title: Situational awareness and information flow in prehospital emergency medical care from the perspective of paramedic field supervisors: a scenario-based study.
abstract: BACKGROUND
  In prehospital emergency medical services, one of the key factors in the successful delivery of appropriate care is the efficient management and supervision of the area's emergency medical services units. Paramedic field supervisors have an important role in this task. One of the key factors in the daily work of paramedic field supervisors is ensuring that they have enough of the right type of information when co-operating with other authorities and making decisions. However, a gap in information sharing still exists especially due to information overload. The aim of this study was to find out what type of critical information paramedic field supervisors need during multi-authority missions in order to manage their emergency medical services area successfully. The study also investigated both the flow of information, and interactions with the paramedic field supervisors and the differences that occur depending on the incident type.
  
  
  METHODS
  Ten paramedic field supervisors from four Finnish rescue departments participated in the study in January-March 2012. The data were collected using semi-structured interviews based on three progressive real-life scenarios and a questionnaire. Data were analysed using deductive content analysis. Data management and analysis were performed using Atlas.ti 7 software.
  
  
  RESULTS
  Five critical information categories were formulated: Incident data, Mission status, Area status, Safety at work, and Tactics. Each category's importance varied depending on the incident and on whether it was about information needed or information delivered by the paramedic field supervisors. The main communication equipment used to receive information was the authority radio network (TETRA). However, when delivering information, mobile phones and TETRA were of equal importance. Paramedic field supervisors needed more information relating to area status.
  
  
  CONCLUSIONS
  Paramedic field supervisors communicate actively with EMS units and other authorities such as Emergency Medical Dispatch, police, and rescue services during the multi-authority incidents. This study provides knowledge about the critical information categories when receiving and sharing the information to obtain and maintain situational awareness. However, further research is needed to examine more the information flow in prehospital emergency care to enable a better understanding of required communication in situational awareness formation.
authors.affiliation: Department of Health and Social Management, University of Eastern Finland, PL 1627, Kuopio, 70211, Finland. teija.norri-sederholm@uef.fi.
authors.forename: Teija
authors.initials: T
authors.lastname: Norri-Sederholm
authors.affiliation: Centre for Pre-hospital Emergency Care, Kuopio University Hospital, PO Box 1777, Kuopio, 70210, Finland. heikki.paakkonen@kuh.fi.
authors.forename: Heikki
authors.initials: H
authors.lastname: Paakkonen
authors.affiliation: Centre for Pre-hospital Emergency Care, Kuopio University Hospital, PO Box 1777, Kuopio, 70210, Finland. jouni.kurola@kuh.fi.
authors.forename: Jouni
authors.initials: J
authors.lastname: Kurola
authors.affiliation: Department of Health and Social Management, University of Eastern Finland, PL 1627, Kuopio, 70211, Finland. kaija.saranto@uef.fi.
authors.forename: Kaija
authors.initials: K
authors.lastname: Saranto
mesh_terms: D000488:Allied Health Personnel / Q000592:standards*; D001364:Awareness; D003142:Communication; D003657:Decision Making; D004632:Emergency Medical Services / Q000592:standards*; D005387:Finland; D006801:Humans; D007407:Interviews as Topic; D010934:Planning Techniques; D024382:Professional Role; D011795:Surveys and Questionnaires