Resilience in Emergency Medical Dispatch: Big R and little r

Emergency medical dispatch (EMD) is integral to emergency health care provision. It involves interaction between humans and computers and needs to be resilient to fluctuating demands. Here we investigate resilience in the London Ambulance Service control room. We find it useful to distinguish between Big R and little r, the former relating to strategy creation and the latter strategy sharing and reuse. Systems can be designed to allow for Big R responses to the unexpected. Little r can facilitate the efficiency, effectiveness and safety of more mundane tasks. This distinction can help research studies in resilience for other health care contexts.