Factors affecting paramedics situational awareness in out of hospital emergencies: A mixed methods systematic review

Out-of-hospital emergency care is complex, time-critical, and demands rapid decisions that directly affect patient safety. Paramedics deliver life-saving treatment in unpredictable environments, requiring swift judgment and adaptability under pressure. Despite expertise, errors occur-especially under stress. Situational awareness (SA), the ability to perceive, interpret, and anticipate key elements, is vital for safe, effective care and coordination. Yet research on how paramedics develop and maintain SA in these challenging settings remains limited, leaving critical knowledge gaps.

This mixed methods systematic review synthesizes evidence on factors influencing paramedics' SA in out-of-hospital emergency care.

Following PRISMA 2020 and JBI guidelines, a comprehensive search of MEDLINE, CINAHL, PsycINFO, and EMBASE identified studies published from 2013 onward.

Four recurring factors affecting SA emerged: The Individual: Cognitive Capacity & Expertise, The Systems: Information Flow & Technological Integration, The Team: Leadership & Distributed Communication, and The Context: Environmental & Scene Complexity.

SA depends on the interaction between individual cognitive capacity and expertise, system-level information flow and technological integration, team-based leadership and communication, and environmental and scene complexity. The findings demonstrate that SA is not an isolated individual skill but an emergent and fragile phenomenon shaped by cognitive, organizational, and contextual demands.