No abstract

Background: Situation awareness and decision making, listed in non-technical skills taxonomies, are critical for effective and safe performance in high-risk professions. These cognitive skills and their behavioral markers have been studied less in emergency medical services (EMS) crew members. This paper aims to review the existing literature and identify important aspects and behavioral markers of situation awareness and decision making in EMS crew membersthose who work in the role of prehospital emergency care providersand to synthesize findings as a basis for developing a rating and training tool. Method: The search for relevant articles was conducted using electronic databases, reference lists of relevant reviews and included articles and personal collection of articles. The selection process based on the PRISMA statement yielded a total of 30 articles that met the eligibility criteria. Their findings were qualitatively synthesized using the structured approach, informed by the already known structure: situation awareness and its elements (gathering information, interpreting information, anticipating future states), decision making and its elements (generating and considering options, selecting and implementing an option, reviewing outcome/decision). Moreover, the element of maintaining standards also emerged as highly relevant for cognitive skills. Results: This review found an increased research interest in the non-technical cognitive skills of EMS crew members. The majority of included articles' research designs were qualitative, then mixed, Delphi, and quantitative. It revealed several specifics of cognitive skills, such as EMS crew members need to holistically assess a wide range of cues and information, to make various health-and safety-related decisions and take EMS standards into account. However, there was only a limited number of observable markers of cognitive skills, such as acts and verbalizations, that could be considered as examples of good behavior. In addition, findings indicate a lack of articles focused on mass-casualty incidents and the interconnection of cognitive skills with other non-technical and medical skills. Conclusion: Further research is needed to get a more comprehensive view of behavioral markers of cognitive skills and to develop a rating and training tool to improve EMS crew members' cognitive performance.

The aim of the study was to identify situation assessment and decision making strategies in emergency medical services physicians and to determine whether their distribution is associated with routine and non-routine situations. The research sample included 15 physicians, who were interviewed about routine and non-routine situations from their practice. The interviews about non-routine situations were conducted using the Critical Decision Method, and its adapted version was created for the purpose of conducting the interviews about routine situations. Generally, qualitative analysis showed that intuitive strategies were most frequently used in situation assessment and decision making but they occurred more in routine situations, by contrast, deliberative strategies were used more in non-routine situations. These findings were supported by statistical tests suggesting that physicians were more likely to change strategies with respect to situational demands.