Assessment of Danish surf lifeguards' skills using in situ simulation: a retrospective cohort study

In situ simulation (ISS) is a form of simulation-based training conducted in participants' working environments to improve clinical performance and system readiness. This study aimed to estimate the incidence of non-satisfactory ISS assessments in the Danish nationwide lifeguard service and to identify associated factors.

This retrospective study analysed ISS assessment reports completed by lifeguard instructors from 2018 to 2023. Unadjusted logistic regression was used to identify factors associated with non-satisfactory assessments, reported as ORs with 95% CIs using the Wald method.

Of 768 ISS assessments, 151 (20%) were non-satisfactory. Baseline characteristics, including wave height, showed no significant differences between satisfactory and non-satisfactory groups. The most frequent scenario was an adult, unconscious drowning patient. Discovery time was significantly longer in the non-satisfactory group (median 26 s (IQR: 3-99) vs 1 s (IQR: 0-11), p<0.01). Distractions were associated with a non-satisfactory ISS assessment (OR 2.58 (95% CI: 1.55 to 4.30), p<0.001). Other significant associations included corrective feedback on beach setup (OR 1.69 (95% CI: 1.13 to 2.52), p=0.01), response time (OR 3.54 (95% CI: 1.66 to 7.53), p=0.001), board rescue (OR 1.83 (95% CI: 1.23 to 2.74), p=0.003), boat rescue (OR 2.98 (95% CI: 1.51 to 5.90), p=0.002), alarm call (OR 1.60 (95% CI: 1.02 to 2.50), p=0.04), defibrillation (OR 3.68 (95% CI: 2.23 to 6.07), p<0.001) and non-technical skills (OR 1.71 (95% CI: 1.19 to 2.46), p=0.004).

Non-satisfactory ISS assessments occurred in 20%. Several modifiable factors were associated with a non-satisfactory assessment, indicating areas for improvement within the organisation and the educational programme.