Page 44 - JSOM Fall 2022

Workload of Swedish Special Forces Operators Experienced

During Stressful Simulation Training
A Pilot Study

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Marie Hindorf, CRNA, MSc *; Peter Berggren, PhD ; Carl-Oscar Jonson, PhD ;
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Lars Lundberg, MD, PhD ; Anders Jonsson, RN, PhD 5

ABSTRACT
Introduction: Stress week was included during training of and workload can be measured using the validated workload
Special Forces (SF) Operators in Sweden to test their ability measurement developed by the NASA­TLX. The NASA­TLX
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and limits for handling stress in different unknown situations is a validated, subjective, and multidimensional assessment tool
and environments at a military training facility in Sweden. used for assessing perceived workload with six subscales: men­
The aim of the study was to examine the effects of stress and tal demand, physical demand, temporal demand, performance,
workload experienced in various tasks during firefighting and effort, and frustration. NASA­TLX scores from single exercises
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military medicine simulation training. Methods: This pilot have been compared to a large dataset in a meta­ analysis by
study was performed during the second day of stress week. Grier et al. , which rated workload scores from high to low.
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The National Aeronautics and Space Administration Task NASA­TLX has been used in several studies to examine stress
Load Index ( NASA­TLX) is a validated, subjective, and mul­ and workload. For example, it has been applied to experi­
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tidimensional assessment tool for rating perceived workload enced helicopter pilots using a flight simulator when evaluating
with six subscales: mental demand, physical demand, tem­ virtual reality as a simulation tool, and for in­depth stress anal­
poral demand, performance, effort, and frustration. These yses during a field experiment involving a handgun shooting
subscales were used as an indicator of stress experienced. The workshop for armed officers. The researchers examined to
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different tasks were assessed by the SF Operators by rating the what extent an exposure to reality­based stress affected the of­
NASA­TLX subscales for each task, which were then analyzed ficers’ working memory and their self­perceived active learning.
and compared using ANOVA. Results: There was a significant When the risk of being shot at occurred, the stress increased as
difference between the two simulation exercises assessed by expected. Previous research on warfighters in military conflicts
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the participants and instructors, and both groups considered has found that cognitive performance can be severely impaired
firefighting to be more demanding than medical. The partici­ and affected by combat stress. Research has shown a connec­
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pants perceived the mental and physical demands as more de­ tion between simulation training and reality. Studies of experi­
manding in the firefighting exercises, as well as for the level enced pilots demonstrate that it is possible to create the same
of frustration and effort. However, no differences regarding conditions in training as in reality. In another study, heart rate
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performance or temporal demands between the simulation ex­ and workload in simulated aircraft sessions was shown to cor­
ercises were found. Conclusion: The principle “train as you relate with real aircraft sessions. The effects of stress (threat)
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fight” implies difficult and demanding situations. When ex­ were also studied by Friberg et al.during two medical interven­

posing Swedish SF Operators to challenging situations, assess­ tions, in which novices were compared to professionals; one of

ment of perceived stress and performance are possible. the measures used was a Swedish version of NASA­TLX. This
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study used the same Swedish version.
Keywords: military training; stress; simulation; NASA-TLX
The Swedish Armed Forces define a stressful environment
as being under constant threat of death, in fear, and where
military personnel can be exposed to disgusting physical cir­
Introduction
cumstances or may witness their comrades being maimed by
The main focus of military training is to increase preparedness shell fire. Even in the civilian context, several duties involve
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for soldiers to perform tasks during stressful events. Swedish SF stressful events, such as firefighting (FF), police work, and am­
Operators undergo stressful and challenging tasks for a week bulance duties. 13–24
(called stress week). The overall aim of stress week is to test
both the SF Operators’ ability and limits to handle stress, to ex­ When Swedish SF Operators undergo simulation training at
pose them for various stressful situations, and to provide train­ the Swedish Armed Forces Military Training Centre, evalua­
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ing as close to reality as possible, thus “train as you fight.” tion of such training is needed to improve the tasks during
When SF Operators undergo simulation training, the stress stress week. An evaluation of stress and workload experienced
*Correspondence to marie.hindorf@mil.se
1 Marie Hindorf is a nurse anesthetist affiliated with Swedish Armed Forces, and Department of Biomedical and Clinical Sciences, Linköping
University, Sweden. Dr Peter Berggren and Dr Carl-Oscar Jonson are scientists affiliated with the Centre for Teaching & Research in Disaster
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Medicine and Traumatology and Department of Biomedical and Clinical Sciences, Linköping University, Sweden. LTC Lars Lundberg and
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5 MAJ Anders Jonsson are affiliated with Swedish Armed Forces, Centre for Defence Medicine, Västra Frölunda, Gothenburg, Sweden, and
University of Borås, Sweden.
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