ABSTRACT
INTRODUCTION: Prehospital teamwork occurs in dynamic environments where paramedics work together using technologies to care for patients. Despite increasing interest in using head-worn displays (HWDs) to support prehospital workers, little is known about how HWDs affect teamwork. METHODS: We tested the effect of HWDs on the team processes and patient care of paramedic trainee teams in a laboratory study using an online prehospital simulation environment, SPECTRa. In a randomized crossover design, 20 two-person teams worked in the SPECTRa laptop environment from separate physical rooms to assess and treat 2 simulated patients in 3 prehospital patient care scenarios. In each scenario, each trainee used either an HWD, a tablet computer (TAB), or no mobile device (CON) to help them monitor the vital signs of both patients. We measured team processes based around 3 themes of mutual understanding, team performance, and administered an 18-item questionnaire about teamwork and use of the devices. RESULTS: The mean number (HWD = 11; TAB = 7; P = 0.061) and duration (HWD = 1746 milliseconds; TAB = 1563 milliseconds; P = 0.504) of attention switches that teams made toward the mobile device did not differ with HWDs or TABs. However, teams switched attention between patients less with HWDs than with TABs (P = 0.026) or CON (P = 0.007) (medians: HWD = 5; TAB = 8; CON = 8). Teams communicated less when using HWDs than TABs (P = 0.017) (medians: HWD = 76; TAB = 96; CON = 83), but there were other mixed effects on communication. Team performance did not differ across device conditions on the timeliness to notice critical patient changes (P = 0.387) (medians: HWD = 244 seconds; TAB = 246 seconds; CON = 168 seconds) or to complete the scenarios (P = 0.212) (medians: HWD = 800 seconds; TAB = 913 seconds; CON = 835 seconds). Questionnaire results revealed some perceived benefits of the HWD. CONCLUSIONS: Head-worn displays may let prehospital teams monitor each other's performance more efficiently than TABs or CON, requiring less communication to maintain patient care performance with lower workload than with TABs. However, improvements in mutual understanding with HWDs compared with CON were more evident in teams' preferences than in actual behavior. Further research is needed to confirm and extend these results.
ABSTRACT
OBJECTIVE: A study of auditory displays for simulated patient monitoring compared the effectiveness of two sound categories (alarm sounds indicating general risk categories from international alarm standard IEC 60601-1-8 versus event-specific sounds according to the type of nursing unit) and two configurations (single-patient alarms versus multi-patient sequences). BACKGROUND: Fieldwork in speciality-focused high dependency units (HDU) indicated that auditory alarms are ambiguous and do not identify which patient has a problem. We tested whether participants perform better using auditory displays that identify the relevant patient and problem. METHOD: During simulated patient monitoring of four patients in a respiratory HDU, 60 non-clinicians heard either (a) IEC risk categories as single-patient alarm sounds, (b) event-specific categories as single-patient alarm sounds, (c) IEC risk categories in multi-patient sequences or (d) event-specific categories in multi-patient sequences. Participants performed a perceptual-motor task while monitoring patients; after detecting abnormal events, they identified the patient and the event. RESULTS: Participants hearing multi-patient sequences made fewer wrong patient identifications than participants hearing single-patient alarms. Advantages of event-specific categories emerged when IEC risk category sounds indicated more than one potential event. Even when IEC and event-specific sounds indicated the same unique event, spearcons supported better event identification than did auditory icon sounds. CONCLUSION: Auditory displays that unambiguously convey which patient is having what problem dramatically improve monitoring performance in a preclinical HDU simulation. APPLICATION: Time-compressed speech assists development of detailed risk categories needed in specific HDU contexts, and multi-patient sound sequences allow multiple patient wellbeing to be monitored.
ABSTRACT
OBJECTIVES: To (1) develop a simulation software environment to conduct prehospital research during the COVID-19 pandemic on paramedics' teamwork and use of mobile computing devices, and (2) establish its feasibility for use as a research and training tool. BACKGROUND: Simulation-based research and training for prehospital environments has typically used live simulation, with highly realistic equipment and technology-enhanced manikins. However, such simulations are expensive, difficult to replicate, and require facilitators and participants to be at the same location. Although virtual simulation tools exist for prehospital care, it is unclear how best to use them for research and training. METHODS: We present SPECTRa-Simulated Prehospital Emergency Care for Team Research-an online simulated prehospital environment that lets participants care concurrently for single or multiple patients remotely. Patient scenarios are designed using Laerdal's SimDesigner. SPECTRa records data about scenario states and participants' virtual interaction with the simulated patients. SPECTRa's supporting environment records participants' verbal communication and their visual and physical interactions with their interface and devices using Zoom conferencing and audiovisual recording. We discuss a pilot research implementation to assess SPECTRa's feasibility. RESULTS: SPECTRa allows researchers to systematically test small-team interaction in single- or multipatient care scenarios and assess the impact of mobile devices on participants' assessment and care of patients. SPECTRa also supports pedagogical features that could allow prehospital educators to provide individual trainees or teams with online simulation training and evaluation. CONCLUSIONS: SPECTRa, an online tool for simulating prehospital patient care, shows potential for remote healthcare research and training.
Subject(s)
COVID-19 , Emergency Medical Services , Humans , Manikins , Pandemics , Patient Care , Patient Care TeamABSTRACT
Digital Imaging Processing (DIP) requires data extraction and output from a visualization tool to be consistent. Data handling and transmission between the server and a user is a systematic process in service interpretation. The use of integrated medical services for management and viewing of imaging data in combination with a mobile visualization tool can be greatly facilitated by data analysis and interpretation. This paper presents an integrated mobile application and DIP service, called M-DIP. The objective of the system is to (1) automate the direct data tiling, conversion, pre-tiling of brain images from Medical Imaging NetCDF (MINC), Neuroimaging Informatics Technology Initiative (NIFTI) to RAW formats; (2) speed up querying of imaging measurement; and (3) display high-level of images with three dimensions in real world coordinates. In addition, M-DIP provides the ability to work on a mobile or tablet device without any software installation using web-based protocols. M-DIP implements three levels of architecture with a relational middle-layer database, a stand-alone DIP server, and a mobile application logic middle level realizing user interpretation for direct querying and communication. This imaging software has the ability to display biological imaging data at multiple zoom levels and to increase its quality to meet users' expectations. Interpretation of bioimaging data is facilitated by an interface analogous to online mapping services using real world coordinate browsing. This allows mobile devices to display multiple datasets simultaneously from a remote site. M-DIP can be used as a measurement repository that can be accessed by any network environment, such as a portable mobile or tablet device. In addition, this system and combination with mobile applications are establishing a virtualization tool in the neuroinformatics field to speed interpretation services.
