Page 47 - JSOM Fall 2022

research assessed the differences in FF and MM exercises us­ on MM. The participants were familiar with performing tasks
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ing NASA­TLX subscales. Clear differences in the rates for in MM as they all were trained in CLS, but they either had no
mental and physical demands between the FF and the MM previous knowledge or modest experience of firefighting. On
simulation exercises were found, and FF was considered to the other hand, the instructors involved in the scenarios were
be significantly more demanding as expected. Other research experienced and had pre­understanding of how strain can be
exemplified the intense physical and psychological stress fire­ perceived in different situations and with other participants.
fighters experience. 31 The instructors may have wished for the exercises to be more
or less difficult depending on their preconceived ideas. This
No significant difference was found for the NASA­TLX tem­ issue can be seen as an unintentional error or bias and may
poral demands dimension between the two conditions (FF have affected the results of the study. Another factor that may
versus MM simulation exercises). With respect to temporal have influenced the results can be the fact that the instructors
demands, these simulation exercises can be further enhanced had not rated each task/scenario like this before, by assessing
to improve the challenges during stress week. One suggestion levels of complexity, physical workload, and difficulty. Gener­
is that because two groups were involved in the simulation ex­ alization was left out in this study due to the small number of
ercises, it should be possible to direct stress toward the groups participants; it seemed to be more relevant to use transferabil­
and have them compete against each other. For example, this ity. The methods, procedures, and tools (NASA­TLX) used are
could mean encouraging one group to beat the time achieved described, allowing for the study to be replicated even in other
by the other group. To put more pressure on the SF Operators contexts. The validity of the study is supported and anchored
with regard to temporal demands, real­life consequences could by the answers on the effects of stress and workload experi­
be considered when doing simulation exercises in MM. For enced during FF and MM simulation training. Statistical cal­
example, if the primary survey takes too long or is not consid­ culations are presented using means and standard deviations.
ered effective, the wounded moulage patient may “die,” and Consensus was reached between the participants and the in­
they must face the moral difficulties of combat. Kotwal et al. structors, identifying the FF exercises as the most stressful task
emphasized that to increase the survival of critically injured performed with high workload. Regarding reliability in the
combat casualties, the time factor and ability to give treatment study, it should be emphasized that the results are dependent
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are important. Simulation exercises in MM in darkness can on repeated measures. The differences between male/female
be further discussed to meet the demands of reality. Other participants were not examined in this study because the re­
research points out the importance of performing training in sults would probably have been unreliable as the number of
such conditions for all military units, for example in research women was low (one participant). Other studies have raised

by Aydin et al. and Bilge et al. 33,34 This requires the instructors the issue of sex. 35–37
to be even more stringent to prepare the SF Operators for real
incidents and “train as you fight.” Previous research points out the advantages of exposure to stress
training in which physiological tolerance to stress improves,
No significant differences were found concerning performance for example, by increasing cardiac output during aerobic train­
between the FF and MM simulation exercises, indicating that ing. Not only is physical training important, but psychological
it may be advised to increase the demands on the participants training is also vital for building flexibility and readiness in
in the exercises, making them more challenging and difficult. various hostile battlefield environments. All of these stress ex­
With respect to differences in frustration levels and effort, posures aim to optimize soldiers’ performance. 35,38
the results showed significant differences between simulation
exercises in FF and MM. The SF Operators experienced FF When looking at the prerequisites, there was a difference be­
as being more frustrating and more strenuous. This may be tween FF and MM simulations. The participants were well
explained by the novel, unknown, and confined environment trained in CLS and had good knowledge on how to handle
where the FF simulation exercises were performed. Other cir­ different medical situations. The FF simulation exercises were
cumstances may have had effect on the participants. The study generally unknown to the participants. To be able to challenge
was accomplished early during stress week; on the second day, the SF Operators, the impacts from the prerequisites must be
they may still have had enough sleep, sufficient food, and the considered and how they may have affected the results of this
combat value was still good. In addition, even if the different study given that the participants were already trained in MM.
simulation exercises were planned the same way, the partici­ This research did not have a baseline, which makes it difficult
pants had an influence on each other in the groups. The sim­ to generate any definitive conclusions. What results and con­
ulation exercises may have been a bit different for the two clusions could be achieved if the participants had had more
groups even though they were carrying out the same simula­ training in FF or if they were not trained in CLS to begin with
tion exercises or tasks. The two groups performed in different remain to be investigated. By giving the participants equal ba­
ways, which may be explained by the individuals in the group, sic knowledge in both FF and MM, the results may change.
age, previous experience, and knowledge. This would ensure that the participants have the same baseline
and the same prerequisites during the different simulation ex­
The instructors’ assessment of the different simulation exer­ ercises and tasks. The way the simulation exercises were ac­
cises revealed an interesting finding. The MM simulation ex­ complished during stress week did not create good conditions
ercises were assessed by the instructors to be less strenuous for the participants to reach cognitive or affective goals. An­
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than the participants had found them to be. Meanwhile the other limitation of the study was the number of participants.
instructors rated the FF simulation exercises to be demanding However, the population of SF Operators is not large. Never­
and assessed the workload for the FF simulation exercises in theless, the methods and procedures tested in this research can
correlation with the participants’ experience. This raises ques­ be used in a comparable larger study. This type of evaluation
tions on why the participants rated the two simulation exer­ of stress and workload using NASA­TLX during simulation
cises differently, and the impact of their previous knowledge exercises can allow for improvements of the different exercises.

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