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Studia Psychologica, Vol. 62, No. 2, 2020, 89-108
https :/ /d oi.org /10 .31577/sp.2 020.02.7 93
Emotion Regulation Strategies in Paramedic Crew Leaders
during a Simulated Stressful Task: A Qualitative Inquiry
Branislav Uhrecký1, Jitka Gurňáková1, Martina Baránková2
1Institute of Experimental Psychology, C entre of Social and Psychological Sciences, Slovak Ac ademy of Sciences,
Dúbravská cesta 9, 841 04 Bratislava, Slovak Republic
2Institute of Applied Psychology, Faculty of Social and Economic Sciences, Comenius University in Bratislava, Mlynské
luhy 4, 821 05 Bratislava, Slovak Republic
In spite of a large body of research in the field of emotion regulation, this subject has not yet been studied
vigorously in naturalistic settings, especially not in the context of task performance. Therefore, it remains
uncertain whether predominant theoretical conceptualizations of emotion regulation (e.g., Gross, 1998)
can be applied to this sort of situation. In this qualitative study, we aimed to identify emotion regulation
strategies of paramedic crew leaders (n = 30) in a simulated task with a sudden onset of a stressful
incident. For this purpose, we analyzed their emotional behavior (i.e., facial expression, voice volume,
body posture and movements etc.) on video recorded performance, and their affective states and emo-
tion regulation strategies based on interviews conducted right after the task. Verbal reports were ana-
lyzed via phenomenologically-laden template analysis. We classified emergent strategies into two basic
categories: task-related (e.g., attention narrowing, mobilization to action, monitoring) and self-supportive
(e.g., emotional distancing, behavioral withdrawal, detachment and selective attention). Results of our
analysis suggest that regulatory strategies are largely implemented on an implicit level of processing and
their function might be a better criterion for their distinction than a type of mental process.
Key words: coping with stress and fatigue, emergency medical service, non-technical skills, naturalistic
decision making, simulated task
Introduction
Despite both emotion regulation and natural-
istic decision making being established tradi-
tions in psychological research, the two para-
digms have barely crossed their paths. W ith
human error being discussed in occupations
such as aviation (W iegmann et al., 2005) or
medicine (Koh n, Corrigan, & Donaldso n,
2000), and stress being mentioned as one of
the major variables behind it (Sexton, 2000),
scientific justification for collaboration between
the two mentioned research traditions is obvi-
ous. In Japan, almost half of the fatal medical
accidents (46.6%) are likely caused by the
human factor (Uramatsu et al., 2017). The re-
search of naturalistic decision making (Klein,
2008) and closely related non-technical skills
(Flin, 2013) has been driven by an ambition to
Correspondence concerning this article should be addressed to Branislav Uhrecký, Institute of Experi-
mental Psychology, Centre of Social and Psychological Sciences, Slovak Academy of Sciences, Dúbravská
cesta 9, 841 04 Bratislava, Slovak Republic. E-mail: expsuhre@savba.sk
ORCID https://orcid.org/0000-0003-3633-1971
Received April 8, 2019
90 Studia Psychologica, Vol. 62 , No. 2 , 2020, 1-10
reduce the human error by studying macro-
cognitions and teamwork processes of pro-
fessionals during performance. Copin g with
difficult subjective states such as stress or fa-
tigue was also acknowledged as a vital skill
for enhancing work performance (Kodate et
al., 2012). Several studies point to the detri-
mental effects of stress on both technical and
non-technical skills in medicine (e.g., Crewther
et al., 2016; Harvey et al., 2012; Krage et al.,
2017), which is likely due to a limited acquisi-
tion of information or acceleration of pace with
trade-offs for accuracy (Maule, 1997). However,
experts can be much more immune to losing
accuracy compared to novices (Pavlidis et al.,
2012). This is in line with claims of Orasanu
(1997) and Klein (1997), who both theorize that
experts should be least affected by stress in
familiar situations where rule-based decisions
are optimal, because they rely on intuitive, bot-
tom-up processes.
However, due to methodological difficulties of
studying coping with stress in terms of observ-
able and measurable behavior (Shields & Flin,
2013), naturalistic studies still resort to exam-
ining effects of various stressors on physiologi-
cal mark ers of stress and performance
(Orasanu, 1997), while mechanisms of coping
with acute stress remain poorly understood.
Therefore, unlike other mental processes, such
as situation awareness, decision making or
uncertainty management, coping with stress
was not conceptualized for the purpose of study
in high-fidelity simulated tasks. Because cop-
ing strategies are framed as global patterns of
behavior and cognition, utilized on regular ba-
sis according to most theories and measure-
ment tools (e.g., Carver, Scheier, & Weintraub,
1989; Folkmann & Lazarus, 1988), they are not
categ ories sufficient for understanding man-
agement of affective states in short time periods
(see Boyle et al., 2011). On account of this limi-
tation in the study of coping, Gross (1998) pre-
sented emotion regulation as a more nuanced
and fine grained conceptualization of how emo-
tions are managed, and he proposed the pro-
cess model of emotion regulation as a frame-
work for understanding and studying emotion
regulation strategies.
The process model still remains the most
satisfactory classification o f ER strategies in
contemporary psychology. Koole (2009) and
Gross (1998, 2015) find an agreement in differ-
entiating three emotion-regulatory systems –
attention (e.g., attentional deployment), cogni-
tion (e.g., reappraisal, emotional distancing) and
body (e.g., ventilation, suppression, relaxation).
Gross (1998, 2015) distinguishes behavioral
strategies of situation selection and situation
modification as forms of emotion regulation as
well. Cognitive reappraisal – reinterpreting the
meaning of a situation into a more positive fram-
ing – is widely considered as the most adaptive
strategy based on empirical evidence (Gross,
2002). Reappraisal is often put into contrast with
suppression, which is an emotion regulatory
strategy that inhibits bodily emotional response.
The use of suppression has several negative
consequences for the subject, including ampli-
fication of experien c ed negative emotion
(Gro ss, 20 02) an d physiological arousal
(Hagemann, Levenson, & Gross, 2006), and
deterioration of cogn itive perf ormanc e
(Richards & Gross, 2000). Turning one’s atten-
tion away from an aversive stimuli – attentional
deployment – is an effective strategy when the
intensity of negative emotion is high (Sheppes,
Catran, & Meiran, 2009).
At this point, it is important to note that mul-
tiple emotion-regulatory systems or strategies
are likely to be implemented in real-life situa-
tions (Aldao & Nolen-Hoeksema, 2013), and
the context of task performance consists of
some additional particu larities and method-
ological challenges. The lines between desir-
able action and emotion regulation may be-
come blurred. Working memory’s preoccupa-
tion with the task may itself serve as a distractor
from aversive stimuli, causing the neutraliza-
tion of emotional experience (van Dillen &
Koole, 2007). Objections were raised with re-
gards to the model’s focus on effortful, top-
down regulatory strategies (Koole, 2009; Koole
& Rothermund, 2011) and its ability to repre-
sent regulatory strategies in real-life conditions
(Campos et al., 2011).
The process model was vastly extended
and improved over time (see Braunstein ,
Studia Psychologica, Vol. 62, No. 2, 2 020, 1-10 91
Gross, & Ochsner, 2017; Gross, 2015; Tamir,
2016). Knowled ge from self-regulation re-
search and motivational factors were taken
into account. Hedonic and instrumental mo-
tives were differentiated. Adopting an endless
feedback loop between situation (or its per-
cept ion) and emotion reg ulation strategy
brought a more authentic representation of
real-life dynamics in which emotion regula-
tion is tak ing plac e. However, Koo le and
Veenstra (2015) argue that the model still
relies on static mental representations as a
driving force. Therefore, it is still lacking in
capturing the emotion regulation as a pro-
cess that is interacting with changing envi-
ronment. At the same time, it remained un-
changed in its rigid classification of emotion
regulation strategies by the type of process.
Rice and Hoffman (2014) believe that a func-
tional perspective, such as the one in theory
of defense mechanisms, could be a better a
criteria for differentiation between regulatory
strateg ies, compared to process m odel’s
schematic approach.
Baumann, Sniezek, and Buerkle (2001) con-
structed a theoretical model of self-regulation
in naturalistic decision making under stress-
ful conditions based on their review of empiri-
cal literature. The central assumption of their
model is that successful management of task
anxiety is dependent on the perception of one’s
own performance during the task. If one’s per-
sonal resources and cap abilities are per-
ceived as insufficient for the task’s demands,
the anxiety raises above a tolerable level. The
performer is thus at a risk of becoming stuck
in a loop between negative self-evaluation of
performance and task anxiety. Motivated self-
evaluation (focusin g on manag eable sub-
tasks) is a protective factor against overwhelm-
ing task anxiety. However, not all negative or
intense emotions need to be regulated as they
might carry a cue to a goal-fulfillin g action
(Mosier & Fisher, 2010).
The cyclical model of impact of emotions on
paramedics’ experience during critical inci-
dents, constructed by Avraham, Goldblatt, and
Yafé (2014) with a grounded theory approach,
postulates similar claims. Negative emotions
lead to a sense of professional inadequacy
and a lack of perceived control over the task,
which further amplifies these emotions. How-
ever, paramedics themselves highlight that a
certain level of detachment from their emotions
is the key protective factor, not positive self-
evaluation of their performance. Because de-
tachment is not explicitly mentioned in the pro-
cess model of emotion regulation (Gross,
1998, 2015), this finding emphasizes the need
to study emotion regulation in professional
performance as a specific phenomenon. The
same principle applies to motivated self-evalu-
ation proposed by Baumann et al. (200 1),
which might have reappraisal as one compo-
nent, but it also consists of attention manage-
ment.
Paramedics have not been given that much
attention by researchers of naturalistic deci-
sion making, compared to other medical oc-
cupations. Assessment manuals of non-tech-
nical skills have been created for surgeons,
anesth esiologists, and assistants of sur-
geons (Flin, 2013), but not yet for paramedics.
Moreover, as was elaborated in the previous
text, coping with stress or fatigue has yet to be
put to an extensive empirical probation in the
study of medical or even naturalistic decision
making. However, coping may not be the most
appropriate term to con ceptualize manage-
ment of emotions in naturalistic settings. We
argue that emotion (or affect) regulation (Gross,
1998, 2015; Koole, 2009) offers more suffi-
cient terminology for this purpose. A few theo-
retical models (Avraham et al., 2014; Baumann
et al., 2001) attempted to set a starting point
for the study of management of distracting
emotions while performing in naturalistic con-
ditions, but more effort is required. It is our
intention to contribute to this line of research.
In this study, we aim to identify, classify and
describe emotion regulation strategies in para-
medic crew leaders during stressful task on
the level of mental processing and observable
behavior as well. Our intention was to design
a study that would enable us to examine affec-
tive states and strategies of their regulation in
complex, naturalistic and experience-near set-
ting s.
92 Studia Psychologica, Vol. 62 , No. 2 , 2020, 1-10
Methods
Two sources of data were utilized for the pur-
pose of this study. Both video recorded proce-
dure of paramedic crews during a simulated
task and transcribed interviews with paramedic
crew leaders were analyzed to accomplish a
fusion and triangulation of behavioral and phe-
nomenological approach.
Participants
Our research sample consisted of 30 para-
medic crew leaders (17 male, 13 female) of
Czech and Slovak nationalities. The age of the
participants ranged from 23 to 47 years (AM =
31.17, SD = 6.67, Mdn = 29.50). Each crew
consisted of the crew leader, paramedic –
driver, and paramedic – operator, with the ex-
ception of two crews having one extra mem-
ber. However, in our study, we focused solely
on crew leaders. One of the crews was ex-
cluded from our research sample due to tech-
nical issues of the video record from our main
camera. Three crews consisting of medical
students were included, while all others were
professional paramedics with a various length
of practice in their occupation, ranging from 1
to 26 years (AM = 7.33, SD = 5.80, Mdn = 7).
Participants were recruited at an international
paramedic competition Rallye Rejvíz 2017. Af-
ter an agreement with the organization board
of this competition, every paramedic that was
interested in competing in this event had to
explicitly agree with taking part in data collec-
tion as a participant in order to be registered.
Each registered competitor received informa-
tion about the planned research a month be-
fore the start of the competition. Specifically,
the information mentioned video recording of
their performance during one of the task and a
post-task interview with the crew leader. Our
entire methodology had been approved by the
ethical board of Slovak Academy of Sciences.
Data Collection
Paramedic crews were video recorded while
performing a simulated task. Four static cam-
eras were placed in a room where the task
was taking place and one camera was
handled by a cameraman who was targeting
the crew leader. An interview with the crew
leader was carried out right after the task had
been completed. The semi-structured inter-
view had a format of a retrospective verbal pro-
tocol with an intention to make the crew leader
recall and describe his/her experience during
the task including his/her intentions, thoughts,
emotions and means of coping with them. The
interviewer was supposed to make the inter-
viewee as specific as possible, so that his/her
experience of the task could be reconstructed
on a timeline (more in Data analysis). Inter-
views were conducted by a group of three re-
searchers and they took from 10 to 15 min-
utes.
Task
The task named “Grill” started as a routine-
type mission, even though paramedic crews
had been informed beforehand about the pos-
sibility of a domestic violence. On the scene,
one paramedic crew (played by figurants) was
taking care of a pregnant drug-addict and the
competing crew was supposed to take care of
an injured female pensioner who was deny-
ing any domestic violence, and her distraught
sister who was blaming the drug addict. After
a few minutes, the drug-addict stabbed a mem-
ber of the other paramedic crew right after the
arrival of a police crew (who are also competi-
tors, not figurants, and therefore their behavior
was not scripted). The aggressor (i.e., the drug
addict) ran to the backroom and was threaten-
ing the police with a knife. Stabbing of the para-
medic caused an acute bleeding, so the com-
peting paramedic crew was supposed to at-
tend, stabilize and monitor the injured para-
medic, and possibly take care of the aggres-
sor if she got injured by the police. The pair of
pensioners, who needed to be properly exam-
ined, was supposed to have an antagonistic
reaction if the policemen shot the aggressor
in their sight. Paramedic crew leaders were
supposed to report the means and directions
Studia Psychologica, Vol. 62, No. 2, 2 020, 1-10 93
of transportation of every patient to dispatch-
ing at the end of the task.
Data Analysis
A codebook for emotional behavior (Appendix
1) was developed by a certified FACS (Facial
Action C oding System; Ekman & Friesen ,
1978) coder after analyzing video records of
every crew during the task “Grill”. The codebook
was largely inspired by basic emotions and
emotion families (see Ekman, 1977; Ekman
& Cordaro, 2011; Wallbott, 1998) and listed 25
categories of emotional behavior. The certified
coder schooled one of the researchers in this
coding tool, so he could independently code
emotional behavior of crew leaders. Subse-
quently, all video records were coded by both
coders, the codes were compared, discussed
and consensus on mism atched data seg-
ments was reached. In addition, the para-
medic crew leaders’ behavior was described
as precisely as possible an d notable situ-
ational cues were also recorded in writing.
Interviews were transcribed and analyzed via
template analysis to identify affective states,
goals and regulatory strategies of crew lead-
ers during the task. We applied the combined,
exploratory-theoretical approach. Especially
our effort to identify regulatory strategies was
theoretically grounded in contemporary knowl-
edge as they are conceptually complex pro-
cesses. A list of regulatory strategies was con-
structed by authors of this study prior to analy-
sis based on four articles (three review articles
and one meta-analysis) that provided exten-
sive summaries of strategies (Gross, 2015;
Koole, 2009; Peňa-Sarrionandia, Mikolajczak,
& Gross, 2015; Webb, Miles, & Sheeran, 2012).
We did not include macro-level means of emo-
tion management such as coping styles, mind-
fulness meditation, etc. Strategies on our list
were grounded in the process model’s frame-
work and each of them was precisely defined.
Strategies proposed by Avraham et al. (2014)
and Baumann et al. (2001) were also added
to this list. The list was applied in data analy-
sis as a coding system that was open to ad-
justments and changes based on data. Be-
cause any statement regarding cognitive pro-
cessing, attention direction or behavioral ac-
tion might indicate emotion regulation without
the sub ject’s explicit awareness (Koo le &
Rothermund, 2011), more latent and interpre-
tative coding procedure had to be applied at
times to identify regulatory strategies. Every
statement indicating emotion regulation was
coded initially and stricter selection process
was applied when re-evaluating our codes. In
comparison, affective states and goals were
co ded more sem an tically (see Gue st ,
McQueen, & Namey, 2011). A codebook for in-
terviews was created by one of the authors
and another coder tested it on a limited dataset.
After initial comparisons and consultation s,
adjustments to the codebook were made and
both coders used it to analyze the entire data-
set. Inter-rater agreement was calculated and
reached moderate levels (κ = 0.66), but both
cod ers were at liberty to suggest their own
codes via memos if they found it appropriate.
Data segments where agreement was not
found or new codes were suggested were re-
appraised afterwards.
After video records and transcriptions of in-
terviews were analyzed, timeline of the task
“Grill” for every paramedic crew leader was
constructed using both sources of data. Inter-
views proved to be rich enough to enable
matching the reported subjective experience
with behavioral data without much doubt and
confusion regarding their placement on a
timeline (illustration of a data segment on a
timeline is in Appendix 2). During this triangu-
lation, we adjusted our categories for regula-
tory strategies and even proposed a few more
(more in results). We looked for patterns in
our timelines regarding regulatory strategies
– what is the situational context of implemen-
tation, which affective state is regulated, what
is the participant’s behavior, etc. – in order to
describe them in the greatest possible depth.
We distinguished time frames where a good
fit between the two sets of our data was not
achieved (i.e., the self-reported and observed
affective state did not match), which resulted
in a greater level of ambiguity and interpreta-
tion. One of the identified subcategories – de-
94 Studia Psychologica, Vol. 62 , No. 2 , 2020, 1-10
tachment and selective attention – was inferred
based on this lack of fit.
Results
Our analysis produced 14 subcategories of
emotion regulation strategies which were
classified as either task-related or self-sup-
portive. W e abandoned the classification sys-
tem of our prior coding scheme based on
the process model, because the differentia-
tion by a type of process was not a good fit
for the content of identified subcategories.
Identified strategies were not distinguishable
purely on merits of process-type. Functional
approach seemed more appropriate. The pri-
mary intention of task-related strategies was
to enhance performance, which inclu ded
regulation of distractive emotions and man-
agement of emotional arousal to meet the
task’s demands. Tolerable an d activating
level of distress, which leads to a desirable
form of action, is a more desirable effect of
task-related strategy compared to a positive
mood or relaxation. On the other hand, self-
supportive strategies served the purpose of
attenuation of negative emotions and/or in-
duction and amplification of positive emotions,
and they had no direct connection to task-
related action. In presentation of our results,
we describe the most comprehensibly por-
trayed strategies in greater detail. All emer-
gent strategies are summarized and shortly
characterized in Table 1.
Table 1 Overview of emergent emotion regulation strategies and frequencies of their occurrence
Strategies Short definition
Occurred in
n
participants
Task – related
Attentional narrowing Focusing one’s attention to a specific set of
stimuli or a subtask. 16
Mobilization to action Directing emotional arousal towards immediate
action. 14
Mobilization to deliberative
concentration
Attempt to think and plan sequentially, step-by-
step. 12
Distancing from the scene Viewing the situation as a whole. 11
Vigilance A state of readiness to react to any critical
event. 13
Monitoring Keeping specific stimuli in check. 11
Relying on a rule-based
procedure
Finding comfort in sticking to guidelines and
automatized processes. 9
Reflection of previous
decisions and events
Dealing with a disappointment by asking
oneself whether an aversive event was
preventable.
4
Self – supportive
Emotional distancing Observing one’s own emotions from a
distanced perspective. 9
Establishing a sense of
connection with the other
Seeking the experience of being in contact with
another person. 5
Detachment and selective
attention
Disconnection from one’s emotions, directing
attention away from negative aspects of
performance.
7
Behavioral withdrawal Withdrawal from a dangerous situation. 6
Venting Reduction of tension by behavioral expression. 6
Positive self-talk Encouraging oneself by positive statements. 3
Studia Psychologica, Vol. 62, No. 2, 2 020, 1-10 95
Table 2 Summary of the descripted expe rience and behavioral signs of major task-related emotion
regulation strategies
Strategy Experiential component Behavioral signs
attentional
narrowing
-
absorption with a set of stimuli or a
subtask
-
some stimuli or all surroundings are
blurred or completely disappeared
-
awareness of emotional state is
dissolved in favor of a limited number
of situational cues and action
-
focused on the current task, not looking around
-
does not respond to stimuli or requests from
his/her team members
-
reverts his/her attention back to a previous
activity if disturbed
-
reacts surprised when informed about course of
events not in his/her immediate proximity
mobilization to action
-
feeling time pressure and urge to act,
even when not understanding the
meaning of what is happening in the
situation
-
feeling professional responsibility to
act
-
energizing one’s own body
-
a sense of emergency in performed procedures
-
acceleration of pace
-
insisting on colleagues to assist quickly
-
increased volume of voice, quick pace of
speech
-
proptosed eyes and slightly open mouth, similar
but not as intense as worry
-
checking clocks
mobilization to
deliberative
concentration
-
the situation is perceived as
suddenly overwhelming
-
a step-by-step thinking brings a
sense of order into chaotic situation
-
does not act, remains vigilant towards the
situation, might even appear confused about
the appropriate course of action
-
action is either hesitant or rushed, but with
moments of interruption
-
summarizing and discussing information with
colleagues
monitoring
-
having a specific expectation or
suspicion that something might get
out of control
-
tension arising from this expectation
-
keeping that aspect of situation in
check by attention or direct action
-
being watchful towards an unstable aspect of
the situation
-
examining the patient anxiously, checking for
some symptoms or vital signs multiple times
vigilance
-
tension arising from an expectation
of some dangerous, averse event
-
being in a state of readiness to react
to a change of situation
- visually scanning the scene
- reacting to sounds (turning of the head)
- being attentive, but suspicious towards
reports of people on the scene, asking
about specific details
distancing
from
the scene
-
stimulating or routine level of stress
-
being above the situation
-
situation is observed as a whole and
thinking is almost effortless
-
instructing and organizing the work of
colleagues
-
no visible emotional expression, appearing
calm and collected
96 Studia Psychologica, Vol. 62 , No. 2 , 2020, 1-10
Specific behavioral and experiential features
of task-related strategies (except minor ones)
are presented in Table 2. The same was not
done for self-supportive strategies, as they
were less tied to specific moments of task
completion (or time units in our timelines), and
therefore we assumed textual description to
be sufficient. Because we had to settle for a
limited set of sample due to constraints of the
competition, we could not achieve a satisfac-
tory theoretical saturation for every subcategory
we identified in our analysis. We did not want
to exclude less saturated subcategories from
the results as they might be elaborated in fu-
ture studies. The density of our data was sat-
isfying for most subcategories of emotion regu-
lation except for three – ventilation, establish-
ing a sense of connection with the other, and
positive self-talk.
Task-Related Strategies
Attentional Narrowing
Referred to as the so-called tunnel vision, of-
ten following mobilization to action and accom-
panied by the use of intuitive rule-based pro-
cedures, this strategy was characterized by an
attentional preoccupation with a specific set of
stimuli or a specific subtask while other stimuli
and subtasks are being ignored. The most typi-
cal situation of use was during an effort to stop
the acute arterial bleeding and stabilize the
patient, which was accompanied by a sense
of trust that the police will keep the paramedic
team safe. Surroundings b ecame acknowl-
edged once a sense of control over an urgent
subtask was maintained. This could take just
one minute or it could last until some of the
patient’s vital signs were checked several
times. Self-awareness was also compromised
by the use of this strategy, as was explicitly
noted by some of our participants.
We were safe, becaus e police was on the
scene, so I could take care of my colleague
[the injured figurant] and I didn’t feel anything...
I guess, because I’m used to making my tun-
nel for what I need to do. And I totally let my
surroundings go, so I just found out there’s
another patient [the aggressor] right before the
end of the task, because I’d been so focused
on my patient, so I had no idea about what’s
going on around me. (P1/26)
The tunnel thing, that’s adrenaline, you know.
The adrenaline is pumping, one is just run-
ning through it and he only looks just at what’s
in front of him, you know. No interest in what’s
on one side or the other. (P3/72)
I usually feel like... empty, e motionally. I’m
just thinking about what needs to be done and
maybe I feel something, but I’m not aware of
it. (P29/53)
The implementation of this strategy was not
always successful. Two participants report us-
ing this strategy, but feeling highly aroused, in
danger and showing signs of fear and alertness
towards the physical conflict between the police
and the aggressor. However, the strategy was
not implemented only as an absorption with
a high-priority subtask during emergency, but
also as a means to filter out frustrating distrac-
tors when the situation was still calm.
Of course, you need to filter out those people,
those that don‘t matter at that moment. And
people do complain quite often as the old lady
did there. (P7/16)
Mobilization to Action
When the situation was interpreted as an emer-
gency, a sense of responsibility and a need to
act arose. These feelings were associated with
their professional role as a paramedic and as
a leader. The fact that it was another para-
medic, a colleague, who was in a need of help,
was also significant for them. A belief that a
paramedic is supposed to act and not be
stunned by any event was explicitly present in
some verbal reports.
I know I need to do something, that I’m not
there to break down. That’s why I’m doing this
job. (P6/064)
It’s some kind of mechanism – like we have
to do something. That someone needs help,
probably even the factor that it’s our colleague
[plays a role]. (P28/44)
Even if the paramedic crew leader did not
fully comprehend the situation, was unsure
Studia Psychologica, Vol. 62, No. 2, 2 020, 1-10 97
about his or others’ safety, or was in a freeze
reaction, this urging to act was often expressed
in a confused tendency to walk towards the
injured paramedic. In some cases, this was
an automatic, reflex-like reaction without any
moment of hesitation.
Priorities changed and that, like… alertness
of organism and mobilization to act immedi-
ately [changed also]. (P15/050)
It’s like I was born this way that I have to press
on the wound. Like you don’t even think about
it. You just rush and do it. (P23/068)
Behavioral manifestations of mobilization to
action included acceleration of pace, a sense
of emergency in sensorimotor operations, and
insisting on colleagues to assist quickly.
Mobilization to Deliberative Concentration
Several participants experienced the situation
as overwhelmingly stressful, chaotic and en-
gulfing, and may have displayed either shock
or fear. Above all, they acted as confused (be-
ing stuck between multiple courses of action
or switching from one operation to another) or
uncertain, lacking in natural fluidity of behav-
ior. As a result of this strategy, action was
rushed at some moments, but there were
multiple moments of in terruption when the
leader was stuck.
This typically occurred to less experienced
paramedic crew leaders (n = 5, avg. length of
practice: 2.4 years) during and immediately
after the incident with the police. For instance,
one of our participants in this study reacted
with vigilance and confusion during the inci-
dent, undecided whether to assist colleagues
whose reaction was quicker or to stay with
the pensioners to keep them safe. He de-
scribed his means of dealing with the emo-
tional arousal as an attempt to approach de-
mands of the situation with sequential think-
ing.
“I guess I’m trying to focus on s tuff singu-
larly… like… what should I do first, what’s
next… that I refuse to accept that this is not
going so well, we’re not gonna make it, but I’d
rather tell myself ‘well, now I need to do this,
then I need to do that’.” (P29/094)
In more experienced paramedics (n = 4, avg.
length of practice: 9.25), this strategy was ap-
plied after initially reacting on impulse to the
acute bleeding and narrowing their focus to
the paramedic figurant for a period of time. As
they were trying to acknowledge other situ-
ational aspects, they had to exert some extra
effort to compensate for their lack of perspec-
tive and to have a sense of control. They de-
scribed their cognitive processing as sequen-
tial and systemizing. On a beh avioral level,
collecting, summarizing or discussing infor-
mation in communication with colleagues was
observed.
I was thinking rationally about it, I was think-
ing we might need some psychological sup-
port for witnesses, those who saw the injured
paramedic. So I was thinking about the next
step. (P25/062)
Monitoring
When a certain aspect of the task seemed out
of control or was likely to cause some trouble
in the leader’s perception, he remained watch-
ful and prepared to react. Most typically, he
would be concerned about the aggressor be-
fore the incident took place, which was pro-
voked by his verbal conflict with one of the pen-
sioners. There was a tendency to turn towards
the source of suspicion or even come to the
figurant paramedic crew to make sure they’re
handling their patient.
Monitoring also occurred when observing
the physical conflict between the police and
the aggressor or during stabilization of the
wounded paramedic when checking his vital
signs multiple times, sometimes overlapping
with narrowed focus. The difference between
the two strategies is that narrowed focus in-
cludes taking action to fix something that is
out o f order as a vital component, while in
monitoring the stimuli is only a prospective cue
for action, likely resulting in lesser demands
on concentration. Thus, refocusing towards
different stimuli or operation would happen
more fluidly.
I was checking my colleagues who were ex-
amining them [pensioners] and because the
98 Studia Psychologica, Vol. 62 , No. 2 , 2020, 1-10
colleague [from figurant crew] told us they’re
taking care of the restless woman [the aggres-
sor], I wanted to keep an eye on her. (P2/020)
Vigilance
Compared to monitoring, vigilance had no
specific focus. Many participants had an ex-
pectation that some danger might be present
in the situation, but did not stick to any hypoth-
esis due to their previous experience with be-
ing unpleasantly surprised in paramedic com-
petitions. Mostly, they expected some form of
aggression and set themselves into a state of
readiness to react to any significant event, but
hypervigilance to any sort of danger (e.g., gas
poisoning) expressed behaviorally as visual
scanning of the scene or hyper-reactivity to
sounds was also present. This could lead to
catching on irrelevant situational cues. For in-
stance, one of the crew leaders was curious
when one of the pensioners mentioned they
had been making coffee prior to paramedics’
arrival, because he considered the possibility
of a gas leak.
I was looking around every corner because
I was expecting s ome kind of a catch. That
lady was saying they had been making coffee,
so I wa s thinking there might be a gas leak,
that there might be some danger. (P2/036)
Hypervigilant participants experienced the
first phase of the task as quite demanding,
while participants vigilant on a lower level de-
scribed their experience as a non-disturbing
tension.
Unfortunately, you expect at some subcon-
scious level that something is going to happen
behind your back on these competitions. (P17/
08)
Distancing from the Scene
Initially identified in the same category as com-
pensation through deliberative concentration,
distancing from the scene was later distin-
guished as a separate regulatory strategy af-
ter triangulation with behavioral data. W hile
also having the aim of comp rehending and
handling all unresolved aspects of the situa-
tion, some participants described their cogni-
tive processing as less effortful, more holistic,
and relaxed. This was behaviorally manifested
as a tendency to step outside the scene and
observe it not just in a mental, but also physi-
cal distance. They generally showed no signs
of emotion in their behavior and they felt above
the situation, which was visible in their ten-
dency to instruct their colleagues or provide
them with information while speaking calmly.
Like I said, it’s a competition, so I didn’t feel
that much. I was more concerned with han-
dling it logistically – to help our pa tient and
also to take care of the old ladies here. I felt no
emotions at that moment. (P10/30)
I was with my colleagues at that moment and
I was telling them what to do, how to proceed,
what should be checked… (P2/024)
Minor Task-Related Regulatory Strategies
Few other strategies beyond the aforemen-
tioned ones were identified, but were not as
prevalent and rich in p articipant’s verbal re-
ports. Reflection o f previous decis ion s and
events was present when crew leaders felt frus-
trated and disappointed with paramedic‘s in-
jury or the pregnant woman’s death. They were
obsessively asking themselves whether they
could have prevented this event or whether it
was their fault. In terms of emotional behavior,
this was manifested as attenuation – being
passive, absent-minded, and mentally iso-
lated from what was happening. Relief or dis-
appointment was observed by the end of the
task. Although likely adaptive in some forms
after the task, this seemed to be deteriorative
to their performance.
Also, some participants found comfort in re-
lying on a rule-based procedure. They reported
that the clarity of guidelines for taking care of
acute arterial bleeding and their internalized
knowledge of these guidelin es made them
feel confident in what they were doing, but this
was also the case for one participant, who
applied the ABCDE heuristic when examining
the injured pensioner after being observably
confused and insecure in reaction to the inci-
dent.
Studia Psychologica, Vol. 62, No. 2, 2 020, 1-10 99
Self-Supportive Strategies
Emotional Distancing
Emotional distancing, in a sense of assum-
ing a distanced position towards one’s own
emotions, was largely dependent upon an in-
teraction with the environment. If the situation
was perceived as a game or a sport, emotions
were still elicited by external events, but one
could remain safe from engulfment by their
intensity. However, it is unclear when this is
caused by conditions of the competition (such
as the presence of referees in the room, au-
thenticity of figurants’ performances, etc.) and
when this is a motivated emotion regulation. It
is very likely that both factors come into play,
but to draw a precise line between them is
difficult from our data. However, at least one of
our participants reported consciously remind-
ing himself of the nature of the situation.
(What helped you to handle this situation?)
This time? I reminded myself it’s a competition.
(P21/50)
It’s different in real-life. I’d be more scared,
definitely. More fear, more res pect. There, I
have this su bcon scious sense of safety be -
cause it’s a competition. (P11/008)
Relieving smile or j oking was observable
on those partic ipants who described their
emotional attitude towards the task as dis-
tanced multiple times, usually in a reaction to
the rambling of one of the pensioners.
Establishing and Maintaining a Sense of Con-
nection with the Other
Another mechanism or regulating one’s affec-
tive state that was co-implemented in interac-
tion with the environment was founded on ex-
periencing some form of connection with an-
other person, which could have been a colleague
or a figurant. The familiarity of colleagues was a
good regulator in words of our participants and
it was not just their presence in a passive sense
of the word that had this effect, because crew
leaders were intuitively but actively reminding
themselves of their presence.
(What was is it specifically that helped you to
handle this situation?) Well, my colleagues,
my contact with them. Verbal or nonverbal, their
body language. We’re a well-coordinated unit,
we’re used to each other. (P15/097)
A few direct behavioral manifestations were
observed, which includes touching or having
a common relieving smile, indicating that this
process is enacted rather under the skin than
outwards.
Communication with figurants could also be
a way of managin g one’s own emotions,
though this was reported in a number of ways.
A simple exchange of first names could have a
regulating effect, but this was also reported
about soothing figurants’ emotions. A tendency
to calm and ground distraught pensioners was
particularly apparent in crew leaders that were
shocked and overwhelmingly stressed by the
incident.
For instance, calming that miss [helped me
feel better] and I tend to touch patients by the
shoulder when I see they might be disturbed,
maybe because I am disturbed too, so that’s
definitely automatic. (P29/64)
Detachment and Selective Attention
Discrepancies between participants’ verbal
reports and observable behavior can often be
caused by imperfections of cognitive appara-
tus, but in some participants they happened to
be so severe they could be interpreted as im-
plicitly motivated. Their emotional distress was
noticeable in forms of shock, freeze reaction,
worries, confusion, uncertainty, helplessness,
etc., but signs of this distress were absent in
their verbal reports. For instance, when asked
directly about their freeze reaction to the stress-
ful incident, two participants answered they are
not even aware this happened and they be-
lieved they had reacted immediately to the
figurant’s bleeding. However, this discrepancy
was not strictly tied to the incident when the
paramedic figurant was stabbed, but mani-
fested throughout their whole narrative about
the course of this task.
After an initial stressful reaction to the inci-
dent, their behavior became inhibited to the
100 Studia Psychologica, Vol. 62 , No. 2 , 2020, 1-10
point of giving the impression of carelessness,
but their facial expression had mild features of
worry (e.g., redness in face, open mouth, prop-
tosed eyes). They answered the interviewer’s
questions usually in terms of mechanistic de-
scription of their behavior and they were either
unaware of any emotional reactions or unable
to elaborate their answer beyond terms such
as stressful or difficult. A tendency to describe
their approach and overall performanc e as
professional and well-handled was present
in some of them.
I don’t even know i f something is going
through my head when I’m on the job. You just
do what you’re supposed to do, you think about
diagnosis and there’s nothin g else [on my
mind]. (P26/16)
Minor Self-Supportive Strategies
Some participants interpreted the incident as
a danger to them and/or to pensioners in the
room and immediately decided to either flee
away from the scene or step further away to
keep a distance, which can be evidently iden-
tified as a behavioral withdrawal. However, this
could be classified as a task-related strategy
when their intention was to take pensioners
with them to keep them safe.
Though not reported in interviews by partici-
pants, signs of behavior that could be marked
as venting were observable, but they were not
too frequent. The most significant sign were
sarcastic remarks, usually towards one of the
pensioners who was very outspoken, but only
once was this expressed with visible frustra-
tion and anger (e.g., headshaking, raised tone
of voice). Unintentional body movements (e.g.,
pulling up sleeves, playing with one’s hair) do
also fit into this category. Also, positive self-
talk occurred in three participants, either re-
ported in an interview or observed on a video
record (e.g., saying aloud “great, that should
be it”).
Discussion
Two broad categories of emotion regulation
strategies emerged in our qualitative analysis
– task-related and self-supportive. Task-re-
lated strategies are largely overlapping with
macrocognitive processes such as situation
awareness, uncertainty management, d eci-
sion making, etc. For a long time, all mental
processes in naturalistic dec ision mak ing
paradigm were list ed as mac roc ogn itio ns
while their emotional component was omitted
(Mosier & Fischer, 2010). Therefore, instead
of just adding a whole new package of mental
processes to the existing body of knowledge
about naturalistic decision making, results of
our study are pointing out a rather different func-
tion of previously described processes. Phe-
nomena such as tunnel vision were already
described in literature c oncerning situation
awareness (e.g., Endsley, 1995), but their
emotion -regulatory fu nction was not dis-
cussed. How professionals cope with difficult
affective states during task performance re-
mains a huge question mark in existing litera-
ture, maybe because it is not something that
professionals do separately from procedures
directed at task completion.
Holistic and functional nature of emotion
regulation strategies in naturalistic setting is
another implication of our qualitative analysis.
Attentional processes seem to be of high im-
portance, but most strategies have multiple
components or occur simultaneously with oth-
ers, such as the narrowed focus that had cog-
nitive and behavioral elements, and often ini-
tially co-occurred with mobilization to action.
This is line with findings of Adamovová and
Halama (2013), who found through an abbre-
viation of critical decision method that para-
medics regulate their emotions mostly by di-
recting their attention and utilizing their emo-
tional arousal towards desirable action.
In comparison to strategies proposed by
Gross (1998, 2015) in the framework of pro-
cess model of emotion regulation, all of the
task-related strategies present novel findings.
Nevertheless, this is not too controversial, in
our perspective, considering that the process
model framework was originally designed for
the study of hedonically motivated emotion
regulation. Our study hints at a possible ne-
cessity of a different framework for emotion
Studia Psychologica, Vol. 62, No. 2, 2 020, 1-10 101
regulation motivated by external goal. However,
the distinction between task-related and self-
supportive strategies is not without its prede-
cessor, as it is quite compatible with problem-
and emotion-focused coping of Lazarus and
Folkman (1984).
While some of our participants declared that
the use of intuitive rule-based procedures had
boosted their self-confidence, mobilization to-
wards deliberative concentration was also
identified as a task-related regulatory strategy.
While the classic macrocognitive framework
would attribute this simply to a lack of automa-
tized processes in inexperienced crew lead-
ers (Klein, 2008), alternative explanation may
come into play. Because the association-
based system produced an output (i.e., emo-
tional response) that preoccupied explicit pro-
cessing, the action tendency of this response
takes priority and bodily signals of intuition are
not available to the conscious mind (for a re-
view on effects of emotion on information pro-
cessing, see Yiend, 2010). However, this in-
terpretation is very much an open to debate.
Two of the self-supportive strategies were
quite prevalent – emotional distancing and
detachment alon g with selective attention
(which happened to co-occur in our research
sample). Both of them appeared to have a char-
acter of a generalized attitude or perhaps even
a personality pattern, because they were mostly
not applied in a specific moment, but carried
out throughout the whole experience during
the task. This is why we distinguished emo-
tional distancing from distancing from the
scene, which was implemented at specific
time frames. It is likely that the emotional dis-
tancing is a prerequisite for the other, but a
paramedic could have described his task ex-
perience from a distanced perspective with-
out explicitly reporting or exhibiting signs of
distancing from the scene. Emotional distanc-
ing is a well-established strategy in the pro-
cess model framework (Oc hsner & Gross,
2008) and could be considered as an adap-
tive strategy according to some empirical stud-
ies (e.g., Kross et al., 2012; Webb et al., 2012).
Adaptiveness of emotional distancing is also
supported by low emotio nal awareness in
goo d female paramedic decision makers in
the Iowa Gambling task, according to the study
of Pilárik and Sarmány-Schuller (2011). We
cannot provide quantitative evidence for this
claim in our study, but the use of this strategy
was associated with reporting the experienced
level of stress as positively stimulating.
In line with studies of Avraham et al. (2014)
or Clompus and Albarran (2016), detachment
was also present in paramedic crew leaders.
As was noted earlier, detachment is not men-
tion ed in the process model (Gross, 1998,
2015), likely because it is concern ed with
explicit forms o f emotion regulation, while
this phenome na remar kably re sembles
the construct of alexithymia (Taylor, Bagby, &
Parker, 1999) and repressive coping style
(Weinberger, 1990). Bo th of them are pre-
sumed to operate on implicit level of process-
ing. Detachment is even classified as a dis-
sociative process by some autho rs (e.g.,
Brown, 2006). We decided to put detachment
and selective attention into one bin because
that is what emerged from our data, but they
may be two separate strategies. Selective at-
tention might be considered as an equivalent
of attentional deployment (Gross, 1998, 2015).
Two of the most famously studied regulatory
strategies – reap praisal and s upp ression
(Gross, 2002) – were not mentioned by our
participants. In the case of reappraisal, this
can be explained by cognitive demands of this
strategy (Koole, 2009; Sheppes et al., 2009).
Implementation of reappraisal could decrease
cognitive resources available for completing
the stressful and time-limited task. Signs of
positive self-talk were found in our data, which
might indicate the use of cognitive reappraisal,
but it also might be a way of preserving focus
on the task (Manera et al., 2014).
The explicitness and implicitness of imple-
mented regulatory strategies is another issue
that arises from our findings. Though it is not
possible to draw precise lines between im-
plicit and explicit strategies (or their compo-
nents), this is not an uncommon issue as cur-
rent neuroscientific evidence sugg ests that
boundaries between implicit and explicit pro-
cessing are gradu al a nd blurred (Miller &
102 Studia Psychologica, Vol. 62 , No. 2 , 2020, 1-10
Schwarz, 2014). Most mental operations or
their components function on both levels of
processing. Some instances of strategy use
might be classified as either explicit or implicit.
For example, attentional narrowing was often
described as a reflex-like mechanism of deal-
ing with a situation, but it was also character-
ized as a conscious effort to filter out unwanted
stimuli on some occasions. In other instances,
strategy could have an explicit goal and im-
plicit implementation (e.g., vigilance) or vice
versa (e.g., reflection of previous decisions and
events), but to claim that this was always the
case with a specific strategy would be an over-
simplification at this point. The fact that the pro-
portion of implicit processing in strategy choice
and implementation might also be determined
by previous experience and automatization
should be considered as well. Therefore, this
is an issue of great gravity, but further investi-
gation is necessary for valid answers.
Limits of the Study
Limits of our study are related to ecological
validity of the simulated task and to validity of
retrospective verbal protocols. As for the limits
of the task “Grill”, the lack of a real menace is a
strong factor. It was admitted by a number par-
ticipants that an escape from the room would
be their first choice if this situation happened
in reality, but the simulated nature of the task
enabled them to stay cool and emotionally dis-
tanced from the situation. The absence of script
for police crews resulted in largely varying con-
ditions, which complicates the generalization
of our results. On the other side, the particular-
ity of this task (physical assault and acute
bleeding) means that the results cannot ex-
tend beyond situation of emergency and dif-
ferent type of strategies might be present in
different situations in the work of a paramedic.
Besides, due to characteristics of a paramedic
competition, we were unable to follow the es-
tablished rules of sampling and theoretical
saturation in qualitative research precisely, as
we had to stick to the data set that was avail-
able. Satisfactory theoretical saturation was still
achieved for a vast majority of identified regu-
latory strategies. Data set painted a very var-
ied picture about some of the less frequent
and less compreh ensively described strate-
gies which resulted in difficulties with fitting
them into a unifying conceptualization.
Inaccuracies in recall of past experience
present a limit of retrospective verbal reports.
These might occur because of the automatic-
ity of mental processes and the mind’s ten-
dency to fill gaps in introspection in order to
tell a coherent narrative (Nisbett & Wilson,
1977), even when the recalled experience is
quite recent. For this reason, it would be more
valid to carry out the retrospective verbal proto-
cols with the assistance of the crew’s video
recorded performance being replayed, but this
was not technically accomplishable in our con-
ditions.
Nevertheless, we believe our results are a
valuable contribution to the study of emotion
regulation in naturalistic setting because data
collection was done using a high-fidelity simu-
lated task and because of validation through
triangulation of verbal reports with video re-
corded performance. Even though simulated
tasks have their shortcomings, compared to
real-life situations, the physiological stress
during simulation can reach the same levels
(Ghazali et al., 2018).
Acknowledgement
This work was sup po rted by grant agenc y
VEGA, no. 2/0070/18, Cognitive and social
skills supporting the quality of performance of
emergency medical services’ professionals.
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Appendix
Appendix 1 Brief codebook for emotional behaviour on video records
No emotional
reaction
Definition No visible change in person’s behavior.
Signs No visible change compared to neutral valence and arousal.
Attunement
Definition Attempt to understand patient’s distress through perception
and mirroring of his emotional state.
Signs
Visually scanning patient’s face, adjustment of facial
expression and body posture to patient, attunement of speech
pace to patient’s mood.
Conversational
smile
Definition Social smile invoked from a communication between
protagonists.
Signs Raised angle labials, some sign of a genuine smile is missing
(most typically raising cheeks).
Smile Definition Spontaneous positive reaction to a humorous situation.
Signs Raised angle labials, raised cheeks.
Alertness
Definition Increased sensitivity to environmental stimuli.
Signs Quick reaction to environmental stimulus, visual scanning of
surroundings.
Emergency
Definition Quick and decisive action with a clear purpose.
Signs
Quick reaction to an emerged situation, movement towards a
goal or patient, decisive and brisk commanding of colleagues,
fluid execution of procedures.
Appendix 1 continues
106 Studia Psychologica, Vol. 62 , No. 2 , 2020, 1-10
Appendix 1 continued
Appendix 1 continues
Fright Definition Quick scared reaction to a possibly dangerous situation.
Signs Dodge backwards, possible vocal reaction.
Freeze reaction
Definition Absolute cessation of a current action.
Signs Being stuck in a certain body posture, remaining in a position
of observer.
Fear / Worry
Definition Caution in a contact with potentially endangering stimulus.
Signs
Keeping distance from potential danger, being cautious but
not stuck, possibly a scared facial expression (eyes: AU 5 -
upper lids raiser, AU 7 - lids tight; mouth: AU 20 lip stretcher,
or 25 - lips part).
Nervousness
Definition Agitation and a tendency to act even if a situation is currently
calm.
Signs
Body movements (jiggling, goalless arm movements),
touching one’s own body, clumsy and inarticulate speech,
avoiding eye contact.
Confusion
Definition A tendency to do multiple tasks at once.
Signs
Sudden change of goal or direction, indecisiveness between
two options, shuffling one’s feet, gazing in multiple directions
in a short time period.
Doubt
Definition Being unsure about the chosen course of action.
Signs Heading towards a specific goal, but hesitating, asking
questions, making sure of the legitimacy of chosen procedure.
Doubtful smile
Definition Slight smile expressing insecurity about the present social
situation.
Signs Slightly raised angle labials, downcast eyes or avoiding eye
contact, short duration.
Relieving smile
Definition Smile with a function of easing stress and pressure.
Signs
Raised angle labials, following after visible tension, possibly
accompanied by a sigh, possible absence of raised cheeks
(AU 6).
Ironic smile
Definition Smile communicating devaluation of the person who is being
addressed.
Signs Pulling angle labials inside (AU 14 dimpler), possibly just on
one side, possibly accompanied by raised eyebrows.
Sarcasm Definition Verbal communication of one’s authority and position above
the other.
Signs Joking on someone else’s account.
Joking Definition Humorous relief of situation’s tension.
Signs Verbally communicating humorous remarks and allusions.
Frustration
Definition Slightly angered emotional reaction to an aversive condition in
the situation.
Signs Headshaking, cessation of current action, sigh, raised voice,
defense against the trigger.
Studia Psychologica, Vol. 62, No. 2, 2 020, 1-10 107
Appendix 1 continued
Helplessness
Definition Inability to execute the desirable action.
Signs Loss of initiative, withdrawal, choosing different
procedure/subtask.
Attenuation Definition Realization of the weight of overcome task/subtask.
Signs Complete lack of action or slowed down movement.
Relief Definition Dissolution of tension.
Signs Sigh, relaxation of arms and shoulders.
Carelessness
Definition Not reacting to a relevant stimulus.
Signs Ignoring or underestimating a critical situation, attentional
deployment, attending another aspect of the situation.
Shame
Definition Appraising one’s previous behavior as socially unacceptable.
Signs
Redness in face, descent of body posture, downcast eyes or
avoiding eye contact, behavioral tendency to not be in the
center of attention.
Disappointment
Definition Failing to fulfil one’s expectations and hopes.
Signs Slouching body posture (head and shoulders), inhibition of all
activity, possibly sad/relaxed facial expression.
Surprise
Definition Reaction to an unexpected event.
Signs
Acquisition of new information (listening or gazing), open
mouth and wide-open eyes, movement towards the source of
surprise.
108 Studia Psychologica, Vol. 62 , No. 2 , 2020, 1-10
Appendix 2 Illustration of a time unit on timeline of paramedic crew leader’s task experience
