Work-related factors, cognitive skills, unsafe behavior and safety incident involvement among emergency medical services crew members: relationships and indirect effects

Abstract

Objectives. This study examines relationships between work-related factors – stress and fatigue, cognitive skills – situation awareness and cognitive flexibility, unsafe behavior and safety incident involvement among emergency medical services (EMS) crew members, and whether cognitive skills and unsafe behavior together indirectly affect the relationship between work-related factors and safety incident involvement. Methods. A sample of 131 EMS crew members working in ground ambulances (physicians, paramedics, ambulance drivers) completed self-report questionnaires. Results. The correlation analysis showed significant positive interrelationships between work-related factors, unsafe behavior and safety incident involvement, and that cognitive skills were significantly negatively related to these variables. The multiple indirect effects analysis revealed significant indirect effects of both work-related factors on safety incident involvement through situation awareness and unsafe behavior, but not through cognitive flexibility. Conclusion. In terms of reducing the number of EMS provider and patient safety incidents, the findings suggest the importance of reducing stress and fatigue in EMS crew members, improving their cognitive skills, in particular situation awareness, and supporting their safety compliance behavior.

Keywords:

• stress
• fatigue
• non-technical skills
• situation awareness
• cognitive flexibility
• unsafe behavior
• safety incidents
• emergency medical services

Acknowledgements

The author would especially like to thank Veronika Marečková for her help with this research. The author designed the research and was the only manuscript contributor; however, Veronika Marečková participated in the translation of questionnaires and the data collection, as part of the data were used in her master’s thesis. This work was supported by the Scientific Grant Agency of the Ministry of Education, Science, Research and Sport of the Slovak Republic and Slovak Academy of Sciences [Grant No. VEGA 2/0070/18, ‘Cognitive and Social Skills Supporting Decision Making and the Quality of Performance of Emergency Medical Services Crew Members’]. The agency did not participate in designing the research, data collection, interpretations of results and writing the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author.

Data availability statement

The raw data that support the findings of this study are available from the corresponding author upon reasonable request.

Ethics approval and consent to participate

The entire Grant No. VEGA 2/0070/18 has been reviewed and received a Favourable Opinion from the Ethics Committee of the Slovak Academy of Sciences, Bratislava, Slovakia. Each participant gave informed consent to participate in the study.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1 In Slovakia, there are two basic types of ground EMS crews. Physician-led crews are composed of three members – a physician, a paramedic and an ambulance driver. Paramedic-led crews are composed of two members – a paramedic and an ambulance driver. Paramedics with an ambulance driving license can work as drivers. Instead of paramedics, EMS crews can also be staffed by nurses with adequate education.

Additional information

Funding

This work was supported by the Scientific Grant Agency of the Ministry of Education, Science, Research and Sport of the Slovak Republic and Slovak Academy of Sciences [Grant No. VEGA 2/0070/18, ‘Cognitive and Social Skills Supporting Decision Making and the Quality of Performance of Emergency Medical Services Crew Members’]; Vedecká Grantová Agentúra MŠVVaŠ SR a SAV.