Background The concept of situation awareness (SA) has become a core theme throughout human factors research. SA is a cognitive process, put simply, it refers to a person’s ability to be aware of what’s going on and to anticipate what will happen next. In an acute pre-hospital setting, practitioners are required to make decisions quickly and often under pressure, these decisions depend on their SA. However, we do not yet know if the type of incident affects a person’s SA. Despite the importance of SA in medicine, few studies have examined SA in the pre-hospital setting. The aim of this study was to determine whether pre-hospital responders are more situationally aware in a familiar or unfamiliar environment using simulated scenarios.

Method This observational study recruited 22 pre-hospital responders to participate two simulated scenarios; one familiar and the other unfamiliar. Following completion of the simulation participants individually completed a modified SAGAT questionnaire to quantitively analyse SA across 10 different factors.

Results The results showed that participants were more situationally aware in an unfamiliar environment (mean familiar: 18.75, mean unfamiliar: 22.75, P value = 0.003). However, participants felt more confident completing the familiar scenario (mean familiar = 4.09 compared to mean unfamiliar=3.87).

Conclusion Pre-hospital responders were more situationally aware in an unfamiliar environment, one reason for this could be due to the lack of experience in these environments practitioners may be more vigilant. Regardless of whether the environment is familiar or unfamiliar, responders are often exposed to complex environments where patients with serious injuries have to be managed and good SA is essential for safely managing a patient. Due to the small sample size and limited knowledge on this topic there would be a value in conducting more research considering the importance of SA in pre-hospital medicine.