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Furthermore, posttesting confidence generally rose compared References
with pretesting confidence in the present study, but somewhat 1. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield
declined for IV application in the NVG condition. Focused re- (2001–2011): implications for the future of combat casualty care.
search is needed to clarify the relationship between confidence J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S431–S437.
and competence in general and in the context of the effective 2. Dubick MA, Holcomb JB. A review of intraosseous vascular ac-
cess: current status and military application. Mil Med. 2000;165
use of tactical lighting to perform life-preserving medical tasks (7):552–559.
in low-light conditions. This line of investigation is vital be- 3. Collins CM. Vascular access: a military perspective. Br J Nurs.
cause of the potentially disastrous impact of overconfidence in 2017;26(19):S39.
conducting medical procedures in low-light conditions. 4. Pozza M, Lunardi F, Pflipsen M. Emergency intraosseous access:
a useful, lifesaving device used in Afghanistan. J Spec Oper Med.
2013;13(1):25–28.
Performance in obtaining IV access was relatively poor in 5. Cooper BR, Mahoney PF, Hodgetts TJ, Mellor A. Intra-osseous
the present study, at least in part because the IV simulation access (EZ-IO) for resuscitation: UK military combat experience.
mannequins made it difficult to visualize the vein. Based on J R Army Med Corps. 2007;153(4):314–316.
participant suggestions, using human volunteers may be more 6. Vassallo J, Horne S, Smith JE. Intraosseous access in the military
realistic for testing NVG adaptors for IV access. Other partic- operational setting. J R Nav Med Serv. 2014;100(1):34–37.
ipants suggested testing focusing adaptors with supplemental 7. Nadler R, Gendler S, Chen J, Lending G, Abramovitch A, Glass-
infrared light or floodlights, an open area for future research. berg E. The Israeli Defense Force experience with intraosseous
access. Mil Med. 2014;179(11):1254–1257.
8. Savell S, Mora AG, Perez CA, Bebarta VS, Maddry JK. En route
Study participants raised concerns that the adaptors might be intraosseous access performed in the combat setting. Am J Disas-
misplaced because they are not attached to NVGs. Addition- ter Med. 2016;11(4):225–231.
ally, attaching the adaptors on site to complete a close-in med- 9. Schwartz RB, Charity BM. Use of night vision goggles and low-
ical task during an active battlefield operation requires fine level light source in obtaining intravenous access in tactical condi-
motor skills and may take time away from casualty care. It is tions of darkness. Mil Med. 2001;166(11):982–983.
therefore important to determine whether focusing adaptors 10. Bilge S, Aydin A, Bilge M, Aydin C, Cevik E, Eryilmaz M. A study
on the tactical safety of endotracheal intubation under darkness.
can be effectively integrated into NVGs. Mil Med. 2017;182(7):e1722–e1725.
11. Aydın A, Bilge S, Aydın C, Bilge M, Çevik E, Eryılmaz M. The
It is crucial to determine optimal training for using focusing success of endotracheal intubation with a modified laryngoscope
adaptors with NVGs. This includes the number of repetitions using night vision goggles. Ulus Travma Acil Cerrahi Derg. 2018;
across various tasks and the impact of bolus “just in time” 24(2):97–103.
predeployment and premission training and practice. As one 12. Gellerfors M, Svensén C, Linde J, Lossius HM, Gryth D. Endo-
tracheal intubation with and without night vision goggles in a he-
participant stated, “With more experience using the adaptors, licopter and emergency room setting: a manikin study. Mil Med.
I may be more likely to use it.” TCCC training may bene- 2015;180(9):1006–1010.
fit from including a greater emphasis on performing medical 13. Derickson MJ, Kuckelman JP, Phillips CJ, et al. Lifesaving inter-
tasks in low-light conditions, whether with tactical lighting, ventions in blackout conditions using night vision technology:
NVGs, or NVG+As. Long-term follow-up studies should be come to the dark side. J Trauma Acute Care Surg. 2019;87(1S
Suppl 1):S191–S196.
conducted to determine skill sustainment and training effects. 14. Brummer S, Dickinson ET, Shofer FS, McCans JP, Mechem CC.
Lastly, analysis of after-action reports may prove fruitful in Effect of night vision goggles on performance of advanced life
determining the efficacy of focusing adaptors on care quality support skills by emergency personnel. Mil Med. 2006;171(4):
and casualty outcomes. 280–282.
15. Faul F, Erdfelder E, Buchner A, Lang A-G. Statistical power anal-
yses using G*Power 3.1: Tests for correlation and regression anal-
Conclusion yses. Behav Res Methods. 2009;41(4):1149–1160.
16. Van Buren JP, Wake J, McLaughlin J, LaPorta AJ, Enzenauer
While this study was limited by the use of mannequins in lab- RW, Calvano CJ. Optimizing tactical medical performance: the
oratory conditions and by the lack of practice opportunities effect of light hue on vision testing. J Spec Oper Med. 2018;18(2):
provided, present findings demonstrate some small advantages 75–78.
of focusing adaptors over NVGs alone but not over the tac- 17. Pedler M, Ruiz F, Lamari M, et al. RW. Red-green versus blue
tical headlamp for IV and IO access in low-light conditions. tactical light: a direct, objective comparison. J Spec Oper Med.
2016;16(4):54–58.
18. Aydin A, Bilge S, Eryilmaz M. Safest light in a combat area while
Acknowledgments performing intravenous access in the dark. J R Army Med Corps.
We appreciate the participants of this study for volunteering 2018;164(5):343–346.
their time and expertise. We also thank Ms Erin Reily and 19. Glaser BG, Strauss A. The Discovery of Grounded Theory: Strat-
Dr Ted Morrison for their assistance with testing procedures. egies for Qualitative Research. Hawthorne, NY: Aldine de Gruy-
Finally, we extend our gratitude to the staff of the NMCSD ter; 1967.
Bioskills Simulation Center for hosting our study and provid- 20. Glaser B. Basics of Grounded Theory Analysis. Mill Valley, CA:
ing material. Sociology Press; 1992.
21. Cohen J. Statistical Power Analysis for the Behavioral Sciences.
New York, NY: Routledge Academic; 1988.
Financial Disclosure 22. Lakens D. Calculating and reporting effect sizes to facilitate
The authors have no financial disclosures. cumulative science: a practical primer for t-tests and ANOVAs.
Front Psychol. 2013;4:863.
23. Tripepi G, Jager KJ, Dekker FW, Zoccali C. Selection bias
Ethical Approval Information
Naval Medical Center San Diego IRB NMCSD.2019.0038. and information bias in clinical research. Nephron Clin Pract.
2010;115(2):c94–c99.
24. Noyes BP, McLean JB, Walchak AC, et al. Red-green tactical
Funding lighting is preferred for suturing wounds in a simulated night en-
This study was self-funded by the authors. vironment. J Spec Oper Med. 2021;21(1):65–69.

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