The aim of this article is twofold. First, it is a theoretical and empirically based contribution to the branch of research that studies enabling conditions of human sense-making. It demonstrates the value of a coherent ecological framework, based on dialogism and interactivity for the study of sense-making, problem-solving and task performance in naturalistic contexts. Second, it presents a promising method for the analysis of cognitive activities, Cognitive Event Analysis, with which we investigate real-life medical interactions, especially the emergence of insights (...) in procedural task performance in emergency medicine. We show how sense-making and insights are accomplished by medical teams when they integrate cultural expertise, professional skills, inter-bodily dynamics, material constraints and affordances within the environment, i.e. when local co-action is embedded in socio-cultural patterns of behaviour. (shrink)