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Task Load Negatively Affects Critical Care Air Transport Team Performance in Simulation.

Richard J Strilka1, Joshua L Fiechter2, Kent C Etherton3

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Physicians in Critical Care Air Transport (CCAT) teams reported higher task load, particularly mental and temporal demands, which correlated with lower team performance. This association was not seen in nurses or respiratory therapists, suggesting physicians uniquely link their perceived performance to team outcomes.

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Area of Science:

  • Military Medicine
  • Critical Care
  • Aeromedical Evacuation
  • Human Factors Engineering

Background:

  • The U.S. Armed Forces' pivot to peer conflict necessitates enhanced Critical Care Air Transport (CCAT) capabilities for high-volume patient movement.
  • Understanding CCAT team task load and its performance impact is crucial for mitigating saturation during complex transport missions.

Purpose of the Study:

  • To quantify task load and assess its relationship with team performance in CCAT teams during a high-fidelity simulation.
  • To identify differences in task load perception and its impact on non-technical skills across provider types (physicians, nurses, respiratory therapists).

Main Methods:

  • A high-fidelity simulation evaluated 44 CCAT teams caring for 2 critically ill patients.
  • Task load was measured using the National Aeronautics and Space Administration Task Load Index (NASA-TLX).
  • Team non-technical performance was assessed using the Team Emergency Assessment Measure (TEAM), analyzed with multilevel Bayesian modeling.

Main Results:

  • Elevated Effort, Mental Demand, and Temporal Demand were reported across all provider types.
  • Physicians (MDs) showed a significant negative correlation between individual task load and team performance (Spearman's ρ = -0.23).
  • This correlation was not statistically reliable for registered nurses (RNs) or respiratory therapists (RTs); MDs linked higher perceived task load and frustration to lower team performance.

Conclusions:

  • Physicians' perceived task load, particularly frustration and mental demand, was negatively associated with team performance, unlike RNs and RTs.
  • Physicians were unique in recognizing team underperformance and attributing it to their own perceived shortcomings.
  • Findings highlight the critical role of physician cognitive and temporal load in CCAT team effectiveness and suggest targeted interventions.