# Impact of collective orientation on the quality of teamwork of emergency medical personnel in simulated prehospital emergency medical care - a prospective observational study

## TL;DR

This study explores how willingness to work in teams (collective orientation) affects the performance of paramedics in simulated emergency scenarios.

## Contribution

The study introduces empirical evidence on the impact of collective orientation on teamwork in prehospital emergency care.

## Key findings

- High collective orientation improved teamwork factors like leadership and task management.
- No significant difference was found in speed or completeness of patient care between high and low collective orientation teams.
- Collective orientation appears most valuable in complex emergencies requiring diverse problem-solving.

## Abstract

High-responsibility teams in prehospital emergency medicine regularly face multidimensional challenges. Collaboration in such teams is vital for the care, safety and outcome of our patients. Collective Orientation (CO) is simply defined as the individual willingness to work with others in a team. Collective Orientation has been proven to have a positive effect on team performance in clinical healthcare. However, data on prehospital emergency medicine is still lacking.

This prospective observational study measured the collective orientation of n = 64 paramedic students in their third year of training using a validated questionnaire. Teams were formed based on the students’ collective orientation (high or low). Two simulation scenarios (tension pneumothorax and bronchospasm) were evaluated using the Time Key Item Product (TKIP) and Team Emergency Assessment Measure (TEAM).

There was no significant difference in the speed and completeness of patient care (TKIP) between low (M = 6605) and high (M = 6967) Collective Orientation (p = 0.133). There was no significant difference in time to diagnosis between low (M = 384 s) and high (M = 405 s) CO (p = 0.128). Teams with high CO undoubtedly achieved better results in teamwork-relevant factors. These factors include leadership (p = 0,031), teamwork (p = 0,052) and task management (p = 0,038). There was no significant difference between low and high CO when using cognitive aids (p = 0,471) or the 10-for-10 principle (p = 0,735).

Collective Orientation must be considered a component of paramedics’ competence to act in paramedic education, as it is characteristic of good teamwork. Further research is needed. The study suggests that Collective Orientation only works in highly complex emergencies outside of linear standard operating procedures or when combined with unanticipated complications. It is clear that leading symptoms that require a wide differential diagnosis demonstrate the value of a high collective orientation.

The online version contains supplementary material available at 10.1186/s12873-025-01399-2.