Emergency vehicles (EVs) are at high risk of accidents during emergency driving. To make use of countermeasures to mitigate these risks, it is important to understand under what circumstances EV-related accidents occur. The common risk factors for EV-related accidents were examined through a systematic literature review. A total of 22 articles were examined for risk factors associated with EV-related accidents. The most reported risk factors were, in order of frequency, intersections, daytime, dry roads, clear weather, urban roads, traffic signals, and angular collisions. The articles were also reviewed for suggested countermeasures to mitigate the risk factors. The most commonly suggested countermeasures were driver training for EV operators, educating the public, exercising caution at intersections, wearing a seatbelt, and intelligent vehicle technologies. Cooperative intelligent transport systems (C-ITSs) have the potential to mitigate the risks of EV-related accidents. Therefore, three C-ITS services were investigated: EV approaching, EV preemption, and geofencing. They could all be used to inform, warn, or control aspects of driving. Each suggested service has the potential to decrease risk factors for EV-related accidents. The current literature review provides guidance on under what circumstance and in what form C-ITSs could be beneficial to prevent EV-related accidents. Further research is needed to examine behavior when drivers are introduced to C-ITSs.

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 < 0.001). Participants applied LAVA TQ faster (74.1 seconds) than CAT (126 seconds ; p < 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.

BackgroundOrganized volunteer initiatives can reduce response times and improve outcomes in emergencies such as cardiac arrests or fires. Retention of volunteers is important to maintain good coverage and capabilities. The current study explores factors underlying volunteers motivation to continue as volunteers.MethodsData from 5347 active volunteers were collected through an online survey. An exploratory factor analysis was used to identify underlying factors that were then used in a regression analysis to predict intention to continue as a volunteer. Group differences based on, among others, number of alarms and prior professional experience in emergency response were explored.ResultsThe results showed that the factors community, self-image, and competence were the strongest positive predictors for the motivation to continue, whereas alarm fatigue and negative experience were the strongest negative predictors. Volunteers with professional background had higher competence and lower Alarm fatigue. Volunteers from rural areas and small cities had higher community than those in large cities.ConclusionsAlarm fatigue can make it hard to retain volunteers, which could be addressed using improved dispatch algorithms. Support after dispatch is important to prevent negative experiences. Finally, increased competence, e.g. through education and training, can improve volunteers motivation to continue.

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.

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 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.

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. 

Train drivers in Sweden had the opportunity to test the new European Rail Transport Management System (ERTMS) during the early implementation of this signaling system in 2011 and 2012. Unfortunately, they have reported many implementation problems. These ERTMS lines have been evaluated as more challenging to drive compared to the previous signaling system. A systematic literature review was conducted to understand what network planning designers typically focus on when analyzing railway driveability and how driveability can be assessed. In the overall picture the impact on driveability originates from both technological, organizational, and train driver aspects. One technological issue found during the investigation is related to the speed profile design. Frequent speed changes were identified as the primary source of negative experiences during driveability evaluations, especially on retrofitted lines. Results also indicate the need for a methodology that includes the driver earlier in the network planning test process, to avoid the costly and time-consuming analysis done after project implementation. The results highlight the importance of the speed profile design to provide good driveability. Cognitive Task Analysis, simulations, and statistical calculations to predict driver and train performance were identified as applicable methods to involve train drivers earlier in the driveability analysis process.

A current issue in the command and control (C2) community is information overload. With more information available and more efficient information-gathering capabilities, modern C2 systems are faced with the problem that the human operators will be confronted with an information environment that may adversely impact their ability to do their jobs. To gain insight into this problem, an interview study was conducted focusing on Swedish emergency response C2 operators to investigate their views on information overload and how the phenomenon may be related to their work. Thirteen participants were recruited from three different Swedish agencies that engage in emergency response work: the police, rescue service, and medical emergency response. A thematic analysis was conducted to identify themes related to how Swedish emergency response C2 operators work with information and how they view information overload. A total of five themes were identified, showing that operators assess and integrate information manually to support their decision-making, mainly relying on their experience to do so, and that operators rely on the control structures of the C2 system to provide them with structured, rich, and relevant information. Operators do not view information overload as a present threat to their work environment, arguing that the C2 systems provide enough support to protect them from unnecessary information load. However, if information overload were to become an issue, operators felt that this would be caused by poorly implemented decision aids, and new information flows that would erode the control structures that support the operators.

Introduction First aid performed by immediate responders can be the difference between life and death in the case of trauma with massive bleeding. To develop effective training programs to teach bleeding control to laypersons, it is important to be aware of beliefs and misconceptions people hold on bleeding and severity of bleeding situations. Method A controlled study was conducted in which 175 American college students viewed 78 video clips of simulated bleeding injuries. The volume of blood present (between 0 and 1900 ml), rate of blood flow, and victim gender were systematically varied within participants. Participants were asked to rate injury severity, indicate the appropriate first aid action, and estimate the amount of time until death for the victim. Results Though the Stop the Bleed (R) campaign recommends training laypeople to treat 165 ml of blood loss as life threatening, participants largely rated this volume of blood loss as minimal, mild, or moderate and estimated that the victim had just under one hour to live. Increased blood loss was associated with increased recommendations to use a tourniquet. However, in the 1900 ml conditions, participants still estimated that victims had around 22 minutes to live and approximately 15% recommended direct pressure as the intervention. Severity ratings and recommendations to use a tourniquet were also higher for the male victim than the female victim. Conclusions Injury classification, intervention selection, and time to death-estimations revealed that training interventions should connect classifications of blood loss to appropriate action and focus on perceptions of how much time one has to respond to a bleeding. The study also revealed a gender related bias in terms of injury classification and first aid recommendations. Bleeding control training programs can be designed to address identified biases and misconceptions while building on existing knowledge and commonly used terminology.

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 (<19) healthy (19-24), and overweight (>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.

Trauma is a critical public health issue as the lead-ing cause of death for Americans between theages of 1 and 44 years.1In response to this reality, anumber of Stop the Bleed educa tion programs arebeing implemented to teach the lay public how to stopexsanguinating hemorrhage in preventable deaths.2Todate, there are limited data available to compare effec-tiveness of these programs. Because there is limitedcapacity to track outcome measures at this time,authors offer direction to practitioners on 12 processmeasures that will best allow comparisons among pro-grams to make informed decisions when implement-ing Stop the Bleed education

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.

Denna rapport presenterar ett nytt kunskapsläge om framtidens skadeplats utifrån de resultat som kommit från forskningsprogrammet Effektiva räddningsinsatser på Framtidens Skadeplats 2015–2020. Rapporten är en omarbetad version baserad på rapporten Att hantera framtidens skadeplatser: scenarier och utgångspunkter för kunskapsutveckling runt räddningsinsatser och skadeplatsarbete som gavs ut av Centrum för forskning inom respons- och räddningssystem (CARER) 2016. I den rapporten presenterades ett underlag för de kommande aktiviteterna som var planerade att genomföras inom forskningsprogrammet. Rapporten beskrev också åtta olika skadeplatsscenarier som togs fram i linje med Myndigheten för samhällsskydd och beredskaps (MSB:s) dåvarande framtidsanalyser samt en analys av då tillgänglig litteratur om olyckor och katastrofer. Dessa scenarier beskrev på ett strukturerat och detaljerat sätt möjliga framtida skadeplatser av särskilt intresse ur ett praktiker- och forskningsperspektiv. 

I denna rapport har dessa åtta scenarier arbetats om och uppdaterats utifrån rådande läge i samhället i dag. De har också utökats med en beskrivning av en möjlig respons så som den kan se ut i framtiden inom tidsramen 10 till 15 år. Denna rapport innehåller också en övergripande beskrivning av de resultat som framkommit från de sex arbetspaketen (AP) i programmet. Inom AP2 redovisas teman om a) frivilliga och civila insatspersoner, b) semi-professionella som första insatsaktörer, c) genus, etnicitet och utsatthet, samt d) efterforskning av försvunna personer. AP3 redovisar teman om a) effektiv utlarmning av frivilliga och semiprofessionella resurser, b) prediktering, c) skadeplatslogistik, samt d) alarmering och effektivare räddningstjänst. AP4 går igenom a) IT-plattformen OP-SENS och b) lägesbilder, medan AP5 redovisar teman om a) utvärdering av ny teknik, b) utvärdering av utbildning och övning, samt c) utvärdering av ny metodik. Slutligen har AP6 redovisat teman om a) nya metoders och resurser effekt på systemnivå, samt b) värdering av frivilliga och semiprofessionella. Dessa forskningsresultat återkommer i scenarierna för att exemplifiera hur de kan omsättas i praktiskt skadeplatsarbete innan, under och efter en insats.

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.

The purpose of this study was to develop a simulation model to evaluate bleeding control kit location strategies for a mass casualty incident scenario. Specifically, the event simulated was an explosion at a large sports arena. The model included a representation of the arena itself, simulated crowd movements following the detonation of an improvised explosive device, injuries and treatments, and different ways for immediate responders to help injured patients using tourniquets. The simulation model gave logically consistent results in the validation scenarios and the simulation outcomes were in line with the expected outcomes. The results of the different tourniquet location scenarios indicated that decentralized placement (more than one location) is better, easy access is important (between rather than at emergency exits) and that an increased number of available tourniquets will result in an increased number of survivors.

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.

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.

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.

Introduction:

Providing patient care in a moving ambulance can be difficult due to various transport-related factors, (e.g., accelerations, lateral forces, and noise). Previous research has primarily focused on cardiopulmonary resuscitation (CPR) performance effects but has neglected to investigate other care interventions.

Aim:

To test a range of different care interventions during different driving scenarios.

Methods:

A workshop with ambulance practitioners was held to create a list of care interventions to be tested. Two ambulance practitioners were recruited to drive an ambulance on a closed test-track while performing care interventions on simulation models. Three driving scenarios of differing difficulty were used. Main outcome measures were estimates of workload using the NASA Task Load Index (TLX) and task difficulty. G-forces and video-data were also collected.

Results:

Estimated workload increased overall as the difficulty of the driving scenario increased, as did task difficulty estimates. However, some care scenarios and interventions were affected less. For example, placing intravenous access increased greatly in difficulty, whereas saturation and blood pressure measurements had more modest increases. TLX scores showed that the primarily estimated physical workload and effort that increased, but also mental and temporal demands for some care scenarios. The more difficult driving scenarios primarily increased the variability of measured G-forces but not necessarily the overall driving speed, indicating that force variability is an important factor to study further.

Discussion:

The study was intended as an initial pilot test of a wide range of care interventions. It will serve as input to future, larger studies of specific interventions and transport-related factors. Overall, this small pilot indicates that more interventions than only CPR should be studied in moving ambulances to investigate potential performance effects. This is important for traffic, patient, and work safety for ambulance workers and patients.

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.

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.

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.

The purpose of this panel will be to discuss current research and challenges relating to the work of first and immediate responders. The main discussion of the panel will have panelist challenge human factors researchers to consider new directions of research addressing current capability and knowledge gaps faced by the first and immediate responder communities.

Objective: The objective of the current study was to develop and evaluate a persuasive decision-support aiming at reducing pre hospital delay and increasing ambulance service use for patients who suffer from a recurrent myocardial infarction. Materials and methods: The system was developed as a prototype mobile application for smartphones. The system was evaluated by four end-users with previous experience of myocardial infarction. The user tests were complemented with cognitive walkthroughs and heuristic evaluation. Results: A total of 14 persuasive design principles were used to guide the design of the system. The usability was regarded as high with an average score of 82 on the System Usability Scale. The users reported that they found the system highly persuasive. Conclusions: User-centered design together with persuasive design principles through iterative testing and development has resulted in a prototype app with potential to improve patients care seeking behavior. The content in the prototype will be further evaluated before it is integrated in educational interventions.

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.

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.

Introduction:

Moulage is the art of creating faked injuries on actors for training purposes. Moulage is commonly used in disaster and emergency medicine training, as it is believed to improve learning through enhanced realism.

Aim:

The aim of the current study was to test the effect of moulage on perceived realism and learning during a joint exercise featuring students from the police, rescue service, and ambulance service.

Methods:

The scenario was a car accident with two victims. Students (n = 135) were divided into 12 groups. Moulage was applied to the victim actors for half the groups (n = 67), whereas the other half (n = 68) experienced the scenario without moulage. Victim cards were used in both scenarios. Immersion, realism, and learning was measured on a 100-point scale immediately post-scenario using a questionnaire.

Results:

Two (moulage group) by three (student population and police, rescue service, or ambulance) ANOVAS on realism, immersion, and learning found no effects on realism or immersion (all p>0.10). There was an effect of student group on learning, F(2, 92) = 3.518, p = 0.034, partial eta square = 0.071, such that the rescue service students had overall lower scores on learning (M = 53.87, SD = 28.29) compared to the police (M = 66.07, SD = 27.55) and ambulance students (M = 74.99, SD = 24.51). Cohen’s ds for moulage effect was calculated to 0.144 for immersion, 0.112 for realism, and 0.003 for learning.

Discussion:

The current study did not find any effects of moulage on immersion, realism, or learning. The effect sizes indicate that any effect of moulage on realism and immersion, should it exist, is in the approximate size of 2-3 points on a 100-point scale. The lack of effect may be due to limitations in the study design, but may also indicate that the use of moulage in addition to victim cards is not necessarily beneficial for novice students’ learning.

Inom ramen för denna studie har ett utbildningskoncept för första-hjälpen åtgärder vid livshotande blödning utvecklats utifrån det amerikanska konceptet "Stop the bleed". Utbildningen riktar sig till räddningstjänstpersonal och har validerats i en pilotutbildning. Utbildningskonceptet kan ligga till grund för en nationellt likriktad och kvalitetssäkrad utbildning av blödningskontrollerande åtgärder för räddningstjänstpersonal.

A pilot project with three substudies (a literature survey, a workshop, and a field experiment at test track) is reported. The intent is to develop realistic and prototypical driving scenarios with associated patient-care tasks, for use in ambulance-simulator studies and training of ambulance personnel, in a future project. The goals were to survey the current knowledge and to collect relevant data on vehicle dynamics and behaviour during simulated emergency scenarios. Prior research has foremost studied the quality of CPR (cardiopulmonary resuscitation) during transport and shown that it is difficult to perform high-quality CPR depending on the transport procedure, vehicle type, and the design of the care space. From the workshop, care interventions were chosen for the subsequent field experiment; based on frequency and difficulty. Factors that affect the care interventions during transport were categorised as motion related, design related, road surface status, and cooperation. The field experiment at a test track showed that workload and difficulty in performing the care interventions were rated higher when the transport entailed more and faster speed changes and turns. Motion-related factors was the highest-rated category with regard to effect on care interventions.

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.

Objective:

We sought to investigate whether expert–novice differences in visual search behavior found in other domains also apply to accident scenes and the emergency response domain.

Background:

Emergency service professionals typically arrive at accidents only after being dispatched when a civilian witness has called an emergency dispatch number. Differences in visual search behavior between the civilian witness (usually a novice in terms of emergency response) and the professional first responders (experts at emergency response) could thus result in the experts being given insufficient or erroneous information, which would lead them to arrive unprepared for the actual situation.

Method:

A between-subjects, controlled eye-tracking experiment with 20 novices and 17 experts (rescue and ambulance service personnel) was conducted to explore expert–novice differences in visual search of accident and control images.

Results:

The results showed that the experts spent more time looking at task-relevant areas of the accident images than novices did, as predicted by the information reduction hypothesis. The longer time was due to longer fixation durations rather than a larger fixation count.

Conclusion:

Expert–novice differences in visual search are present in the emergency domain. Given that this domain is essential to saving lives and also relies heavily on novices as the first link in the chain of response, such differences deserve further exploration.

Application:

Visual search behavior from experts can be used for training purposes. Eye-tracking studies of novices can be used to inform the design of emergency dispatch interviews.

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.

Background Training of medical professionals is important to improve care during mass-causality events. Therefore, it is essential to extend knowledge on how to design valid and usable simulation-based training environments.

Purpose This article investigates how distributed cognition and simulation theory concepts can guide design of simulation-based training environments. We present the design and user evaluation of DigEmergo, a simulator for training and assessing emergency medicine management.

Design approach A prior Distributed Cognition in Teamwork (DiCoT) analysis of the Emergo Train System (ETS) guided the design process. The design objective of DigEmergo was to be useful, usable, retain distributed cognition features of ETS, and strengthen validity and output reliability.

Evaluation Eight expert ETS instructors participated in a formative system evaluation. The Technology Assessment Model (TAM) questionnaire was used to measure usefulness and ease of use. Observations and post-test interviews were conducted to contextualize the measures.

Results The results showed that DigEmergo was perceived as somewhat to quite useful and somewhat easy to use. Overall, expert users considered DigEmergo promising and successful in retaining core ETS features.

Conclusions The study indicates that a design methodology based on distributed cognition and simulation theory can be successfully combined to guide simulator (re)design and strengthen simulator validity.

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.

Study/Objective: In this study, we aimed to design a questionnaire battery for course and simulation exercise evaluation, and pilot-test the battery by evaluating a course on Advanced Prehospital Trauma Care (APTC).

Background: Many course evaluations suffer from simplistic metrics, such as whether the course participants “enjoyed” the course. In contrast, the current study sought to measure (self-estimated) pre- and post-course knowledge, relevant to specific learning objectives, as well as questions pertaining to specific factors of the simulation exercises used in the course (eg, fidelity/realism, learning objective fit, transferability of tools/procedures, usefulness, among others) were selected based on simulation theory and simulation-based training literature.

Methods: Data were collected during a course on APTC. Twelve students participated. The mean professional experience was 15.5 years. The participants completed an informed consent form prior to the study. They completed a pre-course questionnaire, a post-course questionnaire, and a course evaluation form.

Results: The mean self-estimated improvement in theoretical knowledge pertaining to the course objectives was 8.23 on a 0 to 10 scale, and 8.25 for practical skills. Greatest improvement was in advanced airway management, physiological reactions to hypothermia, pneumothorax interventions, special considerations for patients injured by explosives (eg, blast injuries and burns), and medical decision making during an active shooter scenario. The evaluation of the simulation exercises received high marks (mean rating 4.53 [3.92-4.92] out of 5.0) on all aspects. The participants rated the overall course quality at 4.67 (on a 0 to 5 scale), with the simulations, practical exercises, and the structure of moving from theory to practice being mentioned as particularly positive.

Conclusion: Overall, the results showed that the APTC course received high marks on almost all measured factors. Further validation of the questionnaires is needed before general implementation of the battery can be recommended. Such implementation would benefit diverse course development and quality assurance

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: 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.