Using sensors to collect data at emergency incident sites can facilitate analysis of the logistic operations. This can be used to improve planning and preparedness for new operations. Furthermore, real-time information from the sensors can serve as operational decision support. In this work in progress, we investigate the requirements on the sensors, and on the sensor data, to facilitate such an analysis. Through observations of exercises, the potential of using sensors for data collection is explored, and the requirements are considered. The results show that the potential benefits are significant, especially for tracking patients, and understanding the interaction between the response actors. However, the sensors need to be quite advanced in order to capture the necessary data.

Syftet med föreliggande studie var att genom intervjuer med beredskapssamordnare från Sveriges landsting försöka skapa en bild av hur uppfattningen var att skadeplatsen såg ut idag och skulle kunna kommat att förändras på sikt. Vidare önskade intervjustudien söka svar på frågor som rörde komplexiteten på skadeplatsen genom att diskutera ledningsförhållanden, samverkan med andra aktörer, alarmerings- och dirigeringsfunktionernas roll i det svenska sjukvårdsystemet samt hur ett möjligt arbete med ett återtagande av förmågan till ett civilt försvar skulle påverka systemet i sin helhet. Överlag har detta syfte uppnåtts genom ett rikt material kring relevanta frågeställningar som belyst ett flertal kritiska aspekter både i dagens situation men även för framtiden.

Resultatet ger en relativt entydig bild av hur situationen uppfattas på landstingsnivå idag av personalen som behandlar beredskapsfrågorna. Den bild som målas upp fokuserar kanske främst på en upplevd avsaknad av centrala och nationellt övergripande styrningar vilket menligt påverkar förmågan att lyfta ledningsförmågan från regional till nationell nivå vid en större händelse som överstiger den regionala förmågan. Den svenska modellen för att hantera samhällsstörningar av idag är väl anpassad för att hantera händelser inom ramen för det egna länets geografiska område. Befintliga koncept för samverkan och samordning bedöms fungera bra i vardagen, exempelvis vid de vanligaste fallen av skadeplatser: trafik och brand. Detta innebär dock att systemet fungerar väl under förutsättning att händelsen är begränsad i såväl tid och rum som vad avser antalet drabbade. En större händelse eller flera händelser samtidigt på olika platser, särskilt om det finns försvårande faktorer såsom utsläpp av farliga ämnen eller en högre hotbild, skapar försvårande omständigheter som upplevs svårhanterliga idag. I ett framtida scenario upplevs även risken för dessa händelser och terrorattacker att öka. Avhängigheten av IT samt ett samhälle som i allt högre grad förlitar sig på ”just in time”-leveranser gör att sårbarheten har ökat och upplevs fortsätta göra det även i framtiden. Andra viktiga områden som lyfts är nuvarande och befarad framtida brist på kompetent personal samt att utbildnings- och övningsverksamhet inte kan bedrivas i önskvärd utsträckning, delvis på grund av personalbrist och –omsättning.

Vidare syns den generella uppfattningen vara att det saknas ett tydligt ledarskap på nationell nivå då det sällan, om alls, utkommer några direkta styrningar rörande vad som skall uppnås och i vilken utsträckning. Detta har också påvisats i avsnittet ovan rörande före-, under- och efterperspektivet där det finns en klart övervägande del synpunkter på de två förstnämnda perspektiven. Nationell styrning är alltså något som uppfattas vara efterfrågat och då inte bara avseende ledning under insats utan även i frågor rörande enhetlig utrustning och metodik samt utbildnings- och övningsfrågor. Få respondenter har tagit upp efterperspektivet i någon större utsträckning men då det har förekommit har det framförallt berört erfarenhetshanteringsfrågor och den brist som upplevs finnas inom detta specifika område idag. Erfarenheter från den egna verksamheten, såväl i vardagen som vid insatser vid allvarliga händelser, behöver tas om hand, följas upp och sedan utgöra grund för ett levande utvecklingsarbete.

Background

An important aspect of disaster medicine is to be proactive and respond quickly when disaster strikes. In Sweden, the role responsible for swift medical response on the regional level is the designated duty officer.

Methods

A large exercise to assess national medical response ability was conducted. Seven medical regional staffs (a total of 93 individuals participated as tested participants) were involved in handling a large train accident scenario. The exercise was run for 5 hours, where the different regional staffs were located at their regular command posts. The exercise was organized using Emergo Train Systems.

Results

Several capabilities were identified during the exercise as important for the organization to maintain the ability to handle a similar event: documentation and operational picture, communication and terminology, command of resources, strategy for distribution of resources, national co-ordination, and exercise development.

The designated duty officers were central to the exercise in several aspects: 1) in developing and verifying a realistic scenario and preparing background information, 2) as participants in the exercise, 3) assessors of the staffs’ behaviors, and 4) as domain experts when interpreting the exercise outcome.

Conclusions

Using subject matter experts is central to many research domains. However, the more complex a situation is the larger the demand of expertise is. The technical platform allows for coordinating complex exercises, whereas the subject matter expert in terms of the designated duty officer is required to guarantee validity and reliability in these large-scale exercises.

Key messages:

• Running complex scenarios to train and test abilities requires subject matter experts in both planning, preparation, implementation, and assessment.

• Sophisticated simulator and training platforms, such as Emergo Train Systems, facilitates while the designated duty officers are necessary to guarantee validity and reliability in the exercise.

In modern military organizations teamwork performance is central, yet the underlying factors contributing to such performance are debated. The purpose of this paper was to investigate how several known teamwork measures relate to a prior model of operator performance (Nählinder et al, 2004). This study expands this model to the team level and in the command and control domain. Specifically, this paper studies the relationship between individual and team workload measures, situation awareness measures, and performance measures in 18 two-person teams.                 

The study has two major findings: Firstly, the various team cognition measures statistically cluster into four meaningful concepts (workload, teamwork, situation awareness and performance).                 

Secondly, a Structural Equation Model indicates that the relationship between the various individual and team measures can be described in a model resembling the model found in previous studies (Nählinder et al, 2004). In particular, the results show that the general workload in the microworld study has a negative effect on both teamwork and situation awareness. Teamwork, in turn, also affects situation awareness, which has major impact on performance.

Introduction: Rapid and structured medical care is important to increase wounded patients’ chances of survival in modern warfare. This requires a functioning medical chain. 

Aim: The aim of this study was to expand the knowledge of how the battlefield trauma care affects patient outcome in situations with a large number of casualties in the Swedish armed forces. 

Methods: An empirical study with a convergent parallel mixed methods design, which included observations and semi-structured interviews. 

Results: The results show that the trauma care performed at Role 1-units functioned well. The most prominent issue discovered was deficiency in transportation resources for medical evacuation throughout the entire medical chain. 

Conclusion: Despite that the trauma care performed at Role 1-units functions well, casualties are at risk for preventable complications or death. Improved transportation logistics are required to improve the medical capabilities of the Swedish armed forces.

Motion-based games offer positive effects on physical, social, and mental health for the players and have been common during the past decade, enabled by commercial motion tracking devices. However, little is known about the impact of game mechanics on the player experience, movement, and performance in motion-based games. In this paper we present results from a study with 35 participants comparing two different game mechanics, one reactive and one strategic, for a casual motion-based game. The assumption was that a more strategic mechanic would lead to less movement but more enjoyment. However, there was no significant difference in player experience, performance, or movement between the two game mechanics. In addition, a key aspect for the players preferred game mechanics was the perceived amount of thinking the game mechanic required.

INTRODUCTION:

A spatial secondary task developed by the authors was used to measure the mental workload of the participant when transferring suturing skills from a box simulator to more realistic surgical conditions using a fresh cadaver. We hypothesized that laparoscopic suturing on genuine bowel would be more challenging than on the Fundamentals of Laparoscopic Surgery (FLS)-simulated bowel as reflected in differences on both suturing and secondary task scores.

METHODS:

We trained 14 surgical assistant students to FLS proficiency in intracorporeal suturing. Participants practiced suturing on the FLS box for 30 minutes and then were tested on both the FLS box and the bowel of a fresh cadaver using the spatial, secondary dual-task conditions developed by the authors.

RESULTS:

Suturing times increased by >333% when moving from the FLS platform to the cadaver F(1,13) = 44.04, P < .001. The increased completion times were accompanied by a 70% decrease in secondary task scores, F(1,13) = 21.21, P < .001.

CONCLUSION:

The mental workload associated with intracorporeal suturing increases dramatically when trainees transfer from the FLS platform to human tissue under more realistic conditions of suturing. The increase in mental workload is indexed by both an increase in suturing times and a decrease in the ability to attend to the secondary task.

There are currently several educational initiatives to teach first aid courses for medical laypeople, such as the Stop the Bleed campaign. Although much research on educational initiatives has been conducted, there are still factors that remain unexplored, such as the potential effects of blood itself on laypeople’s first aid performance and educational experience. This study investigates such potential effects for performance of the first aid techniques tourniquet application and wound packing, in relation to individual differences in disgust sensitivity and medical fear of blood. The results show that the presence of blood will increase the time a medical layperson takes to apply a tourniquet and pack a wound but does not affect the quality of the aid. Additionally, the disgust sensitivity of the medical layperson was found to predict an increase in application time for the wound packing task, but not the tourniquet application task, when blood was present.

The Stop The Bleed initiative was developed by the Department of Homeland Security to educate lay providers in bleeding reduction strategies. The current study evaluated: (1)three tourniquet instructions using a simulated tourniquet task and (2)participant confidence levels in tourniquet use and lay provider training. Thirty participants with limited clinical experience applied a tourniquet to a simulated limb using one of three instruction sets. Twelve of these participants (40%) participated in a tourniquet training session and focus group to discuss each instruction set. Participants preferred the most simple and pictoral instruction set, and identified opportunities for improvement in each set. Participant confidence in tourniquet use increased significantly following the task and the focus group. After the focus group, participant confidence in instructing lay providers on proper tourniquet use significantly increased. Adding key steps, contextual pictures, and indicators of success to instructions could support lay providers stop the bleed in life-threatening situations

Introduction

Hemorrhage control initiated by laypeople, or immediate responders, can be a crucial link for increased survival among victims with hemorrhage. An increased interest in hemorrhage control training for laypeople have resulted in numerous publications in the area, showing that training laypeople in hemorrhage control can be successful (Nichols & Horstman, 2022; Tang et al., 2022). To this date, it is unknown which training factors are associated with successful training outcomes and to what extent. The objective of this study is to review and analyze past and present literature on hemorrhage control training for laypeople, in order to highlight current knowledge gaps, and direct future research.

Method

A systematic literature review was performed by reviewing and analyzing the literature. Five electronic databases, CINAHL, Embase, PubMed, Scopus, and Web of Science, were used in the literature search. Search keywords were chosen among the variations and synonyms to the words: “laypeople” AND “hemorrhage” AND “training” AND “stop the bleed”. To examine where the knowledge gaps exist in terms of training effectiveness, a theoretical model by Cannon-Bowers et al. (1995) was chosen as theoretical lens, and each record was categorized into six training outcome categories: reactions, attitude change, learning, training performance, job performance, and results/organizational effectiveness, according to the content of the reviewed studies.

Preliminary results

In total, 2962 records were initially identified for screening, and 1186 records were kept after duplicate removal and deletion of incomplete records. After title and abstract review, 186 records were sought for retrieval. This will be further reduced into a fewer number of records for full text review after additional screening. By categorizing the records into the six training outcome categories, previous research efforts can be highlighted, as well as it creates an opportunity for future research suggestions.

Conclusion

By equipping the public with the necessary knowledge and tools for hemorrhage control, lives can be saved. By examining the literature on hemorrhage control training effectiveness, suggestions for future research and educational practice can be made.

Objective The purpose of this study was to compare laypeoples and professional first responders ability to perform tourniquet application and cardiopulmonary resuscitation (CPR) during calm and stressful circumstances. Background Life-threatening bleeding is a major cause of death that could be prevented by fast and appropriate first aid interventions. Therefore, laypeople are now being trained in bleeding control skills, transforming them from bystanders to immediate responders. However, critics have questioned whether laypeople are able to perform during more stressful conditions. Method Twenty-four laypersons and 31 professional first responders were tested in two conditions: a calm classroom scenario and a stressful scenario consisting of paintball fire and physical exertion. Stress and workload were assessed along with task performance. Results The experimental manipulation was successful in terms of eliciting stress reactions. Tourniquet application performance did not decline in the stressful condition, but some aspects of CPR performance did for both groups. First responders experienced higher task engagement and lower distress, worry and workload than the laypeople in both the calm and stressful conditions. Conclusion Stress did not affect first responders and laypeople differently in terms of performance effects. Stress should therefore not be considered a major obstacle for teaching bleeding control skills to laypeople. Application Tourniquet application can be taught to laypeople in a short amount of time, and they can perform this skill during stress in controlled settings. Concerns about laypeoples ability to perform under stress should not exclude bleeding control skills from first aid courses for civilian laypeople.

BACKGROUND: Although the Stop the Bleed campaigns impact is encouraging, gaps remain. These gaps include rapid skill decay, a lack of easy-to-use tourniquets for the untrained public, and training barriers that prevent scalability. A team of academic and industry partners developed the Layperson Audiovisual Assist Tourniquet (LAVA TQ)& mdash;the first audiovisual-enabled tourniquet for public use. LAVA TQ addresses known tourniquet application challenges and is novel in its design and technology. STUDY DESIGN: This study is a prospective, randomized, superiority trial comparing the ability of the untrained public to apply LAVA TQ to a simulated leg vs their ability to apply a Combat Application Tourniquet (CAT). The study team enrolled participants in Boston, MA; Frederick, MD; and Linkoping, Sweden in 2022. The primary outcome was the proportion of successful applications of each tourniquet. Secondary outcomes included: mean time to application, placement position, reasons for failed application, and comfort with the devices. RESULTS: Participants applied the novel LAVA TQ successfully 93% (n = 66 of 71) of the time compared with 22% (n = 16 of 73) success applying CAT (relative risk 4.24 [95% CI 2.74 to 6.57]; p &lt; 0.001). Participants applied LAVA TQ faster (74.1 seconds) than CAT (126 seconds ; p &lt; 0.001) and experienced a greater gain in comfort using LAVA TQ than CAT. CONCLUSIONS: The untrained public is 4 times more likely to apply LAVA TQ correctly than CAT. The public also applies LAVA TQ faster than CAT and has more favorable opinions about its usability. LAVA TQs highly intuitive design and built-in audiovisual guidance solve known problems of layperson education and skill retention and could improve public bleeding control. (c) 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

Importance  Trauma is the leading cause of death for US individuals younger than 45 years, and uncontrolled hemorrhage is a major cause of trauma mortality. The US military’s medical advancements in the field of prehospital hemorrhage control have reduced battlefield mortality by 44%. However, despite support from many national health care organizations, no integrated approach to research has been made regarding implementation, epidemiology, education, and logistics of prehospital hemorrhage control by layperson immediate responders in the civilian sector.

Objective  To create a national research agenda to help guide future work for prehospital hemorrhage control by laypersons.

Evidence Review  The 2-day, in-person, National Stop the Bleed (STB) Research Consensus Conference was conducted on February 27 to 28, 2019, to identify and achieve consensus on research gaps. Participants included (1) subject matter experts, (2) professional society–designated leaders, (3) representatives from the federal government, and (4) representatives from private foundations. Before the conference, participants were provided a scoping review on layperson prehospital hemorrhage control. A 3-round modified Delphi consensus process was conducted to determine high-priority research questions. The top items, with median rating of 8 or more on a Likert scale of 1 to 9 points, were identified and became part of the national STB research agenda.

Findings  Forty-five participants attended the conference. In round 1, participants submitted 487 research questions. After deduplication and sorting, 162 questions remained across 5 a priori–defined themes. Two subsequent rounds of rating generated consensus on 113 high-priority, 27 uncertain-priority, and 22 low-priority questions. The final prioritized research agenda included the top 24 questions, including 8 for epidemiology and effectiveness, 4 for materials, 9 for education, 2 for global health, and 1 for health policy.

Conclusions and Relevance  The National STB Research Consensus Conference identified and prioritized a national research agenda to support laypersons in reducing preventable deaths due to life-threatening hemorrhage. Investigators and funding agencies can use this agenda to guide their future work and funding priorities.

Resilience has in recent decades been introduced as a term describing a new perspective within the domains of disaster management and safety management. Several theoretical interpretations and definitions of the essence of resilience have been proposed, but less work has described how to operationalise resilience and implement the concept within organisations. This case study describes the implementation of a set of general resilience management guidelines for critical infrastructure within a Swedish Regional Medical Command and Control Team. The case study demonstrates how domain-independent guidelines can be contextualised and introduced at an operational level, through a comprehensive capability development programme. It also demonstrates how a set of conceptual and reflective tools consisting of educational, training and exercise sessions of increasing complexity and realism can be used to move from high-level guidelines to practice. The experience from the case study demonstrates the value of combining (1) developmental learning of practitioners’ cognitive skills through resilience-oriented reflection and interaction with dynamic complex open-ended problems; (2) contextualisation of generic guidelines as a basis for operational methodological support in the operational environment; and (3) the use of simulation-based training as part of a capability development programme with increasing complexity and realism across mixed educational, training and exercise sessions. As an actual example of a resilience implementation effort in a disaster medicine management organisation, the study contributes to the body of knowledge regarding how to implement the concept of resilience in operational practice.

Introduction: Successful tourniquet application increases survival rate of exsanguinating extremity hemorrhage victims. Tactile feedback during tourniquet application training should reflect human tissue properties in order to increase success in the field. This study aims to understand the mechanical properties of a human limb during tourniquet application. Method: Six cadaveric extremities-three uppers and three lowers-were tested from three body mass index groups: low (&lt;19) healthy (19-24), and overweight (&gt;24). Each specimen donned with a tourniquet and mounted to a servo-hydraulic testing machine, which enabled controlled tightening of the tourniquet while recording the tourniquet tension force and strap displacement. A thin-film pressure sensor placed between the specimen and the tourniquet recorded contact pressure. Each limb was tested with the tourniquet applied at two different sites resulting in testing at the upper arm, forearm, thigh, and shank. Results: The load displacement curves during radial compression were found to be nonlinear overall, with identifiable linear regions. Average contact pressure under the tourniquet strap at 200N and 300N of tension force was 126.3 (sigma= 41.2) mm Hg and 205.3 (sigma = 75.3) mm Hg, respectively. There were no significant differences in tissue stiffness or contact pressure at 300N of tension force between limb (upper vs. lower) or body mass index. At 200N of tension, the upper limb had significantly higher contact pressure than the lower limb (P= 0.040). Relative radial compression was significantly different between upper (16.74, sigma = 4.16%) and lower (10.15, sigma = 2.25%) extremities at 200N tension (P= 0.005). Conclusions: Simulation of tissue compression during tourniquet application may be achieved with a material exhibiting elastic properties to mimic the force-displacement behavior seen in cadaveric tissue or with different layers of material. Different trainers for underweight, healthy, and overweight limbs may not be needed. Separate tourniquet training fixtures should be created for the upper and lower extremities.

I ett samarbete mellan Linköpings universitet och MSB (Myndigheten för samhällsskydd och beredskap) har ett utbildningskoncept baserat på STB (Stop the Bleed) för svensk räddningstjänst tagits fram (Prytz & Jonson, 2019). I samband med utvecklingen av utbildningen genomfördes pilotutbildningar under 2018 och 2019 med Sörmlandskustens Räddningstjänst, Räddningstjänsten i Eskilstuna och Västra Sörmlands Räddningstjänst. Forskning har visat att kunskaperna från utbildning i blödningskontrollerande åtgärder börjar förfalla så snart som 30 dagar efter genomförd utbildning (Pasley et al., 2018), liksom för andra kunskaper som hjärt-lungräddning (HLR; Madden, 2006; Moser & Coleman, 1992; Broomfield, 1996, Zieber & Sedgewick, 2018). Det finns därför ett behov av fler uppföljningsstudier efter utbildningar i blödningskontroll för att förstå hur kunskaper bibehålls över tid (Goralnick et al., 2020). Vidare finns även ett behov att följa upp den praktiska nyttan av utbildningar i blödningskontrollerande första hjälpen-åtgärder och effekten på räddningstjänstens förmåga. 

Den aktuella studien är en uppföljningsstudie av pilotutbildningen som genomfördes 2018/2019. Forskningsfrågorna som ämnades besvaras i studien var:

1. Hur har kunskaperna om blödningskontroll förändrats under den tid som gått sedan utbildningen 2018/2019? 
2. Har den räddningstjänstpersonal som utbildades i blödningskontroll haft praktisk nytta av utbildningen? Hur förberedda upplevde de sig vara i de situationerna? 
3. Har erfarenheter av skarpa situationer påverkat tilltron personalen har till sin egen förmåga att hantera svåra blödningar? 

Studien genomfördes som en kvantitativ enkätstudie. Totalt deltog 48 representanter från räddningstjänsterna i Sörmland i studien. Resultatet visar inledningsvis att kunskapsnivån hos räddningstjänstpersonalen är fortsatt hög med goda resultat på kunskapsprovet. Nivån är dock något lägre 2021 än vad den var 2018/2019. Vidare visade resultaten att en majoritet av den räddningstjänstpersonal som svarade på enkäten har hanterat skarpa situationer med blödningar efter att de genomfört pilotutbildningen och att den upplevda nyttan med utbildningen var hög. Deltagarnas självförtroenden gällande hanteringen av skarpa situationer var högre efter utbildningen, jämfört med skarpa situationer de upplevt innan utbildningen. Över lag visar resultatet att denna typ av utbildning ökar räddningstjänstens förmåga att hantera händelser där det förekommer allvarliga blödningar, och att räddningstjänstpersonalen är positivt inställda till utbildningar i den form som gavs i pilotutbildningen 2018/2019.

Introduction:

The Stop the Bleed campaign in the United States aims to teach bleeding control techniques, such as tourniquets, to the public. Educational consortium guidelines advocate using brief web- or video-based material. Another option is posters or flyers distributed at, for example, workplaces or public spaces.

Aim:

The aim of the current study was to evaluate the relative efficacy between a flyer and a video to teach tourniquet application skills to members of the public in Sweden.

Methods:

A total of 38 participants (27 male, 11 female) from the general public completed the study. Their ages ranged from 19 to 73 (M=32, SD=14). None had prior experience with tourniquet applications. One group (n=18) received tourniquet instructions on a flyer and one (n=20) received a 5-minute video instruction. Both groups completed pre- and post-questionnaires and a practical tourniquet application test.

Results:

Independent samples t-tests showed that the video-based instructions resulted in fewer application errors (M=1.40 out of 10, SD=1.19) compared to the flyer group (M=3.61, SD=2.40), t(36)=3.651, p=0.001, and higher post-task satisfaction (M=3.89 out of 5, SD=0.74 compared to M=3.39, SD=1.15). However, the flyer-group was faster (M=86.22 seconds, SD=27.28) compared to the video group (M=112.25, SD=42.22), t(36)=2.229, p=0.032.

Discussion:

Video instructions appear superior to flyers in terms of teaching correct tourniquet application to the general public. The longer total application time includes steps taken after bleeding control has been achieved (e.g. securing tourniquet straps and time notation), which may have contributed to the application time difference. The results support the educational guidelines that suggest video-based instructions for teaching basic tourniquet skills to laypeople are more effective.

Introduction: Head nurses at emergency departments often assume responsibility for managing the initial response to a major incident, and to create surge capacity. Training is essential to enable these nurses to perform an effective disaster response. Evaluating the effects of such training is however complicated as real skill only can be demonstrated during a real major incident. Self-efficacy has been proposed as an alternative measure of training effectiveness. Purpose: The aim of this study was to examine if short, small-scale computer-based simulation exercises could improve head emergency nurses general and specific self-efficacy and initial incident management skills. Method: A within-group pretest-posttest design was used to examine 13 head nurses general and specific self efficacy before and after an intervention consisting of three short computer based simulation exercises during a 1-h session. Management skills were assessed using the computer simulation tool DigEmergo. Results: The exercises increased the head nurses general self-efficacy but not their specific self-efficacy. After completing the first two exercises they also exhibited improved management skills as indicated by shorter time to treatment for both trauma and in-hospital patients. Conclusion: This study indicates that short computer based simulation exercises provide opportunities for head nurses to improve management skills and increase their general self-efficacy.

The European Rail Traffic Management System (ERTMS) will replace national standards with the aim to promote cross-border traffic and enhance efficiency. The transition involves a shift from lineside signalling to mostly in- cabin information via a Driver Machine Interface (DMI). Previous research indicates that this may lead to a decrease in driver attention to the outside world and to a decrease in workload, leading to boredom. Using a train simulator, 41 participants drove the same track with the ERTMS system and the Swedish national standard (ATC) while wearing eye- tracking equipment. Subjective workload and boredom assessments were made after each drive. An analysis of the first set of reduced data (15 participants) showed that the formal attentional requirements like the monitoring of speed changes and signals were fulfilled in almost all cases, regardless of system. Overall, however, the data indicate that in line with previous research the drivers focus their attention more to the inside of the train when using the ERTMS system. This is corroborated by the finding that horn blowing is slightly delayed with the ERTMS system. Perceived workload was generally low, with the ERTMS system experienced to be more boring. We draw the preliminary conclusion that while formal attentional requirements are fulfilled for both systems, the ERTMS system likely has a tendency to pull the drivers’ overall attention inwards. Given that for the ERTMS system most relevant information is presented inside of the train on the DMI, this is not surprising, but needs to be addressed by the authorities.

We report on a design exploration into how a large multi-touchtabletop display can be used for information visualization. Wedesigned an interface where users explored a tagged photocollection by bi-manual manipulation of the collections’ tagcloud. User feedback showed that despite the availability ofmulti-touch most of the actual interactions were single-touch.However, some particular natural actions, such as grabbing thetag cloud and partitioning it into two parts, were often carriedwith both hands. Thus our user study indicates that multi-touchcan act as a useful complementary interaction method ininformation visualization interfaces.

In this article we report an exploratory video-based analysis of bodily actions - specifically head movements and bodily orientations - of two older adults (+65) in their everyday life, as they are about to leave their homes. We show that action patterns can serve an adaptive function to monitor the physical surrounding of objects and spaces, and we argue that these adaptive functions assist prospective memory processes. First, we found that ongoing activities, some partially unrelated to the activity of leaving home, coupled with the structure of the physical environment could assist the participants in remembering intentions before leaving home. Second, we found that participants attended to, and therefore stayed in control of, important spaces and objects through targeted and redundant scanning of such important spaces. In the context of previous research on the effects of cognitive aging, we hypothesize that these bodily action patterns coupled with the efficient shaping of spaces can be important for the general older population to compensate for a decline in prospective memory ability.

Introduction:

Assessing disaster preparedness in a given region is a complex problem. Current methods are often resource-intensive and may lack generalizability beyond a specific scenario. Computer-based stochastic simulations may be an additional method but would require systems that are valid, flexible, and easy to use. Emergo Train System (ETS) is an analog simulation system used for disaster preparedness assessments.

Aim:

To digitalize the ETS model and develop stochastic simulation software for improved disaster preparedness assessments.

Methods:

A simulation software was developed in C#. The simulation model was based on ETS. Preliminary verification and validation (V&V) tests were performed, including unit and integration testing, trace validation, and a comparison to a prior analog ETS disaster preparedness assessment exercise.

Results:

The software contains medically validated patients from ETS and is capable of automatically running disaster scenarios with stochastic variations in the injury panorama, available resources, geographical location, and other variables. It consists of two main programs: an editor where scenarios can be constructed and a simulation system to evaluate the outcome. Initial V&V testing showed that the software is reliable and internally consistent. The comparison to the analog exercise showed a general high agreement in terms of patient outcome. The analog exercise featured a train derailment with 397 injured, of which 45 patients suffered preventable death. In comparison, the computer simulation ran 100 iterations of the same scenario and indicated that a median of 41 patients (IQR 31 to 44) would suffer a preventable death.

Discussion:

Stochastic simulation methods can be a powerful complement to traditional capability assessments methods. The developed simulation software can be used for both assessing emergency preparedness with some validity and as a complement to analog capability assessment exercises, both as input and to validate results. Future work includes comparing the simulation to real disaster outcomes.

Background: Målen för detta projekt var att undersöka det aktuella kunskapsläget samt att samla in naturalistiska fordonsdynamiska data samt beteendedata vid olika simulerade utryckningsscenarier för att framöver utforma realistiska och prototypiska körscenarier med tillhörande vårduppgifter för användning i ambulanssimulatorförsök och träning av ambulanspersonal. Methods: För att uppnå målen genomfördes tre delstudier: en litteraturstudie, en workshop och ett fältexperiment på testbana. Results: Resultat Av litteraturstudien framgick det att den tidigare forskningen främst studerat kvaliteten av HLR under transporter. Trots skillnader i definitioner av kvalitet, tillämpade standarder och studiedesign framstår det som att det tveklöst föreligger svårigheter att under transport utföra hjärt–lungräddning (HLR) med hög kvalitet. Några studier har undersökt orsakerna till varför det är svårt att utföra HLR med god kvalitet och det har identifierats faktorer relaterade till transportförfarandet, fordonstyp och vårdutrymmets design. Under workshopen identifierades ett flertal vårdinterventioner som svåra att genomföra under transport; och de ansågs generellt som svårare att genomföra under transport i ambulansen än annars (t.ex. på sjukhus). Det framkom också en del faktorer som ansågs påverka vårdinterventionerna under transport. Dessa påverkansfaktorer kunde delas in i kategorierna rörelserelaterade, designrelaterade, vägbanans statusoch samarbete. Flertalet av dessa faktorer överensstämmer med de faktorer som rapporterats i litteraturstudien. Under fältexperimentet på testbana rapporterade deltagarna ökad arbetsbelastning och ökad svårighet i att utföra vårdinterventionerna allt eftersom transporten bestod av fler och hårdare hastighetsförändringar och kurvtagningar. Med ökad svårighetsgrad ökade även förekomsten av färdrelaterade faktorer, vilket var den kategori som ansågs påverka utförandet av interventionerna i störst utsträckning. Slutsatser Många vårdinterventioner, inte bara HLR, är svåra att utföra under transport. Orsakerna till svårigheterna som uppstår under transport kan hänföras till hur ambulansen rör sig, hur vårdutrymmet är designat, hur vägbanan är beskaffad, och hur samarbetet mellan föraren och den som vårdar patienten fungerar. Rörelserelaterade orsaker ter sig proportionerliga mot svårigheterna att utföra vårdinterventioner – men alla vårdinterventioner påverkas inte på samma sätt och i samma utsträckning, vilket bör studeras vidare.

The American College of Surgeons (ACS) and the Department of Homeland Security (DHS) encourage the use of tourniquets as part of the “Stop the Bleed” campaign. Both have provided instructions for layperson tourniquet application in order to save the life of a hemorrhaging trauma victim. This study sought to compare the impact of using ACS and DHS instructions with manufacturer-provided instructions for the completion of simulated tourniquet application steps. Thirty surgical trainees completed a simulated tourniquet application with one of the three instruction sets. Their completion time and success for each step were measured. Participants that received ACS instructions failed the fewest number of steps (p < 0.01) and completed the task faster (Mean (SD) = 70 (33) seconds) compared to those with the manufacturer-provided instructions (p < 0.01). Tourniquet instruction sets need to be refined in order to optimize the success rate of just-in-time guidance for tourniquet application.

Objective

The American College of Surgeons (ACS) encourages clinicians to provide training to laypeople on tourniquet application. It is unclear whether clinicians are confident in their abilities and equipped with adequate knowledge, skills, and resources. This study aimed to determine surgical trainee knowledge and attitudes regarding tourniquet application and compare the effectiveness of instructions.

Methods

Thirty surgical trainees performed a tourniquet application simulation using a Combat Application Tourniquet and one of the three instructions sets developed by ACS, Department of Homeland Security, and the tourniquet manufacturer. Participants reported tourniquet knowledge, attitudes, and confidence and discussed the instructions. One instruction set was updated and compared to the original set with 20 new trainees.

Results

Participants with ACS instructions passed the greatest number of steps (p < 0.01) and completed the task significantly faster compared to those with manufacturer instructions (p < 0.01). Participants (80%) reported favorable views toward tourniquets but 30–60% did not align with to ACS tourniquet guidelines. Focus group participants suggested revisions to the ACS instructions. Comparing the original and revised version of these instructions resulted in no significant improvements.

Conclusions

ACS instructions provide guidance; however, improvements to tourniquet instruction are needed for success in controlling exsanguinating hemorrhage.

Exsanguinating trauma is a common cause of death. Placing bleeding control kits in public areas has been suggested as a countermeasure. Similarly, automatic external defibrillators (AEDs) are placed in public areas in case of cardiac arrests. Both severe bleeding and cardiac arrests require rapid care and people must be able to quickly find relevant emergency equipment. This study explores where and how people search for such equipment. Twenty participants wearing eye-tracking glasses searched for bleeding control kits and AEDs in a public building. The participants visually searched features such as signs with maps, written information, and other emergency equipment. The participants expressed elevators and staircases, open areas, entrances, and the reception to be places where medical emergency equipment would likely be placed. The results suggest that these features and places may be suitable for medical emergency equipment or directions.

Organiserade frivilliga är en allt viktigare del av samhällets beredskap. Initiativ som Sms-livräddare och Civila Insatspersoner (CIP) kan stötta professionella responsorganisationer och möjliggöra snabbare respons till händelser som hjärtstopp eller mindre bränder. Att få personer att ställa upp som frivilliga och sedan fortsätta vara frivilliga är väsentligt för att dessa initiativ ska ha en samhällsnytta. Tidigare studier har visat att det finns många faktorer som motiverar personer att bli frivilliga. Det saknas dock forskning på vilka faktorer som är mest avgörande för att personer ska fortsätta vara engagerade som frivilliga.

Därför genomfördes våren 2022 en enkätstudie av forskare inom Centrum för Forskning i Respons- och Räddningssystem (CARER), där 5 300 personer som var engagerade antingen som Sms-livräddare eller CIP:ar svarade på frågor om vad som motiverade dem att vara frivilliga och om de hade för avsikt att fortsätta vara frivilliga i framtiden. En explorativ faktor-analys genomfördes för att visa på de underliggande faktorer som var gemensamma i svaren. I denna faktoranalys upptäcktes totalt 12 underliggande faktorer baserat på de 48 frågorna i enkäten. Dessa faktorer analyserades därefter med en regressionsanalys för att undersöka vilka av dessa som är mest avgörande i frivilligas motivation att fortsätta vara frivilliga.

Resultatet visade att de faktorer som hade störst positiv inverkan på motivationen att fortsätta vara frivillig var Socialt sammanhang, Självbild, och Kompetens. De faktorer som hade störst negativ inverkan var Larmtrötthet och Negativa upplevelser. Resultaten från studien kan användas för att genomföra interventioner för att öka frivilligas motivation, genom att till exempel motverka larmtrötthet genom smartare utlarmningsalgoritmer eller utbildningsinsatser som ökar de frivilligas kompetens, och då förhoppningsvis även behålla fler frivilliga över tid.

In the current study, interaction using gaze control was compared to computer mouse using the MATB-II (Multi-Attribute Task Battery) environment. The study had two aims; the first was to explore the utility of low-cost technologies in a rapid prototyping and testing environment for aviation. The second aim was to use such an environment to compare a novel interaction device (a low-cost gaze control device) to a familiar interaction device (computer mouse). Method: Thirty participants performed two scenarios with each interaction device. The software MATB-II provided simulated flight tasks and recorded performance. Mental workload was assessed by the NASA Task Load Index (TLX) questionnaire after each scenario. Results: The results showed that gaze control resulted in significantly higher overall mental workload than computer mouse. Performance was better with mouse in two of the four tasks. Conclusions: Concerning the first aim, the study demonstrated the value of low-cost technology for initial user testing before using more expensive high-fidelity environments. Concerning the second aim, the computer mouse resulted in better performance and lower mental workload. This may either be due to higher user familiarity with computer mouse interaction or to limitations of the gaze control equipment and insufficient adjustments of the interface design to optimize for gaze control.

Contemporary crisis management studies often make use of the concept of resilience. However, resilience as a term has a wide variety of meanings and has been criticized as lacking operationalization and empirical validation. The current study aimed to link resilience concepts to observable behaviour within a disaster medicine management system. Resilience concepts, captured in so-called capability cards and further operationalized into six resilience prerequisites, were used in the study. An experienced crisis management team participated in a large-scale crisis management exercise and behaviours were captured through observations, video and audio recordings. Using a markers and strategies analytical framework, two blinded raters classified observable behaviours that exemplified resilient practice. The analysis showed a high degree of agreement (79%) between the combined operationalized capability cards and resilience prerequisites and the empirical classification of behaviours. The current study shows an empirical link from resilience concepts to observable behaviours during an exercise. Observed episodic narratives exemplify empirically connected specific strategies to specific resilience markers. These results demonstrate a method with observed narratives for analyzing resilience in crisis management teams using a markers and strategies approach. Future studies can use the results to create structured observation protocols to evaluate resilient behaviours in crisis management teams.

Introduction:

Resilience is often described as a desirable holistic approach to disaster preparedness. However, the term has a wide variety of meanings and is hard to operationalize and implement in disaster management. A goal for the EU H2020 project DARWIN was to operationalize resilience for incident management teams.

Aim:

To test the resilience operationalization by analyzing command team behaviors in a major incident exercise and trace observations to resilience theory.

Methods:

A regional medical command and control team (n=11) was observed when performing in a functional simulation exercise of a mass casualty incident (300 injured, 1800 uninjured) following the collision of a cruise ship and an oil tanker close to the Swedish coast. Audio and video recordings of behaviors and communications were reviewed for resilient behaviors based on the DARWIN guidelines using the “resilience markers for small teams” framework (Furniss et al., 2011).

Results:

A total of 121 observed instances of resilient behaviors were found in the material. In 95 cases (79%) the observed behaviors followed a priori hypothesized connections between resilient strategies and general markers. Certain marker-strategy combinations occurred frequently, such as 18 observations where the strategy “understand crucial assumptions” occurred together with the marker “adapting to expected and unexpected events.”

Discussion:

Resilience has the potential to contribute to a more holistic disaster management approach. The findings that the observations, in general, correspond to the expected relationship between theoretical concretization and contextualization supports the DARWIN effort to operationalize resilience theory. This is a prerequisite for developing observational protocols for training and further studies of resilient behaviors in disaster management teams.

Objective To achieve resilience in the response of a major incident, it is essential to coordinate major processes and resources with the aim to manage expected and unexpected changes. The coordination is partly done through timely, adequate, and resilience-oriented decisions. Accordingly, the aim of the present paper is to describe factors that affected decision-making in a medical command and control team during the early COVID-19 pandemic.Methods This study used a qualitative method in which 13 individuals from a regional public healthcare system involved in COVID-19 related command and control were interviewed. Data was collected through semi-structured interviews and analyzed using qualitative content analysis.Results The factors affecting decision-making in medical command and control during early COVID-19 pandemic were grouped into 5 themes: organization, adaptation, making decisions, and analysis, as well as common operational picture.Conclusions The present study indicated that decision-making in medical command and control faces many challenges in the response to pandemics. The results may provide knowledge about disaster resilience and can be utilized in educational and training settings for medical command and control.

Visual blood loss estimation occurs in a variety of medical contexts and may impact everything from interventions by immediate responders to the likelihood of receiving blood transfusions in a hospital setting. However, research suggests that visual blood loss estimation is inaccurate for laypeople and medical professionals. The aim of the current study was to conduct a systematic literature review to determine the current state of knowledge on visual blood loss estimation accuracy and identify directions for future research. A structured search resulted in 1799 titles that were subsequently screened. A total of 72 articles were coded for comparison. Based on the evaluation, several gaps were identified, most notably related to factors of the situation that may influence estimation accuracy such as blood flow and victim/patient gender. Directions for future research are proposed based on identified gaps.

A severe hemorrhage can result in death within minutes, before professional first responders have time to arrive. Thus, intervention by bystanders, who may lack medical training, may be necessary to save a victims life in situations with bleeding injuries. Proper intervention requires that bystanders accurately assess the severity of the injury and respond appropriately. As many bystanders lack tools and training, they are limited in terms of the information they can use in their evaluative process. In hemorrhage situations, visible blood loss may serve as a dominant cue to action. Therefore, understanding how medically untrained bystanders (i.e., laypeople) perceive hemorrhage is important. The purpose of the current study was to investigate the ability of laypeople to visually assess blood loss and to examine factors that may impact accuracy and the classification of injury severity. A total of 125 laypeople watched 78 short videos each of individuals experiencing a hemorrhage. Victim gender, volume of blood lost, and camera perspective were systematically manipulated in the videos. The results revealed that laypeople overestimated small volumes of blood loss (from 50 to 200 ml), and underestimated larger volumes (from 400 to 1900 ml). Larger volumes of blood loss were associated with larger estimation errors. Further, blood loss was underestimated more for female victims than male victims and their hemorrhages were less likely to be classified as life-threatening. These results have implications for training and intervention design.

To design interventions for teaching laypeople how to respond in hemorrhage situations, it is necessary to understand factors that influence their perception of blood loss. Although lab-based research offers more experimental control, it limits access to certain kinds of participants. Therefore, the purpose of this study was to compare results from an online administration of a web-based application (SABLE) to data collected using the same application in a lab. Participants viewed 78 5-second video clips of simulated bleeding injuries with a male or female victim and different volumes of blood loss. They estimated the volume of blood loss after each video. The results replicated the general findings from prior research and revealed no significant differences in estimations or estimation accuracy between the online and lab-based administration of SABLE. Results are discussed in terms of applicability to research practice. 

PurposeVolunteers play an increasingly important role in emergency response logistics. However, to make most use of their capabilities, they need to be dispatched to the emergency site in an effective manner and coordinated on-site. The purpose of this study is to present a requirements specification and initial design proposal for ICT-enabled dispatch of volunteers as first responders as part of emergency response digitalized co-production initiatives.Design/methodology/approachThe study uses a case study approach inspired by action research and the theoretical lens of digitalized co-production. It includes a variety of methods for data collection, including interviews with volunteers, document analysis and participation in workshops.FindingsThe major themes identified are geofencing, dispatch coordination, dynamic resource allocation and communication and collaboration. First priority requirements include geofencing alert and positioning, a joint application programming interface, receipt of alert, receipt if arrival at incident site, withdrawal of resources, chat functionality and the ability to alert in descending order within the geofenced areas to avoid alarm fatigue. As to coordination and dynamic resource allocation, e.g. built-in alert restrictions, ability to pre-select profiles and to dispatch based on competence/training, capacity and equipment would enable a more optimized response.Originality/valueWhile previous research on digital volunteerism mainly embraces spontaneous volunteers and social media, this study addresses long-time collaboration with professional response organizations - digitalized co-production - with a focus on the dispatch, coordination and task allocation of volunteers that are central to their integration with emergency response logistics.

Workload transitions are situations where operators are suddenly confronted with levels of workload substantially different from previously established levels. Workload transitions may affect the operators' state of stress and coping behaviors but previous research has not conclusively demonstrated the nature of those. The first goal of the current work was to investigate the discrepant findings of the previous literature. Two experiments were conducted where participants were asked to perform a digit detection task that suddenly shifted between low and high event rates (i.e., low and high workload, respectively). The first experiment used a large magnitude transition that resulted in a decrease in reported levels of task engagement and effort. Over time, the reported stress and workload ratings of the transitioned groups approached the nontransitioned control groups. A second experiment was conducted using a moderate magnitude transition. This second experiment replicated the findings from the first experiment, with the key difference being that the transition from a low to more a more moderate level of workload resulted in higher, sustained task engagement and effort. Two main conclusions are drawn from these results. First, over time the stress and workload levels of individuals who experience a transition will approach those reported by nontransitioned individuals. Future workload transition research must therefore consider the effect of the time from transition. Second, the magnitude of the transition may influence the coping response such that a moderate transition may result in increased task-oriented, effortful coping whereas a large magnitude transition may result in decreased effortful coping. 

Purpose– The purpose of this paper is to explore the workload and shared workload awareness in a staff performing command and control (C2) work during a planned major incident (MI) empirical case in Sweden. Design/methodology/approach– Data on workload and shared awareness were collected during live C2-work using qualitative observations and in-situ interviews mixed with quantitative questionnaires. Findings– A content analysis of the qualitative data revealed categories of workload sources. Quantified workload estimates showed changes in workload levels over time and staff roles, which were also contextualized using the results of the qualitative data. Data on shared awareness indicated that team workload awareness shifted over time according to common patterns. This study demonstrates a promising methodology to study C2-related factors during live EMS work. Research limitations/implications– The observed variations in workload imply that research that relies only on post-task measurements of workload may be inaccurate. Future research could use this method to investigate the connection between workload and performance during different types of MIs. Originality/value– The results can be used to inform future Göteborgsvarvet C2-teams in terms of when, why, and for whom task load changes, which would support predictive allocation of resources.