Assessment of Danish surf lifeguards’ skills using in situ simulation: a retrospective cohort study

BACKGROUND: In situ simulation (ISS) is a form of simulation-based training conducted in participants' working environments to improve clinical performance and system readiness. This study aimed to estimate the incidence of non-satisfactory ISS assessments in the Danish nationwide lifeguard service and to identify associated factors.

METHODS: This retrospective study analysed ISS assessment reports completed by lifeguard instructors from 2018 to 2023. Unadjusted logistic regression was used to identify factors associated with non-satisfactory assessments, reported as ORs with 95% CIs using the Wald method.

RESULTS: Of 768 ISS assessments, 151 (20%) were non-satisfactory. Baseline characteristics, including wave height, showed no significant differences between satisfactory and non-satisfactory groups. The most frequent scenario was an adult, unconscious drowning patient. Discovery time was significantly longer in the non-satisfactory group (median 26 s (IQR: 3-99) vs 1 s (IQR: 0-11), p<0.01). Distractions were associated with a non-satisfactory ISS assessment (OR 2.58 (95% CI: 1.55 to 4.30), p<0.001). Other significant associations included corrective feedback on beach setup (OR 1.69 (95% CI: 1.13 to 2.52), p=0.01), response time (OR 3.54 (95% CI: 1.66 to 7.53), p=0.001), board rescue (OR 1.83 (95% CI: 1.23 to 2.74), p=0.003), boat rescue (OR 2.98 (95% CI: 1.51 to 5.90), p=0.002), alarm call (OR 1.60 (95% CI: 1.02 to 2.50), p=0.04), defibrillation (OR 3.68 (95% CI: 2.23 to 6.07), p<0.001) and non-technical skills (OR 1.71 (95% CI: 1.19 to 2.46), p=0.004).

DISCUSSION AND CONCLUSIONS: Non-satisfactory ISS assessments occurred in 20%. Several modifiable factors were associated with a non-satisfactory assessment, indicating areas for improvement within the organisation and the educational programme.