Stress and Decision-Making in Trauma Patient Resuscitation.

Decisionmaking in real life stressful environments is difficult to investigate yet critical to many military and civil operations. Using trauma patient resuscitation and anesthesia as a research vehicle we studied decision-making under stress in a real environment. We established video data acquisition systems in the admitting areas of a Level-l Shock Trauma Center. A multi-media database was accumulated using the system which contains videotapes of over 100 real cases, the associated medical records and audiotapes of reviews by participant and non-participant subject matter experts. A video analysis methodology was developed that includes a computer-driven video analysis system, a task-based performance measurement instrument, a recall questionnaire, and a scheme for collecting subjective stress ratings. Results of our inquiries include: (1) The decision-making errors were found to have been caused by failure to follow standard operating procedures, poor communication, and faults in the system which hindered performance and promote errors. (2) Subtle clinical cues are critical to making diagnoses (3) Teams used implicit means to coordinate and many team coordination errors could be attributed to the lack of explicit communications (4) Perceived stress followed a unidimensional pattern. With the tools developed in this project, it was shown that it was feasible to collect audio-video data of decision-making and to measure stress in real environments such as trauma patient resuscitation.