Objective:Recent concerns for the strength and stability of the emergency medical services (EMS) workforce have fueled interest in enhancing the entry of EMS clinicians into the workforce. However, the educational challenges associated with workforce entry remain unclear. Our objective was to evaluate the educational pathway of entry into the EMS workforce and to identify factors that lead to the loss of potential EMS clinicians.Methods:This is a cross-sectional evaluation of all US paramedic educational programs, with enrolled students, in the 2019 Committee on Accreditation of Educational Programs for the EMS Professions annual report survey. This data set includes detailed program characteristics and metrics including program attrition rate (leaving before completion), and certifying exam pass rates. Descriptive statistics were calculated, and multivariable logistic regression analysis was conducted to evaluate the association between high program attrition rates (>30%) and program specific characteristics.Results:In 2019, 640 accredited programs met inclusion with 17,457 students enrolled in paramedic educational programs. Of these, 13,884 students successfully graduated (lost to attrition, 3,573/17,457 [21%]) and 12,002 passed the certifying exam on the third attempt (lost to unable to certify, 1,882/17,457 [11%]). High program attrition rates were associated with longer programs (>12 months), small class sizes (<12 students), and regional locations.Conclusions:Nearly 1 in 3 paramedic students were lost from the potentially available workforce either owing to attrition during the educational program or failure to certify after course completion. Attrition represented the largest loss, providing an avenue for future targeted research and interventions to improve EMS workforce stability.

Anaphylaxis is an allergic reaction that occurs from exposure to an allergen. There has been an upward trend in the rates of hospitalization and Emergency Department (ED) visits related to anaphylaxis across the U.S., Europe, and Australia. Although fatal anaphylaxis is not a common occurrence, delays in treatment are nearly always associated with fatalities. Therefore, time is one of the leading variables related to successful outcomes associated with anaphylaxis treatment during prehospital care. Perhaps even more importantly, prehospital care faces a shortage of certified professionals. Some programs offer accelerated timelines to credential students faster than usual to make up for demand. In rural portions of the United States, paramedics and EMTs are leaving the field at alarming rates, causing significant changes in staffing and workload. The changes we are currently facing in the healthcare industry result in an unprecedented need for efficient, effective, and low-cost training solutions to prepare healthcare professionals and train community members to provide support before the arrival of EMS personnel. Emerging technologies, such as augmented and virtual reality (AR/VR) have been identified as a potential way to train timely care. Still, they have not been fully evaluated from a human performance perspective. This work aims to clearly identify how VR can enhance training through a review of the extant literature. By mapping areas where 3D user interfaces (3DUIs) could be leveraged for training for encounters with a patient suffering from anaphylaxis, this paper demonstrates the practical use of VR/AR for training anaphylaxis response in community-based care settings.

Firefighters rely on visual information to make tactical decisions during structure fire events. Consequently, user interface design for public safety requires a comprehensive understanding of how these visual cues impact performance in terms of expertise and domain knowledge, as well as cognitive load. However, very few studies have captured baseline measures (e.g., subjective workload) associated with the use of pre-incident planning, the phase prior to deciding how to extinguish the fire. Virtual environments and 3D modeling have been suggested as a tool that can better support the exploration of emerging technology to better support pre-incident planning practices. Sixty-four (n = 64) North American firefighters participated in this study. Our work focuses on providing baseline data to define effective ways to present building and hazard information to incident commanders using both current systems (e.g., 2D diagrams) and emerging technologies (e.g., 3D models, virtual reality, augmented reality).

Human-to-human telepresence is rising to mainstream use, and there is opportunity to provide rich experiences through novel interactions. While previous systems are geared towards situations where two users are previously acquainted, or provide channels for verbal communication, our work focuses on situations where audio is not desirable or available, by incorporating vibro-tactile commands into a telepresence setup. We present results from a lab-based study regarding a human-to-human telepresence system which enables one person to remotely control another through these vibro-tactile cues. We conducted a study with 8 participants to solicit their feedback when acting as a Streamer, 8 additional participants to solicit feedback as a Viewer, and 30 bystanders, through surveys and debriefing sessions. While our participants generally found the application favorable, we did find mixed feelings towards vibro-tactile devices, and much room for improvement for the whole interaction. We discuss the implications of our findings and provide design guidelines for future telepresence developers.

Due to rapid advances in technology, particularly location-based services, there has been an increase in the availability of self-reporting hazard tools and mobile applications. However, many challenges remain in understanding stakeholders' perceptions of community risk reduction (CRR) information systems and the impact these self-reports have on emergency response. This paper addresses the gap in the existing literature by combining theories and data from multiple disciplines. Existing research has traditionally focused on Wildland-Urban Interface (WUI), citizen science for Geographic Information Systems (GIS), and participatory mapping. Still, the extant literature does not comprehensively evaluate community stakeholders' perceptions and engagement in emergency preparedness efforts, particularly for applications intending to engage both civilians and first responders. More importantly, there is little existing research to better understand the relationships that exist between the first responders, technology, and residents they serve in their first-due areas. Consequently, this paper aims to provide an overview on how to best support multiple stakeholders and to foster more constructive communication between first responders and the communities they serve through technology mediated self-reporting tools.

High profile structure fires, like the Grenfell Tower tragedy, have demonstrated that the quality of the information provided to firefighters arriving on the scene of an emergency is a matter of life or death. It has been suggested that access to structural information such as electronic building plans or unmanned aerial vehicle footage may bridge the information gap to help first responders build situation awareness at the incident scene. However, these technologies have not been fully evaluated from a human performance perspective. The use of pre-incident plans (PIPs), information captured systematically about a facility prior to an emergency, provides a way for firefighters to leverage data about a structure, increasing their efficiency and effectiveness in managing a fire and ultimately reducing fatalities and property damage. However, no standard interface configuration currently exists for presenting and displaying PIP information to firefighters digitally. This dissertation investigates the human factors implications associated with leveraging emerging technology in the form of 3D models and situated visualization techniques for displaying PIP information to fireground incident commanders. Through a series of mixed-method (qualitative and quantitative) studies, this dissertation directly captures user requirements and human performance data from firefighters in the form of focus groups, field data, surveys, and user study data. Based upon qualitative participant feedback and objective user study data, this series of studies evaluates the usability (efficiency, effectiveness, satisfaction) of three different user interface configurations. This data serves as a foundation for standardizing the way PIP information is presented to first responders. Further recommendations are suggested for how to effectively present and display PIP information to better support fireground incident commanders operating in dangerous and unpredictable environments.

Paramedics and Emergency Medical Technicians (EMTs) often serve dual roles in their communities as both emergency medical providers and firefighters. Therefore, the demands and needs of these providers are different than those working directly in a hospital emergency room or medical office. Medics are required to treat a patient in less than ideal conditions where seconds can mean the difference between life and death. The goal of this work is to better understand how research informing technology for the emergency room (ER) can be linked to improving the user experience of EMTs and paramedics in the field. Through a review of relevant literature, we capture lessons learned in conveying information quickly, linking necessary information from disparate sources, and giving these providers accurate information to successfully treat and transport patients during prehospital care.

This work presents a comparison of two applications (Augmented Reality (AR) and desktop) to author Scenario-Based Training (SBT) simulations. Through an iterative design process two interface conditions are developed and then evaluated qualitatively and quantitatively. A graph based authoring visualization help designers understand the scenario learning artifacts and relationships. No significant difference was found on time taken to complete tasks nor on the perceived usability of the systems. However, Desktop was perceived as more efficient, corroborated by the significantly higher number of mistakes made in AR. Findings are presented towards building better AR immersive authoring tools.

In a fire suppression operation, seconds can mean the difference between a fatality or successful incident management. There have not been many recent studies that examine the information, tools, and technologies firefighters rely upon to gather facts about the incident scene before arrival. We conducted an international, web-based survey in which 50 firefighters of varying ranks characterized the benefits and challenges of using pre-incident plans, documents that assist firefighters in understanding information about a facility during an emergency. Our analysis showed that despite demographic differences in regions and the size of the population served, most departments reported severe challenges in accessing and retrieving planning information. Based upon participant feedback, we shed light on the problems with existing user interfaces and provide a path forward for the human factors community to build robust technology for first responders operating in dangerous and unpredictable environments.

The cognitive demands and skills required of a fire engine company when assessing the scene of an incident and the systems they use to manage this information are a matter of life or death. We conducted a case study with an entire fire battalion in Florida (35 firefighters at varying levels of command) to assess their routine technology needs. Using a cognitive work analysis approach, we found that the firefighters in our study relied on mission critical systems that often failed, as well as disparate secondary systems that lacked integration. Capability gaps and inaccessible data also increased the likelihood of errors, creating frustration in the systems that both helped and hindered these firefighters in their daily job tasks. We describe what firefighters need from technology in its present state and we outline usability issues for technology designers and practitioners to leverage in the design of future systems.

Interactive simulation is one of the most prominent methods used to train and measure learning outcomes across multiple disciplines. Despite the ubiquity of simulation-based training in a variety of domains including nursing, serious games, military operations, etc., there is a paucity of research on how simulation experience is defined and how individual differences impact user experience. Towards this end, this paper provides a critical review of the existing literature. We describe how we can leverage existing findings and emergent themes to better understand and define simulation experience, and we outline areas for further investigation of the role of individual differences in user experience to enhance not only training outcomes, but also perception of simulation.

Every year, structure fires account for billions of dollars in property damage and injuries to firefighters and civilians. Emerging technologies, such as augmented and virtual reality (AR/VR) have been identified to assist in mitigating the loss of life and property, but they have not been fully evaluated. The goal of this work is to clearly identify how AR can enhance fire suppression operations by mapping feedback from a needs assessment conducted with firefighters to the areas where technology could be leveraged to support an initial incident assessment ( size up), demonstrating the practical use of AR for the fire service.

We present an exploratory study to assess the benefits of using Augmented Reality (AR) in training sports rule comprehension. Soccer is the chosen context for this study due to the wide range of complexity in the rules and regulations. Observers must understand and holistically evaluate the proximity of players in the game to the ball and other visual objects, such as the goal, penalty area, and other players. Grounded in previous literature investigating the effects of Virtual Reality (VR) scenarios on transfer of training (ToT), we explore how three different interfaces influence user perception using both qualitative and quantitative measures. To better understand how effective augmented reality technology is when combined with learning systems, we compare results on the effects of learning outcomes in three interface conditions: AR, VR and a traditional Desktop interface. We also compare these interfaces as measured by user experience, engagement, and immersion. Results show that there were no significance difference among VR and AR; however, these participants outperformed the Desktop group which needed a higher number of adaptations to acquire the same knowledge.

As research on teams becomes increasingly sophisticated, scientists face challenges related to understanding collaboration at multiple levels of analysis, beyond that of the individual or the group alone. Grounded in Hackman's work on interaction and levels of analysis, this chapter explores theory development for understanding team collaboration from multiple perspectives. We argue that to enhance and improve the study of collaboration and to increase explanatory power, the development of theory must focus not only on the major issues at each level, micro, meso, macro, but also issues that cross these levels of analysis in team interaction. This method of cross-level analysis provides insight on some of the causal factors related to better understanding collaboration effectiveness. Furthermore, this chapter explores the need to leverage complementarity within and between disciplines to enhance our understanding of team interaction and to provide a more holistic method for assessing collaboration in a variety of complex domains.

In order to create effective human-robot teams, robots must possess social capabilities that match the expectations of their human teammates. However the ability of robots to approximate human capacities is limited due to technological constraints. Human-animal teams have thus been suggested as a suitable analog for modeling teaming between humans and non-humans. Due to the limited capacity for animals to express their intentions, it follows that human-animal relationships can provide a basic framework for understanding how humans interpret information from teammates with limited social faculties. The purpose of this paper is provide research recommendations to identify specific areas in which human-animal teams can be used to model human-robot teams and to provide suggestions for investigating this model empirically in the context of social interaction.