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

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.