JMIR Publications

ABSTRACT

Background:

Optimal responses to major incidents in road tunnels involve efficient decision-making among the responding emergency services (fire and rescue services, police, and ambulances). The infrequent occurrence of road tunnel incidents may entail unfamiliarity with the tunnel environment and lead to uncertain and inefficient decision-making among emergency services commanders. Ambulance commanders have requested tunnel-specific learning materials to improve their preparedness.

Objective:

The aim of this paper is to assess decision-making among ambulance commanders in simulated road tunnel incidents after participating in a purpose-built e-learning course designed to support timely and correct decisions in this context.

Methods:

We conducted a web-based intervention study involving 20 participants from emergency medical services in Sweden, who were randomly allocated to a test or control group. The control group (n=10) received a lecture on general incident management, the intervention group (n=10) completed an e-learning course consisting of five modules focused on tunnel structure, safety, and collaboration in response. The participants took part in two simulations-based assessments for ambulance commander decision-making in major road tunnel incidents after one month and six months after their allocated study intervention. In each simulation, the participants decided on the best course of action at 15 independent decision points, designed as multiple-choice questions. The primary outcome was the correct response to the incident-specific decision to enter the tunnel appropriately. The secondary outcome measurements were correct or incorrect responses and the time taken to decide for each of the 15 decisions. Limited in-depth follow-up interviews were conducted with participants (n=5) and collected data were analyzed using qualitative content analysis.

Results:

All 20 participants completed the first simulation, and 16 (80%) completed the second. The main finding was that none (0/20) of the participants correctly answered the question on entering the tunnel system in the one-month assessment. There were no significant differences between the groups (P=.59, two sample test of proportions) in the second assessment. The e-learning course was not associated with more correct answers at the first assessment, including accounting for participant factors (mean difference between groups -.58 points, -1.88–.73, 95% CI, P=.36). The e-learning course was not associated with a shorter time to completion compared to the non-intervention group in either assessment. Interviews identified 3 categories linked to the main outcome information (lack of), risk (limited knowledge and equipment), mitigation (access to maps and aide-memoires).

Conclusions:

Ambulance commanders’ reluctancy to enter a road tunnel system in major incidents could result in delayed treatment of time-sensitive injuries. The observed hesitation may have several plausible causes, as for example lack of actionable intelligence and tunnel-specific plans. This novel approach to assess commander decision-making may be transferable to other environments and organizations, where rapid decision-making is of vital importance.