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Objective To achieve resilience in the response of a major incident, it is essential to coordinate major processes and resources with the aim to manage expected and unexpected changes. The coordination is partly done through timely, adequate, and resilience-oriented decisions. Accordingly, the aim of the present paper is to describe factors that affected decision-making in a medical command and control team during the early COVID-19 pandemic.Methods This study used a qualitative method in which 13 individuals from a regional public healthcare system involved in COVID-19 related command and control were interviewed. Data was collected through semi-structured interviews and analyzed using qualitative content analysis.Results The factors affecting decision-making in medical command and control during early COVID-19 pandemic were grouped into 5 themes: organization, adaptation, making decisions, and analysis, as well as common operational picture.Conclusions The present study indicated that decision-making in medical command and control faces many challenges in the response to pandemics. The results may provide knowledge about disaster resilience and can be utilized in educational and training settings for medical command and control.

Objective:Bleeding control measures performed by members of the public can prevent trauma deaths. Equipping public spaces with bleeding control kits facilitates these actions. We modeled a mass casualty incident to investigate the effects of public bleeding control kit location strategies.Methods:We developed a computer simulation of a bomb exploding in a shopping mall. We used evidence and expert opinion to populate the model with parameters such as the number of casualties, the publics willingness to aid, and injury characteristics. Four alternative placement strategies of public bleeding control kits in the shopping mall were tested: co-located with automated external defibrillators (AEDs) separated by 90-second walking intervals, dispersed throughout the mall at 10 locations, located adjacent to 1 exit, located adjacent to 2 exits.Results:Placing bleeding control kits at 2 locations co-located with AEDs resulted in the most victims surviving (18.2), followed by 10 kits dispersed evenly throughout the mall (18.0). One or 2 kit locations placed at the malls main exits resulted in the fewest surviving victims (15.9 and 16.1, respectively).Conclusions:Co-locating bleeding control kits with AEDs at 90-second walking intervals results in the best casualty outcomes in a modeled mass casualty incident in a shopping mall., Funding Agencies|United States Department of Homeland Security Science & Technology Directorate (DHS-ST); Swedish Civil Contingencies Agency and Linkoeping University institutional funds

BACKGROUND: Although the Stop the Bleed campaigns impact is encouraging, gaps remain. These gaps include rapid skill decay, a lack of easy-to-use tourniquets for the untrained public, and training barriers that prevent scalability. A team of academic and industry partners developed the Layperson Audiovisual Assist Tourniquet (LAVA TQ)& mdash;the first audiovisual-enabled tourniquet for public use. LAVA TQ addresses known tourniquet application challenges and is novel in its design and technology. STUDY DESIGN: This study is a prospective, randomized, superiority trial comparing the ability of the untrained public to apply LAVA TQ to a simulated leg vs their ability to apply a Combat Application Tourniquet (CAT). The study team enrolled participants in Boston, MA; Frederick, MD; and Linkoping, Sweden in 2022. The primary outcome was the proportion of successful applications of each tourniquet. Secondary outcomes included: mean time to application, placement position, reasons for failed application, and comfort with the devices. RESULTS: Participants applied the novel LAVA TQ successfully 93% (n = 66 of 71) of the time compared with 22% (n = 16 of 73) success applying CAT (relative risk 4.24 [95% CI 2.74 to 6.57]; p < 0.001). Participants applied LAVA TQ faster (74.1 seconds) than CAT (126 seconds ; p < 0.001) and experienced a greater gain in comfort using LAVA TQ than CAT. CONCLUSIONS: The untrained public is 4 times more likely to apply LAVA TQ correctly than CAT. The public also applies LAVA TQ faster than CAT and has more favorable opinions about its usability. LAVA TQs highly intuitive design and built-in audiovisual guidance solve known problems of layperson education and skill retention and could improve public bleeding control. (c) 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved., Funding Agencies|Defense Health Agency via the Transforming Technology for the Warfighter grant [NM91959717]; US Department of Defense; Swedish Civil Contingencies Agency; Henry M Jackson Foundation

Objective The purpose of this study was to compare laypeoples and professional first responders ability to perform tourniquet application and cardiopulmonary resuscitation (CPR) during calm and stressful circumstances. Background Life-threatening bleeding is a major cause of death that could be prevented by fast and appropriate first aid interventions. Therefore, laypeople are now being trained in bleeding control skills, transforming them from bystanders to immediate responders. However, critics have questioned whether laypeople are able to perform during more stressful conditions. Method Twenty-four laypersons and 31 professional first responders were tested in two conditions: a calm classroom scenario and a stressful scenario consisting of paintball fire and physical exertion. Stress and workload were assessed along with task performance. Results The experimental manipulation was successful in terms of eliciting stress reactions. Tourniquet application performance did not decline in the stressful condition, but some aspects of CPR performance did for both groups. First responders experienced higher task engagement and lower distress, worry and workload than the laypeople in both the calm and stressful conditions. Conclusion Stress did not affect first responders and laypeople differently in terms of performance effects. Stress should therefore not be considered a major obstacle for teaching bleeding control skills to laypeople. Application Tourniquet application can be taught to laypeople in a short amount of time, and they can perform this skill during stress in controlled settings. Concerns about laypeoples ability to perform under stress should not exclude bleeding control skills from first aid courses for civilian laypeople., Funding Agencies|Swedish Civil Contingencies Agency; ALF Grant, Region Ostergotland

Introduction Hemorrhage control initiated by laypeople, or immediate responders, can be a crucial link for increased survival among victims with hemorrhage. An increased interest in hemorrhage control training for laypeople have resulted in numerous publications in the area, showing that training laypeople in hemorrhage control can be successful (Nichols & Horstman, 2022; Tang et al., 2022). To this date, it is unknown which training factors are associated with successful training outcomes and to what extent. The objective of this study is to review and analyze past and present literature on hemorrhage control training for laypeople, in order to highlight current knowledge gaps, and direct future research. Method A systematic literature review was performed by reviewing and analyzing the literature. Five electronic databases, CINAHL, Embase, PubMed, Scopus, and Web of Science, were used in the literature search. Search keywords were chosen among the variations and synonyms to the words: “laypeople” AND “hemorrhage” AND “training” AND “stop the bleed”. To examine where the knowledge gaps exist in terms of training effectiveness, a theoretical model by Cannon-Bowers et al. (1995) was chosen as theoretical lens, and each record was categorized into six training outcome categories: reactions, attitude change, learning, training performance, job performance, and results/organizational effectiveness, according to the content of the reviewed studies. Preliminary results In total, 2962 records were initially identified for screening, and 1186 records were kept after duplicate removal and deletion of incomplete records. After title and abstract review, 186 records were sought for retrieval. This will be further reduced into a fewer number of records for full text review after additional screening. By categorizing the records into the six training outcome categories, previous research efforts can be highlighted, as well as it creates an opportunity for future research sug

Organiserade frivilliga är en allt viktigare del av samhällets beredskap. Initiativ som Sms-livräddare och Civila Insatspersoner (CIP) kan stötta professionella responsorganisationer och möjliggöra snabbare respons till händelser som hjärtstopp eller mindre bränder. Att få personer att ställa upp som frivilliga och sedan fortsätta vara frivilliga är väsentligt för att dessa initiativ ska ha en samhällsnytta. Tidigare studier har visat att det finns många faktorer som motiverar personer att bli frivilliga. Det saknas dock forskning på vilka faktorer som är mest avgörande för att personer ska fortsätta vara engagerade som frivilliga. Därför genomfördes våren 2022 en enkätstudie av forskare inom Centrum för Forskning i Respons- och Räddningssystem (CARER), där 5 300 personer som var engagerade antingen som Sms-livräddare eller CIP:ar svarade på frågor om vad som motiverade dem att vara frivilliga och om de hade för avsikt att fortsätta vara frivilliga i framtiden. En explorativ faktor-analys genomfördes för att visa på de underliggande faktorer som var gemensamma i svaren. I denna faktoranalys upptäcktes totalt 12 underliggande faktorer baserat på de 48 frågorna i enkäten. Dessa faktorer analyserades därefter med en regressionsanalys för att undersöka vilka av dessa som är mest avgörande i frivilligas motivation att fortsätta vara frivilliga. Resultatet visade att de faktorer som hade störst positiv inverkan på motivationen att fortsätta vara frivillig var Socialt sammanhang, Självbild, och Kompetens. De faktorer som hade störst negativ inverkan var Larmtrötthet och Negativa upplevelser. Resultaten från studien kan användas för att genomföra interventioner för att öka frivilligas motivation, genom att till exempel motverka larmtrötthet genom smartare utlarmningsalgoritmer eller utbildningsinsatser som ökar de frivilligas kompetens, och då förhoppningsvis även behålla fler frivilliga över tid.

Exsanguinating trauma is a common cause of death. Placing bleeding control kits in public areas has been suggested as a countermeasure. Similarly, automatic external defibrillators (AEDs) are placed in public areas in case of cardiac arrests. Both severe bleeding and cardiac arrests require rapid care and people must be able to quickly find relevant emergency equipment. This study explores where and how people search for such equipment. Twenty participants wearing eye-tracking glasses searched for bleeding control kits and AEDs in a public building. The participants visually searched features such as signs with maps, written information, and other emergency equipment. The participants expressed elevators and staircases, open areas, entrances, and the reception to be places where medical emergency equipment would likely be placed. The results suggest that these features and places may be suitable for medical emergency equipment or directions.

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., Funding Agencies|Swedish Civil Contingencies Agency (MSB); European UnionEuropean Commission [653289]

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.

There are currently several educational initiatives to teach first aid courses for medical laypeople, such as the Stop the Bleed campaign. Although much research on educational initiatives has been conducted, there are still factors that remain unexplored, such as the potential effects of blood itself on laypeople’s first aid performance and educational experience. This study investigates such potential effects for performance of the first aid techniques tourniquet application and wound packing, in relation to individual differences in disgust sensitivity and medical fear of blood. The results show that the presence of blood will increase the time a medical layperson takes to apply a tourniquet and pack a wound but does not affect the quality of the aid. Additionally, the disgust sensitivity of the medical layperson was found to predict an increase in application time for the wound packing task, but not the tourniquet application task, when blood was present.

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.

Informationsöverbelastning är fenomenet där mängden tillgänglig information en beslutsfattare har tillgång till är så stor att den i sig leder till försämrade förutsättningar för beslutsfattande. Informationsöverbelastning är ett potentiellt framtida problem inom ledningssystem för respons och räddning, då nya informationskällor och mer effektiva datainsamlingsmöjligheter kan leda till en kraftigt ökad mängd information. En studie i två delar genomfördes för att undersöka informationsöverbelastning. Den första delen bestod av en litteraturöversikt över fenomenet både individuellt sett och från ett systemperspektiv. Den andra delen var en intervjustudie med 13 deltagare från svenska blåljusorganisationer som inkluderar polis, räddningstjänst och akutsjukvård. Deltagarna som intervjuades arbetar med ledning av räddning- och responsinsatser för mindre och större händelser på olika nivåer, från det operativa till det strategiska perspektivet. En tematisk analys på intervjumaterialet visade på fem teman rörande informationsöverbelastning i det svenska räddningssystemet: Man behöver information för att förstå lägesbilden, och man behöver en lägesbild för att förstå informationen Informationshantering är en medveten och manuell process Information är nyckeln till framgång men all information är inte användbar Informationsöverbelastning orsakad av mängden information är inte ett problem Informationsöverbelastning är ett strukturellt problem Sammantaget visar dessa teman att beslutsfattare i de svenska räddningssystemen arbetar manuellt, aktivt och medvetet med information och att de förlitar sig på sin tidigare erfarenhet för att kunna utföra sitt uppdrag effektivt. Vidare förlitar beslutsfattarna sig på själva ledningsstrukturen för att säkerställa att den information de tar del av är strukturerad, meningsfull och relevant för uppdraget och beslutsfattarens roll i ledningssystemet. Informationsöverbelastning sågs inte som ett aktuellt problem, då ledningsstrukturen ska fun, A current issue in the command and control (C2) community is information overload. With more information available and more efficient information-gathering capabilities, modern C2 systems are faced with the problem that the human operators will be confronted with an information environment that may adversely impact their ability to do their jobs. To gain insight into this problem, an interview study was conducted focusing on Swedish emergency response C2 operators to investigate their views on information overload and how the phenomenon may be related to their work. Thirteen participants were recruited from three different Swedish agencies that engage in emergency response work: the police, rescue service, and medical emergency response. A thematic analysis was conducted to identify themes related to how Swedish emergency response C2 operators work with information and how they view information overload. A total of five themes were identified, showing that operators assess and integrate information manually to support their decision-making, mainly relying on their experience to do so, and that operators rely on the control structures of the C2 system to provide them with structured, rich, and relevant information. Operators do not view information overload as a present threat to their work environment, arguing that the C2 systems provide enough support to protect them from unnecessary information load. However, if information overload were to become an issue, operators felt that this would be caused by poorly implemented decision aids, and new information flows that would erode the control structures that support the operators.

Introduction: Successful tourniquet application increases survival rate of exsanguinating extremity hemorrhage victims. Tactile feedback during tourniquet application training should reflect human tissue properties in order to increase success in the field. This study aims to understand the mechanical properties of a human limb during tourniquet application. Method: Six cadaveric extremities-three uppers and three lowers-were tested from three body mass index groups: low (<19) healthy (19-24), and overweight (>24). Each specimen donned with a tourniquet and mounted to a servo-hydraulic testing machine, which enabled controlled tightening of the tourniquet while recording the tourniquet tension force and strap displacement. A thin-film pressure sensor placed between the specimen and the tourniquet recorded contact pressure. Each limb was tested with the tourniquet applied at two different sites resulting in testing at the upper arm, forearm, thigh, and shank. Results: The load displacement curves during radial compression were found to be nonlinear overall, with identifiable linear regions. Average contact pressure under the tourniquet strap at 200N and 300N of tension force was 126.3 (sigma= 41.2) mm Hg and 205.3 (sigma = 75.3) mm Hg, respectively. There were no significant differences in tissue stiffness or contact pressure at 300N of tension force between limb (upper vs. lower) or body mass index. At 200N of tension, the upper limb had significantly higher contact pressure than the lower limb (P= 0.040). Relative radial compression was significantly different between upper (16.74, sigma = 4.16%) and lower (10.15, sigma = 2.25%) extremities at 200N tension (P= 0.005). Conclusions: Simulation of tissue compression during tourniquet application may be achieved with a material exhibiting elastic properties to mimic the force-displacement behavior seen in cadaveric tissue or with different layers of material. Different trainers for underweight, healthy, a, Funding Agencies|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; Mayo Clinic Material and Structural Testing Core

Trauma is a critical public health issue as the lead-ing cause of death for Americans between theages of 1 and 44 years.1In response to this reality, anumber of Stop the Bleed educa tion programs arebeing implemented to teach the lay public how to stopexsanguinating hemorrhage in preventable deaths.2Todate, there are limited data available to compare effec-tiveness of these programs. Because there is limitedcapacity to track outcome measures at this time,authors offer direction to practitioners on 12 processmeasures that will best allow comparisons among pro-grams to make informed decisions when implement-ing Stop the Bleed education