Do paramedic students have situational awareness during high-fidelity simulation? A mixed-methods pilot study.

BACKGROUND:In order for paramedics to maintain safety for themselves, their partners, their patients, and the public, they must be situationally aware. To be situationally aware they must be able to recognize a situation, correctly interpret it, and analyse that information in order to anticipate future events. There are limited empirical data that identify whether or not paramedic students are situationally aware. OBJECTIVE:The aim of this study is to determine if paramedic students are situationally aware during high-fidelity simulation. METHOD:This mixed-methods pilot study was undertaken in a high-fidelity paramedic simulation lab. Twelve students participated in an out-of-hospital simulation, each while wearing a point-of-view camera. Data were derived from pre/post assessment surveys, performance assessments, debriefing with the situational awareness global assessment technique (SAGAT), and a full video debriefing. These data were used to determine whether students were able to recognize information, properly interpret that information, and accurately anticipate how that information would affect future events. Thematic analysis of the video debriefings was undertaken with emergent themes being extracted. RESULTS:Quantitative data measures were derived from SAGAT data and performance assessments. Students recognized 42% (30/71) of the physiological and global items related to an emergency patient and the emergency scene itself. Of the items they recognized, they properly interpreted 34% (15/44) of them, leading to the ability to properly project 40% (24/60) of patient clinical progression. During student interviews, several themes were identified as key factors contributing to their loss of situational awareness, inlcuding tunnel vision, stress, and lack of an organized approach. CONCLUSIONS:This study suggests that paramedic students are not situationally aware. Students failed to recognize some events. Of the events they did recognize, they were unable to properly interpret what they meant or how future events would unfold. It appears students lack situational awareness due to being stressed, failing to focus, and lacking an organized approach. Further research is needed to determine improved best practices in paramedic situational awareness education.