Page 48 - JSOM Fall 2022

Results and knowledge like this can be used when planning the moulage patients that the participants found stressful. They
next stress week, and simulation exercises can be modified to also appreciated that the instructors did not reveal details of
challenge the SF Operators even more. As the results show, the tasks and that the focus was to train and not to prepare for
participants do not experience the simulation exercises as diffi­ exercises. The short reviews from the instructors after scenar­
cult to handle. This in turn may indicate that an increase in the ios concerning participants’ performances noted an increased
level of difficulty in simulation exercises is possible, maybe by time for training, and that the use of other units such as “en­
adding more advanced or complex tasks. The exercises in stress emies” or curious journalists increased the realism of the sce­
week were designed to create stress for the participants, and narios, which in turn made the SF Operators work harder to
to make them reach their limits to increase their experience of solve set tasks. Additionally, the constant variation of scenar­
how they react to stress. The challenge for the instructors was ios and tasks created a fast pace. Credibility increased in the
to plan for training at a suitable level of workload, both men­ scenarios with realistic forms of support in casualty evacua­
tal and physical, regarding performance, temporal demands, tion or medical evacuation, and the FF exercise was experi­
effort, and frustration level. The simulation exercises should be enced as being the most stressful scenario. Regarding the cons
challenging enough to be stressful. When simulation exercises or suggestions for improvement in the simulation exercises,
are accomplished in the Swedish Armed Forces, the exercises the participants recommended increased complexity and level
per se are often evaluated, but not the individuals’ experiences of difficulty in the scenarios – they wanted more challenging
of workload or stress. Further evaluations may be needed in tasks both mentally and physically to create increased stress.
this area, and the NASA­TLX can be used as a complement Depending on the participants’ combat value, they suggested
in simulation exercises. Based on the results in this study, the varying the intensity of the scenarios (increasing and decreas­
overall aim of stress week was not achieved in the first two ing the intensity of the tasks) and wanted more information
days. Additionally, new concerns were raised regarding how to on results and performance during the tasks. They also sug­
train the next group of SF Operators during simulation exer­ gested repeating the scenario when exercises were not being
cises in FF and MM. The simulation exercises may benefit from performed in an acceptable way. They wanted more time for
being performed in other ways and perhaps at a higher level of the scenarios and suggested reducing the amount of food from
stress. Augmenting the stress level may lend itself to assisting the beginning of stress week. Participants also noted that for
SF Operators in making correct decisions and solving demand­ some of the tasks, further evaluation was needed to decrease
ing tasks even when the physical workload is high. This is to insecurity and concerns. The final suggestion was to include
prepare them for real­life combat situations and thus “train as consequence­based tasks in the scenarios.
you fight.” The NASA­TLX subscales on mental and physical
demands can then be used to investigate if the next stress week Based on the results from this pilot study and the suggestions
can be considered as being more stressful compared to the sim­ from the participants, further development of stress week is
ulation exercises in this research. needed.

Recovery is also of interest to balance resting and perform­
ing. This is important to eliminate fatigue and restore vigor, Further Research
which has been shown as part of psycho­physiological recovery Further research could focus on the previous knowledge of
process in research among elite athletes. Research has shown the participants when undergoing simulation training during
that being well­trained, fit, and having endurance speeds up stress week, and maybe they need basic knowledge in FF to
recovery. This is seldom done by professional workers who of­ meet the NATO principle “train as you fight.” Because the
ten ignore the need to sleep and rest. This increases the risk of number of participants was low and not representative of the
40
a negative spiral of stress. Previous research on firefighters whole population of Operators in the Swedish Armed Forces,
showed that small breaks, such as sitting down or removing further research could focus on workload in simulation ex­
jackets and helmets when on an incident site, affected recov­ ercises for additional Swedish Armed Forces personnel to in­
41
ery. In this simulation training, the overall aim was to test the crease the strength of the study.
participants’ ability to handle stress, therefore recovery was not
included. As researchers, we had no influence on this issue be­
cause stress week was planned by others. To take recovery into Conclusion
account, it may be important to gain knowledge about how Exposing SF Operators and employees in the Swedish Armed
strenuous the exercise had been. Performing complex tasks Forces to demanding situations enables assessments of per­
and not having time to recover can be hazardous. When the ceived stress and participant performance. With knowledge
lack of recovery becomes apparent or when a person is under of workload experienced during simulation training, exercises
a high workload for a long time, the body and mind will even­ can be designed to challenge the participants in line with re­
tually become exhausted, and the risk of bad decision­making al­life situations, thus “train as you fight.”
is imminent. 42,43 To be proactive and reduce the risk for mental
exhaustion and fatigue, recovery may be included at the begin­ Author Contributions
ning of stress week when scenarios such as those in this study MH was responsible for study design, collection, and anal­
are performed for SF Operators. The recovery issue can then ysis of the data and writing the manuscript. PB contributed
be accounted for during simulation training, for example, by to analysis of data and writing the manuscript. COJ contrib­
taking short breaks between each task/scenario. uted to study design, interpretation of the data, and manu­
script work. LL contributed to analysis of data and writing
Stress week as a whole was evaluated from the participants’ the manuscript. AJ contributed to study design, interpretation
point of view. The comments from the participants regarding of data, analysis of data, and writing the manuscript. All au­
simulation exercises in FF and MM were divided into pros and thors took part in the final revisions and approved the final
cons. The pros included realistic MM scenarios with damaged version.

46 | JSOM Volume 22, Edition 3 / Fall 2022