Background Previous studies have suggested that paramedics are not situationally aware during their initial prehospital education nor during online simulation. No known research has measured situational awareness (SA) of paramedics during actual emergency calls for service.

Method An observational cross section study of paramedics in a busy 911 system during emergency calls for service. Utilizing the situational awareness global assessment technique (SAGAT) paramedics were asked a short series of questions during periodic stops during the emergency calls by trained observers. The questions were based on a previously proven theoretical framework of SA for paramedicine focusing on the paramedic’s ability to properly recognize events, interpret their meaning, and then predict how they may unfold in the future.

Results While observing 10 licensed paramedics, a total of 67 emergency calls for service were observed over a 4-week period. During those calls, 387 queries were asked of the paramedics during the actual emergency. Paramedics successfully answer 24% of the recognition questions, 32% of the interpretation questions, and 45% of the prediction questions. Overall SA was 34%.

Conclusion Paramedics were not situationally aware. They struggled the most with recognition questions, possibly due to high levels of stress and tunnel vision while on scene with patients. Of the events that they were able to recognize, they performed better at properly interpreting what those events meant and how those events may unfold in the future. Future studies are needed to determine if a targeted educational approach may improve SA and then, possibly, patient outcomes.

Conflict of interest None.

Funding None.