Situation Awareness Global Assessment Technique Research Articles

Analysis of driver behavior at grade-separated intersections to support design

Understanding driver behaviors in varied traffic scenarios is critical to the design of safe and efficient roadways and traffic control device. This research presents an analysis of driver cognitive workload, situation awareness (SA) and performance for three different scenarios, including a standard intersection and contraflow grade-separated intersections (C-GSI) and quadrant GSI (Q-GSI) with lane assignment sign manipulations. The study used a simulator-based driving experiment with application of the NASA Task Load Index and Situation Awareness Global Assessment Technique to assess the influence of the scenarios on driver behavioral responses. The findings reveal challenges for drivers navigating the C-GSI, characterized by diminished SA and elevated workload. These states were associated with behaviors such as delayed lane changes, missed opportunities for appropriate lane changes, heightened acceleration behavior within deceleration segments, and frequent speeding. In contrast, while drivers in the Q-GSI scenario faced elevated workloads, their SA remained steady, largely due to lane-specific signs facilitating early lane changes. Although the Q-GSI led to increased speed variability and slight increases in deceleration, the use of supplementary speed signage revealed a promising alternative to the S-intersection. Correlation analysis highlighted a significant relationship between mental workload and acceleration responses, indicating that increased acceleration was associated with higher mental workload. In addition, a significant negative correlation between driver perceived performance and absolute lane deviations indicated that drivers with higher self-assessed performance were more accurate in lane-keeping. The study underscores the need for GSIs and signage designs that support driver SA, manage cognitive workload to improve driver performance and increase road safety.

Exploring construction workers' attention and awareness in diverse virtual hazard scenarios to prevent struck-by accidents

Repetitive tasks in construction reduce workers' attentiveness of hazards on sites. This decline in attentiveness can be influenced by their situation awareness level. However, research on the relationship between attentiveness and situation awareness is scarce in the construction safety domain. This study employs eye-tracking techniques to investigate how visual attention changes due to variations in workers’ situation awareness levels. A virtual reality-based experiment was conducted to evaluate the situation awareness level of individual workers and examine its relationship with attentiveness towards different hazards using the situation awareness global assessment technique and linear regression analysis. The experimental findings reveal that the overall trend of allocating attention toward hazards declined over time. Furthermore, the attentiveness of workers varied depending on their situation awareness levels and the type of hazardous condition. Throughout the experiment, the group with a low situation awareness failed to sustain their vigilance toward hazards as effectively as the group with a high situation awareness. The outcomes of this study will help construction safety trainers understand variations in workers' vigilance behavior over time and, thus mitigate the risk of accidents owing to inattentiveness at job sites.

“Who Said That?” Applying the Situation Awareness Global Assessment Technique to Social Telepresence

As with all remotely controlled robots, successful teleoperation of social and telepresence robots relies greatly on operator situation awareness; however, existing situation awareness measurements, most being originally created for military purposes, are not adapted to the context of social interaction. We propose an objective technique for telepresence evaluation based on the widely accepted Situation Awareness Global Assessment Technique, adjusted to suit social contexts. This was trialled in a between-subjects participant study ( n = 56) comparing the effect of mono and spatial (binaural) audio feedback on operator situation awareness during robot teleoperation in a simulated social telepresence scenario. Subjective data were also recorded, including questions adapted from Witmer and Singer’s Presence Questionnaire, as well as qualitative feedback from participants. No significant differences in situation awareness measurements were detected; however, correlations observed between measures call for further research. This study and its findings are a potential starting point for the development of social situation awareness assessment techniques, which can inform future social and telepresence robot design decisions.

An Eye-Fixation Related Electroencephalography Technique for Predicting Situation Awareness: Implications for Driver State Monitoring Systems.

This study developed a fixation-related electroencephalography band power (FRBP) approach for situation awareness (SA) assessment in automated driving. Maintaining good SA in Level 3 automated vehicles is crucial to drivers' takeover performance when the automated system fails. A multimodal fusion approach that enables the analysis of the visual behavioral and cognitive processes of SA can facilitate real-time assessment of SA in future driver state monitoring systems. Thirty participants performed three simulated automated driving tasks. After each task, the Situation Awareness Global Assessment Technique (SAGAT) was deployed to capture their SA about key elements that could affect their takeover task performance. Participants eye movements and brain activities were recorded. Data on their brain activity after each eye fixation on the key elements were extracted and labeled according to the correctness of the SAGAT. Mixed-effects models were used to identify brain regions that were indicative of SA, and machine learning models for SA assessment were developed based on the identified brain regions. Participants' alpha and theta oscillation at frontal and temporal areas are indicative of SA. In addition, the FRBP technique can be used to predict drivers' SA with an accuracy of 88% using a neural network model. The FRBP technique, which incorporates eye movements and brain activities, can provide more comprehensive evaluation of SA. Findings highlight the potential of utilizing FRBP to monitor drivers' SA in real-time. The proposed framework can be expanded and applied to driver state monitoring systems to measure human SA in real-world driving.

The Impact of Environmental Features on Drivers’ Situation Awareness Using Real-World Driving Scenarios

Advanced driver assistance systems (ADAS) need to account for the driver’s awareness of the environment to be effectively used. This study examines the impact of environmental features (eg, visual complexity, object density, roadway type, lighting) on drivers’ situation awareness (SA). This is achieved using a controlled study with 40 participants. Using a split-plot design, the participants were shown 30 out of 75 real-world driving scenarios displayed in a driving simulator environment. Participants’ responses to Situational Awareness Global Assessment Technique (SAGAT) queries on the type and coordinates of objects in the scene were used to calculate SA scores. A hurdle model was developed to estimate participants’ SA scores. The key findings highlight visual complexity as a significant predictor of SA scores. This predictor was easy to compute and able to capture the complexity of objects that impact road safety as well as the visual clutter in the background. The model showed that drivers were able to identify at least one object of interest in complex environments with high visual complexity and with many objects. A higher proportion of vulnerable road users was associated with a greater likelihood of a non-zero SA score, but the SA score was lower compared to environments with higher proportions of cars. The findings of this study provide insights into the environmental factors to be considered for SA predictive models.

The effects of motivation and noise on situation awareness: A study based on SAGAT and EEG

The current research results have differences in the correlation between situation awareness (SA) and physiological data, and there is a lack of systematic research on the influence of motivation and noise on SA. This study investigated the correlation between SA and electroencephalogram (EEG) signals under the effects of motivation and noise.The independent variables were motivation (two levels: positive and negative) and noise (three levels: no noise, natural noise, and speech noise). And the dependent variable were the levels of SA in perception, comprehension and projection. Participants were required to observe traffic videos of three types of noise under two types of motivation and complete the Situation Awareness Global Assessment Technique (SAGAT) questionnaire after each video. We recorded the participants' EEG signals and calculated the average relative power of the delta, theta, alpha, and beta bands of each brain region.The results showed that the levels of perception and projection under negative motivation were higher than those under positive motivation. The level of perception was negatively correlated with the delta band power in the central lobe and theta power in the occipital lobe. The level of projection was negatively correlated with the delta band power in the frontal, central, parietal, and occipital lobes, positively correlated with the theta band power, and negatively correlated with the delta band power in the temporal lobe. Therefore, negative motivation can improve the individual's perception and projection levels. The delta and theta band power may reliably measure SA.This study can help improve team member's SA by establishing motivational rules and better develop physiological measures of SA.

Effects of cybersecurity knowledge and situation awareness during cyberattacks on autonomous vehicles

Autonomous vehicles offer many potential benefits; however, this expansion of cyber-physical systems also introduces a new potential vulnerability through cybersecurity threats. It is therefore important to understand the role vehicle occupants can play in preventing and responding to cyberattacks. The objective of this study is to (1) evaluate drivers’ responses to unexpected cyberattacks, and (2) evaluate how cybersecurity knowledge affects situation awareness (SA) during cyberattacks on automated driving. A driving simulator study with 20 participants was conducted to measure drivers’ performance during unexpected cyberattacks on a SAE Level 2 partially-autonomous vehicle and the infrastructure in the driving environment. Each participant experienced four driving scenarios, each scenario with a different cyberattack. Two cyberattacks were directly on the vehicle and two were on the infrastructure. Situation Awareness Global Assessment Technique (SAGAT) was used to measure participants’ situation awareness during the drives and at the time of the cyberattacks. Participant takeover responses to the cyberattacks were collected through the driving simulator. Participants also completed a cybersecurity knowledge survey at the end of the experiment to assess their previous overall cyber awareness and experience with autonomous vehicles. Most of the participants recognized the cyberattacks, however only about half of the participants chose to takeover control of the vehicle during the attacks, and in one attack no one overtook the automation. Results from ANOVAs showed significantly higher SA for participants with greater familiarity with cybersecurity terms and vehicle-to-everything technology. In addition, SA scores were significantly higher for participants who believed security systems (i.e., firewall, encryption) are important and for those who felt protected against cybercrimes. The present results suggest that increased cybersecurity knowledge can cause a high level of situation awareness during automated driving, which can help drivers to control unexpected driving situations due to cybersecurity attacks.

Investigating the relationship between eye movements and the situation awareness of forklift operators for accident prevention

This study investigated differences in eye movement indicators among forklift operators with different situation awareness (SA) and the relationship between eye movement indicators and the SA of forklift operators to verify the effectiveness of eye movement tracking in assessing SA and the factors affecting operators’ SA for improving forklift operation safety. An eye movement tracking system was used to collect eye movement data from 15 forklift operators while they performed a series of forklift tasks. The SA global assessment technique (SAGAT) was used to determine the SA score of each operator. The results indicated that the fixation duration percentage (FDP), fixation count percentage (FCP) and average fixation duration (AFD) all had a positive relationship with SA in the work-related area of interest (AOI). These findings support eye movement tracking as an effective technique to quantitatively evaluate forklift operators’ SA and provide insights into how forklift operators’ SA could be improved.

A situation awareness assessment method based on fuzzy cognitive maps

The status of an operator's situation awareness is one of the critical factors that influence the quality of the missions. Thus the measurement method of the situation awareness status is an important topic to research. So far, there are lots of methods designed for the measurement of situation awareness status, but there is no model that can measure it accurately in real-time, so this work is conducted to deal with such a gap. Firstly, collect the relevant physiological data of operators while they are performing a specific mission, simultaneously, measure their status of situation awareness by using the situation awareness global assessment technique (SAGAT), which is known for accuracy but cannot be used in real-time. And then, after the preprocessing of the raw data, use the physiological data as features, the SAGAT's results as a label to train a fuzzy cognitive map (FCM), which is an explainable and powerful intelligent model. Also, a hybrid learning algorithm of particle swarm optimization (PSO) and gradient descent is proposed for the FCM training. The final results show that the learned FCM can assess the status of situation awareness accurately in real-time, and the proposed hybrid learning algorithm has better efficiency and accuracy.

Investigating the impact of context and environment on driver’s situation awareness

The objective of this study is to assess drivers’ ability to detect objects and the trajectory of these objects in scenarios with different environmental complexity levels. This is examined in the context of situation awareness (SA), defined as theperception, comprehension and projection of the environmental properties andpositions. The Situation Awareness Global AssessmentTechnique (SAGAT) was used in a video-based driving simulation study, where participants were asked to mark all objects in the order ofperceived risk and select the corresponding objecttype. This provided spatially continuous SA responses for the objects of interest (i.e.,pedestrians, cars and cyclists). The findings showed that object type and size, visual complexity, number of objects and roadway typehada significant impact ontheoperator’s ability toperceiveobjectsaswellastoprojectthe object trajectories. The resultsprovideus some insightsinchoosing predictorsbesideseye-tracking data for SA predictive model.

A novel study of situational awareness among out-of-hospital providers during an online clinical simulation

BackgroundOut-of-hospital providers must be situationally aware in order to maintain safety for themselves, their patients, the public, and their crew. They must be able to recognize situations, interpret them, and predict how those situations may unfold in the future. MethodA mixed-methods explanatory sequential design where out-of-hospital providers in Oklahoma, USA, participated in an 18-minute online simulation and then had their situational awareness (SA) measured. Upon completion, participants provided feedback during scheduled interviews. ResultsA total of 156 out-of-hospital providers participated. Participants were not situationally aware. While not statistically significant, those with higher education had higher SA scores. Participants perceived that the simulation processes were beneficial to their ongoing care in the field, and were satisfied with the online simulation environment. ConclusionsOut-of-hospital providers are not situationally aware during an online clinical simulation. While they are focused intently on the surroundings of the scene, they do not put that same focus on the patient. With the appropriate technology and setup, the use of the Situational Awareness Global Assessment Technique (SAGAT) during online simulation is feasible and could enhance clinical performance. Further studies are needed to determine if overall education or years of clinical experience play a role in out-of-hospital SA.

The effect of working memory training on situation awareness in a flight simulator

The close relationship between working memory and situation awareness (SA) has been confirmed and further empirical investigations are lacking. The main aim of this study was to demonstrate the feasibility of working memory training for improving SA. Thirty-eight participants completed a challenging flight scenario in a high-fidelity flight simulator and were randomized into a training group (n = 20) or a control group (n = 18). The training group engaged in an adaptive dual N-back task for 2 weeks, while the control group was given a negative control task. Three-dimensional situation awareness rating technique (3D-SART) scores and situation awareness global assessment technique (SAGAT) scores were recorded to evaluate pretest and posttest SA. The results showed that both situational understanding dimension scores in the 3D-SART and SAGAT scores were significantly increased from the pretest to the posttest in the training group, while the control group showed no significant differences. It was concluded that working memory training can effectively improve individuals’ SA, which has important implication for future research.

Can a targeted educational approach improve situational awareness in paramedicine during 911 emergency calls?

BackgroundParamedics must be situationally aware in order to avoid human error and protect themselves, their partner, their patient, and the public. Previous research has suggested that paramedics lack situational awareness (SA), possibly due to a lack of an organized approach, distraction, and a poor understanding of SA. There is no educational approach provided to paramedics that is known to improve their levels of SA. If such an approach were provided, it could possibly reduce human error and lead to improved outcomes. ObjectiveThe aim of this study is to determine whether providing paramedics with a targeted educational approach, including aspects from crew resource management (CRM) such as sterile cockpit and Endsley’s model for SA, can improve overall SA during emergency calls. MethodsA prospective, quasi-experimental before-and-after study was used, in which out-of hospital paramedics were observed during 911 emergency calls. Baseline SA was measured using the situational awareness global assessment technique (SAGAT). Paramedics were then given a targeted educational lesson focusing on elements of SA and CRM as well as a novel quick reference tool to utilize during 911 calls. Post intervention SA was then measured again, and before-and-after results were compared for difference of mean scores. ResultsThe overall baseline SA was 62% increasing to 86% following the educational intervention. The Wilcoxon Ranked Sum was used to assess for statistically significant differences between mean SA performance in the same group of paramedics before and after the intervention. The increase in SA was found to be statistically significant where p = 0.011. ConclusionsA targeted educational approach focusing on CRM and a novel quick reference tool may increase SA levels of paramedics during 911 emergency calls. Further studies are needed with bigger cohorts. Paramedicine educational institutions and out-of-hospital agencies should consider implementing this targeted approach with their students and currently practicing providers.

Understanding the impact of the walking environment on pedestrian perception and comprehension of the situation

PurposeErroneous pedestrian perception and comprehension of the walking environment have been recognized as the culprit in unsafe walking. There have been many studies to understand how pedestrian perception and comprehension of the surrounding situation are affected in laboratory settings. However, the real walking environment is characterized as a complex combination of various dynamic and static objects, all of which are important for pedestrian safety and diversely affect pedestrians. Therefore, this study aims to understand how pedestrian perception and comprehension of a pedestrian's surroundings are affected by the types and states (i.e., dynamic or static) of the perceived objects as well as the complexity of the walking environment using real-world experiments. MethodsIn this study, the pedestrians’ level of perception and comprehension of various static (e.g., traffic lights, signs) and dynamic (e.g., other pedestrians, cars) objects were measured using the Situational Awareness Global Assessment Technique while they walked through different walking zones. Results and contributionsThe results indicated that the pedestrians' awareness was more affected by the type of information that the objects delivered (e.g., safety-related information) and the complexity of the walking environment than the objects’ state. This study demonstrates the differences in pedestrian perception and comprehension based on the characteristics of the walking environment to help determine ways that can enhance the awareness of pedestrians to improve walking safety.

Do team and task performance improve after training situation awareness? A randomized controlled study of interprofessional intensive care teams

BackgroundWhen working in complex environments with critically ill patients, team performance is influenced by situation awareness in teams. Moreover, improved situation awareness in the teams will probably improve team and task performance. The aim of this study is to evaluate an educational programme on situation awareness for interprofessional teams at the intensive care units using team and task performance as outcomes.MethodTwenty interprofessional teams from the northern part of Sweden participated in this randomized controlled intervention study conducted in situ in two intensive care units. The study was based on three cases (cases 0, 1 and 2) with patients in a critical situation. The intervention group (n = 11) participated in a two-hour educational programme in situation awareness, including theory, practice, and reflection, while the control group (n = 9) performed the training without education in situation awareness. The outcomes were team performance (TEAM instrument), task performance (ABCDE checklist) and situation awareness (Situation Awareness Global Assessment Technique (SAGAT)). Generalized estimating equation were used to analyse the changes from case 0 to case 2, and from case 1 to case 2.ResultsEducation in situation awareness in the intervention group improved TEAM leadership (p = 0.003), TEAM task management (p = 0.018) and TEAM total (p = 0.030) when comparing cases 1 and 2; these significant improvements were not found in the control group. No significant differences were observed in the SAGAT or the ABCDE checklist.ConclusionsThis intervention study shows that a 2-h education in situation awareness improved parts of team performance in an acute care situation. Team leadership and task management improved in the intervention group, which may indicate that the one or several of the components in situation awareness (perception, comprehension and projection) were improved. However, in the present study this potential increase in situation awareness was not detected with SAGAT. Further research is needed to evaluate how educational programs can be used to increase situation awareness in interprofessional ICU teams and to establish which components that are essential in these programs.Trial registrationThis randomized controlled trial was not registered as it does not report the results of health outcomes after a health care intervention on human participants.

Using eye-tracking to investigate the effects of pre-takeover visual engagement on situation awareness during automated driving

Automated driving systems are becoming increasingly prevalent throughout society. In conditionally automated vehicles, drivers may engage in non-driving-related tasks (NDRTs), which can negatively affect their situation awareness (SA) and preparedness to resume control of the vehicle, when necessary. Previous work has investigated engagement in NDRTs, but questions remain unanswered regarding its effect on drivers’ SA during a takeover event. The objective of the current study is to use eye-tracking to aid in understanding how visual engagement in NDRTs affects changes in SA of the driving environment after a takeover request (TOR) has been issued. Thirty participants rode in a simulated SAE Level 3 automated driving environment and engaged in three separate pre-TOR tasks (Surrogate Reference Task, Monitoring Task, and Peripheral Detection Task) until presented with a TOR. Situation Awareness Global Assessment Technique (SAGAT) scores and gaze behavior were recorded during the post-TOR segment. Overall, longer times spent viewing the driving scene, and more dispersed visual attention allocation, were observed to be associated with better overall SA. Also, location-based eye tracking metrics show most promise in differentiating between task conditions with significantly different SAGAT scores. Findings from this work can inform the development of real-time SA assessment techniques using eye movements and ultimately contribute to improved operator roadway awareness for next-generation automated transportation.

Mindfulness Is Related to the Situational Awareness of Medical Students Confronted with Life-Threatening Emergency Situations.

Background: Emergency medicine can impose a heavy psychological burden on healthcare workers. Stress experienced during life-threatening situations may disrupt situational awareness (SA), i.e., the perception of environmental elements with respect to time and space, the comprehension of their meaning, and the projection of their state into the near future. We aimed to investigate whether mindfulness (a special way of paying attention: conscious, non-judgmental, and oriented to the present moment) can be related to the SA levels among final-year medical students confronted with life-threatening situations during medical simulations. Methods: The simulations were constructed as high-fidelity scenarios in children and adults (ClinicalTrials.gov ID: NCT03761355). The components of mindfulness were assessed using the Five Facet Mindfulness Questionnaire. SA among students was assessed using The Situation Awareness Global Assessment Technique at three levels: (1) data, (2) comprehension, and (3) projection. Results: In total, 117 students were included. Level 1 SA positively correlated with the overall mindfulness score and its components, i.e., nonreactivity, conscious presence, and nonjudgment. Moreover, level 3 SA significantly correlated with the description, but not with the overall mindfulness score. A regression model showed that nonreactivity explained 34% of Level 1 of SA variability. The addition of conscious presence and nonjudgment into this model did not change its predictive value. Conclusions: nonreactivity a component of mindfulness of final-year medical students is related to the meticulous data collection of patients in life-threatening situations.

Impact of a shared decision-making mHealth tool on caregivers\u2019 team situational awareness, communication effectiveness, and performance during pediatric cardiopulmonary resuscitation: study protocol of a cluster randomized controlled trial

BackgroundEffective team communication, coordination, and situational awareness (SA) by team members are critical components to deliver optimal cardiopulmonary resuscitation (CPR). Complexity of care during CPR, involvement of numerous providers, miscommunication, and other exogenous factors can all contribute to negatively influencing patient care, thus jeopardizing survival. We aim to investigate whether an mHealth supportive tool (the Interconnected and Focused Mobile Apps on patient Care Environment [InterFACE]) developed as a collaborative platform to support CPR providers in real-time and share patient-centered information would increase SA during pediatric CPR.MethodsWe will conduct a prospective, cluster randomized controlled trial by groups of 6 participants in a tertiary pediatric emergency department (33,000 consultations/year) with pediatric physicians and nurses. We will compare the impact of the InterFACE tool with conventional communication methods on SA and effective team communication during a standardized pediatric in-hospital cardiac arrest and a polytrauma high-fidelity simulations. Forty-eight participants will be randomized (1:1) to consecutively perform two 20-min video-recorded scenarios using either the mHealth tool or conventional methods. The primary endpoint is the SA score, measured with the Situation Awareness Global Assessment Technique (SAGAT) instrument. Enrollment will start in late 2020 and data analysis in early 2021. We anticipate that the intervention will be completed by early 2021 and study results will be submitted in mid 2021 for publication.DiscussionThis clinical trial will assess the impact of a collaborative mHealth tool on increasing situational awareness and effective team communication during in-hospital pediatric resuscitation. As research in this area is scarce, the results generated by this study may become of paramount importance in improving the care of children receiving in-hospital CPR, in the era of increasing communication technology.Trial registrationClinicalTrials.gov NCT04464603. Registered on 9 July 2020.

Construction workers’ awareness of safety information depending on physical and mental load

ABSTRACT Construction is one of the most dangerous occupations. The most prominent reason for worker accidents is unsafe behavior, particularly rooted in the inability to recognize and appropriately respond to risk factors. Previous studies have investigated worker perception and comprehension of construction hazards and safety information in laboratory settings. A relationship has been found between workload and workers’ situation awareness (SA), a useful concept for understanding risk perception and comprehension. However, it is necessary to investigate the actual construction environment to increase the real-world applicability of the research results. This experimental study analyzed workers’ SA in relation to physical and mental workloads acquired while performing work at a construction site. Perception (Level-1-SA) and comprehension (Level-2-SA) were measured using the SA Global Assessment Technique as subjects walked inside a facility under construction and performed inspection or construction works. Statistically significant differences were found between perception and comprehension of safety-related information. It was also found that mental load negatively affected SA. This study provided external validation of previously investigated effects of workload on workers’ perception and comprehension of safety-related elements at real construction sites. The study’s findings can improve the understanding of workers’ safety behaviors and help suggest directions for safety management guidelines.

Do paramedic students have situational awareness during high-fidelity simulation? A mixed-methods pilot study

BackgroundIn order for paramedics to maintain safety for themselves, their partners, their patients, and the public, they must be situationally aware. To be situationally aware they must be able to recognize a situation, correctly interpret it, and analyse that information in order to anticipate future events. There are limited empirical data that identify whether or not paramedic students are situationally aware. ObjectiveThe aim of this study is to determine if paramedic students are situationally aware during high-fidelity simulation. MethodThis mixed-methods pilot study was undertaken in a high-fidelity paramedic simulation lab. Twelve students participated in an out-of-hospital simulation, each while wearing a point-of-view camera. Data were derived from pre/post assessment surveys, performance assessments, debriefing with the situational awareness global assessment technique (SAGAT), and a full video debriefing. These data were used to determine whether students were able to recognize information, properly interpret that information, and accurately anticipate how that information would affect future events. Thematic analysis of the video debriefings was undertaken with emergent themes being extracted. ResultsQuantitative data measures were derived from SAGAT data and performance assessments. Students recognized 42% (30/71) of the physiological and global items related to an emergency patient and the emergency scene itself. Of the items they recognized, they properly interpreted 34% (15/44) of them, leading to the ability to properly project 40% (24/60) of patient clinical progression. During student interviews, several themes were identified as key factors contributing to their loss of situational awareness, inlcuding tunnel vision, stress, and lack of an organized approach. ConclusionsThis study suggests that paramedic students are not situationally aware. Students failed to recognize some events. Of the events they did recognize, they were unable to properly interpret what they meant or how future events would unfold. It appears students lack situational awareness due to being stressed, failing to focus, and lacking an organized approach. Further research is needed to determine improved best practices in paramedic situational awareness education.