Situational Awareness

Situational Awareness


Growing up in the Navy, I learned early on that situational awareness was critical to the safety of myself and those around me and sortie completion rates. Working around aircraft on the flight deck of "supercarrier" minding your position to what was occurring was lifesaving, or at least had the potential to reduce your chances of being blown off the ship or running into a spinning propeller. Foreseeing the turning of an F-14 Tomcat or EA6B Prowler was, in many cases, an opportunity for one to avoid the potential for being knocked down by the jet exhaust and then ran over by a taxiing aircraft, and moreover, the outcome of the mission.

What I did not understand at the time and granted I was barely 18 years old was, how this construct was something more significant, its application more excellent, and its impact life-changing, literally. In psychology, there is a branch dedicated to human factors, and within this arm, there is something called "cognitive engineering." This term has evolved over the years and is commonly known as cognitive ergonomics. It is defined rudimentarily as the way humans interact with their surroundings on a cognitive level, so mental action and the process of utilizing and applying knowledge.

That said, I am now a paramedic, nearly 41, and have evolved from my 18-year self. As a newer medic, I spent a lot of focus on simply trying to process the situation in front of me and how to apply my newly formed skills to treat a patient. As time progressed, I became more familiar with these surroundings, better understood patient care, and was eventually able to take that information and apply it to the potential for a patient to do well or in the worst-case scenario, decompensate and code.

The aforementioned paragraph is, in essence, situational awareness and eerily familiar to my days on the flight deck, however, applied differently. In an article written by Lauria et al. (2019), the authors discuss how the development of situational awareness can lead to better outcomes, specifically in resuscitation, a place where many of us want to thrive. The big question, is this something we can do on our own, does it come naturally, or is it something we need to train actively? I do not have a specific answer, although I think that many psychologists would say that it requires training. 

So, how can we train and apply this to our practice? Does a more realistic simulation impact one’s ability to forecast a patient's prognosis? Is this something that can be taught in classrooms during EMT and paramedic school, or do we need an apprenticeship before ever being released to the streets so that we can learn from those who have "mastered" this construct? If you would like to know more about simulation a good place to start is the National Association for EMS Educators and their vision statement on simulation. Here is the link-

With that, I think if you listen to the Dr. Lauria interview in a few weeks, there might be some answers. Until then, think pragmatically, study and stay current on the literature, pay attention to your surroundings; vital signs, medications, vent settings, etc. and try to imagine yourself in a situation where you would need to respond accordingly and effectively, now talk through it. I do this on the way to work, and on the way to runs, it allows me to work through the call, see the room, and think through interventions I may need to provide. Finally, communicate with everyone, that includes family and your partner/s, doing so might show that you have not yet seen the big picture and have tunnel vision from reading the dispatch notes still [1].

Thanks for reading and as always be PragMedic





T. Norri-Sederholm, H. Paakkonen, J. Kurola, and K. Saranto, "Situational awareness and information flow in prehospital emergency medical care from the perspective of paramedic field supervisors: a scenario-based study," Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2015.


M. J. Lauria, M. K. Ghobrial and C. M. Hicks, "Force of habit: Developing situation awareness in critical care transport," Air Medical Journal, vol. 38, pp. 48-50, 2019.