Discussion
cognitive overload, overdose, opioid overdose
To optimize the ability of a bystander to accurately follow instructions in a stressful environment, the mode of instruction must be tailored to the working memory function under stress. Our results show that an audio component is most effective when it is phrased directly and/or appears in conjunction with visual instruction. Questions Q1 and Q5 displayed the most accurate responses for both intervention and control groups, with 97.4% accuracy for both questions in the control group and the 93.5% and 92.9% accuracy on Q1 and Q5 respectively in the intervention group (Table There must be a balance of audio and visual output due to the possibility of cognitive overload [The control group did significantly better in accuracy on the visual-only Q2 than the intervention group, with 76.9% accuracy in the control group and 54.4% accuracy in the intervention group (In a similar context, the audio-only question Q3 was overall lower in accuracy than audio-only Q5. Results for Q3 showed 66.6% accuracy in the control group and 58.4% accuracy in the intervention group, compared to 97.4% accuracy in the control group and 92.2% accuracy in the intervention group for Q5. The instructions in Q3 asked the participant to identify the second word that they heard from a list of random words, while Q5 asked the participant to identify the first sound that they heard from a series of animal noises. Because the content of both questions would be considered generally familiar and simple, we do not suspect the specifics of the words or sounds to be at play in the accuracy discrepancy between questions. Rather, we postulate that the primacy effect [Our study finds that a stressful environment negatively impacts the ability of the working memory to respond accurately to instructions. While this was expected, the variety of instruction methods used in our study implies that certain types of instructions provided to bystanders are more likely to improve outcomes for opioid overdose victims. Administrating naloxone to victims is likely to be impacted by the inevitably stressful environment of a medical emergency, so the instructions for bystanders must be effective. Only half the number of participants in the intervention group followed instructions with 100% accuracy when compared to the control group. By extension, if only half of the bystanders who receive instructions are able to successfully intervene, then the instructions are not effective enough to maximize clinical outcomes of overdose victims. Therefore, we recommend that instructions presented to bystanders are direct, containing a balance of audio and visual components to avoid cognitive overload in stressful environments. Important information should be clearly stated with one task to perform at a time.