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Visual estimates of blood loss by medical laypeople: Effects of blood loss volume, victim gender, and perspective
Old Dominion Univ, VA 23529 USA.
Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.
Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering.
Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.ORCID iD: 0000-0003-1383-375X
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2020 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 15, no 11, article id e0242096Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE , 2020. Vol. 15, no 11, article id e0242096
National Category
Other Medical Sciences not elsewhere specified
Identifiers
URN: urn:nbn:se:liu:diva-172075DOI: 10.1371/journal.pone.0242096ISI: 000593948000058PubMedID: 33180812Scopus ID: 2-s2.0-85096062693OAI: oai:DiVA.org:liu-172075DiVA, id: diva2:1512734
Note

Funding Agencies|Swedish Civil Contingencies Agency [2018-12395 MSB]

Available from: 2020-12-28 Created: 2020-12-28 Last updated: 2026-05-11
In thesis
1. Perceiving Emergencies: Laypeople's Judgement, Stress, and Performance in Traumatic Bleeding
Open this publication in new window or tab >>Perceiving Emergencies: Laypeople's Judgement, Stress, and Performance in Traumatic Bleeding
2026 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Att uppfatta en nödsituation : Lekmäns bedömning, stress och prestation vid traumatisk blödning
Abstract [en]

Traumatic hemorrhage is one of the leading causes of preventable death worldwide, and early hemorrhage control is critical for survival. In many emergency situations, the first individuals present are medical laypeople rather than professional responders. These immediate responders face extreme time pressure, uncertainty, and stress, yet are increasingly expected to initiate life-saving interventions such as hemorrhage control. Despite widespread implementation of civilian hemorrhage control initiatives, including the Stop the Bleed (STB) campaign, limited empirical knowledge exists regarding how laypeople perceive traumatic injuries, interpret severity, and perform hemorrhage control under realistic conditions. Training programs have largely been informed by clinical and military perspectives, with comparatively little grounding in cognitive science or human factors.

This thesis examines the cognitive, perceptual, and affective mechanisms underlying laypeople’s responses to life-threatening bleeding. Drawing on theories from cognitive science and human factors, most notably Brunswik’s lens model, naïve theories, and stress theory, the thesis conceptualizes medical emergencies as epistemic events shaped by uncertainty, probabilistic cues, and human sensemaking. From this perspective, recognizing and responding to hemorrhage is not solely a matter of technical skill acquisition, but of judgment under uncertainty, cue interpretation, and performance under stress.

The thesis consists of six papers. Five papers employing experimental, simulation-based methods, and one literature review. The included studies investigate how factors such as stress, exposure to blood, and visual characteristics of injuries influence laypeople’s ability to recognize hemorrhage, estimate blood loss, prioritize victims, and perform bleeding control interventions. Several studies directly assess performance rather than relying on surrogate outcomes such as confidence or intention, thereby addressing a key limitation in existing bleeding control research.

Across the included papers, the results demonstrate that laypeople’s hemorrhage control performance is systematically affected by cognitive and environmental constraints. Stress and salient trauma cues can impair both perceptual judgment and motor performance, while mismatches between perceived severity and actual injury severity highlight limitations in current training approaches. The findings suggest that conventional training models may insufficiently account for how laypeople attend to, interpret, and act upon probabilistic cues in emergency contexts.

By integrating empirical findings with theory-informed analysis, this thesis contributes to a more cognitively grounded understanding of layperson emergency response. The work advances knowledge on how hemorrhage control training can be better aligned with human perceptual and decision-making processes, and offers implications for the design of more effective, realistic, and transferable training for the general public. Ultimately, this research aims to support training practices that enhance early intervention capacity and societal resilience in medical emergencies.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2026. p. 137
Series
Linköping Studies in Arts and Sciences, ISSN 0282-9800 ; 940
Keywords
Conceptual change, First aid, Hemorrhage, Judgement, Perception, Stress, Begreppsförändring, Första hjälpen, Blödning, Bedömning, Perception, Stress
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-223744 (URN)10.3384/9789181185973 (DOI)9789181185966 (ISBN)9789181185973 (ISBN)
Public defence
2026-06-05, Ada Lovelace, B-building, Campus Valla, Linköping, 09:00 (English)
Opponent
Supervisors
Note

Funding: Part of this work have been funded by the Swedish Civil Defence and Resilience Agency (Swedish: Myndigheten för civilt försvar, MCF), former Swedish Civil Contingencies Agency (Swedish: Myndigheten för samhällskydd och beredskap, MSB), (2018-12395 MSB). Additionally, part of this work has also been funded by the ALF Grant, Region Östergötland, and by the National Board of Health and Welfare (Swedish: Socialstyrelsen).

Available from: 2026-05-11 Created: 2026-05-11 Last updated: 2026-05-11Bibliographically approved

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