A novel study of situational awareness among out-of-hospital providers during an online clinical simulation.

BACKGROUND: Out-of-hospital providers must be situationally aware in order to maintain safety for themselves, their patients, the public, and their crew. They must be able to recognize situations, interpret them, and predict how those situations may unfold in the future. METHOD: A mixed-methods explanatory sequential design where out-of-hospital providers in Oklahoma, USA, participated in an 18-minute online simulation and then had their situational awareness (SA) measured. Upon completion, participants provided feedback during scheduled interviews. RESULTS: A total of 156 out-of-hospital providers participated. Participants were not situationally aware. While not statistically significant, those with higher education had higher SA scores. Participants perceived that the simulation processes were beneficial to their ongoing care in the field, and were satisfied with the online simulation environment. CONCLUSIONS: Out-of-hospital providers are not situationally aware during an online clinical simulation. While they are focused intently on the surroundings of the scene, they do not put that same focus on the patient. With the appropriate technology and setup, the use of the Situational Awareness Global Assessment Technique (SAGAT) during online simulation is feasible and could enhance clinical performance. Further studies are needed to determine if overall education or years of clinical experience play a role in out-of-hospital SA.

Can a targeted educational approach improve situational awareness in paramedicine during 911 emergency calls?

BACKGROUND: Paramedics must be situationally aware in order to avoid human error and protect themselves, their partner, their patient, and the public. Previous research has suggested that paramedics lack situational awareness (SA), possibly due to a lack of an organized approach, distraction, and a poor understanding of SA. There is no educational approach provided to paramedics that is known to improve their levels of SA. If such an approach were provided, it could possibly reduce human error and lead to improved outcomes. OBJECTIVE: The aim of this study is to determine whether providing paramedics with a targeted educational approach, including aspects from crew resource management (CRM) such as sterile cockpit and Endsley's model for SA, can improve overall SA during emergency calls. METHODS: A prospective, quasi-experimental before-and-after study was used, in which out-of hospital paramedics were observed during 911 emergency calls. Baseline SA was measured using the situational awareness global assessment technique (SAGAT). Paramedics were then given a targeted educational lesson focusing on elements of SA and CRM as well as a novel quick reference tool to utilize during 911 calls. Post intervention SA was then measured again, and before-and-after results were compared for difference of mean scores. RESULTS: The overall baseline SA was 62% increasing to 86% following the educational intervention. The Wilcoxon Ranked Sum was used to assess for statistically significant differences between mean SA performance in the same group of paramedics before and after the intervention. The increase in SA was found to be statistically significant where p = 0.011. CONCLUSIONS: A targeted educational approach focusing on CRM and a novel quick reference tool may increase SA levels of paramedics during 911 emergency calls. Further studies are needed with bigger cohorts. Paramedicine educational institutions and out-of-hospital agencies should consider implementing this targeted approach with their students and currently practicing providers.

A Rare Case of Bilateral Neurogenic Thoracic Outlet Syndrome Following Neck Injury.

Thoracic Outlet Syndrome (TOS) is a rare condition caused by compression of the neurovascular structures of the thoracic outlet. Patients with TOS are found to have a greater prevalence of supernumerary or abnormal first ribs compared to the general population. Symptoms can sometimes be incited by a neck injury, especially in patients with abnormal cervical anatomy. This case report highlights a unique patient with bilateral cervical ribs who presented with complicated symptoms following a neck injury who required a series of surgical interventions to improve.

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.

What Is Known About Situational Awareness in Paramedicine?: A Scoping Review.

BACKGROUND: Without situational awareness (SA), it is possible that paramedics, crews, patients, and the public may be at risk for injury or medical error. At present, it appears that minimal attention has been given to SA in the setting of paramedicine. OBJECTIVE: To map the state of existing literature evaluating SA in paramedicine. METHODS: To examine the breadth of knowledge available about SA and paramedicine. Searches of five electronic databases and grey literature were conducted to identify papers published related to SA and paramedicine. A narrative approach to synthesising and mapping the literature was used. RESULTS: The concepts of paramedicine and SA yielded 1,125 results which, after screening, included 20 papers for qualitative synthesis. While the literature does show that SA can be measured in allied health simulations, this review shows that there is a very limited empirical understanding of SA and paramedicine. CONCLUSIONS: While possessing SA has been shown to reduce accidents in other industries such as aviation and off-shore drilling, SA has not been researched in depth in paramedicine. Several knowledge gaps were identified that need further research including the potential effects of possessing, or not possessing, SA in paramedicine.