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Prioritization of victims with traumatic bleeding among medical laypeople – An experimental study
Linköping University, Department of Computer and Information Science, Human-Centered Systems. Linköping University, Faculty of Science & Engineering. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.ORCID iD: 0000-0002-4416-2525
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
Linköping University, Department of Computer and Information Science, Human-Centered Systems. Linköping University, Faculty of Science & Engineering. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.ORCID iD: 0000-0001-5943-0679
2025 (English)In: Human Factors in Healthcare, ISSN 2772-5014, Vol. 8, article id 100116Article in journal (Refereed) Published
Abstract [en]

Introduction

Immediate responders, or medical laypeople, are believed to be a useful resource in trauma response. However, efficiently providing first aid interventions such as bleeding control, in scenarios with multiple casualties require prioritization among several injured victims. This study aims to explore how medical laypeople prioritize among victims in forced choice scenarios.

Methods

A controlled online experiment was conducted where participants were presented with 276 image pairs of victims with simulated injuries. The amount of blood loss (100 ml, 500 ml, 900 ml), gender (man, woman), skin color (light, dark), facial expression (unconscious, in pain) and wound visibility (visible, covered) was manipulated across the image stimuli.

Results429 participants completed the experiment. The findings show that victims with greater blood loss are more likely to be prioritized than victims with lower blood loss. Response time indicates that blood loss is likely to be a major factor while prioritizing victims. Victim gender, skin color, facial expression and wound visibility all significantly affect prioritization to some extent.

ConclusionThis study shows that apparent prioritization biases are to be expected in the prehospital setting during medical emergencies for medical laypeople. Such biases could be mitigated through training and education.

Place, publisher, year, edition, pages
Elsevier BV , 2025. Vol. 8, article id 100116
Keywords [en]
Decision-making; Hemorrhage; Trauma; Immediate responder; Prioritization
National Category
Applied Psychology
Identifiers
URN: urn:nbn:se:liu:diva-219951DOI: 10.1016/j.hfh.2025.100116ISI: 001627770800001Scopus ID: 2-s2.0-105022170489OAI: oai:DiVA.org:liu-219951DiVA, id: diva2:2020836
Funder
Swedish National Board of Health and WelfareAvailable from: 2025-12-11 Created: 2025-12-11 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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