Exploring Combat Tourniquet Application Errors and Duration Among Skilled and Novice Medical Trainees.

INTRODUCTION: The use of tourniquets in combat medicine continues to be a key focus as they have consistently been shown to combat one of the leading causes of preventable death on the battlefield, massive hemorrhage to extremities. The present study analyzed tourniquet application among combat medics (68W) and combat lifesavers (CLSs) in a training environment to determine whether trainees' performance is consistent among one another and whether performance can be associated with participant demographics such as experience or role. MATERIALS AND METHODS: Study participants treated male and female patient simulators within a tactical field care phase, both of which experienced an amputated leg and required the application of a Combat Application Tourniquet (CAT). To assess tourniquet application variability and performance, a series of application subtasks and potential errors were measured via video coding of the scenarios by a team of 5 coders. Time to tourniquet application and tourniquet application duration were also coded to assess correlations between application duration and variability or performance. RESULTS: Results from analyzing tourniquet application subtasks and errors through a series of one-way ANOVA tests showed that application of the CAT first, hasty CAT application, and high tourniquet application were not predictive of participant role, time within the role, and self-reported tourniquet skill, confidence, or experience. Such demographic variables were also not predictive of successful tourniquet application as defined by the number of windlass rod rotations. Results from binomial logistic regressions showed that participant role and self-reported tourniquet skill and experience were predictors of tourniquet application duration. CONCLUSION: The findings suggest that high variability in CAT application methodology and performance exists among CLS and combat medics, which is largely not predictable by various demographics such as role, experience within the designated role, and self-reported confidence, skill, or experience. The observed disconnect between training or experience and CAT application performance suggests substantial variability in the consistency of training for both CLS and 68W soldiers. These inconsistencies may stem from variability in instructor knowledge, teaching styles, or training materials or may be developed through informal methods such as experiences in the field or recommendations from colleagues and experts. These findings highlight a potential need to reassess CAT application training, particularly in regard to consistency and validation. Finally, it should be noted that the study's findings may be limited or fail to capture some study effects because of the sample size and wide range of reported experience among participants.

Evaluation of driver navigational errors and acceptance of a simulated J-turn intersection.

The J-turn intersection is a novel roadway design which decreases the points of conflict at an intersection, by restricting straight crossing and left-turning movements from the minor road across the highway. The novelty of the intersection design may lead to driver errors and dissatisfaction. This study provides an examination of how naïve or first-time drivers may initially navigate J-turns during their first and early exposures to the novel intersection design. Thirty-six participants with limited previous experience and knowledge of J-turns participated in a simulation study to examine their acceptance of J-turns and left turning navigational performance at three simulated J-turn intersections in counterbalanced order, each featuring one of three signage levels. Results revealed participants committed slightly more frequent minor errors (e.g., inefficient lane selection) and significantly more major errors (e.g., missed U-turn) during the first J-turn exposure and these errors tended to decline during subsequent exposures, while moderate severity errors (e.g., risky lane change) slightly increased. Participants' J-turn acceptance significantly declined following simulated driving exposure. The decline in J-turn acceptance was found to be greater among participants who experienced major severity errors; however, more frequent minor errors were associated with increased acceptance. Signage level had little effect on errors, but participants preferred improved signage or on-road markings to guide crossing movements. This work suggests that advanced educational programs and community initiatives should be utilized to prepare drivers for how to navigate J-turns rather than only rely on J-turn exposure to improve driver performance and acceptance.

Task-Relevant Smartphone Messages Within Work Zones: A Driving Simulation Study.

OBJECTIVE: This study explored the impact of in-vehicle messages relative to roadside messages to alert drivers to events within a simulated work zone, in order to determine if these messages can improve driving performance within the work zone. BACKGROUND: Safety risks in work zones are usually mitigated by design standards and clear signage to communicate work zone information to drivers. Due to distraction and other driving task demands, these signs are not always noticed by motorists, nor are they always followed when they are noticed. METHOD: The driving simulation tested drivers in two different types of work zones, shoulder work, and lane closure. Participants drove through these work zones three times, each with different messaging interfaces to communicate hazardous events to the driver. The interfaces included a roadside, portable changeable message sign, a smartphone presenting only auditory messages, and a smartphone presenting audio-visual messages. RESULTS: There was significantly better driving performance on key metrics including lane deviation for the in-vehicle message conditions relative to the roadside signs. Furthermore, drivers directed visual attention toward the roadway for the in-vehicle message conditions relative to the roadside sign condition. CONCLUSION: The results indicate that in-vehicle messaging could provide benefits to primary task performance in driving if the message content is appropriately designed. APPLICATION: The findings provide support for a design framework to support in-vehicle communication to drivers approaching work zones and other environments to safely alert them to hazards.

A Pilot Study on the Role of Experience and Patient Gender on MARCH Treatment Sequence.

INTRODUCTION: The brevity of training for soldiers and combat medics to learn how to provide treatment on the battlefield may restrict optimal performance for treating chest and airway injuries, particularly when treating female soldiers. The present study tested treatment performance on patient simulators by battlefield medic trainees to determine whether there is a need for more extensive training on chest and airway procedures on female soldiers. MATERIALS AND METHODS: Battlefield medic trainees treated male and female patient simulators in counterbalanced order. The assessment considered the effects of patient gender and order on procedures performed, particularly critical chest and airway interventions such as needle chest decompression (NCD), and considered the appropriate order of treatment tasks. Four coders rated video footage of three simulated procedures, i.e., tourniquet, chest seal (front and back application), and NCD, using a binary coding system to determine completeness and order correctness according to the Massive hemorrhage, Airway, Respiration, Circulation, and Head injury/Hypothermia (MARCH) mnemonic. RESULTS: Results from analysis of variance showed that when presented with a female patient first, trainees performed significantly fewer total procedures on both the female and male simulators. More experienced trainees completed significantly more procedures compared to trainees with minimal experience. Results from the binary logistic regression showed that trainees with more experience and trainees presented with the male patient simulator first performed significantly more procedures in the correct order. Finally, an examination of the NCD procedure found that trainees presented with the female patient simulator first had more errors and that trainees with less experience were less likely to perform the procedure adequately. CONCLUSIONS: The findings suggest that treating a female patient first may lead to undertreatment of both patients. Furthermore, the observed differences in treating sensitive areas of the body (e.g., near female breasts) suggest providing greater opportunities for trainees to practice often missed or incorrectly performed procedures. Treating a female patient remains a novel experience for many trainees, such that trainees are less likely to fully treat a female patient and are less likely to treat female soldiers for the most life-threatening injuries. In fact, the initial presentation of the female patient simulator appeared to affect experienced trainees, suggesting that removing the experience of novelty and stress requires more extensive exposure and alternative training. The study's small sample size with a wide range of trainee experience may limit the findings, which may fail to capture some study effects. Finally, the study did not request trainees' experience treating female soldiers, so future studies should examine the extent to which experience is predictive of performance. There is a need for more interactive approaches in patient simulations to provide opportunities for practice, especially those that require the treatment of sensitive areas.

Characteristics and Risk Factors for Electric Scooter-Related Crashes and Injury Crashes among Scooter Riders: A Two-Phase Survey Study.

Electric scooters (or e-scooters) are among the most popular micromobility options that have experienced an enormous expansion in urban transportation systems across the world in recent years. Along with the increased usage of e-scooters, the increasing number of e-scooter-related injuries has also become an emerging global public health concern. However, little is known regarding the risk factors for e-scooter-related crashes and injury crashes. This study consisted of a two-phase survey questionnaire administered to a cohort of e-scooter riders (n = 210), which obtained exposure information on riders' demographics, riding behaviors (including infrastructure selection), helmet use, and other crash-related factors. The risk ratios of riders' self-reported involvement in an e-scooter-related crash (i.e., any crash versus no crash) and injury crash (i.e., injury crash versus non-injury crash) were estimated across exposure subcategories using the Negative Binomial regression approach. Males and frequent users of e-scooters were associated with an increased risk of e-scooter-related crashes of any type. For the e-scooter-related injury crashes, more frequently riding on bike lanes (i.e., greater than 25% of the time), either protected or unprotected, was identified as a protective factor. E-scooter-related injury crashes were more likely to occur among females, who reported riding on sidewalks and non-paved surfaces more frequently. The study may help inform public policy regarding e-scooter legislation and prioritize efforts to establish suitable road infrastructure for improved e-scooter riding safety.

Applying Restorative Environments in the Home Office While Sheltering-in-Place.

OBJECTIVE: The objective of this review was to spotlight specific methods for people working from home to apply restorative environment research to improve productivity and mental health during shelter-in-place. BACKGROUND: The COVID-19 pandemic has led to sheltering-in-place and telework. While necessary, these strategies may lead to negative consequences such as social isolation and worse performance. However, nature environments have been shown to have a variety of positive effects in several different settings, including improved attention, positive affect, and increased job satisfaction, and these may be translated to the home workspace setting. METHOD: This provides a narrative review of the environmental psychology literature, describing articles involving nature in a task performance or stress context and how it has been applied. It then moves on to discuss how these findings could possibly be applied in the context of workers during the COVID-19 pandemic. RESULTS: Although beneficial results are mixed, the review found a variety of relatively simple and cost-effective methods that could assist workers during the COVID-19 pandemic, including taking a break in nature and implementing nature in the workspace. APPLICATION: The application of restorative environment research could be an efficient way of mitigating the negative psychological effects due to at-home sheltering and telework in order to combat COVID-19.

Can the Biophilia Hypothesis Be Applied to Long-Duration Human Space Flight? A Mini-Review.

The International Space Station (ISS) has around 3-5 crew members on-board at all times, and they normally stay on the ISS for about 5-7months in duration. Since March 2020, 170 long-duration space missions have occurred on the ISS. Thus, long-duration space missions are an integral part of space exploration and will only continue to expand in duration as missions to the Moon and Mars are on the horizon. However, long-duration space missions present several challenges to human crew members. Most of these challenges have been associated with physiological adaptation to microgravity, including motion sickness, muscle atrophy, and cardiovascular deconditioning. While not as well-studied, another major factor to consider when planning long-duration space missions is the psychological impact of the environment on the astronauts. Astronauts living in space will be unable to access natural landscapes and other environments found to have restorative effects on psychological stress and overall well-being. On top of being unable to access these restorative natural environments, astronauts will also be exposed to the stressful, unfamiliar environment of space. The purpose of this mini-review is to first summarize the literature related to stressors associated with space. Next, an overview of the large breadth of literature on the biophilia hypothesis and restorative environments will be provided, as these may serve as relatively simple and cost-effective solutions to mitigate the stress faced during long-duration space missions. Lastly, considerations related to the design of such environments in a space capsule as well as future directions will be presented.

Restoring Attentional Resources With Nature: A Replication Study of Berto's (2005) Paradigm Including Commentary From Dr. Rita Berto.

OBJECTIVE: The aim of this study is to replicate Berto's (2005) heavily cited work on attention restoration. BACKGROUND: Nature interventions have gained increased interest for improving performance of attentionally demanding tasks. Berto (2005) indicated that viewing digital nature images could improve performance on a subsequent response inhibition task, the sustained attention to response task (SART). However, experimental design and statistical concerns about her experiments as well as failure to support her findings across multiple unpublished studies in our laboratory provided rationale for this replication study. METHOD: Twenty participants were each assigned to one of three digital image conditions: nature, urban, and control. Participants performed the SART before and after digital image exposure. RESULTS: SART performance metrics (total correct target responses, mean response time, and transformed d') were analyzed using 2 (SART) × 3 (image interventions) mixed design ANOVAs. The results failed to replicate Berto (2005). CONCLUSION: Possible reasons for not replicating Berto (2005) are discussed, including (1) sample differences, (2) different testing environments and procedures, (3) insufficient attentional depletion, and (4) individual differences. APPLICATIONS: Research needs to determine the effectiveness of such interventions, the specific attention tasks that might benefit, and the individual difference variables relevant for attention restoration.

Superior side sound localisation performance in a full-chassis driving simulator.

Alerts presented through the auditory modality improve drivers' crash avoidance performance in driving simulations, but drivers' ability to accurately localise the source of the auditory alerts is understudied. Because the results of driving simulation studies may hinge on assumptions that sound locations are accurately perceived by drivers, this study used a sound localisation task in a full-chassis driving simulator. Twenty-nine participants engaged in a sound localisation task while seated in the driving simulator. Performance was assessed by sound localisation accuracy, relative directional error, and participant confidence across seven sound sources surrounding the simulator. Performance was best when sounds were presented in left and right cardinal regions, and poorest when presented from the front and rear. Participants were less confident in their localisation judgments when sounds were presented from the rear. Practitioner summary: Drivers' ability to accurately localise auditory alerts is understudied. Participants performed an auditory localisation task with external sounds while seated in a full-chassis driving simulator. Participants were better detecting sounds from the sides instead of the front and rear. This has implications for external auditory alarms during driving. Abbreviations: ANOVA: analysis of variance; dB: decibel; f: frequency; Hz: hertz; LHD: left hand drive; ms: milliseconds; RTI: realtime technologies; s: seconds; SPL: sound pressure level.

The Abbreviated Vigilance Task and Its Attentional Contributors.

OBJECTIVE: To measure contributing attentional processes, particularly that of executive attention, to two iterations of the abbreviated vigilance task. BACKGROUND: Joel Warm was at the forefront of vigilance research for decades, and resource theory is currently the dominant explanation for the vigilance decrement. The underlying mechanisms contributing to both overall performance and the decrement are only partly understood. METHOD: Seventy-eight participants answered questionnaires about their attentional skills and stress state, performed the Attention Network Test and two blocks of the 12-min abbreviated vigilance task, with a brief break between the two vigils during which they viewed images intended to affect performance. Changes in oxygenated hemoglobin were measured with functional near-infrared imaging. RESULTS: Expected patterns were observed for both iterations of the abbreviated vigilance task, with performance declining after the first 2 min. Manipulations intended to evaluate whether executive processes contributed to vigilance performance failed to observe an effect. Other factors, particularly orienting and alerting attentional networks, task engagement, and subclinical ADHD symptomology were associated with performance. Significant factors for the first and second vigilance blocks were different. CONCLUSION: We suggest that (a) cognitive control is not a predominant factor, at least for the abbreviated vigilance task, and (b) attentional mechanisms and stress states affecting performance on the abbreviated vigilance task change over time. APPLICATION: Potential applications of this research include the use of breaks for sustained attention tasks involving high sensory load, and implications for the use of the abbreviated vigilance task as a proxy for general vigilance processes.