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Laypeople perception and interpretation of simulated life-threatening bleeding: a controlled experimental study
Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Biomedical and Clinical Sciences.ORCID iD: 0000-0001-5943-0679
Old Dominion Univ, VA USA.
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.
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.
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2021 (English)In: BMC Emergency Medicine, E-ISSN 1471-227X, Vol. 21, no 1, article id 100Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
BMC , 2021. Vol. 21, no 1, article id 100
Keywords [en]
Blood loss estimation; Bleeding control; Training; Laypeople; Immediate responder
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:liu:diva-179428DOI: 10.1186/s12873-021-00496-2ISI: 000693076900001PubMedID: 34481458Scopus ID: 2-s2.0-85114371111OAI: oai:DiVA.org:liu-179428DiVA, id: diva2:1596416
Note

Funding Agencies|Swedish Civil Contingencies Agency; Linkoping University

Available from: 2021-09-22 Created: 2021-09-22 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)
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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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