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Multimodal Team Performance Assessments in Simulated Military en Route Critical Care Missions.
William T Davis1,2,3, Roger D Dias4,5, Steven Yule6,7
1Science and Technology Division, 59th Medical Wing En route Care Research Center, TX 78234, United States.
Military Medicine
|November 12, 2025
Summary
Enhanced non-technical skills in en route critical care (ERCC) teams improve technical performance and reduce critical action times. This study highlights the importance of teamwork and cognition for effective casualty care in challenging environments.
Area of Science:
- Military Medicine
- Emergency Medical Services
- Team Performance Science
Background:
- Combat operations necessitate advanced en route critical care (ERCC) capabilities to manage complex patient loads.
- Evaluating ERCC team performance in field settings is crucial for optimizing care standards.
- Emerging sensor technology allows detailed assessment of technical and non-technical skills.
Purpose of the Study:
- To assess the relationship between non-technical team performance and time to critical action in simulated ERCC missions.
- To identify factors influencing team effectiveness in high-stress, resource-limited environments.
- To provide foundational data for improving ERCC team training and operational strategies.
Main Methods:
- Conducted simulations with 14 multi-provider ERCC teams (physician, nurse, respiratory therapist/nurse) caring for 2 simulated casualties.
- Utilized audio-video recordings analyzed with the Assessment of Combat Casualty Non-Technical Skills (AC2ENTS) Rubric for non-technical performance.
- Measured technical performance by time to critical action completion and assessed workload using the NASA Task Load Index (NASA-TLX).
Main Results:
- Higher non-technical team skills scores correlated significantly with shorter times to critical actions (r = -0.60, P = .0222).
- Specific non-technical skills like situational awareness (r = -0.70) and decision-making (r = -0.63) were most predictive of technical performance.
- Lower reported workload (NASA-TLX) was associated with better information gathering (r = -0.54) and anticipation (r = -0.61).
Conclusions:
- Improved non-technical team performance is directly associated with superior technical performance in simulated ERCC missions.
- These findings validate the critical role of non-technical skills in ERCC operations.
- Supports the need for enhanced assessment and training of casualty care teams in field settings.
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