Designing Novel Physiologic Monitor Displays for Combat Medics
Authors: Cummins Mabel L , Yang Sean , Sicard Caroline , Shive Joshua , Schlesinger Joseph J 
Published: August 2024

ABSTRACT

Introduction
Combat medics who are responsible for the care of injured warfighters face challenges from their reliance on medical alarms that exceed the noise levels recommended by the WHO. This is because the elevated noise levels in military facilities, particularly from vehicular units and weaponry, compromise the combat medics’ effectiveness and attentiveness to medical alarms. We previously designed a graphical (“configural”) display to communicate patients’ vital signs and found that when the configural display and traditional numerical display were concurrently presented to participants, it produced the fastest identification of patient vital signs and triggered the fewest number of alarms. This study used eye tracking to assess how participants direct visual attention to and engage with concurrently presented numerical and configural vital sign displays.

Materials and Methods
We recruited 30 undergraduate students with normal hearing and vision for this study. Subjects were tasked with monitoring a simulated patient’s vital signals using simultaneously presented numerical and configural vital sign displays. Concurrently, they performed an N-back task to simulate the multitasking required in a military environment. We manipulated the eccentricity and display position of the numerical and configural displays through 4 orientations, with each orientation being used in a monitoring block lasting 12 minutes. Continuous eye tracking was utilized to collect physiological data about participant display preference.

Results
We used eye tracking to analyze several metrics: Total display viewing time, total viewing time percentage, number of dwells (groups of eye fixations), mean fixations per dwell, and fixation patterns during an emergency event. Participants spent more time looking at the configural display than the numerical display during nominal monitoring and emergency events. During emergencies, the percentage of time individuals spent looking at the configural display increased from 30 to 50%, while there was no corresponding increase in the participants’ looking at the numerical display. When there were 2 concurrent emergency events instead of 1, total viewing time did not increase, suggesting that participants did not need to change their viewing strategy when the emergency situation complexity increased. Also, during emergencies, participants directed nearly half of their fixations to the configural display during the first 2 seconds of an emergency, while only directing fewer than 5% of fixations to the numerical display during that same period. The average response time for an emergency event was around 2 seconds, which suggests that participants obtained relevant information from the configural display in this time period.

Conclusions
We found that when a patient monitor contains both a configural display and a numerical display, participants look at the configural display. Furthermore, during time-sensitive situations, participants utilize the configural display to provide important information. We suggest this because the configural display integrates the relevant vital signs into one display. These findings provide justification for pursuing integrated vital sign displays to efficiently communicate patient conditions in complex environments. On the battlefield, swift decision-making is essential, as combat medics must minimize the time required to assess and act in critical situations.