Cognitive skills of emergency medical services crew members: a literature review

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.

Clinical Reasoning among Registered Nurses in Emergency Medical Services: A Case Study

“…Clinical reasoning has attracted significant research interest, especially in hospital contexts. While these studies often focus on physicians and patient safety, some recent work has taken a broader view (Andersson et al, 2019; Perona et al, 2019; Sedlár, 2020), with increased attention to CR in EMS contexts. Much of the extensive research on CR relates to diagnosis, including the accuracy of EMS field diagnoses as compared to hospital discharge diagnoses (Magnusson et al, 2020; Wilson et al, 2018) and difficulties in assessing or managing conditions like sepsis (Sjösten et al, 2019), stroke (Andersson et al, 2018) or cases involving resuscitation (Andersson et al, 2021; Brandling et al, 2017).…”

Balancing structure and flexibility in the ambulance service: the pursuit of professional judgement in caring and learning

“…This thesis has, in line with previous research, indicated situational awareness 23 as a foundational aspect in medical assessments, clinical reasoning, clinical decision-making, and patient safety [173][174][175][176][177][178][179][180]. The preceptors used talking aloud during caregiving and created mental schemata for recurring sources of information to support the students to collect the correct cues and avoid cognitive biases in clinical decision-making.…”

‘We Ought to Be Professionals’: Strategies of Intrapersonal and Interpersonal Emotion Regulation of Emergency Medical Services Professionals in Confrontation With the Death of a Newborn in Simulated Task

“…However, the methodological foundations and body of knowledge about coping with stress and communication with patients in paramedic profession are thinner compared to the study of cognitive skills such as decision-making and situation awareness (see Sedlár, 2020) as well as communication skills in team performance (see Manser, 2009). This is due to greater difficulty of assessment of these skills from observable behavior, especially in the case of stress management (Shields & Flin, 2012).…”