicians work under direct supervision, performing technical procedures and providing basic life support. Meanwhile, driverrescuers, beyond their transport duties, often have first aid and basic life support training, allowing them to actively assist in care procedures (Silva, Cordeiro & Drummond, 2024; Rodrigues, da Silva & Galhardo, 2024; Ludwig et al., 2025). In more structured services or high-complexity scenarios—such as mass casualty incidents, disasters, or large-scale emergencies— professionals like physiotherapists, psychologists, and others are also involved. Their inclusion broadens the scope of care and supports a truly comprehensive approach that addresses not only biological, but also emotional and social dimensions of the patient (Albino, 2024; Cruz Gonzalez, 2024). Thus, integrated multidisciplinary team performance is a strategic element in enhancing emergency care, enabling more effective, timely, and needs-based interventions. However, this integration is not automatic—it requires effective communication, mutual recognition and respect among professionals, and a strong commitment to interdisciplinary practice. The ability to work collaboratively and overcome fragmented care models is frequently cited in the literature as essential for ensuring both effectiveness and humanization in prehospital care (Cruz Gonzalez, 2024). Various studies reviewed emphasize that the success of multidisciplinary action in PHC is closely tied to team cohesion and clearly defined roles and responsibilities. Major barriers to true interdisciplinary practice include the lack of integrated protocols, communication failures, and training that remains largely discipline-specific. In this regard, preparing professionals for collaborative work—especially under the high-pressure, unpredictable conditions typical of PHC—remains a critical challenge for health education programs (Trevizan Pastore & Ferreira, 2024). Therefore, it is essential to adopt continuous education strategies that foster collaborative competencies, interprofessional dialogue, and collective knowledge-building, all aimed at establishing ethical, high-quality care centered on the comprehensive needs of patients in acute distress. The organization of the multidisciplinary team must thus be understood not only as a functional structure, but also as a relational and political construct that directly impacts the quality and effectiveness of actions within prehospital care (Correa et al., 2025). Challenges in the Performance of the Multidisciplinary Team in Emergency Situations The performance of multidisciplinary teams in prehospital emergency contexts is shaped by a series of structural, organizational, and subjective challenges that directly affect the effectiveness of care and compromise the safety of both professionals and users. These challenges become particularly acute in critical scenarios characterized by high unpredictability, limited time for clinical decision-making, and the need for immediate responses. Such conditions demand not only technical proficiency but also collaborative work capacity, emotional resilience, and professional adaptability (Bonilla Fallas, 2024; Trevizan Pastore & Ferreira, 2024; Honorato et al., 2025). One of the most frequently reported obstacles in the specialized literature concerns communication failures—both within teams and across different levels and services in the Emergency Care Network (RAU). The lack of integrated protocols, limited interoperability between information systems, and the absence of well-defined workflows hinder care continuity and the effective coordination between prehospital care services and referral units such as Emergency Care Units (UPAs) and higher-complexity hospitals. In many instances, teams operate in isolation, making critical decisions based on fragmented or outdated information, which increases the risk of adverse events and undermines comprehensive care (Pereira et al., 2024; Mól, Alves & Soares, 2024). Regarding working conditions, operational overload is a major concern, exacerbated by long shifts, exhausting routines, and a shortage of qualified human resources. Precarious employment arrangements—such as temporary contracts, outsourcing, and lack of job security—further contribute to functional instability and hinder the development of strong professional relationships. This instability negatively affects team cohesion and the effectiveness of collaborative work. Additionally, deficiencies in infrastructure— such as inadequate or deteriorated ambulances, equipment, and essential materials—limit the ability to respond to urgent demands and expose both patients and professionals to avoidable risks (Silva, Cordeiro & Drummond, 2024; Correa et al., 2025). Another critical issue involves the physical and mental deterioration of PHC workers, who are continuously exposed to extreme situations such as mass casualty incidents, on-site deaths, urban violence, and intense human suffering. Recent studies report high rates of burnout syndrome, anxiety disorders, and depression among emergency care professionals, highlighting the weakness of institutional strategies for mental health support. The lack of formal spaces for listening, psychosocial support, and effective workplace health promotion policies exacerbates this scenario of vulnerability (Honorato et al., 2025; Santana et al., 2025). Furthermore, the absence of institutional spaces for collective planning, practice evaluation, and joint development of care strategies represents a significant barrier to truly multidisciplinary performance. In many services, a hierarchical and fragmented logic persists, impeding the establishment of horizontal working relationships and obstructing mutual recognition of each professional’s knowledge and competencies (Cruz Gonzalez, 2024; Bonilla Fallas, 2024; de Oliveira et al., 2025; Mól, Alves & Soares, 2024). Therefore, the challenges faced by multidisciplinary teams in PHC are not limited to technical aspects—they also encompass ethical, relational, and political dimensions. Overcoming them requires public policies aimed at valuing health work, implementing interprofessional training processes, and adopting management models that promote democratized decision-making and humanized care relationships (da Silva Oliveira et al., 2025). Potentialities and Best Practices in Multidisciplinary Performance in Prehospital Care Despite the numerous challenges present in the prehospital care (PHC) context, scientific literature highlights a significant set of potentialities and best practices that have concretely contributed to improving the quality of care and strengthening multidisciplinary work in this field. These potentialities show that, when actions are well planned, structured, and supported by institutional policies, Copyright © ISRG Publishers. All rights Reserved. DOI: 10.5281/zenodo.17614669 195 integrated efforts among various professional categories not only enhance clinical effectiveness but also improve user experience and promote the value of health work (de Oliveira et al., 2025; Honorato et al., 2025). One of the most notable strategies is the adoption of shared clinical protocols, which promote standardized care practices, reduce variability in interventions, and ensure greater coherence among team members’ actions. When these protocols are evidence-based and adapted to local contexts, they support joint decision-making and reinforce team cohesion—especially in critical situations that demand agility, accuracy, and synchronization. However, effective implementation requires participatory processes and sustained investment in continuing education (da Silva Oliveira et al., 2025). In this regard, interprofessional training and realistic simulations have emerged as highly effective educational practices. By replicating emergency scenarios in controlled environments, these strategies help develop technical, communication, and leadership skills, while also fostering mutual recognition of each profession’s unique competencies. Furthermore, such activities enable the identification of weaknesses in care workflows and allow for the refinement of clinical protocols (Silva, Cordeiro & Drummond, 2024). The promotion of relational and communication skills within multidisciplinary teams is also a core component of best practices in prehospital care. Abilities such as active listening, empathy, assertive communication, and respect for differing perspectives are essential for building user-centered care, particularly in emotionally demanding environments. However, these competencies are often underestimated in health education curricula, underscoring the need for their continuous development throughout professional life (Correa et al., 2025). Another key aspect is the growing integration of digital technologies and computerized systems to support clinical decision-making and medical regulation. Tools such as geolocation systems, ambulance dispatch apps, mobile electronic medical records, and telemedicine devices have significantly transformed the dynamics of PHC. These innovations improve response times, optimize resource distribution, and provide real-time access to clinical information. When applied ethically and strategically, they strengthen the problem-solving capacity of teams and enhance integration across various levels of the healthcare network (Santana et al., 2025). Additionally, there is increasing recognition of the importance of humanized practices in PHC, even under pressure for rapid and effective responses. Emphasizing qualified listening, welcoming attitudes, and respect for patient dignity—even in technically adverse environments—has become an ethical and care-related differentiator. Research shows that humanized interventions can reduce patient suffering, strengthen bonds between users and teams, and increase satisfaction with the care received, thereby promoting continuity of care after emergency events (Correa et al., 2025; da Silva Francisco, da Silva & de Almeida Cruz, 2024). Therefore, the potentialities identified should not be seen as isolated solutions, but rather as structural elements of a care culture that is multidisciplinary, interdisciplinary, and centered on comprehensive attention. This culture must be reinforced through public policies, institutional guidelines, and management models committed to healthcare excellence (Rodrigues et al., 2025). Conclusion The performance of the multidisciplinary team in prehospital care (PHC) during emergency situations is a strategic component in ensuring effective, safe, and humanized care. Based on the literature analysis, it is evident that while teamwork is a powerful tool for enhancing emergency response, its effectiveness remains constrained by various structural, organizational, and educational challenges. Key obstacles identified include weak communication among professionals and services, precarious working conditions, the lack of integrated clinical protocols, and the physical and psychological exhaustion of teams. These issues hinder practice cohesion and make it difficult to establish a truly interdisciplinary approach. However, the literature also highlights several potentialities that must be strengthened, such as the implementation of shared clinical protocols, the adoption of digital technologies to support decisionmaking, interprofessional training, and the promotion of humanized practices—even in highly complex contexts. Emergency care, by its unpredictable and demanding nature, requires not only immediate technical responses but also the ability to coordinate diverse knowledge and practices, rooted in ethical, collaborative principles and centered on user needs. In this sense, investing in continuous training, valuing relational competencies, structuring integrated public policies, and strengthening the health care network are essential steps for enhancing multidisciplinary work in PHC. Ultimately, this study underscores the importance of broadening the discussion around the role of multidisciplinary teams in prehospital care, taking into account both the challenges faced and, more importantly, the best practices already established across various regions. 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