"Little is known about how packages perform in emergency contexts and the behaviors that Emergency Medical Service (EMS) responders use to deal with any shortcomings in package designs in these environments. Our years of work with healthcare providers in varied care settings yields anecdotal evidence that emergency personnel interact differently with healthcare packaging than providers in perioperative environments (e.g. one-handed use and use of teeth/tools for opening). It is not unreasonable to purport that these behaviors have the potential to play a role in patient outcomes. As such, investigation into difficulties with packaging, the designs, and conditions that induce them, is warranted.The overarching goal of this work is to develop packages optimized for prehospital settings and austere use contexts. In support of this overarching goal, work presented here was directed by four specific aims;2022Aim 1-Verify the presence of difficulties with packaging in prehospital contexts, coping strategies employed to overcome difficulties and begin to characterize prevalence.2022Aim 2- Identify factors (both package design and context) that induce unintended behaviors (e.g. use of teeth and scissors) in prehospital settings.2022Aim 3-Create simulation scenarios (contexts) that induce the unintended behaviors/coping strategies studied previously.2022Aim 4- Develop an understanding of affordance behaviors EMS personnel use to deal with packaging (i.e. coping strategies) during tasks (opening, identifying and using) and characterize design cues and contextual factors that induce them.In support of Aim 1, a survey was distributed to 12,000 paramedics. Of the 1,912 responses (16% response rate), 1,702 were usable for analysis. Survey results reinforced anecdotal observations that EMS providers have difficulty with packaging, namely, identifying, opening, and using. Over 20% of respondents included in the analysis reported that they had experienced difficulties identifying (21.1 %) or opening (20.0%) medications and identifying (17.1 %) or opening (23.5%) medical supplies within the past year. This was reported to negatively impact patient care for between 1.2% (identifying a medication) and 3.0% (opening supplies) of total responses. The results suggested difficulties associated with packaging use (identify, open, and use) induced coping strategies and negative patient outcomes and supports our anecdotal observation that paramedics use coping strategies (e.g. one hand use and use of teeth/tools, etc.) to deal with shortcomings of package design.In support of Aims 2 and 3, we created a collective case study gathered using a series of semi-structured interviews for the purpose of designing the final study, a formative usability study employing simulation scenarios for two patients. Findings suggested patient demographics (namely infants and obese patients); condition (those requiring care on multiple systems-e.g. pulmonary and cardiac) and behavior (e.g. drunk, belligerent, intoxicated, non-responsive patients) formed "worst case" scenarios. Sudden stops, bumps and potholes were all reported as further impacting difficulties. These findings coupled with a thorough review of ISO 2631 and the literature regarding whole body vibration and human ability informed decisions regarding the creation of a vibration profile intended to present realistic, but extreme, conditions likely to induce difficulties.Leveraging learnings from Aims 1 and 2, simulation scripts were drafted and conducted in our ambulance simulator that incorporated motion with licensed paramedics. Video collected from varied angles was analyzed post-hoc to conduct a formative usability analysis. Usability metrics included in analysis were informed by ISO 9241-11; namely, 1) efficiency (time task analysis), 2) error (identification of designs that induced unintended behaviors, and 3) self-reported satisfaction (informed by ISO 9241-11 (2018 International Organization for Standardization [ISO], 2018)."--Pages ii-iii.
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