A/Prof Paul Simplson2, Mr Jacob Tant1,2, Dr Robin Pap2
1NSW Ambulance, Bankstown, Australia, 2Western Sydney University, Campbelltown, Australia
Biography:
Jacob Tant is a Critical Care Paramedic with NSW Ambulance, where he has worked since 2015. He is also a sessional academic with Western Sydney University, contributing to paramedic education since 2020. Jacob is completing a Master of Research at WSU, focusing on cognitive load management in paramedic practice.
Abstract:
Introduction: Paramedics operate in complex, dynamic, and time-critical environments characterised by uncertainty, competing demands, and high cognitive burden. The risk of cognitive overload has important implications for clinical reasoning, decision-making, and patient safety. Despite the significance, there is currently little understanding of how paramedics actively manage cognitive load in real-world practice. This study aimed to develop a theoretically informed understanding of cognitive load management by paramedics in operational contexts.
Methods: This study used constructivist grounded theory in the tradition of Charmaz. Semi-structured interviews were conducted with Australian paramedics across a range of clinical and operational contexts. Data collection and analysis occurred concurrently, informed by constant comparative methods. Initial and focused coding were undertaken iteratively, supported by memo-writing to develop conceptual categories. Theoretical sampling guided subsequent data collection to refine emerging insights, with analysis continuing until theoretical sufficiency was achieved. Reflexivity was maintained throughout to acknowledge the co-constructed nature of the findings and researcher positionality.
Results: Cognitive load was described as finite and requiring active regulation. Five key interrelated processes were identified: embedding practice until it becomes second nature; offloading cognitive work to tools and aids; shaping the environment to reduce competing cognitive demands; distributing cognitive work across the team; and stepping back to monitor and regain control. These strategies were applied dynamically in response to situational demands.
Conclusion: Cognitive load management in paramedicine is an active, integrated process. This study provides a framework to inform future research, education, clinical practice, and system design.