title: Effective teamwork and communication mitigate task saturation in simulated critical care air transport team missions.
abstract: BACKGROUND
  Critical Care Air Transport Teams (CCATTs) are a critical component of the United States Air Force evacuation paradigm. This study was conducted to assess the incidence of task saturation in simulated CCATT missions and to determine if there are predictable performance domains.
  
  
  METHODS
  Sixteen CCATTs were studied over a 6-month period. Performance was scored using a tool assessing eight domains of performance. Teams were also assessed during critical events to determine the presence or absence of task saturation and its impact on patient care.
  
  
  RESULTS
  Sixteen simulated missions were reviewed and 45 crisis events identified. Task saturation was present in 22/45 (49%) of crisis events. Scoring demonstrated that task saturation was associated with poor performance in teamwork (odds ratio [OR] = 1.96), communication (OR = 2.08), and mutual performance monitoring (OR = 1.9), but not maintenance of guidelines, task management, procedural skill, and equipment management. We analyzed the effect of task saturation on adverse patient outcomes during crisis events. Adverse outcomes occurred more often when teams were task saturated as compared to non-task-saturated teams (91% vs. 23%; RR 4.1, p < 0.0001).
  
  
  CONCLUSIONS
  Task saturation is observed in simulated CCATT missions. Nontechnical skills correlate with task saturation. Task saturation is associated with worsening physiologic derangements in simulated patients.
authors.affiliation: Department of Surgery and Institute for Military Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH 45267.
authors.forename: Bradley
authors.initials: B
authors.lastname: Davis
authors.affiliation: Department of Surgery and Institute for Military Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH 45267.
authors.forename: Katherine
authors.initials: K
authors.lastname: Welch
authors.affiliation: United States Air Force Center for Sustainment of Trauma and Readiness Skills, 234 Goodman Avenue, Cincinnati, OH 45213.
authors.forename: Sharon
authors.initials: S
authors.lastname: Walsh-Hart
authors.affiliation: Department of Surgery and Institute for Military Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH 45267.
authors.forename: Dennis
authors.initials: D
authors.lastname: Hanseman
authors.affiliation: United States Air Force Center for Sustainment of Trauma and Readiness Skills, 234 Goodman Avenue, Cincinnati, OH 45213.
authors.forename: Michael
authors.initials: M
authors.lastname: Petro
authors.affiliation: United States Air Force Center for Sustainment of Trauma and Readiness Skills, 234 Goodman Avenue, Cincinnati, OH 45213.
authors.forename: Travis
authors.initials: T
authors.lastname: Gerlach
authors.affiliation: Department of Surgery and Institute for Military Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH 45267.
authors.forename: Warren
authors.initials: W
authors.lastname: Dorlac
authors.affiliation: Department of Surgery and Institute for Military Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH 45267.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Collins
authors.affiliation: Department of Surgery and Institute for Military Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH 45267.
authors.forename: Timothy
authors.initials: T
authors.lastname: Pritts
mesh_terms: D017732:Air Ambulances; D003142:Communication; D003299:Cooperative Behavior; D003422:Critical Care; D006126:Group Processes; D006801:Humans; D008889:Military Personnel; D010348:Patient Care Team; D061214:Patient Safety; D000066908:Simulation Training; D013647:Task Performance and Analysis; D014481:United States; D016526:Workload