Introduction: Situational awareness (SA, also called situation awareness) is the ability to take in relevant information about an event in order to understand it and take effective action. Maintaining effective SA as an emergency medical dispatcher (EMD) may be more difficult than in other, similarly complex roles because of the remote nature of an emergency call for help. This study attempts to provide insight on one remote SA situation by reporting on a simulation study in which cardiopulmonary resuscitation (CPR) instructions were provided over the phone to laypeople, whose behavior was observed by researchers as they performed the instructed actions (or didn't).
Objective: The primary objectives of this study were to identify (a) whether callers were performing the actions instructed by the EMDs, (b) whether EMDs took any specific actions to ensure that they were aware of the actual situation on scene and the caller's actions, and (c) whether there were any common or predictable types of disconnect between the instructed and performed actions.
Methods: This study comprised the qualitative, observational portion of a previously published prospective, randomized, controlled study that was conducted by simulating cardiac arrest calls to 911 using layperson-caller participants at four locations in Salt Lake City, Utah, USA.
Results: Eleven common behaviors were observed that indicated disconnects between the instructions provided by the EMD and the actions performed by the participant callers. In general, the common elements that led to poor (or even non-performed) CPR involved the speed at which instructions were provided back-to-back, missed or misunderstood information, "gaps" or periods of EMD silence, and uncertainty about how to physically manage the phone (and the interaction with the EMD) while providing CPR.
Conclusion: The results of the metronome case study suggest a model of SA for EMDs as they gather, interpret, and transmit information for the caller, the team, and the entire profession. Future studies will evaluate the best ways to integrate SA into protocol development and how best to measure and assess it through quality assurance.