## 3 Novel Human Machine Team Design
### Human-in-the-Loop (HIL) Simulation Method
#### 3.3.2 Experiment Case 2: Medic Treating Patient  
1. Testing Scenario: The testing scenario developed in this case has a major portion in common with the first case study. The scenario explains a situation in which a patient suffers profuse bleeding and a block in the airways and therefore needs immediate medical attention. The task assigned to ECP begins with the cessation of bleeding by proper application of two tourniquets, as mentioned in Case Study 1. It also involves assessing a patient's airways, respiration rate, and capillary refill and pulse rate, then concludes with the patient's history collection. The total number of steps composed to accomplish an established scenario is seventeen. Here, the task to assess a patient's airways comprises of seven steps as well as another two steps to diagnose a patient's respiration rate. Meanwhile, the task to assess capillary refill and pulse rate comprises of four steps and another four for collecting the patient's background information. The process protocol is also chosen from military medic first responder training, known as MARCHE. 2. Experimental Setup: A complete human manikin model with a massive hemorrhage on its left leg was considered for the experiment, as shown in Figure 7. In addition, Amazon Echo, based on the VBSA platform, was also utilized in this experiment similarly to Case Study 1 to assist trainees in emergency medical care. The experiment is carried out at the Immersive Simulation Center in a controlled environment at The University of Toledo. As part of the experimental setup briefing, testing and survey rooms were arranged with total isolation. The testing room comprised of a human manikin model, VBSA, ECP, and information dashboard with displays. The purpose of the task execution display is to avoid an additional workload that the participant has to endure by remembering the entire step sequence. The experiment is also video logged with participants' identity discretion, while an independent observer appraises the performance of the trainee and the VBSA. The performance metrics such as task execution, implementation errors, recording errors, and subjective cognitive load of the participant are taken into consideration. Interested readers are encouraged to refer to [5; 47] for detailed information on platform selection and software development. 3. Experiment Objectives: In this experiment, the objective of the case study is to evaluate the performance of the medic and the VBSA individually and as a team. As per the established scenario, VBSA assists the ECP in providing medical assistance to the patient. In this process, parameters such as the errors committed by both human and VBSA during task execution, mental workload experienced by an ECP, the VBSA's task monitoring performance, interaction effort between ECP and VBSA, effect of NLP on task success, team cohesion, and time taken to finish the task are put to evaluation. The prime difference between Case Studies 1 and 2 is the participant's medical pre-knowledge in emergency medical care and the absence of a control population set in the experimental process. It is hypothesized that the combination of human and machine team will greatly enhance task execution and capacity handling. In addition, the application of VBSA also reflects on minimization of errors. Figure 7: Experimental setup: participants treating manikin patient in Case 2 (reproduced from [5]). Participants: As aforementioned in the above section, it was required that the participants have pre-knowledge of the medical process; thus, medical students were chosen for the experiment. As presented in Table 2, a total of 52 candidates from different branches of medical school at The University of Toledo participated in the experiment. The range of degrees held by the participants varied from high school to Ph.D. Among them, eighteen candidates were male, while the rest were female. Advertisements were posted within the medical college to hire people who volunteered for the experiment.