Related Experiment Video
Updated: Oct 25, 2026
Eye Tracking During A Complex Aviation Task For Insights Into Information Processing
Published on: April 4, 2025
Visual behavior of flight nurses during initial prehospital care inside an ambulance: A cross-sectional observational
Hidekazu Hishinuma1, Noboru Iwata2, Takafumi Noguchi3
1Graduate School of Nursing, Dokkyo Medical University, Mibu, Tochigi, Japan; Department of Adult Nursing, Dokkyo Medical University School of Nursing, Mibu, Tochigi, Japan.
Background:
Prehospital emergency care requires rapid acquisition and prioritization of visual information under time constraints and in confined clinical environments. Although healthcare expertise is often associated with efficient visual scanning, evidence from real-world clinical settings remains limited because most studies have been conducted in controlled simulations.
Objective:
To quantitatively analyze flight nurses' visual behavior during initial prehospital care provided inside an ambulance after their rendezvous with the ground ambulance crew and examine whether gaze behavior is associated with their experience levels.
Design:
A cross-sectional observational study using wearable eye-tracking technology.
Setting:
A helicopter emergency medical service base hospital in Japan, with observations focused on initial prehospital care provided inside an ambulance after rendezvous with the ground ambulance crew.
Participants:
Nine flight nurses were included: two in the novice group, four in the intermediate group, and three in the expert group. These groups contributed 10, 30, and 20 cases, respectively, for a total of 60 cases.
Methods:
Gaze behavior was recorded using a Tobii Pro Glasses 3 wearable eye-tracking device. Fixation count per minute, visit count per minute, and total fixation duration per minute were calculated across 11 areas of interest. Principal component analyses were conducted separately for each gaze measure. Generalized estimating equations, with flight nurses specified as the subject, were used to examine associations between principal component scores and experience group. A sensitivity analysis was conducted using the natural logarithm of the cumulative dispatch count as a continuous predictor.
Results:
Four principal components were retained for each of the three gaze measures. Significant associations with experience groups remained for four components after adjustment for multiple comparisons. The novice group showed higher team-related fixation than the intermediate and expert groups, higher body- and measurement-related visits than the expert group, higher team- and documentation-related visits than both other groups, and higher body- and measurement-related total fixation duration than the intermediate group. In the sensitivity analysis, a greater cumulative dispatch experience was associated with lower scores for the body- and measurement-related and team-related fixation components, as well as the body- and measurement-related and team- and documentation-related visit components.
Conclusions:
Flight nurses' visual information acquisition during ambulance-based initial prehospital care was associated with experience level, particularly for gaze behavior involving body and measurement information, team members, and documentation. These findings suggest that experience-related gaze patterns during ambulance-based initial prehospital care may inform future approaches to visual information acquisition training for flight nurses.
Registration:
Not registered.
