Page 45 - JSOM Fall 2022

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using NASA­TLX may support future stressful training to exceed those of the general civilian population.” High per­
meet the principle “train as you fight.” formers are identified as being self­driven with realistic ex­
pectations, who accomplish set tasks with high quality and

The aim of the study was to examine the effects of stress and are goal­focused. 26,27 In a study by Guidry et al., the authors
workload experienced during FF and military medicine (MM) discuss the importance of presenting challenging tasks for the
simulation training. high performers to prevent boredom. 27,28 In California, the
Naval Postgraduate School has established a high performer
track (HPT) pilot program that identifies high performing ma­
Methods
rines to produce effective leaders. 29
This pilot study was performed to test the feasibility of meth­
ods and procedures, and to search for possible effects for Instructors
simulation training in a military context that may be worth All 11 instructors involved in the exercises had been working
following up in a similar larger study. In this paper, the pilot as instructors at the military training facility for many years.
study is referred to as the study. In addition to military experience, one instructor had been a
firefighter for 26 years and another instructor had 5 years of
The full­scale simulation training was designed to be stressful experience as a firefighter. One instructor had been working
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and meet the principle of “train as you fight.” NASA­TLX as a paramedic for 20 years. The instructors’ experience is rel­
was used to assess workload and stress experienced by the evant as the instructors working at the MTF are required to
participants when they took part in the simulation exercises undergo special training and selection for instruction in the
in FF and MM. This study was performed in 2016 during the specific environment. Thus, not just any instructor can be used
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second day of stress week when the SF Operators were under­ in this environment. The instructors were required to have
going simulation training and were exposed to various types knowledge of current regulations, risks, safety instructions at
of exercises in unknown and novel environments at a Swedish the facility, and ensure that the safety instructions were fol­
military training facility (MTF). A quasi­experimental design lowed, as well as support the participants if needed when per­
between groups with repeated measurements was used. The in­ forming the tasks in the scenarios. As such, special competence
dependent variables were the different exercises accomplished, in either FF or MM was essential. The instructors assessed the
described below. The dependent variables were the scores for different tasks and exercises used in the scenarios by rating the
the NASA­TLX dimensions with the six subscales. level of complexity, physical workload, and difficulty for each
task/exercise on a scale between 1 and 10. The objective was
Participants to put the training in the correct context when the exercises
On arrival at the MTF, the 12 SF Operators were recruited for and tasks were being assessed and whether the exercises were
the study. They were informed about the upcoming research challenging enough.
and one individual (male) declined to take part in the study
and was excluded. The participants had no previous experi­ Procedure
ence of being exposed to stressful combat situations as they The study required collaboration with the instructors at the
were new trainees. None of the participants were familiar with Swedish Armed Forces Military Training Centre and with the
the NASA­TLX. They received detailed information about the commander of the SF Operators in Sweden. Briefing before
tool both at the initial information session for stress week and the simulation exercises was diminutive, with no information
when they filled in the first questionnaire in conjunction with on what to expect to test the participants’ ability to handle
the first simulation exercise. unforeseen events during stress week. Upon arrival on the first
day, the SF Operators received information about the research
All participants had previously passed compulsory physi­ and safety instructions. On the second day, they had fire ex­
cal tests and fulfilled the basic requirements for the Swedish tinguisher practice, an update of smoke diver equipment, and
Armed Forces before being accepted as SF Operators. The basic FF training before the scenarios. By implementing this
physical tests and basic requirements included a 10­km run in practice sessions, there was assurance that participants could
less than 51 minutes; a field test involving running for 2 km handle the equipment used in simulation exercises. The re­
in a maximum of 10 minutes with full combat equipment (ap­ maining scenarios and events of stress week were not evalu­
proximately 22 kg; full combat equipment includes military ated in this study since these are classified as restricted.
boots, full uniform, with armor, combat vest, combat helmet,
combat water bottle containing 1L of water, weapon with as­ The 11 participants were informed about the NASA­TLX
sociated equipment); swimming 400 m; another swim of 25 m and the aim of stress week. The participants were randomly
and then saving a “drowning person” (doll) 3–4 m deep; pass­ divided into two groups by a colleague of the first author not
ing various strength tests; and passing the multistage fitness involved in the research. The participants were divided into
test (MSFT), also called the BEEP test. two groups for technical reasons, operative requirements,
and safety instructions when performing exercises in FF fa­
When the selection for new SF Operators was in progress, the­ cilities with limited or confined spaces in heat. Randomiza­
oretical examinations and physical tests were examined. Indi­ tion was used to prevent bias of the results due to unknown
viduals with high scores in these tests who were considered as factors.
being particularly motivated were selected as high performers
and completed a Combat Life Saver (CLS) course before at­ The training consisted of two different simulation exercises in:
tending stress week. “High performer” has been defined in (1) MM and (2) FF. When the participants had finished their
previous research by Karch et al. as a requirement that “mil­ first exercise, they quickly switched to the next one. The first
itary personnel in high­performance occupational specialties group started with an MM simulation exercises in the field in
[…] maintain medical and physical standards of fitness that cold weather (≤ 0°C, windy, snowing). Different tasks had to

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