This paper presents an ethnographic study consisting of non-participatory observations of a Swedish regional medical command and control team during their crisis response to the COVID-19 pandemic. The field-notes from the observations were analyzed using a deductive content analysis with categories representing teamwork processes. The content analysis showed that the studied regional medical command and control team was engaged in all but one of the predefined teamwork processes. Furthermore, the content analysis also added to the understanding of the regional medical command and control teamÂ’s work procedures by emphasizing how the team was engaged in the different processes. Lastly, the content analysis also made it possible to identify potential developmental needs of the studied regional medical command and control team.

Planning, designing, facilitating, and evaluating are central activities for instructors when conducting exercises.When conducting these activities, instructors usually rely on past experiences since structured educations orguides for instructors do not exist. It is therefore evident that there is a need for such educations or guides.

In this study, the contents of a guide for instructors are proposed. The contents are based on seven semi-structuredinterviews with novel and experienced instructors, where they were asked to map their procedures for conductingexercises through a journey map. The interviews resulted in material which was transcribed and analysed using athematic analysis. The thematic analysis emphasized five themes to consider when acting as an instructor, namelyroles, realism, defining purpose and goals, learning, and planning and acting.

The results from the interviews, combined with past literature, resulted in proposed contents for an instructor’sguide which is currently being developed.

In trauma teams, coordination can be established through a centralised leader. The team can also use a decentralised strategy. In this descriptive study of video-recorded trauma resuscitations, using quantification of qualitative data, Social Network analysis of all real-time communications of eight in-real-life (IRL) and simulated trauma teams explained team social structure. The communication network structures in the simulated scenarios were more centralised using individually directed speech and had a high proportion of communication to update all team members. Such a structure might be the result of work performed in a complexity-stripped simulation environment where simplified task-executions required less interactions, or from work revolving around a deteriorating patient, imposing high demands on rapid decision-making and taskwork. Communication IRL was mostly decentralised, with more variability between cases, possibly due to unpredictability of the IRL case. The flexibility to act in a decentralised manner potentiates adaptability and seems beneficial in rapidly changing situations.Practitioner summary: Efficient collaboration in trauma teams is essential. Communication in in-real-life and simulated trauma teams was analysed using social network analysis. The simulation teams were overall more centralised compared to the IRL teams. The flexibility to act decentralised seems beneficial for emergency teams as it enables adaptability in unpredictable situations.

Climate change is tightly coupled to the usage of energy in differentforms. Creating and using sustainable energy solutions is increasinglybeing recognized as the greatest challenge of our time. Theenergy crisis concerns everyone who consumes energy or servicesthat rely on energy to be performed, in practice almost everythingwe buy. However, the temporal and psychological distance to climatechange has led to a situation where the consequences of ourenergy usage often is considered a future problem or “someoneelse’s” problem. Current methods to increase awareness and understandingof climate change and the need to create sustainableenergy solutions are usually based on simulation or negotiationgames. Methods similar to crisis management exercises are uncommon.In this paper, we propose to use Megagames, large scale socialgames, as a method for increasing the awareness of the challengesrelated to creating sustainable energy solutions. Examples fromtwo Megagame test runs are provided and discussed.

The COVID-19 pandemic has had a global impact om society. Different countries and organizations have chosen different approaches to manage this crisis. This paper aims to describes how public Swedish actors (county administrative boards, municipalities, and regional councils) evaluated their management of the COVID-19 pandemic. Also, the paper aims to suggest improvements for crisis management strategies. Applying a meta-evaluation approach to open reports from the public organizations means collecting evaluation reports, determining if they fit the inclusion criteria, and if so, include them in the analysis. Included reports were categorized and given points indicating different types of merits. In addition, a thematic analysis of conclusions was conducted. 110 evaluation reports from 98 different organizations are included in the analysis. The importance of evaluating, having a structure for data collection, analysis, and reporting is reflected in the quality of the reports. Four identified themes offer an understanding of areas in need for development among Swedish regional councils, municipalities, and county administrative boards.

This paper presents an analysis of situation reports used and created by a crisis management team within the Swedish healthcare sector during the early phase of the COVID-19 pandemic. The analysis was conducted through a deductive content analysis, where categories were identified based on the concepts of common operational pictures, sensemaking, and situation awareness. In the analysis, support for all identified categories was found. Based on the analysis and the concepts, future recommendations regarding what type of information that ought to be included in situation reports were created. These recommendations include, amongst others, the categories of consequences, how it is perceived by the public, objectives, status and implications of information, future scenarios, actions, resources, and work procedures.

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: Stress week was included during training of Special Forces (SF) Operators in Sweden to test their ability and limits for handling stress in different unknown situations and environments at a military training facility in Sweden. The aim of the study was to examine the effects of stress and workload experienced in various tasks during firefighting and military medicine simulation training.

Methods: This pilot study was performed during the second day of stress week. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) is a validated, subjective, and multidimensional assessment tool for rating perceived workload with six subscales: mental demand, physical demand, temporal demand, performance, effort, and frustration. These subscales were used as an indicator of stress experienced. The different tasks were assessed by the SF Operators by rating the NASA-TLX subscales for each task, which were then analyzed and compared using ANOVA.

Results: There was a significant difference between the two simulation exercises assessed by the participants and instructors, and both groups considered firefighting to be more demanding than medical. The participants perceived the mental and physical demands as more demanding in the firefighting exercises, as well as for the level of frustration and effort. However, no differences regarding performance or temporal demands between the simulation exercises were found.

Conclusion: The principle "train as you fight" implies difficult and demanding situations. When exposing Swedish SF Operators to challenging situations, assessment of perceived stress and performance are possible.

Background: Although 40 years has passed since the Institute of Medicine released its report "To Err Is Human," error counts are still high in healthcare. The understanding and training of nontechnical skills and teamwork thus remains a pertinent area for improvement. Most evaluation of nontechnical skills of trauma teams takes place in simulation rooms. The aim of this study was to determine if real trauma resuscitation communication could be analyzed using the speech classification system of verbal response modes, otherwise known as the verbal response mode taxonomy and, if so, if there is a predominant approach of verbally delivering messages. Methods: Video and audio recordings of 5 trauma team resuscitations were transcribed. Communication was coded using the verbal response mode taxonomy for both form and intent. The rate of mixed-mode communication (unmatched form and intent) and pure-mode communication were calculated and compared between the participants roles. Comparisons were made with simulated material published in other research. Results: The most frequent mixed-mode communication was acknowledgment in service of confirmation. Question in service of a question was the most used pure-mode communication. Six predominant roles were seen, which matched well with the roles in the simulations. Conclusion: The verbal response mode taxonomy can be used to study communication during real trauma resuscitation, and it was found that pure-mode communication was predominant, meaning that the grammatical form matches the intent. Verbal response mode methodology is time consuming and requires analysts with domain knowledge. Comparisons show some differences between simulations and our material indicating that verbal response modes can be used to evaluate differences in communication. (C) 2021 Elsevier Inc. All rights reserved.

The Covid-19 pandemic has disrupted the health care system and affected all sectors of society, including criticalinfrastructures. In turn, the impact on society’s infrastructures has impacted back on the health care sector. Theseinteractions have created a system of associated risks and outcomes, where the outcomes of risks are risksthemselves and where the resulting consequences are complex vicious cycles. Traditional risks assessmentmethods cannot cope with interdependent risks.This paper describes a novel risk systemicity approach to elicit and mitigate the systemic risks of a majorpandemic. The approach employed the internet-based software strategyfinder™ in workshops to elicit relevantrisk information from sixteen appropriately selected experts from the health care sector and major sectors impactedby and impacting back on the health care sector. The risk information was processed with powerful analyticaltools of strategyfinder to allow the experts to prioritise portfolios of strategies attacking the vicious cycles. 

This paper reports on experiences of creating resilience-empowering simulation-gaming exercises concerning disruptions in the payment system. The aim of the exercises was to utilize gaming-simulation as a training environment where teams of practitioners can learn to develop in-depth understanding of systemic interaction (i.e., cascading effects of disruptions) and learn how to develop collaborative resilience across many different critical infrastructures. Interaction between different stakeholders in the payment system, such as business owners, banks, municipality crisis managers are considered as the foundation for building collaborative resilience. Designing the exercises in such a way that they encourage and support such interactions are therefore seen as a primary design goal. This paper describes lessons learned from the process of conducting the 17 exercises in terms of creating a well-balance simulation and an immersive experience.

BackgroundThis study outlines key aspects of professional development among health professionals in low- and middle-income countries (LMIC). LMICs need support in developing their continuing medical education, and non-technical skills (NTS) that have been neglected in this respect. Given the nature of NTS, educational methods should be used experientially. This study aims to explore an interactive educational approach to increase NTS among health care professionals in an LMIC setting.MethodsA design-based research approach was applied to develop an educational method. Key NTS concepts were identified, which directed the selection of research-based surveys. A series of workshops was designed in which a survey-based experiential approach was developed. The educational process followed a pattern of individual reflection, small group discussion and relating the concepts to the local practice in a wider group.ResultsAn approach to increase NTS in LMIC settings emerged in iterative development through conducting workshops with health care teams in the Balkans. The topics could be grouped into individual, team, and organisational dimensions. The approach can be described as survey-based experiential learning involving steps in recurring interaction with participants. The steps include identifying concepts in individual, team and organization dimensions and contextualising them using experiential learning on the individual and group levels.ConclusionAn overarching approach has been developed that addresses NTS in an LMIC setting. The survey-based experiential learning approach can be beneficial for raising professional awareness and the development of sustainable healthcare settings in LMICs.

Background

The use of clinical practice guidelines in clinical and organizational decision-making improves the care of patients and patient safety. Guidelines make healthcare consistent and efficient. In many low- and middle income countries healthcare workers depend on guidelines developed in higher income countries. For these to be useful and accepted they need to be adapted to the local setting. The aim of the study was to implement pre-hospital treatment guidelines into an organization that was not currently using guidelines. The study was partnership between a Swedish pre-hospital training organization and local ambulance service organizations in Kosovo.

Methods

An iterative process of implementing the guidelines was used:

• Identify guidelines appropriate for the local organization.
• In sets of five, have the guidelines translated into Albanian.
• Adapt the guidelines to the local conditions and context.
• Approval of guidelines by an expert group.
• Begin using the guidelines within the target organization.

Results

The first set of five guidelines was translated, approved, and implemented into the organizations. To improve acceptance, both practitioners and decision-makers were involved in the process. Seven workshops were held, with a total of 104 participants. In follow-up discussions participants said they accepted the guidelines and that they would be useful in their daily work.

Conclusions

It is important to evaluate to what extent the guidelines have been accepted, understood, and used. The success and acceptance is due to the flexible procedure managing the full implementation process. Adapting guidelines to fit with local needs and requirements using local experts made the guidelines accessible and useful. The workshop discussions established justification and approval.

Key messages

• Involve local experts in contextualising guidelines to increase acceptance from the start.
• Support building a robust local implementation organization to assist and administer change.

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: 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.

Background

Improved trauma management can reduce the time between injury and medical interventions, thus decreasing morbidity and mortality. Triage at the emergency department is essential to ensure prioritization and timely assessment of injured patients. The aim of the present study was to investigate how a lack of formal triage system impacts timely intervention and mortality in a sub-Saharan referral hospital. Further, the study attempts to assess potential benefits of triage towards efficient management of trauma patients in one middle income country.

Methods

A prospective descriptive study was conducted. Adult trauma patients admitted to the emergency department during an 8-month period at Moi Teaching and Referral Hospital in Eldoret, Kenya, were included. Mode of arrival and vital parameters were registered. Variables included in the analysis were Injury Severity Score, time before physician’s assessment, length of hospital stay, and mortality. The patients were retrospectively categorized according to the Rapid Emergency Triage and Treatment System (RETTS) from patient records.

Results

A total of 571 patients were analyzed, with a mean Injury Severity Score of 12.2 (SD 7.7) with a mean length of stay of 11.6 (SD 18.3) days. The mortality rate was 1.8%. The results obtained in this study illustrate that trauma patients admitted to the emergency department at Eldoret are not assessed in a timely fashion, and the time frame recommendations postulated by RETTS are not adhered to. Assessment of patients according to the triage algorithm used revealed a significantly higher average Injury Severity Score in the red category than in the other color categories.

Conclusion

The results from this study clearly illustrate a lack of correct prioritization of patients in relation to the need for timely assessment. This is further demonstrated by the retrospective triage classification of patients, which identified patients with high ISS as in urgent need of care. Since no significant difference in to time to assessment regardless of injury severity was observed, the need for a well-functioning triage system is apparent.

In situations requiring humanitarian interventions the contexts are demanding with hard environments. Humanitarian workers are exposed to conflict, poverty, famine or natural disasters, together with witnessing personal tragedies. This creates a demanding work context, challenging the mental health, and 30% of aid workers report symptoms of PTSD after field assignments (McDonald, 2015). Several stressors affecting also originate from organizational factors (Lopez Cardozo et al. 2012), but few studies describe how humanitarian actors work to improve staff care practices.

Objective, easy to use, and easy to comprehend assessment methods for measuring shared understanding in teams are hard to find. This paper describes an experiment where a measure called Shared Priorities, which is based on ranking of self-generated strategic items, is assessed. Trained teams were compared to non-trained teams in a dynamic problem-solving task. The maturity of the participating teams was also assessed using a content analysis measure. The Shared Priorities measure was used alongside other well-documented measures of team awareness based on self-rating. Results show that the Shared Priorities measure correlates with task performance and could also distinguish between trained and non-trained teams. However, the Shared Priorities measure did not correlate with the other team measures (cf. CARS – Crew Awareness Rating Scale – and DATMA – Distributed Assessment of Team Mutual Awareness), suggesting that it captures a different quality of teamwork than the self-rating measures. Further, the Shared Priorities measure was found to be easily administered.

Critical infrastructures become more and more entangled and rely extensively on information technology. A deeper insight into the relationships between critical infrastructures enables the actors involved to more quickly understand the severity of information technology disruptions and to identify robust cross-functional mitigating actions. This study illustrates how and why disruptions in the payment system in Sweden could create cascading effects in other critical infrastructures with potentially severe consequences for many citizens, government institutions and companies. Data from document studies, interviews and workshops with field experts reveal seven challenges for collective cross-functional critical infrastructure resilience that need to be dealt with: 1) Shortage of food, fuel, cash, medicine; 2) Limited capacity of alternative payment solutions; 3) Cities are more vulnerable than the countryside; 4) Economically vulnerable groups in society are more severely affected; 5) Trust maintenance needs; 6) Crisis communication needs; 7) Fragmentation of responsibility for critical infrastructures across many actors. 

Study/Objective: The purpose of this paper is to describe the procedure of identifying and developing quality indicators during educational activities. In addition, the steps taken to assure the validity and reliability of the indicators are presented.

Background: In Sweden a national effort has been made to structure the work processes for crisis preparedness. That is, the process for regional health point of contact and the designated duty officer, has been modified in an attempt to support a shared view regarding collaboration and command during societal disturbances. The effort consists of education and training of designated duty officers, while also developing quality indicators for assessing the work process before the designated duty officer declare a major incident.

Methods: The work of identifying and developing the quality indicators was carried out in focus groups with domain experts.

Results: Initially the work processes of the designated duty officer were thoroughly analyzed and described. The work process was separated into three distinct phases. Focus was on the first two phases. These process steps, have thereafter been connected to concrete behaviors or products that are assessed. The quality indicators are directed towards two levels; if a process step has been carried out within the time-frame, and also the performance quality of an indicator. For example, has an operational picture been established within three minutes of the alarm call? If so, what was the quality of the decision based on, the event description, the consequence description, or the measures description?

Conclusion: The aim of the quality indicators is to make sure that educational activities that are performed does in fact result in actual, and measurable impact. This approach confirms to what extent the activities are successful.

Background: The pre-hospital triage process aims at identifying and prioritizing patients in the need of prompt intervention and/or evacuation. The objective of the present study was to evaluate triage decision skills in a Mass Casualty Incident drill. The study compares two groups of participants in Advanced Trauma Life Support and Pre-Hospital Trauma Life Support courses. Methods: A questionnaire was used to deal with three components of triage of victims in a Mass Casualty Incident: decision-making; prioritization of 15 hypothetical casualties involved in a bus crash; and prioritization for evacuation. Swedish Advanced Trauma Life Support and Pre-Hospital Trauma Life Support course participants filled in the same triage skills questionnaire just before and after their respective course. Results: One hundred fifty-three advanced Trauma Life Support course participants were compared to 175 Pre-Hospital Trauma Life Support course participants. The response rates were 90% and 95%, respectively. A significant improvement was found between pre-test and post-test for the Pre-Hospital Trauma Life Support group in regards to decision-making. This difference was only noticeable among the participants who had previously participated in Mass Casualty Incident drills or had experience of a real event (pre-test mean +/- standard deviation 2.4 +/- 0.68, post-test mean +/- standard deviation 2.60 +/- 0.59, P = 0.04). No improvement was found between pre-test and post-test for either group regarding prioritization of the bus crash casualties or the correct identification of the most injured patients for immediate evacuation. Conclusions: Neither Advanced Trauma Life Support nor Pre-Hospital Trauma Life Support participants showed general improvement in their tested triage skills. However, participation in Mass Casualty Incident drills or experience of real events prior to the test performed here, were shown to be advantageous for Pre-Hospital Trauma Life Support participants. These courses should be modified in order to assure proper training in triage skills.

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.

Denna avhandling beskriver utvecklingen av ett mätinstrument för att värdera delad förståelse hos team. Syftet har varit att utveckla ett mätinstrument som är användbart, förståeligt, objektivt, flexibelt och självförklarande. Team som arbetar i naturalistiska miljöer förväntas ha en delad förståelse för gemensamma mål och hur dessa ska uppnås. Befintliga tekniker och mätinstrument för värdering av delad förståelse hos team är att de ofta lider av ett eller flera av följande problem: de är dyra, svåra att använda, tidskrävande, kräver expertis, och bygger många gånger på subjektiva bedömningar. Genom att utgå från teoribildningen inom teamkognition ställs följande forskningsfrågor: 1) Hur kan delad förståelse i team mätas utan nackdelarna hos befintliga metoder? 2) Hur kan delad förståelse i team mätas utan att riskera att färgas av partiskheten hos egenbedömningar och/eller experters värderingar? 3) Kan teamprestation förstås bättre med hjälp av ett instrument som mäter delad förståelse?

Dessa frågeställningar besvaras i de sex delstudier som presenteras i denna avhandling där ett instrument (som kallas shared priorities) utvecklats för att mäta delad förståelse. Tillämpningen innebär att medlemmarna i ett team individuellt får generera och rangordna faktorer som de anser vara viktiga för att teamet ska nå sitt/sina gemensamma mål och därefter rangordna varandras faktorer. Genom att beräkna överensstämmelsen i dessa rangordningar erhålls ett mått på teamets delade förståelse. Fördelen med detta instrument, i jämförelse med tidigare mått, är att det kostar mindre, är lättare att använda, tar mindre tid, inte kräver någon domänexpertis, och att mätmetoden inte bygger på rent subjektiva bedömningar. I den sista delstudien erhålls resultat där instrumentet shared priorities korrelerar med prestation, vilket stöder tidigare forskning om delad förståelse. En statistisk modell (SEM) visar på instrumentets validitet och reliabilitet.

The purpose with this chapter is to present a study of the effectiveness of an Armoured Brigade Headquarters (HQ) in some specific respects. Important issues were (1) how is the HQ Staff dimensioned in relation to its tasks, (2) how does the three staff processes work (Planning, Execution and Coordination / Decision) and (3) how well does the HQ’s Standard Operating Procedure (SOP) and Battle Rhythm  function in the light of the HQ’s organization and work processes? The study was designed as a survey study and was based on the following four instruments: (1) Military Command Team Effectiveness Instrument (CTEF 2.0; Essence, Vogelaar, Baranski, Berggren, Van Buskirk, Goodwin & Myller, 2008); (2) Measurement of workload according to the Borg scale (Borg, 1998); (3) Subjective assessments of quality of the Brigade HQ’s orders and reports, and (4) verification that the Brigade HQ followed it’s Standard Operating Procedure. Fifty-four staff members of an Armoured Brigade HQ volunteered as participants. In the study, the HQ was challenged with a peace support / peace keeping operation exercise.

The overall result regarding the CTEF and quality measurements on orders and reports indicate that the HQ worked well during the entire exercise and that the SOP and Battle Rhythm worked rather well. However, through the CTEF, four problem areas were identified. These areas regarded (1) the level of uncertainty in the mission, (2) the high complexity of the task, (3) the perceived instability of the objectives that were supposed to be attained in the mission environment, and (4) a high level of workload in some staff sections. Three of these areas are not under the control of the Brigade HQ (high level of uncertainty, high task complexity and unstable objectives of the operation). However, the fourth area, workload, could be influenced. Some staff sections seem to be undermanned in the current organization and that problem needs to be handled, by increasing some staff sections or by moving some duties to other sections.

A command and control environment is a dynamic and complex setting with complicated technical systems where teams of operators interact to reach shared goals. This study presents an experiment in which we, by means of Structural Equation Modeling (SEM), explain the relations between basic concepts of command and control environments: mental workload, frustration, situational awareness, and performance. This paper reports a LISREL analysis of the Baroutsi, Berggren, Nählinder, & Johansson (2013) data. From that data, a new latent variable “Frustration” emerges, which now can be included in the model.

Objective, easy to use, easy to comprehend, high face- validity assessment methods for measuring shared awareness in teams are hard to find. This paper describes an experiment where a new measure called Shared Priorities, which is based on ranking of self-generated strategic items, is tested. Trained teams were compared to non-trained teams in a dynamic problem-solving task in terms of performance and shared awareness. The shared priorities measure was used alongside other, well-documented measures of team awareness based on self-rating. The results show that the Shared Priorities measure correlate with performance and could also distinguish between trained and non-trained teams. However, the Shared Priorities measure did not correlate with the other team measures, suggesting that it captures a different quality of team work than the self-rating measures. Further, the shared priorities measure was found to be easily administered and gained a high user acceptance.

The paper discusses the need for an easy-to-use, easy-to-administer measure that can capture shared understanding in a team of professionals working together towards a successful performance. In the paper the development of such a measure is described using two empirical studies. Command-and-Control tasks are complex and often dynamic, and a way of capturing the degree of which a team of individuals have a common understanding of priorities in such a task is imperative.

Two studies are presented. In the first study students participated in a microworld experiment where they tried to rank order pre-determined factors in order to measure shared understanding. In the second study officers from the Swedish Armed Forces participated in an exercise where they rank ordered self-generated factors. 

Shared situation awareness is hard to measure, especially in operative environments such as crisis management. In this paper the purpose is to develop a novel method to measure to what extent the team has shared situation awareness that can be used in operations. 20 two person teams participated in a study where a dynamic and evolving tactical decision-making task was solved. Shared situation awareness, shared priorities, and team performance were assessed. The results show that the shared priorities measure in this study did not relate to shared situation awareness. Several methodological concerns was identified which could have affected the results. The measure did relate to subjective ratings of cooperation which is very interesting and it is suggested that the measure captured aspects of teamwork. The shared priorities measure was easy to employ, required little preparation, and is a promising addition to team research

The purpose of the experiments was to investigate how inhalation of 100% oxygen affected cognitive performance. A test battery was developed that was designed to capture different aspects of cognitive processes, i.e., perception, attention, working memory, long-term memory and prospective memory. All tests were verbally based, thus reducing cognitive spatial processes to a minimum. In experiment 1, 48 participants volunteered in a complete factorial within-participant design. Two different conditions for type of gas were used, inhalation of 100% oxygen and inhalation of breathing air (approximately 21% oxygen balanced with nitrogen). The inhalation was performed during the 1 min prior to starting each separate test. The instructions for each test were given during the inhalation period. All participants inhaled oxygen or breathing air through a Swedish military pilot mask. Physiological (heartbeats per minute and blood oxygen saturation level) reactions were recorded continuously throughout the session. Participants also completed a mood-state questionnaire before and after the test battery. The results revealed that cognitive performance were not affected by inhalation. Hence, this experiment does not replicate previous findings that suggest that inhalation of 100% oxygen could increase cognitive performance. Another experiment was performed to control for methodological issues. Experiment 2 revealed exactly the same pattern, i.e., inhalation of oxygen did not affect cognitive functioning.