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French, J. P., D. Maclean, K. David, A. McCoy, S. Benjamin, J. Fraser, T. Pishe, and P. Atkinson. "P049: Changes in situational awareness of emergency teams in simulated trauma cases using an RSI checklist." CJEM 20, S1 (May 2018): S74. http://dx.doi.org/10.1017/cem.2018.247.
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Introduction: Situational awareness (SA) is the team understanding patient stability, presenting illness and future clinical course. Losing SA has been shown to increase safety-critical events in multiple industries. SA can be measured by the previously validated Situational Awareness Global Assessment Tool (SAGAT). Checklists are used in many safety-critical industries to reduce errors of omission and commission. An RSI checklist was developed from case review and published evidence.The New Brunswick Trauma Program supports an inter-professional simulation-based medical education program Methods: Simulations were facilitated in three hospitals in New Brunswick from April 2017 to October 2017. Learner profiles were collected. The SAGAT tool was completed by a research nurse at the end of each scenario. SAGAT scores were non-normally distributed, so results were expressed as medians and interquartile ranges. Mann Whitney U tests were used to calculate statistical significance. To understand the effect of the of an RSI checklist a comparison was made between SAGAT scores at baseline in scenario 1, and the same first scenario completed after a washout period. A Poisson regression analysis will be used to account for the effect of confounding variables in further analyses. Results: The group was composed of Registered Nurses (8), Physicians (7), and Respiratory Therapists (2). Situational awareness increased significantly with the use of an RSI checklist after 1 day of 4 simulations. The washout period ranged between 5 weeks and 8 weeks. The baseline situational awareness of the whole group during scenario 1 was 9 +/− 0.5 (median, IQR), and with the RSI checklist was 12 +/−1 (median, IQR). The difference was highly statistically significant, p=< 0.001. This level of situational awareness using checklist is comparable to the SAGAT scores after 10 scenarios. Conclusion: In this provisional analysis, the use of an RSI checklist was associated with an increase in measured situational awareness. Higher levels of situational awareness are associated with greater patient safety. A Poisson regression model will be used to understand the confounding effects of user expertise and the likely interaction with simulation exposure.
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Pérez-Wulff, Juan, Daniel Márquez, Jesús Veroes, Jonel Di Muro, Carlos Lugo, Rafael Cortés, Susana De Vita, Kenny Araujo, Edinson Valencia, and Stefanía Robles. "Listas de chequeo en obstetricia: ayudas cognitivas que salvan vidas." Revista de Obstetricia y Ginecología de Venezuela 80, no. 04 (December 7, 2020): 292–302. http://dx.doi.org/10.51288/00800406.
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Objective: To propose the use of eight checklists in the country’s obstetric emergency rooms. Methods: An interdisciplinary team was established with physicians specializing in obstetrics and gynecology, perinatology, fetal maternal medicine, critical medicine, anesthesiology, infectology and neonatology. Upon determination of the main pathologies affecting maternal mortality in Venezuela, multiple checklists used in different centers worldwide, publications available in databases and expert opinions were reviewed. They adapted to the realities of the country and medical availability and prioritized medical actions, laboratory tests, drug treatment and diagnostic elements. Results: Checklists for postpartum hemorrhage, obstetric sepsis, hypertensive pregnancy disorders (preeclampsia with signs of severity and eclampsia), magnesium sulfate poisoning, placental acretism, maternal cardiopulmonary resuscitation, and trauma and pregnancy are presented. Conclusion: The checklists resulting from the initiative of the Society of Obstetrics and Gynecology of Venezuela are available to all health personnel who require them for implementation in educational simulation scenarios and in clinical practice, as an additional tool for finding better outcomes in patients who require high complexity management in maternity rooms. Keywords: Checklist, Postpartum hemorrhage, Obstetric sepsis, Hypertensive pregnancy disorders, Magnesium sulfate poisoning, Placental acretism, Maternal cardiopulmonary resuscitation, Trauma and pregnancy
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Binstadt, Emily, Rachel Dahms, Amanda Carlson, Cullen Hegarty, and Jessie Nelson. "When the Learner Is the Expert: A Simulation-Based Curriculum for Emergency Medicine Faculty." Western Journal of Emergency Medicine 21, no. 1 (December 19, 2019): 141–44. http://dx.doi.org/10.5811/westjem.2019.11.45513.
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Emergency physicians supervise residents performing rare clinical procedures, but they infrequently perform those procedures independently. Simulation offers a forum to practice procedural skills, but simulation labs often target resident learners, and barriers exist to faculty as learners in simulation-based training. Simulation-based curricula focused on improving emergency medicine (EM) faculty’s rare procedure skills were not discovered on review of published literature. Our objective was to create a sustainable, simulation-based faculty education curriculum for rare procedural skills in EM. Between 2012 and 2019, most EM teaching faculty at a single, urban, Level 1 trauma center completed an annual two-hour simulation-based rare procedure lab with small-group learning and guided hands-on instruction, covering 30 different procedural education sessions for faculty learners. A questionnaire administered before and after each session assessed EM faculty physicians’ self-perceived ability to perform these rare procedures. Participants’ self-reported confidence in their performance improved for all procedures, regardless of prior procedural experience. Faculty participation was initially mandatory, but is now voluntary. Diverse strategies were used to address barriers in this learner group including eliciting learner feedback, offering continuing medical education credits, gradual roll-out of checklist assessments, and welcoming expertise of faculty leaders from EM and other specialties and professions. Participants perceived training to be most helpful for the most rarely-encountered clinical procedures. Similar curricula could be implemented with minimal risk at other institutions.
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Lee-Nobbee, P., S. MacGillivray, R. Lam, J. Guilfoyle, A. Mikrogianakis, Y. Lin, V. Grant, and A. Cheng. "P090: The use of a pediatric pre-arrival and pre-departure trauma checklist to improve clinical care in a simulated trauma resuscitation: a randomized trial." CJEM 20, S1 (May 2018): S88—S89. http://dx.doi.org/10.1017/cem.2018.288.
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Introduction: The purpose of this study is to determine if the introduction of a pre-arrival and pre-departure Trauma Checklist as a cognitive aid, coupled with an educational session, will improve clinical performance in a simulated environment. The Trauma Checklist was developed in response to a quality assurance review of high-acuity trauma activations. It focuses on pre-arrival preparation and a pre-departure review prior to patient transfer to diagnostic imaging or the operating room. We conducted a pilot, randomized control trial assessing the impact of the Trauma Checklist on time to critical interventions on a simulated pediatric patient by multidisciplinary teams. Methods: Emergency department teams composed of 2 physicians, 2 nurses and 2 confederate actors were enrolled in our study. In the intervention arm, participants watched a 10-minute educational video modelling the use of the trauma checklist prior to their simulation scenario and were provided a copy of the checklist. Teams participated in a standardized simulation scenario caring for a severely injured adolescent patient with hemorrhagic shock, respiratory failure and increased intracranial pressure. Our primary outcome of interest was time measurement to initiation of key clinical interventions, including intubation, first blood product administration, massive transfusion protocol activation, initiation of hyperosmolar therapy and others. Secondary outcome measures included a Trauma Task Performance score and checklist completion scores. Results: We enrolled 14 multidisciplinary teams (n=56 participants) into our study. There was a statistically significant decrease in median time to initiation of hyperosmolar therapy by teams in the intervention arm compared to the control arm (581 seconds, [509-680] vs. 884 seconds, [588-1144], p=0.03). Time to initiation of other clinical interventions was not statistically significant. There was a trend to higher Trauma Task Performance scores in the intervention group however this did not reach statistical significant (p=0.09). Pre-arrival and pre-departure checklist scores were higher in the intervention group (9.0 [9.0-10.0] vs. 7.0 [6.0-8.0], p=0.17 and 12.0 [11.5-12.0] vs. 7.5 [6.0-8.5], p=0.01). Conclusion: Teams using the Trauma Checklist did not have decreased time to initiation of key clinical interventions except in initiating hyperosmolar therapy. Teams in the intervention arm had statistically significantly higher pre-arrival and pre-departure scores, with a trend to higher Trauma Task Performance scores. Our study was a pilot and recruitment did not achieve the anticipated sample size, thus underpowered. The impact of this checklist should be studied outside tertiary trauma centres, particularly in trainees and community emergency providers, to assess for benefit and further generalizability.
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Amirrafiei, Arash, Seyyed Mahdi Zia Ziabari, Fatemeh Haghshenas-Bakerdar, Ehsan Kazemnejad-Leili, and Payman Asadi. "Clinical competencies of emergency medical services paramedics in responding to emergency conditions using Objective Structured Clinical Examination (OSCE) in Guilan." Journal of Emergency Practice and Trauma 7, no. 2 (May 16, 2021): 101–5. http://dx.doi.org/10.34172/jept.2021.03.
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Objective: Evaluating the abilities of emergency medical services (EMS) staff who are in the frontline of the diseases could be an excellent reflection of the accuracy of curriculum both before and after graduation. This study was done to determine the clinical competencies of Guilan EMS staff in responding to emergency conditions using Objective Structured Clinical Examination (OSCE). Methods: In this descriptive study, 70 EMS staff from selected Emergency Centres in Guilan were recruited. Data were collected using a questionnaire and a checklist which included 9 different skills. Validity of the checklist was assessed by obtaining the opinions of 10 experts. The content validity index (CVI) and content validity ratio (CVR) of the checklist were 0.7 and 0.8, respectively. The reliability of the checklist was obtained using the test-retest method (r=0.89). In order to collect data, observations were done using the designated checklist. Data were analysed using SPSS software version 22 and descriptive statistical tests. Results: Findings showed that 56.3% of the paramedics got good scores for trauma competency but the mean scores for two competencies of spinal cord immobilization and vehicle extrication were low, indicating major skills problem. There was a statistically significant relationship between education (P=0.02) and work experience (P=0.03) as well as clinical skills in confronting trauma. Conclusion: Although the EMS staff had an acceptable range of performance in most of the skills, it seems that there is a need for training of performance-based competencies in which paramedics had a poor performance.
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Forristal, C., K. Hayman, N. Smith, S. Mal, M. Columbus, N. Farooki, S. McLeod, K. Van Aarsen, and D. Ouellette. "LO43: Perceptions of airway checklists and the utility of simulation in their implementation emergency medicine practitioner perspectives." CJEM 20, S1 (May 2018): S21—S22. http://dx.doi.org/10.1017/cem.2018.105.
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Introduction: Checklists used during intubation have been associated with improved patient safety. Since simulation provides an effective and safe learning environment, it is an ideal modality for training practitioners to effectively employ an airway checklist. However, physician attitudes surrounding the utility of both checklists and simulation may impede the implementation process of airway checklists into clinical practice. This study sought to characterize attitudinal factors that may impact the implementation of airway checklists, including perceptions of checklist utility and simulation training. Methods: Emergency medicine (EM) residents and physicians working more than 20 hours/month in an emergency department from two academic centres were invited to participate in a simulated, randomized controlled trial (RCT) featuring three scenarios performed with or without the use of an airway checklist. Following participation in the scenarios, participants completed either a 26-item (control group), or 35-item (checklist group) paper-based survey comprised of multiple-choice, Likert-type, rank-list and open-ended questions exploring their perceptions of the airway checklist (checklist group only) and simulation as a learning modality (all participants). Results: Fifty-four EM practitioners completed the questionnaire. Most control group participants (n=24/25, 96.0%) believed an airway checklist would have been helpful (scored 5/7 or greater) for the scenarios. The majority of checklist group participants (n=29) believed that the checklist was helpful for equipment (27, 93.1%) and patient (26, 89.6%) preparation, and post-intubation care (21, 82.8%), but that the checklist delayed definitive airway management and was not helpful for airway assessment, medication selection, or choosing to perform a surgical airway. This group also believed that using the airway checklist would reduce errors during intubation (27, 93.1%) and that the simulated scenarios were beneficial for adopting the use of the checklist (28, 96.6%). Fifty-three participants (98.1%) believed that simulation is beneficial for continuing medical education and 51 respondents (94.4%) thought that skills learned in this simulation were transferable. Conclusion: EM practitioners participating in a simulation-based RCT of an airway checklist had positive attitudes towards both the utility of airway checklists and simulation as a learning modality. Thus, simulation may be an effective process to train practitioners to use airway checklists prior to clinical implementation.
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Hoopes, Katherine, Tessa Lewitt, Anum Naseem, Anne Messman, and Sarkis Kouyoumjian. "Improving Medical School Education on the Care of Sexual Assault Patients: A Quasi-Randomized Controlled Study." International Journal of Medical Students 9, no. 2 (June 22, 2021): 129–39. http://dx.doi.org/10.5195/ijms.2021.797.
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Introduction: Comprehensive healthcare for survivors of sexual violence is essential to prevent the diverse sequelae associated with the assault. In partnership with a local rape crisis center, we designed an educational module with the goal of training medical students on the basic needs of sexual assault patients with the aim to see if there was a significant difference in preparedness to counsel such patients.
Methods: This quantitative quasi-randomized controlled study tested the effectiveness of an educational module on improving medical student preparedness for encounters with victims of sexual assault. A one-hour presentation, focusing on basic medical and legal knowledge regarding sexual abuse and compassionate patient-centered care, was provided to the intervention group during their compulsory Year 4 Emergency Medicine clerkship orientation. At the end of the month, students in the intervention and control groups were assessed using a standardized patient encounter simulating the presentation of a victim of sexual assault. Scores were determined by standardized patients, who utilized two checklists-one widely used for communication skills (KEECC-A) and the other focusing on sexual assault (WC-SAFE-specific).
Results: For the KEECC-A, there was no significant difference in scores between the control and intervention groups (p=0.9257, 95% Confidence Interval [95%CI] 14.42,15.58]). The WC-SAFE-specific checklists were significantly different between the intervention and control groups (p=0.0076, 95%CI 3.79,4.21).
Conclusion: Our sexual assault module increased preparedness of medical students for encounters with sexual assault victims and provide trauma-informed care.
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Delp, Scott L., Peter Loan, Cagatay Basdogan, and Joseph M. Rosen. "Surgical Simulation: An Emerging Technology for Training in Emergency Medicine." Presence: Teleoperators and Virtual Environments 6, no. 2 (April 1997): 147–59. http://dx.doi.org/10.1162/pres.1997.6.2.147.
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The current methods of training medical personnel to provide emergency medical care have several important shortcomings. For example, in the training of wound debridement techniques, animal models are used to gain experience treating traumatic injuries. We propose an alternative approach by creating a three-dimensional, interactive computer model of the human body that can be used within a virtual environment to learn and practice wound debridement techniques and Advanced Trauma Life Support (ATLS) procedures. As a first step, we have developed a computer model that represents the anatomy and physiology of a normal and injured lower limb. When visualized and manipulated in a virtual environment, this computer model will reduce the need for animals in the training of trauma management and potentially provide a superior training experience. This article describes the development choices that were made in implementing the preliminary system and the challenges that must be met to create an effective medical training environment.
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Bhoi, Sanjeev, DK Sharma, Sheetal Singh, Sapna Ramani Sardana, and Sonia Chauhan. "Code Blue Policy for a Tertiary Care Trauma Hospital in India." International Journal of Research Foundation of Hospital and Healthcare Administration 3, no. 2 (2015): 114–22. http://dx.doi.org/10.5005/jp-journals-10035-1047.
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ABSTRACT “Code Blue” is generally used to indicate a patient requiring resuscitation or in need of immediate medical attention, most often as the result of a respiratory arrest or cardiac arrest. When called overhead, the page takes the form of “Code Blue, (floor), (room)” to alert the resuscitation team where to respond. Every hospital, as a part of its disaster plans, sets a policy to determine which units provide personnel for code coverage. In theory, any emergency medical professional may respond to a code, but in practice the team makeup is limited to those with advanced cardiac life support or other equivalent resuscitation training. Frequently, these teams are staffed by physicians (from anesthesia and internal medicine in larger medical centers or the emergency physician in smaller ones), respiratory therapists, pharmacists, and nurses. A code team leader will be a physician in attendance on any code team; this individual is responsible for directing the resuscitation effort and is said to “run the code”. This phrase was coined at Bethany Medical Center in Kansas City, Kansas. The term “code” by itself is commonly used by medical professionals as a slang term for this type of emergency, as in “calling a code” or describing a patient in arrest as “coding”.1 The purpose of this study is to make available policy with regard to Code Blue which can be followed in a tertiary care hospitals. It was a descriptive cross-sectional study carried out between January and June 2015. The study population included doctors, nursing personnel, paramedical staff and quality managers of tertiary care hospital from public and private hospitals. Checklist was made after an exhaustive review of literature which was then improvised. The checklist was discussed in focused group discussion held on 1 June 2015, and suggestions were incorporated. Validation of the checklist was also done by experts in various private and public hospitals. Subsequently, interaction was done with study population against the backdrop of the checklist and Code Blue policy was formulated. How to cite this article Singh S, Sharma DK, Bhoi S, Sardana SR, Chauhan S. Code Blue Policy for a Tertiary Care Trauma Hospital in India. Int J Res Foundation Hosp Healthc Adm 2015;3(2):114-122.
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French, J. P., K. David, S. Benjamin, J. Fraser, J. Mekwan, and P. Atkinson. "MP19: Interprofessional airway microskill checklists facilitate the deliberate practice of direct intubation with a bougie and airway manikins." CJEM 20, S1 (May 2018): S47. http://dx.doi.org/10.1017/cem.2018.173.
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Introduction: Deliberate practice (DP) is the evolution of practice using continually challenging and focused practice on a particular task. DP involves immediate feedback, time for problem-solving and evaluation, and opportunities for repeated performance. Mircroskills training breaks down larger tasks into multiple smaller subtasks and then adds opportunities for feedback and adjustment for each subtask. Microskills training is routinely used to achieve excellence in competitive sports, martial arts, military operations, and music. Endotracheal intubation is a complex task with a clinically significant complication and failure rate. Methods: Two doctors and three nurses developed stepwise team microskills checklist from case review, simulations and published evidence. The checklist was tested, evaluated and developed during four days of simulation faculty team training. The final 36 item checklist was used to facilitate skills training for doctors, nurses, respiratory therapists and ACPs in one level 2, and two level 3 trauma centers from April 2017 to October 2017. The microskills checklist was used in four phases: 1. Group discussion of each microskill step 2. Groups of three team members; operator, assistant and microskill facilitator (using the checklist) to enable the deliberate analysis of the teams current performance. Each subtask is performed with immediate peer and where necessary faculty feedback. Changes are recorded. 3. Total task run though without interruption. Changes are recorded. 4. Repetition and feedback using different team members, manikins, including time pressure. User satisfaction surveys were collected after the skills training session Results: Results. Teams were composed of Registered Nurses (8), Physicians (9), and Respiratory Therapists (2). All of the teams experienced a change in practice. The median number of microskills changed for MDs 13/30, RNs 7/16. The commonest changes in practice were patient positioning (all teams). All professions agreed strongly that the approach produces a positive change in practice (median score 4.8/5). Conclusion: Microskills checklist facilitate endotracheal intubation with a bougie skill development in interprofessional teams in this provisional analysis.
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Schofield, Louise, Emma Welfare, and Simon Mercer. "In-situ simulation." Trauma 20, no. 4 (July 23, 2017): 281–88. http://dx.doi.org/10.1177/1460408617711729.
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‘In-situ’ simulation or simulation ‘in the original place’ is gaining popularity as an educational modality. This article discusses the advantages and disadvantages of performing simulation in the clinical workplace drawing on the authors’ experience, particularly for trauma teams and medical emergency teams. ‘In-situ’ simulation is a valuable tool for testing new guidelines and assessing for latent errors in the workplace.
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Purdy, E., C. Alexander, J. Matulich, and V. Brazil. "MP21: Improving the relational aspects of trauma care through translational simulation." CJEM 22, S1 (May 2020): S49—S50. http://dx.doi.org/10.1017/cem.2020.169.
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Introduction: Major trauma care is complex, and requires individuals and teams to perform together in time critical, high stakes situations. Scenario based simulation is well established as a strategy for trauma teamwork improvement, but its role in the relational and cultural aspects of trauma care is less well understood. Relational Coordination theory offers a framework though which we aimed to understand the impact of an established trauma simulation program Methods: We studied simulation activities using a narrative survey of trauma providers from anaesthesia, emergency medicine, medical imaging, surgery, trauma service, intensive care and pre-hospital providers at Gold Coast University Hospital, in conjunction with data from an ethnography. Data analysis was performed using a recursive approach - a simultaneous deductive approach using the relational coordination framework and an inductive analysis. Results: 95/480 (19.8%) staff completed free text survey questions on simulation. Deductive analysis of data from this narrative survey results using the RC framework domains identified examples of shared goals, shared knowledge, communication, and mutual respect. Two major themes from the inductive analysis – “Behaviour, process and system change”, and “Culture and relationships” - aligned closely with findings from the RC analysis, with additional themes of “Personal and team learning” and the “Impact of the simulation experience” identified. Conclusion: Our findings suggest that an established trauma simulation program can have a profound impact on the relational aspects of care and the development of a collaborative culture, with perceived tangible impacts on teamwork behaviours and institutional systems and processes. The RC framework – shared knowledge, shared goals and mutual respect in the context of communication that is timely, accurate, frequent and problem-solving based – can provide a common language for simulation educators to design and debrief simulation exercises that aim to have a translational impact.
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Magalini, S., M. Di Mugno, A. De Gaetano, G. La Posta, D. Sermoneta, and D. Gui. "(A143) European Project SICMA (Simulation of Crisis Management Activities) for Medical Management of Maxi Emergency Trauma Patients." Prehospital and Disaster Medicine 26, S1 (May 2011): s41. http://dx.doi.org/10.1017/s1049023x11001440.
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IntroductionModern emergencies and disasters are progressively changing from relatively simple, predictable events controllable with standard management solutions to complex critical situations for which managers and first responders require innovative and affordable tools.MethodsThe European Project SICMA (Simulation of Crisis Management Activities) provides a modeling of the behavior of the entire Health Service System during field emergency operations, as well as the rules it operates by. Use of simulation technologies offers a significant improvement on current management activities allowing decision makers to confront several organizational alternatives not only with static situations but with evolving scenarios.ResultsSICMA simulates main structural and behavioral elements of maxi emergency and mass casualties, from individual casualties and evolution of their health status, activity of the police force and fire brigade on the accident site, crowd dynamics, sanitary personnel expertise, to ambulance and helicopter transportation depending on traffic and weather conditions. The system also simulates rescue doctrines (i.e. “Casualty Clearing Station” or “Scoop and run”), transportation priorities according to color codes, doctrines for assignment of new casualty to neighboring hospitals, hospital resources and involvement, final clinical outcome of individual casualties. Patient health status and physiological reserve of single casualty is based on the ABCD ATLS system, considering with a simple algorithm both level of damage and rate of worsening in time.ConclusionUtilizing this simulation system, managers who predispose organizational and logistic procedures may modify the main elements in order to identify the optimal resource allocation and the best procedures to save the most human lives.
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French, J. P., K. David, S. Benjamin, J. Fraser, J. Mekwan, and P. Atkinson. "P048: Interprofessional airway microskill checklists facilitate the deliberate practice of surgical cricothyrotomy with 3-D printed surgical airway trainers." CJEM 20, S1 (May 2018): S73—S74. http://dx.doi.org/10.1017/cem.2018.246.
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Introduction: Deliberate practice (DP) is the evolution of practice using continually challenging and focused practice on a particular task. DP involves immediate feedback, time for problem-solving and evaluation, and opportunities for repeated performance. Microskills training breaks down larger tasks into multiple smaller subtasks and then adds opportunities for feedback and adjustment for each subtask. Microskills training is routinely used to achieve excellence in competitive sports, martial arts, military operations, and music. Surgical cricothyrotomy is a rarely performed safety critical task. Methods: Two doctors and three nurses developed stepwise team microskills checklists from case review, simulations and published evidence. The checklist was tested, evaluated and developed during four days of simulation faculty team training. The final 30 item checklist was used to facilitate skills training for doctors, nurses, respiratory therapists and ACPs in one level 2, and two level 3 trauma centers from April 2017 to October 2017. Commonly available airway trainers were retrofitted with the 3-D printed larynx. The microskills checklist was used in four phases: 1. Group discussion of each microskill step; 2. Groups of three team members; operator, assistant and microskill facilitator (using the checklist) to enable the deliberate analysis of the teams current performance. Each subtask is performed with immediate peer and where necessary faculty feedback - changes are recorded; 3. Total task run through without interruption - changes are recorded; 4. Repetition and feedback using different team members, manikins, including time pressure. User satisfaction surveys were collected after the skills training session Results: Teams were composed of Registered Nurses (8), Physicians (9), and Respiratory Therapists (2). All of the teams experienced a change in practice. The median number of microskills changed for MDs 12/21, RNs 6/12. The commonest changes in practice were equipment preparation (all teams). All professions agreed strongly that the approach produces a positive change in practice (median score 5/5). Conclusion: Microskills checklists facilitate cricothyrotomy skill development in interprofessional teams in this provisional analysis.
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Couperus, K. "77 Virtual Reality Trauma Simulation: An Immersive Method to Enhance Medical Personnel Training and Readiness." Annals of Emergency Medicine 74, no. 4 (October 2019): S30. http://dx.doi.org/10.1016/j.annemergmed.2019.08.081.
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Smolle, Josef, Gerhard Prause, and Freyja-Maria Smolle-Jüttner. "Emergency treatment of chest trauma — an e-learning simulation model for undergraduate medical students☆." European Journal of Cardio-Thoracic Surgery 32, no. 4 (October 2007): 644–47. http://dx.doi.org/10.1016/j.ejcts.2007.06.042.
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Glomb, Nicolaus W., Adeola A. Kosoko, Cara B. Doughty, Marideth C. Rus, Manish I. Shah, Megan Cox, Cafen Galapi, Presley S. Parkes, Shelley Kumar, and Bushe Laba. "Needs Assessment for Simulation Training for Prehospital Providers in Botswana." Prehospital and Disaster Medicine 33, no. 6 (November 13, 2018): 621–26. http://dx.doi.org/10.1017/s1049023x18001024.
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AbstractBackgroundIn June 2012, the Botswana Ministry of Health and Wellness (MOHW; Gaborone, Botswana) initiated a national Emergency Medical Services (EMS) system in response to significant morbidity and mortality associated with prehospital emergencies. The MOHW requested external expertise to train its developing workforce. Simulation-based training was planned to equip these health care providers with clinical knowledge, procedural skills, and communication techniques.ObjectiveThe objective of this study was to assess the educational needs of the pioneer Botswana MOHW EMS providers based on retrospective EMS logbook review and EMS provider feedback to guide development of a novel educational curriculum.MethodsData were abstracted from a representative sample of the Gaborone, Botswana MOHW EMS response log from 2013-2014 and were quantified into the five most common call types for both adults and children. Informal focus groups with health professionals and EMS staff, as well as surveys, were used to rank common response call types and self-perceived educational needs.ResultsBased on 1,506 calls, the most common adult response calls were for obstetric emergencies, altered mental status, gastrointestinal/abdominal pain, trauma, gynecological emergencies, and cardiovascular and respiratory distress-related emergencies. The most common pediatric response calls were for respiratory distress, gastrointestinal complaints/dehydration, trauma and musculoskeletal injuries, newborn delivery, seizures, and toxic ingestion/exposure. The EMS providers identified these same chief complaints as priorities for training using the qualitative approach. A locally relevant, simulation-based curriculum for the Botswana MOHW EMS system was developed and implemented based on these data.Conclusions: Trauma, respiratory distress, gastrointestinal complaints, and puerperal/perinatal emergencies were common conditions for all age groups. Other age-specific conditions were also identified as educational needs based on epidemiologic data and provider feedback. This needs assessment may be useful when designing locally relevant EMS curricula in other low-income and middle-income countries.GlombNW, KosokoAA, DoughtyCB, RusMC, ShahMI, CoxM, GalapiC, ParkesPS, KumarS, LabaB.Needs assessment for simulation training for prehospital providers in Botswana. Prehosp Disaster Med. 2018;33(6):621–626.
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Argintaru, N., A. Petrosoniak, C. Hicks, K. White, M. McGowan, and S. H. Gray. "P010: Code Silver: Lessons learned from the design and implementation of Active Shooter Simulation In-Situ Training (ASSIST)." CJEM 19, S1 (May 2017): S80—S81. http://dx.doi.org/10.1017/cem.2017.212.
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Introduction: Hospital shootings are rare events that pose extreme and immediate risk to staff, patients and visitors. In 2015, the Ontario Hospital Association mandated all hospitals devise an armed assailant Code Silver protocol, an alert issued to mitigate risk and manage casualties. We describe the design and implementation of ASSIST (Active Shooter Simulation In-Situ Training), an institutional, full-scale hybrid simulation exercise to test hospital-wide response and readiness for an active shooter event, and identify latent safety threats (LSTs) related to the high-stakes alert and transport of internal trauma patients. Methods: A hospital-wide in-situ simulation was conducted at a Level 1 trauma centre in downtown Toronto. The two-hour exercise tested a draft Code Silver policy created by the hospital’s disaster planning committee, to identify missing elements and challenges with protocol implementation. The scenario consisted of a shooting during a hospital meeting with three casualties: a manikin with life-threatening head and abdomen gunshot wounds (GSWs), a standardized patient (SP) with hypotension from an abdominal GSW, and a second SP with minor injuries and significant psychological distress. The exercise piloted the use of a novel emergency department (ED)-based medical exfiltration team to transport internal victims to the trauma bay. The on-call trauma team provided medical care. Ethnographic observation of response by municipal police, hospital security, logistics and medical personnel was completed. LSTs were evaluated and categorized using video framework analysis. Feasibility was measured through debriefings and impact on ED workflow. Results: Seventy-six multidisciplinary medical and logistical staff and learners participated in this exercise. Using a framework analysis, the following LSTs were identified: 1) Significant communication difficulties within the shooting area, 2) Safe access and transport for internal casualties, 3) Difficulty accessing hospital resources (blood bank) 4) Challenges coordinating response with external agencies (police, EMS) and 5) Delay in setting up an off-site command centre. Conclusion: In situ simulation represents a novel approach to the development of Code Silver alert processes. Findings from ethnographic observations and a video-based analysis form a framework to address safety, logistical and medical response considerations.
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Azadeh, Mohammad Reza, Mohammad Parvaresh Massoud, Mina Gaini, and Amir Hemta. "Comparative Study of Road Traffic Accident Victims Transferred by Air and Ground Emergency to Shahid Beheshti Medical Center in Qom City, Iran, 2015-2018." Health in Emergencies & Disasters Quarterly 6, no. 4 (July 1, 2021): 225–34. http://dx.doi.org/10.32598/hdq.6.4.397.1.
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Background: Prehospital emergency department provides land, air, boat, and rail ambulance care. This study aimed to compare the situation of air and ground emergency casualties in road traffic accidents transferred to Shahid Beheshti Medical Center in Qom City, Iran, 2015-2018. Materials and Methods: The present study is a retrospective descriptive-analytical study. All road traffic accident victims transferred to Shahid Beheshti Medical Center in Qom by prehospital emergency land or air staff from 2015 to 2018 at 6 to 20 o’clock were included in this study (census method). The exclusion criteria included burns, death, transmission during cardiopulmonary resuscitation or by urban ambulances, and information deficiencies. We used a researcher-made checklist to examine victims’ age, sex, type of transmission, type of accident, type of trauma, distance, initial vital signs, time intervals, and day of the accident. SPSS software version 16 was used to analyze the data. Data were compared in two groups with the t test and the Chi-square test. Results: A total of 2057 casualties were included in the study: 566 casualties were transferred by air emergency and 1491 by ground emergency. The mean age of air emergency casualties was significantly lower than the ground emergency (P=0.008). Trauma to the neck, chest, abdomen and lower back was significantly higher in air emergency casualties, but hand and foot trauma were more common in ground emergency casualties. Most air missions took place on holidays or weekends, while most ground missions were done during weekdays (P<0.001). The mean distance of the air emergency missions was more than Beheshti Medical Center (P<0.001). Compared with ground emergency casualties, air emergency casualties had average systolic blood pressure, lower level of consciousness, and higher heart rate and respiration (P<0.001). The mean duration of transfer from the accident scene to the medical center in the air emergency was significantly shorter (P<0.001). Conclusion: Air emergency casualties were usually accompanied by more critical vital signs and severe injuries to the neck, chest, abdomen, and back. This study can provide clinical triage criteria that focus on key environmental factors and reduced transport time. Further studies are needed to investigate the consequences of traffic accident casualties at the medical center to determine which subgroups will benefit most from using air emergency.
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Hamid, Kamran S., Benedict U. Nwachukwu, Sayon Dutta, Bret A. Nicks, and Eben A. Carroll. "Management of Extremity Injuries by Residents: Can We improve Quality and Efficiency through a Simple Checklist?" Duke Orthopaedic Journal 6, no. 1 (2016): 7–11. http://dx.doi.org/10.5005/jp-journals-10017-1062.
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ABSTRACT Introduction Variation in practice among resident physicians is a barrier to providing consistent, high-quality care to patients with musculoskeletal injuries. Materials and methods A multidisciplinary group at an academic center developed a checklist for managing suspected extremity injuries in adults. Simulation testing was conducted in which 17 Emergency Medicine residents were randomized by year of training into cohorts of 8 “checklist” residents and 9 “no checklist” residents. Each resident performed 2 case simulations and was evaluated based on adherence to 12 predefined critical process measures. Results Usage of the checklist resulted in a decrease in delay of care events (8.3 vs 27.3%, p < 0.01) and decrease in potential medical errors (5.7 vs 22.2%, p < 0.01). All levels of training demonstrated improvements, and first-year residents using the checklist performed significantly better than third-year residents without the checklist, demonstrating decrease in delay of care events (8.3 vs 26.4%, p < 0.05) and decrease in potential medical errors (5.6 vs 18.1%, p < 0.05). Conclusion Implementation of a simple checklist can reduce delays in care and potential medical errors in the management of extremity injuries by resident physicians. Hamid KS, Nwachukwu BU, Nicks BA, Dutta S, Carroll EA. Management of Extremity Injuries by Residents: Can We improve Quality and Efficiency through a Simple Checklist? The Duke Orthop J 2016;6(1):7-11. IRB statement This simulation was undertaken as part of an institutional quality improvement project and was granted Institutional Review Board exemption.
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Rosqvist, Eerika, Marika Ylönen, Paulus Torkki, Jussi P. Repo, and Juha Paloneva. "Costs of hospital trauma team simulation training: a prospective cohort study." BMJ Open 11, no. 6 (June 2021): e046845. http://dx.doi.org/10.1136/bmjopen-2020-046845.
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ObjectivesThis study investigated the costs of 2-hour multiprofessional in situ hospital trauma team simulation training and its effects on teams’ non-technical skills using the T-NOTECHS instrument.BackgroundSimulation is a feasible and effective teaching and learning method. Calculating the costs of simulated trauma team training in medical emergency situations can yield valuable information for improving its overall cost-effectiveness.DesignA prospective cohort study.SettingTrauma resuscitation room in Central Finland Hospital, Finland.Participants475 medical professionals in 81 consecutive, simulated trauma teams.Primary and secondary outcome measuresTeam simulation training costs in 2017 and 2018 were analysed in the following two phases: (1) start-up costs and (2) costs of education. Primary outcome measures were training costs per participant and training costs per team. Secondary outcome measures were non-technical skills, which were measured on a 5–25-point scale using the T-NOTECHS instrument.ResultsThe annual mean total costs of trauma team simulation training were €58 000 for 40 training sessions and 238 professionals. Mean cost per participant was €203. Mean cost per team was €1220. The annual costs of simulation training markedly decreased when at least 70–80 teams participated in the training. Mean change in T-NOTECHS score after simulation training was +2.86 points (95% CI 1.97 to 3.75;+14.5%).ConclusionsThe greater the number of teams trained per year, the lower the costs per trauma team. In this study, we developed an activity-based costing method to calculate the costs of trauma team simulation training to help stakeholders make decisions about whether to initiate or increase existing trauma team simulation training or to obtain these services elsewhere.
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Lehner, Markus, Ellen Heimberg, Florian Hoffmann, Oliver Heinzel, Hans-Joachim Kirschner, and Martina Heinrich. "Evaluation of a Pilot Project to Introduce Simulation-Based Team Training to Pediatric Surgery Trauma Room Care." International Journal of Pediatrics 2017 (2017): 1–6. http://dx.doi.org/10.1155/2017/9732316.
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Introduction. Several studies in pediatric trauma care have demonstrated substantial deficits in both prehospital and emergency department management.Methods. In February 2015 the PAEDSIM collaborative conducted a one and a half day interdisciplinary, simulation based team-training course in a simulated pediatric emergency department. 14 physicians from the medical fields of pediatric surgery, pediatric intensive care and emergency medicine, and anesthesia participated, as well as four pediatric nurses. After a theoretical introduction and familiarization with the simulator, course attendees alternately participated in six simulation scenarios and debriefings. Each scenario incorporated elements of pediatric trauma management as well as Crew Resource Management (CRM) educational objectives. Participants completed anonymous pre- and postcourse questionnaires and rated the course itself as well as their own medical qualification and knowledge of CRM.Results. Participants found the course very realistic and selected scenarios highly relevant to their daily work. They reported a feeling of improved medical and nontechnical skills as well as no uncomfortable feeling during scenarios or debriefings.Conclusion. To our knowledge this pilot-project represents the first successful implementation of a simulation-based team-training course focused on pediatric trauma care in German-speaking countries with good acceptance.
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Hong, Yucai, and Xiujun Cai. "Effect of team training on efficiency of trauma care in a Chinese hospital." Journal of International Medical Research 46, no. 1 (June 29, 2017): 357–67. http://dx.doi.org/10.1177/0300060517717401.
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Objective Multidisciplinary trauma teams are the standard of care in the USA, but staffing differences and lack of advanced trauma life support training hinder replication of this system in Chinese hospitals. We investigated the effect of simulation team training on initial trauma care. Methods Over 15 months, we compared grade I trauma patients cared for by the trained team and those cared for using traditional practice on times from emergency room arrival to tests/procedures. Propensity-score analysis was performed to improve between-group comparisons. Results During the study, 144 grade I trauma patients were treated. Trained team patients showed shorter times from emergency room arrival to initiation of hemostasis (31.0 [13.5–58.5] vs. 113.5 [77–150.50] min), blood routine report (8 [5–10.25] vs. 13 [10–21] min), other blood tests (21 [14.75–25.75] vs. 31 [25–37] min), computed tomography scan (29.5 [20.25–65] vs. 58.5 [30.25–71.25] min) and tranexamic acid administration (31 [13–65] vs. 90 [65–200] min). Similar results were obtained for the propensity-score matched cohort. Conclusion Simulation team training could help reduce time to blood routine reports, scans and hemostasis. Assessment of available resources and development of targeted team training could improve care in resource-limited hospitals.
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Moore, D., K. Atchison, and J. Boone. "(A106) Nursing Simulation in Disaster Management." Prehospital and Disaster Medicine 26, S1 (May 2011): s29—s30. http://dx.doi.org/10.1017/s1049023x11001087.
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In the United States in 2010, there were 81 federal disasters, for this reason and at the request of our clinical partners, when West Coast University (WCU) started its Baccalaureate of Science in Nursing (BSN) program in 2008, it recognized the need to have a course in disaster management. The Disaster Management course was developed in concert with other parts of the curriculum such as Leadership, Physical Assessment, Critical Care courses to help students focus their assessment and intervention skills to prepare them to be future responders. As a component of the skill development, simulation exercises were developed in the simulation center within the college of nursing. To prepare students to respond to disasters, a variety of scenarios were developed to meet national patient safety goals and various types of disaster and emergency situations. In the scenarios students learn how to work as a team, follow the chain of command, assess and rapidly intervene to such medical crisis such as hemorrhaging, trauma, burns, cardiac arrest and respiratory arrest. They also learn how to delegate to the appropriate personnel as well as leadership skills. Students find this educational and reassuring to be able to practice these very high level sentinel events in a secure environment where they will get immediate feedback not only from instructors but from their peers. Preliminary research have identified students having significant improvement in their clinical skills from the first to the third exercise in regards to assessment, intervention, communication, and delegation. We have received feedback from our clinical partners that our students are better prepared than their current emergency staff in regards to disaster management and to that end we plan to work with our clinical partners to translate our class into an online course so their staff can be trained on disaster management.
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Di Mugno, M., S. Magalini, A. De Gaetano, G. La Posta, D. Sermoneta, and D. Gui. "(A144) Health Status Casualty Model for Simulation of Crisis Management Activities (EU SICMA Project)." Prehospital and Disaster Medicine 26, S1 (May 2011): s41. http://dx.doi.org/10.1017/s1049023x11001452.
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IntroductionThe European Project SICMA (Simulation of Crisis Management Activities) provides a modeling of the behavior of the entire Health Service System during field emergency operations, as well as the rules it operates by. The first step toward chain procedure modelling in the management of major emergencies is the representation of a traumatized patient whose health status can be followed in time during simulation. Since management of the trauma patient follows criteria of stabilization of main physiological functions, a trauma patient model was developed based on fundamental pathophysiological functions independently of specific lesion characterization. Methods: Each patient's health status was modelled according to 5 parameters (ATLS): A(airway), B(breathing), C(circulatory), D(disability), E(Exposure). Patient samples are extracted from a 10.000.000 patient database, generated by considering real anatomical lesions compatible with type and severity of considered scenarios (explosion, building collapse, fire, gunfight). Simulated lesion characteristics were then converted to pathophysiological parameters. Each physiological compensation parameter was represented by: (1) baseline value expressed as percentage of altered function; (2) function reduction rate over time, obtained by a mathematical approximation of clinical worsening. From level of function, rate of worsening and function-specific death thresholds, estimated time-to-death according to sustained damage is computed.ResultsThis model allows simulation of evolution of patient health status both in absence of medical care, but also under therapy, in terms of immediate increment of each single parameter (“temporary” treatment), and of reduction or zeroing of parameter dec14rement rate (“definitive” treatment).ConclusionThis model, based on evaluation of physiological parameters, presents an advantage over the consideration of single lesions, because simulating logical procedures that guide treatment choice in real situations can provide a more accurate assessment of casualities for those actors assigned to management of major emergencies.
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Gutenstein, Marc, Sampsa Kiuru, and Steve Withington. "Development of a Rural Inter-professional Simulation Course: an initiative to improve trauma and emergency team management in New Zealand rural hospitals." Journal of Primary Health Care 11, no. 1 (2019): 16. http://dx.doi.org/10.1071/hc18071.
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ABSTRACT BACKGROUND AND CONTEXT New Zealand is a largely rural nation. Despite the regionalisation of trauma services, rural hospitals continue to provide trauma and emergency care. A dedicated rural inter-professional team-based simulation course was designed, as part of a wider strategy of using simulation-based education to address the disparity in experience and training for rural hospital teams providing emergency and trauma care. ASSESSMENT A pre-course questionnaire identified learning needs. Post-course evaluation and a follow-up survey assessed participants’ perception of the course, and whether lasting changes in clinical or organisational practice occurred. RESULTS Three courses were provided over 2 years to 60 interprofessional participants from eight rural hospitals. The course employed an interprofessional faculty and used skill workshops and high-fidelity trauma simulations to address learning needs identified in pre-course research. Evaluation showed the course to be an effective learning experience for participants. The post-course survey indicated possible lasting changes in team performance and rural hospital protocols. This educational strategy also allowed the collection of research data for investigating rural team dynamics and interprofessional learning. STRATEGIES FOR IMPROVEMENT Further development of rural interprofessional simulation courses should include more diverse clinical content, including paediatric and medical scenarios. Participant access was sometimes limited by typical rural challenges such as hospital staffing and locum availability. LESSONS Rural simulation-based education is both effective for rural trauma team training and a vehicle for rural research; however, there are challenges to participant access and course sustainability, which echo the rural–urban disparity.
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Miller, Danielle, Nicholas Pokrajac, Jessica Ngo, Moises Gallegos, William Dixon, Kelly Roszczynialski, Kristen Ng, Nounou Taleghani, and Michael Gisondi. "Simulation-Based Mastery Learning Improves the Performance of Donning and Doffing of Personal Protective Equipment by Medical Students." Western Journal of Emergency Medicine 23, no. 3 (May 2, 2022): 318–23. http://dx.doi.org/10.5811/westjem.2022.2.54748.
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Introduction: Medical students lack adequate training on how to correctly don and doff personal protective equipment (PPE). Simulation-based mastery learning (SBML) is an effective technique for procedural education. The aim of this study was to determine whether SBML improves proper PPE donning and doffing by medical students. Methods: This was a prospective, pre-test/post-test study of 155 medical students on demonstration of correct PPE use before and after a SBML intervention. Subjects completed standard hospital training by viewing a US Centers for Disease Control and Prevention training video on proper PPE use prior to the intervention. They then participated in a SBML training session that included baseline testing, deliberate practice with expert feedback, and post-testing until mastery was achieved. Students were assessed using a previously developed 21-item checklist on donning and doffing PPE with a minimum passing standard (MPS) of 21/21 items. We analyzed differences between pre-test and post-test scores using paired t-tests. Students at preclinical and clinical levels of training were compared with an independent t-test. Results: Two participants (1.3%) met the MPS on pre-test. Of the remaining 153 subjects who participated in the intervention, 151 (98.7%) reached mastery. Comparison of mean scores from pre-test to final post-test significantly improved from an average raw score of 12.55/21 (standard deviation [SD] = 2.86), to 21/21(SD = 0), t(150) = 36.3, P <0.001. There was no difference between pre-test scores of pre-clinical and clinical students. Conclusion: Simulation-based mastery learning improves medical student performance in PPE donning and doffing in a simulated environment. This approach standardizes PPE training for students in advance of clinical experiences.
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Reilly, Laura, Patty Sullivan, Sharon Ninni, Denise Fochesto, Karen Williams, and Brandee Fetherman. "Reducing Foley Catheter Device Days in an Intensive Care Unit." AACN Advanced Critical Care 17, no. 3 (July 1, 2006): 272–83. http://dx.doi.org/10.4037/15597768-2006-3006.
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The prolonged use of indwelling urinary catheters can lead to many complications, the most prevalent being urinary tract infections. These hospital-acquired infections can increase hospital costs, length of stay, and mortality rates. Evidence-based guidelines for the prevention of urinary tract infections are compared and discussed. Minimizing indwelling urinary catheter use is well-recognized in the literature to reduce the risk of these infections. To decrease the incidence of catheter-associated urinary tract infections, the staff of a 22-bed, mixed medical, surgical, and trauma intensive care unit focused on reducing the number of foley catheter device days. A multidisciplinary team was convened to create an evidence-based plan. Staff nurses were engaged in the development and implementation of the plan. Criteria-based foley catheter guidelines, a decision-making algorithm, and a daily checklist were implemented that led to a significant reduction in foley catheter device days and a decrease in catheter-associated urinary tract infections.
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Quon, Samantha, Jeffrey Riddell, Kelsey Bench, Clare Roepke, and Elizabeth Burner. "Training Leaders in Trauma Resuscitation: Teacher and Learner Perspectives on Ideal Methods." Western Journal of Emergency Medicine 23, no. 2 (February 13, 2022): 192–99. http://dx.doi.org/10.5811/westjem.2021.5.51428.
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Introduction: Effective leadership improves patient care during medical and trauma resuscitations. While dedicated training programs can improve leadership in trauma resuscitation, we have a limited understanding of the optimal training methods. Our objective was to explore learners’ and teachers’ perceptions of effective methods of leadership training for trauma resuscitation. Methods: We performed a qualitative exploration of learner and teacher perceptions of leadership training methods using a modified grounded theory approach. We interviewed 28 participants, including attending physicians, residents, fellows, and nurses who regularly participated in trauma team activations. We then analyzed transcripts in an iterative manner to form codes, identify themes, and explore relationships between themes. Results: Based on interviewees’ perceptions, we identified seven methods used to train leadership in trauma resuscitation: reflection; feedback; hands-on learning; role modeling; simulation; group reflection; and didactic. We also identified three major themes in perceived best practices in training leaders in trauma resuscitation: formal vs informal curriculum; training techniques for novice vs more senior learner; and interprofessional training. Participants felt that informal training methods were the most important part of training, and that a significant part of a training program for leaders in trauma resuscitation should use informal methods. Learners who were earlier in their training preferred more supervision and guidance, while learners who were more advanced in their training preferred a greater degree of autonomy. Finally, participants believed leadership training for trauma resuscitation should be multidisciplinary and interprofessional. Conclusion: We identified several important themes for training leaders in trauma resuscitation, including using a variety of different training methods, adapting the methods used based on the learner’s level of training, and incorporating opportunities for multidisciplinary and interprofessional training. More research is needed to determine the optimal balance of informal and formal training, how to standardize and increase consistency in informal training, and the optimal way to incorporate multidisciplinary and interprofessional learning into a leadership in trauma resuscitation training program.
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Liang, Yong, Yugeng Liu, Bo Liu, Aimin Xu, and Junyu Wang. "Deep Learning-Based Medical Information System in First Aid of Surgical Trauma." Computational and Mathematical Methods in Medicine 2022 (April 16, 2022): 1–11. http://dx.doi.org/10.1155/2022/8789920.
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The aim of this study was to explore the application of process reengineering integration in trauma first aid based on deep learning and medical information system. According to the principles and methods of process reengineering, based on the analysis of the problems and causes of the original trauma first aid process, a new set of trauma first aid integration process is established. The Deep Belief Network (DBN) in deep learning is used to optimize the travel path of emergency vehicles, and the accuracy of travel path prediction of emergency vehicles under different environmental conditions is analyzed. DBN is applied to the surgical clinic of the hospital to verify the applicability of this method. The results showed that in the analysis of sample abscission, the abscission rates of the two groups were 2.23% and 0.78%, respectively. In the analysis of the trauma severity (TI) score between the two groups, more than 60% of the patients were slightly injured, and there was no significant difference ( P > 0.05 ). In the comparative analysis of treatment effect and family satisfaction between the two groups, the proportion of rehabilitation patients in the experimental group (55.91%) was significantly better than that in the control group, and the satisfaction of the experimental group ( 7.93 ± 0.59 ) was significantly higher than that of the control group ( 5.87 ± 0.43 ) ( P < 0.05 ). Therefore, integrating Wireless Sensor Network (WSN) measurement and process reengineering under the medical information system provides feasible suggestions and scientific methods for the standardized trauma first aid.
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Chen, Carol, Alexander Werne, Katharine Osborn, Holly Vo, Upendo George, Hendry Sawe, Newton Addo, and Andrea Cruz. "Effectiveness of a Pediatric Emergency Medicine Curriculum in a Public Tanzanian Referral Hospital." Western Journal of Emergency Medicine 21, no. 1 (December 19, 2019): 134–40. http://dx.doi.org/10.5811/westjem.2019.10.44534.
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Introduction: The World Health Organization recently recognized the importance of emergency and trauma care in reducing morbidity and mortality. Training programs are essential to improving emergency care in low-resource settings; however, a paucity of comprehensive curricula focusing specifically on pediatric emergency medicine (PEM) currently exists. The African Federation for Emergency Medicine (AFEM) developed a PEM curriculum that was pilot-tested in a non-randomized, controlled study to evaluate its effectiveness in nurses working in a public Tanzanian referral hospital. Methods: Fifteen nurses were recruited to participate in a two-and-a-half-day curriculum of lectures, skill sessions, and simulation scenarios covering nine topics; they were matched with controls. Both groups completed pre- and post-training assessments of their knowledge (multiple-choice test), self-efficacy (Likert surveys), and behavior. Changes in behavior were assessed using a binary checklist of critical actions during observations of live pediatric resuscitations. Results: Participant-rated pre-training self-efficacy and knowledge test scores were similar in both control and intervention groups. However, post-training, self-efficacy ratings in the intervention group increased by a median of 11.5 points (interquartile range [IQR]: 6-16) while unchanged in the control group. Knowledge test scores also increased by a median of three points (IQR: 0-4) in the nurses who received the training while the control group’s results did not differ in the two periods. A total of 1192 pediatric resuscitation cases were observed post-training, with the intervention group demonstrating higher rates of performance of three of 27 critical actions. Conclusion: This pilot study of the AFEM PEM curriculum for nurses has shown it to be an effective tool in knowledge acquisition and improved self-efficacy of pediatric emergencies. Further evaluation will be needed to assess whether it is currently effective in changing nurse behavior and patient outcomes or whether curricular modifications are needed.
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Chen, Carol, Alexander Werne, Katharine Osborn, Holly Vo, Upendo George, Hendry Sawe, Newton Addo, and Andrea Tenner. "This Article Corrects: “Effectiveness of a Pediatric Emergency Medicine Curriculum in a Public Tanzanian Referral Hospital”." WestJEM 21.2 March Issue 21, no. 2 (January 27, 2020): 469. http://dx.doi.org/10.5811/westjem.2020.1.46579.
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Introduction: The World Health Organization recently recognized the importance of emergency and trauma care in reducing morbidity and mortality. Training programs are essential to improving emergency care in low-resource settings; however, a paucity of comprehensive curricula focusing specifically on pediatric emergency medicine (PEM) currently exists. The African Federation for Emergency Medicine (AFEM) developed a PEM curriculum that was pilot-tested in a non-randomized, controlled study to evaluate its effectiveness in nurses working in a public Tanzanian referral hospital. Methods: Fifteen nurses were recruited to participate in a two-and-a-half-day curriculum of lectures, skill sessions, and simulation scenarios covering nine topics; they were matched with controls. Both groups completed pre- and post-training assessments of their knowledge (multiple-choice test), self-efficacy (Likert surveys), and behavior. Changes in behavior were assessed using a binary checklist of critical actions during observations of live pediatric resuscitations. Results: Participant-rated pre-training self-efficacy and knowledge test scores were similar in both control and intervention groups. However, post-training, self-efficacy ratings in the intervention group increased by a median of 11.5 points (interquartile range [IQR]: 6-16) while unchanged in the control group. Knowledge test scores also increased by a median of three points (IQR: 0-4) in the nurses who received the training while the control group’s results did not differ in the two periods. A total of 1192 pediatric resuscitation cases were observed post-training, with the intervention group demonstrating higher rates of performance of three of 27 critical actions. Conclusion: This pilot study of the AFEM PEM curriculum for nurses has shown it to be an effective tool in knowledge acquisition and improved self-efficacy of pediatric emergencies. Further evaluation will be needed to assess whether it is currently effective in changing nurse behavior and patient outcomes or whether curricular modifications are needed.
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Sytnik, P., A. Hussain, and J. Brooks. "P129: The impact of high performance physician training on resident wellness and clinical performance." CJEM 18, S1 (May 2016): S121. http://dx.doi.org/10.1017/cem.2016.303.
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Introduction / Innovation Concept: There are numerous research studies in the medical literature, which demonstrate how the experience of a medical residency can contribute towards burnout. The escalating performance pressures and expectations during residency training have the potential to negatively impact upon physician health and clinical performance. The purpose of this prospective cohort study was to test the effectiveness of the High Performance Physician (HPP) program among General Surgery residents at the University of Manitoba with regard to burnout and clinical performance. Methods: This program was delivered over a 9-week period. All 26 residents were asked to complete the Maslach Burnout Inventory - Human Services Survey (MBI-HSS). Each resident then participated as the team leader for a 15-minute trauma resuscitation simulation. Three attending physicians from Surgery & Emergency Medicine assessed resident performance and ability to manage work-based stressors. Following the simulation, each resident received a debrief interview. Once the HPP curriculum had been completed, residents took part in a second high fidelity simulation session and again completed the MBI-HSS. Curriculum, Tool, or Material: The HPP program offered through the Department of Emergency Medicine (EM), is a performance enhancement based curriculum. It is designed to equip physicians with mental skills to help optimize focus, arousal control, stress management, communication, and teamwork. Further, to utilize these skills to cope and respond more effectively to the inherent performance pressures that may present within one’s area of specialization. Conclusion: The Emotional Exhaustion domain of the MBI-HSS demonstrated a statistically significant decrease. The other domain scores were not statistically significant. Simulation domain scores did not demonstrate a statistically significant difference in performance between the pre- and post-HPP curriculum simulation sessions. A summative content analysis of the interview data demonstrated that residents believed internal barriers to situational awareness were the most significant impact on performance. Further study is required to determine if differences are seen in long-term follow-up.
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Horner, Daniel, Benjamin Daniels, Nicola Murray, Gareth Allen, and Claire Baylis. "292 Emergency airway management outside the operating room; a three year prospective service evaluation and quality improvement project." Emergency Medicine Journal 37, no. 12 (November 23, 2020): 836–37. http://dx.doi.org/10.1136/emj-2020-rcemabstracts.22.
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Aims/Objectives/BackgroundEmergency airway management outside a controlled theatre environment has been previously associated with a high rate of adverse events. Several initiatives to improve safety (such as video laryngoscopy, checklists, simulation training etc..) have been studied in isolation.It remains unclear as to whether these interventions have been embedded in the Emergency Department (ED) and whether they offer cumulative marginal gains in safety.Methods/DesignA prospective 3-year service evaluation delivered at a major trauma and neurosciences centre between 2016 and 2019. We designed a rolling quality improvement program to mitigate procedural airway risk through collaborative multidisciplinary team (MDT) working, education and transparent metrics.PDSA cycles included documentary guidance (including flowcharts and checklists), high fidelity simulation training, equipment redesign, prefilled medications and mandatory reporting items (figure 1).Abstract 292 Figure 1Abstract 292 Figure 2Primary induction agents selected throughout the study periodAbstract 292 Figure 3Results/ConclusionsWe analysed prospectively collected data on 1181 intubation episodes outside a theatre environment over a 39 month period, of which 575 (48.7%) were performed out of hours and 635 (53.8%) were performed in the ED.Bedside consultant presence and periprocedural checklist use both showed a sustained increase during the study period. Use of ketamine and thiopentone as primary induction agents increased and decreased, respectively (figure 2). Cricoid pressure and video laryngoscopy (VL) utilisation rates remained relatively static throughout, as did a first pass success (FPS) rate of between 83.0 to 93.5%.Composite major complications (including sustained hypotension and/or critical hypoxia) were significantly reduced during the study period, as demonstrated via statistical process chart (SPC) mapping (figure 3).In conclusion, we found a quality improvement program to be associated with a sustained reduction in the risk of major complications following emergency airway management. This improvement was not explained by simple direct changes in procedural care, such as the use of VL or technique changes resulting in improved FPS, but may have been influenced by unknown confounding variables.
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Truta, Teodora Sorana, Cristian Marius Boeriu, Marc Lazarovici, Irina Ban, Marius Petrişor, and Sanda-Maria Copotoiu. "Improving Clinical Performance of an Interprofessional Emergency Medical Team through a One-day Crisis Resource Management Training." Journal of Critical Care Medicine 4, no. 4 (October 1, 2018): 126–36. http://dx.doi.org/10.2478/jccm-2018-0018.
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Abstract Introduction: Errors are frequent in health care and Emergency Departments are one of the riskiest areas due to frequent changes of team composition, complexity and variety of the cases and difficulties encountered in managing multiple patients. As the majority of clinical errors are the results of human factors and not technical in nature or due to the lack of knowledge, a training focused on these factors appears to be necessary. Crisis resource management (CRM), a tool that was developed initially by the aviation industry and then adopted by different medical specialties as anesthesia and emergency medicine, has been associated with decreased error rates. The aim of the study: To assess whether a single day CRM training, combining didactic and simulation sessions, improves the clinical performance of an interprofessional emergency medical team. Material and Methods: Seventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. Twenty individual interprofessional teams were created. Each team was assessed before and after the training, through two in situ simulated exercises. The exercises were videotaped and were evaluated by two assessors who were blinded as to whether it was the initial or the final exercise. Objective measurement of clinical team performance was performed using a checklist that was designed for each scenario and included essential assessment items for the diagnosis and treatment of a critical patient, with the focus on key actions and decisions. The intervention consisted of a one-day training, combining didactic and simulation sessions, followed by instructor facilitated debriefing. All participants went through this training after the initial assessment exercises. Results: An improvement was seen in most of the measured clinical parameters. Conclusion: Our study supports the use of combined CRM training for improving the clinical performance of an interprofessional emergency team. Empirically this may improve the patient outcome.
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Costello, L., N. Argintaru, A. Wong, R. Simard, M. Chacko, and N. Meshkat. "MP18: Addressing unrealistic expectations: a novel transition to discipline curriculum in emergency medicine." CJEM 21, S1 (May 2019): S48. http://dx.doi.org/10.1017/cem.2019.153.
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Innovation Concept: Emergency medicine (EM) programs have restructured their training using a Competence by Design model. This model emphasizes entrustable professional activities (EPAs) that residents must fulfill before advancing in their training. The first EPA (EPA 1) for the transition to discipline (TTD) stage involves managing the unstable patient. Data from the University of Toronto (U of T) program suggests residents lack enough exposure to these patient presentations during TTD – creating a disconnect between anticipated clinical exposure and the expectation for residents to achieve competence in EPA 1. Methods: To overcome this gap, U of T EM faculty specifically targeted EPA 1 while designing the TTD curriculum. Kern's six-step approach to curriculum development in medical education was used. This six-step approach involves: problem identification, needs assessment, goals and objectives, education strategies, implementation and evaluation. To maximize feasibility of the new curriculum, existing sessions were mapped against EPAs and required training activities to identify synchrony where possible. Residents were scheduled on EM rotations with weekly academic days that included this novel curriculum. Curriculum, Tool or Material: Didactic lectures, procedural workshops and simulation were closely integrated in TTD to address EPA 1. Lectures introduced approaches to cardinal presentations. An interactive workshop introduced ACLS and PALS algorithms and defibrillator use. Three simulation sessions focused on ACLS, shock, airway, trauma and the altered patient. A final simulation session allowed spaced-repetition and integration of these topics. After the completion of TTD, residents participated in a six-scenario simulation OSCE directly assessing EPA 1. Conclusion: The curriculum was evaluated using a multifaceted approach including surveys, self-assessments, faculty feedback and OSCE performance. Overall, the curriculum achieved its goal in addressing EPA 1. It was well-received by faculty and residents. Residents rated the sessions highly, and self-reported improved confidence in assessing unstable patients and adhering to ACLS algorithms. The simulation OSCE demonstrated expected competency by residents in EPA 1. One limitation identified was the lack of a pediatric simulation session which has now been incorporated into the curriculum. Moving forward, this innovative curriculum will undergo continuous cycles of evaluation and improvement with a goal of applying a similar design to other stages of CBD.
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Gershon, MHS, DrPH, Robyn R. M., Allison N. Canton, BA, Lori A. Magda, MA, Charles DiMaggio, PhD, Dario Gonzalez, MD, FACEP, and Mitchell W. Dul, OD, MS. "Web-based training on weapons of mass destruction response for emergency medical services personnel." American Journal of Disaster Medicine 4, no. 3 (May 1, 2009): 153–61. http://dx.doi.org/10.5055/ajdm.2009.0024.
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Objective: To develop, implement, and assess a web-based simulation training program for emergency medical services (EMS) personnel on recognition and treatment of ocular injuries resulting from weapons of mass destruction (WMD) attacks.Design: The training program consisted of six modules: WMD knowledge and event detection, ocular anatomy, ocular first aid (ie, flushing, cupping, and patching), and three WMD simulations (ie, sarin gas release, anthrax release, and radioactive dispersal device). Pretest, post-test, and 1-month follow-up test and a program evaluation were used to measure knowledge gain and retention and to assess the effectiveness of the program.Setting: New York State EMS.Participants: Four hundred and sixty-four individuals participated in the training program and all waves of the testing (86 percent retention rate).Main Outcome Variables: The effectiveness of the training intervention was measured using pretest and post-test questionnaires and analyzed using dependent t-tests.Results: Assessment scores for overall knowledge increased from the pretest (mean 15.7, standard deviation [SD] = 2.1) to the post-test (mean = 17.8, SD = 1.3), p = 0.001, and from pretest (mean = 15.7, SD = 2.1) to 1-month follow-up test (mean = 16.6, SD = 2.0), p 0.001. Ninety-two percent of respondents indicated that the program reinforced understanding of WMDs.Conclusions: This training method provides an effective and low-cost approach to educate and evaluate EMS personnel on emergency treatment of eye trauma associated with the use of WMD. Online training should also be supplemented with hands-on practice and refresher trainings.
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Opar, Susan P., Matthew W. Short, Jennifer E. Jorgensen, Robert B. Blankenship, and Bernard J. Roth. "Acute Coronary Syndrome and Cardiac Arrest: Using Simulation to Assess Resident Performance and Program Outcomes." Journal of Graduate Medical Education 2, no. 3 (September 1, 2010): 404–9. http://dx.doi.org/10.4300/jgme-d-10-00020.1.
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Abstract Background Simulation training has emerged as an effective method of educating residents in cardiac emergencies. Few studies have used emergency simulation scenarios as an outcome measure to identify training deficiencies within residency programs. Purpose The purpose of this study was to evaluate postgraduate year-1 (PGY-1) residents on their ability to manage an acute coronary syndrome and cardiac arrest scenario before and after internship in order to provide outcome data to improve program performance. Methods A total of 58 PGY-1 residents from 10 medical specialties were evaluated using a human patient simulator before and after internship. They were given 12 minutes to manage a patient with acute coronary syndrome and ventricular fibrillation due to hyperkalemia. An objective checklist following basic and advanced cardiac life support guidelines was used to assess performance. Results A total of 58 interns (age, 25 to 44 years [mean, 29.1]; 38 [65.6%] men; 41 [70.7%] allopathic medical school graduates) participated in both the incoming and outgoing examination. Overall chest pain scores increased from a mean of 60.0% to 76.1% (P < .01). Medical knowledge performance improved from 51.1% to 76.1% (P < .01). Systems-based practice performance improved from 40.9% to 71.0% (P < .01). However, patient care performance declined from 93.4% to 80.2% (P < .01). Conclusions A simulated acute coronary syndrome and cardiac arrest scenario can evaluate incoming PGY-1 competency performance and test for interval improvement. This assessment tool can measure resident competency performance and evaluate program effectiveness.
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Fortier, É., V. Paquet, M. Émond, J. Chauny, S. Hegg, C. Malo, P. Carmichael, J. Champagne, and C. Gariepy. "P048: Current practices of management for mild traumatic brain injuries with intracranial hemorrhage." CJEM 21, S1 (May 2019): S80. http://dx.doi.org/10.1017/cem.2019.239.
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Introduction: The radiological and clinical follow-up of patients with a mild traumatic brain injury (mTBI) and an intracranial hemorrhage (ICH) is often heterogeneous, as there is no official guideline for CT scan control. Furthermore, public sector health expenditure has increased significantly as the number of MRI and CT scan almost doubled in Canada in the last decade. Therefore, the main objective of this study was to describe the current management practices of mTBI patients with intracranial hemorrhage at two level-1 trauma centers. Methods: Design: An historical cohort was created at the CHU de Québec – Hôpital de l'Enfant-Jésus (Québec City) and Hôpital du Sacré-Coeur (Montréal). Consecutive medical records were reviewed from the end of 2017 backwards until sample saturation using a standardized checklist. Participants: mTBI patients aged ⩾16 with an ICH were included. Measures: The main and secondary outcomes were the presence of a control CT scan and neurosurgical consultation/admission. Analyses: Univariate descriptive analyses were performed. Inter-observer measures were calculated. Results: Two hundred seventy-four patients were included, of which 51.1% (n = 140) came from a transfer. Mean age was 60.8 and 68.9% (n = 188) were men. Repeat CT scan was performed in 73.6% (n = 201) of our patients as 12.5% showed a clinical deterioration. The following factors might have influenced clinician decision to proceed to a repeat scan: anticoagulation (association of 87.1% with scanning; n = 27), antiplatelet (84.1%; 58), GCS of 13 (94.1%; 16), GCS of 14 (75%; 72) and GCS of 15 (70.2%; 111). 93.0% (n = 254) of patients had a neurosurgical consultation and only 6.7% (17) underwent a neurosurgical intervention. Conclusion: The management of mild traumatic brain injury with hemorrhage uses a lot of resources that might be disproportionate with regards to risks. Further research to identify predictive factors of deterioration is needed.
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Hultin, Magnus, Karin Jonsson, Maria Härgestam, Marie Lindkvist, and Christine Brulin. "Reliability of instruments that measure situation awareness, team performance and task performance in a simulation setting with medical students." BMJ Open 9, no. 9 (September 2019): e029412. http://dx.doi.org/10.1136/bmjopen-2019-029412.
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ObjectivesThe assessment of situation awareness (SA), team performance and task performance in a simulation training session requires reliable and feasible measurement techniques. The objectives of this study were to test the Airways–Breathing–Circulation–Disability–Exposure (ABCDE) checklist and the Team Emergency Assessment Measure (TEAM) for inter-rater reliability, as well as the application of Situation Awareness Global Assessment Technique (SAGAT) for feasibility and internal consistency.DesignMethodological approach.SettingData collection during team training using full-scale simulation at a university clinical training centre. The video-recorded scenarios were rated independently by four raters.Participants55 medical students aged 22–40 years in their fourth year of medical studies, during the clerkship in anaesthesiology and critical care medicine, formed 23 different teams. All students answered the SAGAT questionnaires, and of these students, 24 answered the follow-up postsimulation questionnaire (PSQ). TEAM and ABCDE were scored by four professionals.MeasuresThe ABCDE and TEAM were tested for inter-rater reliability. The feasibility of SAGAT was tested using PSQ. SAGAT was tested for internal consistency both at an individual level (SAGAT) and a team level (Team Situation Awareness Global Assessment Technique (TSAGAT)).ResultsThe intraclass correlation was 0.54/0.83 (single/average measurements) for TEAM and 0.55/0.83 for ABCDE. According to the PSQ, the items in SAGAT were rated as relevant to the scenario by 96% of the participants. Cronbach’s alpha for SAGAT/TSAGAT for the two scenarios was 0.80/0.83 vs 0.62/0.76, and normed χ² was 1.72 vs 1.62.ConclusionTask performance, team performance and SA could be purposefully measured, and the reliability of the measurements was good.
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Rubeis, Giovanni, and Florian Steger. "Is Live-Tissue Training Ethically Justified? An Evidence-based Ethical Analysis." Alternatives to Laboratory Animals 46, no. 2 (May 2018): 65–71. http://dx.doi.org/10.1177/026119291804600206.
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Trauma training is a crucial element of medical education in the civilian sector, as well as in the military sector. Its aim is to prepare physicians, medics and nurses for stressful and demanding emergency situations. Training methods include live-tissue training (LTT) on animal models and simulation-based trauma education. For LTT, blast, gunshot or stab wounds are inflicted on anaesthetised animals, mostly goats and pigs, but sometimes non-human primates. This training method raises ethical concerns, especially in the light of increasingly sophisticated simulation-based methods. Despite these non-animal alternatives, LTT is still widely used due to its presumed educational benefits. In this paper, the question of whether LTT can still be justified, is discussed. We developed a normative framework based on the premise that LTT can only be ethically justified when it yields indispensable benefits, and when these benefits outweigh those of alternative training methods. A close examination of the evidence base for the presumed advantages of LTT showed that it is not superior to simulation-based methods in terms of educational benefit. Since credible alternatives that do not cause harm to animals are available, we conclude that LTT on animal models is ethically unjustified.
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Pallas, Jeremy David, John Paul Smiles, and Michael Zhang. "Cardiac Arrest Nurse Leadership (CANLEAD) trial: a simulation-based randomised controlled trial implementation of a new cardiac arrest role to facilitate cognitive offload for medical team leaders." Emergency Medicine Journal 38, no. 8 (January 26, 2021): 572–78. http://dx.doi.org/10.1136/emermed-2019-209298.
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BackgroundMedical team leaders in cardiac arrest teams are routinely subjected to disproportionately high levels of cognitive burden. This simulation-based study explored whether the introduction of a dedicated ‘nursing team leader’ is an effective way of cognitively offloading medical team leaders of cardiac arrest teams. It was hypothesised that reduced cognitive load may allow medical team leaders to focus on high-level tasks resulting in improved team performance.MethodsThis randomised controlled trial used a series of in situ simulations performed in two Australian emergency departments in 2018–2019. Teams balanced on experience were randomised to either control (traditional roles) or intervention (designated nursing team leader) groups. No crossover between groups occurred with each participant taking part in a single simulation. Debriefing data were collected for thematic analysis and quantitative evaluation of self-reported cognitive load and task efficiency was evaluated using the NASA Task Load Index (NTLX) and a ‘task time checklist’ which was developed for this trial.ResultsTwenty adult cardiac arrest simulations (120 participants) were evaluated. Intervention group medical team leaders had significantly lower NTLX scores (238.4, 95% CI 192.0 to 284.7) than those in control groups (306.3, 95% CI 254.9 to 357.6; p=0.02). Intervention group medical team leaders working alongside a designated nursing leader role had significantly lower cognitive loads than their control group counterparts (206.4 vs 270.5, p=0.02). Teams with a designated nurse leader role had improved time to defibrillator application (23.5 s vs 59 s, p=0.004), faster correction of ineffective compressions (7.5 s vs 14 s, p=0.04), improved compression fraction (91.3 vs 89.9, p=0.048), and shorter time to address reversible causes (107.1 s vs 209.5 s, p=0.002).ConclusionDedicated nursing team leadership in simulation based cardiac arrest teams resulted in cognitive offload for medical leaders and improved team performance.
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Clancy, C., R. Mahony, and V. Meighan. "52 AUDIT CYCLE EXAMINING QUALITY IMPROVEMENT POST EMERGENCY DEPARTMENT MULTI-DISCIPLINARY SIMULATION BASED MEDICAL EDUCATION TRAINING ON HIP FRACTURE CARE." Age and Ageing 50, Supplement_3 (November 2021): ii9—ii41. http://dx.doi.org/10.1093/ageing/afab219.52.
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Abstract Background The care of patients with hip fractures is a surrogate marker of trauma care. Irish hip Fracture Standard 1 involves patients with a hip fracture being admitted to an orthopaedic ward bed within 4 hours of attending the ED. We wanted to audit our current practice and introduce a quality improvement project to improve the timeliness and efficiency of care of our hip fracture patients compared with the gold standard IHFS 1. We introduced a 90 minute multidisciplinary simulation training programme on the hip fracture pathway to our ED in February 2021. All key stakeholders were represented; from Emergency Medicine, Orthopaedics, Nursing (EM and Orthopaedic), Radiology, Radiography, Porters (32 people overall). Because of COVID-19, the training was available in person and online via Zoom. Methods We performed a retrospective audit of patients presenting to TUH ED with a proximal third of femur fracture between 4th February and 31st March inclusive in 2020 and 2021, pre and post introduction of multidisciplinary simulation based medical education on the hip fracture pathway. Data was collected from the electronic record database (Symphony). We recorded the following data; Results 2020 n = 31. Average time to ward—8 hrs 29 mins. 26% patients reached ward <4 hours. (8/31). 2021 n = 25. Average time to ward—5 hrs 58 mins (32% reduction vs 2020). 72% patients reached ward <4 hours. (18/25) (46% increase vs 2020). Conclusion Simulation based medical education is a successful intervention to improve compliance with our hip fracture pathway, time from presentation to transfer to an orthopaedic ward bed and achieve IHFS 1.
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Dunne, C., and M. Parsons. "P038: A procedural skills needs assessment targeting physicians providing emergency department coverage in rural Newfoundland and Labrador." CJEM 21, S1 (May 2019): S76. http://dx.doi.org/10.1017/cem.2019.229.
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Introduction: Maintaining competence in high-acuity low-occurrence (HALO) procedures is often difficult due to their infrequent occurrence. While simulation is a valuable tool to hone skills, providing effective simulation-based education (SBE) to learners outside academic centers can be challenging. Utilizing a mobile tele-simulation unit (MTU) with expert instruction from a geographically separated mentor could prove a valuable approach to overcoming barriers in this setting. However, to maximize benefit and buy-in, the training modules developed for this unique delivery method must align with the needs of those practicing in rural settings. Objectives: - To evaluate the procedural skills training needs of emergency medicine (EM) physicians in rural Newfoundland and Labrador (NL) - To inform the development of simulation modules designed for use in a MTU Methods: A web-based needs assessment was distributed to physicians registered with the NL Medical Association, working in rural locations, and having EM listed as their primary specialty. Participants evaluated their comfort, performance frequency and desire to have further training for 12 HALO procedures. Two EM physicians selected these from a broader list of core procedural skill competencies for CCFP-EM residents at Memorial University. Participants were also able to suggest other procedures that might benefit from SBE. Results: The data collection occurred for 8 weeks with a 68% response rate (N = 22). No respondents had formal EM training outside of exposure in family medicine residency. 60% had 10+ years practicing EM. Chest tube insertion (100%), difficult intubation (92.3%) and surgical airway (92.3%) were the procedures that most respondents felt required more SBE. In practice, they most often performed bag-valve ventilation, splint application and procedural sedation (>10 per year). Additional procedures felt to require SBE were central venous line placement and trauma assessment. Opportunities to participate in SBE were limited (66.7%-less than annually). Despite this, most participants agreed SBE would be a significant benefit if accessible (93.3%). The greatest barriers to SBE included lack of equipment, rural location, and time necessary for travel to larger centres. Conclusion: The provision of medical care in rural settings can be particularly challenging when HALO procedures must be performed. Unique delivery methods of SBE targeted to the needs of rural practitioners may help bridge gaps in knowledge and technical skills.
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Rigby, I., I. Walker, T. Donnon, D. Howes, and J. Lord. "52. Simulation based training improves resident competence in the performance of critical resuscitation procedures." Clinical & Investigative Medicine 30, no. 4 (August 1, 2007): 56. http://dx.doi.org/10.25011/cim.v30i4.2813.
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We sought to assess the impact of procedural skills simulation training on residents’ competence in performing critical resuscitation skills. Our study was a prospective, cross-sectional study of residents from three residency training programs (Family Medicine, Emergency Medicine and Internal Medicine) at the University of Calgary. Participants completed a survey measuring competence in the performance of the procedural skills required to manage hemodynamic instability. The study intervention was an 8 hour simulation based training program focused on resuscitation procedure psychomotor skill acquisition. Competence was criterion validated at the Right Internal Jugular Central Venous Catheter Insertion station by an expert observer using a standardized checklist (Observed Structured Clinical Examination (OSCE) format). At the completion of the simulation course participants repeated the self-assessment survey. Descriptive Statistics, Cronbach’s alpha, Pearson’s correlation coefficient and Paired Sample t-test statistical tools were applied to the analyze the data.
Thirty-five of 37 residents (9 FRCPC Emergency Medicine, 4 CCFP-Emergency Medicine, 17 CCFP, and 5 Internal Medicine) completed both survey instruments and the eight hour course. Seventy-two percent of participants were PGY-1 or 2. Mean age was 30.7 years of age. Cronbach’s alpha for the survey instrument was 0.944. Pearson’s Correlation Coefficient was 0.69 (p < 0.001) for relationship between Expert Assessment and Self-Assessment. The mean improvement in competence score pre- to post-intervention was 6.77 (p < 0.01, 95% CI 5.23-8.32).
Residents from a variety of training programs (Internal Medicine, Emergency Medicine and Family Medicine) demonstrated a statistically significant improvement in competence with critical resuscitation procedural skills following an intensive simulation based training program. Self-assessment of competence was validated using correlation data based on expert assessments.
Dawson S. Procedural simulation: a primer. J Vasc Interv Radiol. 2006; 17(2.1):205-13.
Vozenilek J, Huff JS, Reznek M, Gordon JA. See one, do one, teach one: advanced technology in medical education. Acad Emerg Med. 2004; 11(11):1149-54.
Ziv A, Wolpe PR, Small SD, Glick S. Simulation-based medical education: an ethical imperative. Acad Med. 2003; 78(8):783-8.
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Foroughian, Mahdi, and Davood Soroosh. "Epidemiological and Demographic Status of Violence and Strife in the Emergency Department of Sabzevar Emdad Hospital." International Journal of Medical Toxicology and Forensic Medicine 11, no. 4 (January 3, 2022): 34370. http://dx.doi.org/10.32598/ijmtfm.v11i4.34370.
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Background: Violence and strife are among the most important causes of health threats and account for more than half a million deaths per year, especially at young ages. Considering the young population of Iran and the occurrence of identity crisis in the young age group and the fact that this phenomenon is costly for our country’s health care system, this study was conducted to investigate the factors related to violence and strife and the related mortality in patients admitted to the Sabzevar Emdad Emergency department. Methods: In this descriptive cross-sectional study, 207 patients who were admitted to Sabzevar Emdad Hospital in 2017 following strife were included. The inclusion criterion was hospitalized patients who were referred to the Emergency department following the strife and the exclusion criterion was incomplete registration of patients’ information. The data collection tool was a researcher-made checklist. Data analysis was performed using SPSS software version 18. Results: The Mean±SD age of patients was 34.81±14.75 years. Most patients were from urban living places, while the mortality rate, gender, and the cause of trauma were not statistically associated with patients’ place of residence. The most common type of lesions following strife was bruising, tearing, and scratching accounting for nearly 70% of cases. The most common site of injury was bruising and scratching in the head and neck, followed by tears and fractures in the limbs. In general, the most common site of injury was the upper extremity followed by the head and neck. The majority of patients (52%) underwent medical treatment, including receiving medication, dressing, and splinting, while 37% of patients were referred to the operation room for surgery. A significant relationship was observed between mortality rate and the site of injury (P=0.001). Conclusion: The results showed that in Sabzevar city, the prevalence of strife is higher among men. Also, the most common effects following these types of trauma are bruising, scratching, and tearing. It seems that by providing appropriate solutions and creating a culture and increasing people’s awareness of injuries caused by strife, it would be possible to pave the way for reducing such injuries in the future.
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Tan, Ting Xu, Paula Buchanan, and Erin Quattromani. "Teaching Residents Chest Tubes: Simulation Task Trainer or Cadaver Model?" Emergency Medicine International 2018 (July 24, 2018): 1–6. http://dx.doi.org/10.1155/2018/9179042.
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Objective. To compare simulation task trainers (sim) with cadaver for teaching chest tube insertion to junior residents.Methods.Prospective study involving postgraduate year (PGY) one and two emergency medicine (EM) and PGY-1 surgery residents. Residents were randomized into sim or cadaver groups based on prior experience and trained using deliberate practice. Primary outcomes were confidence in placing a chest tube and ability to place a chest tube in a clinical setting during a seven-month follow-up period. Secondary outcomes include skill retention, using an objective assessment checklist of 15 critical steps in chest tube placement, and confidence after seven months.Results. Sixteen residents were randomized to cadaver (n=8) and simulation (n=8) groups. Both groups posttraining had statistically significant increase in confidence. No significant difference existed between groups for median posttraining assessment scores (13.5 sim v 15 cadaver). There was no statistically significant difference between groups for confidence at any point measured. There was moderate correlation (0.58) between number of clinical attempts reported in a seven-month follow-up period and final assessment score.Conclusion. Both sim and cadaver models are effective modalities for teaching chest tube placement. Medical education programs can use either modalities to train learners without notable differences in confidence.
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Dunne, C., J. Chalker, K. Bursey, and M. Parsons. "P039: The iterative evaluation and development of a core and high-acuity low-occurrence simulation-based procedures training program for emergency medicine trainees." CJEM 21, S1 (May 2019): S77. http://dx.doi.org/10.1017/cem.2019.230.
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Introduction: Competency-based skills development has driven the evolution of medical education. Simulation-based education is established as an essential tool to supplement clinical encounters and it provides the opportunity for low-stakes practice of common and high-acuity low-occurrence (HALO) procedures and scenarios. This is particularly important for emergency medicine trainees working to build confidence, knowledge, and skills in the field. Methods: In the procedural training sessions, learners rotate through 6 small-group stations over a 3-hour period. Skills topics are determined from faculty input, prior session feedback, and literature reviews. Topics included chest tubes, airway intervention, lumbar punctures and trauma interventions. Online content and brief written materials are used for pre-session learning. The small groups use hands-on faculty-guided training, with real-time feedback. Printed materials supplement key learning points at the stations. A combination of low-fidelity task trainers and simulated patients are used for practice and demonstration. R3 EM residents have the opportunity to mentor junior learners. Brief participant surveys are distributed at each session to gather qualitative and quantitative feedback. Results: Feedback forms were completed by 79/85 (92.9%) learners over a period of 4 years (2015-2018). Participants included medical students (11.8%), EM residents (52.9%), and non-EM residents (35.3%). 84.8% (67/79) gave positive qualitative feedback on the sessions, citing points such as the beneficial practice opportunities, quality of instruction, and utility of the models. Updated surveys (N = 26) used a 5-point Likert scale (1 = disagree strongly; 5 strongly agree) in addition to qualitative feedback. Participants indicated that sessions were valuable, and informative (M = 4.692, SD = 0.462; M = 4.270, SD = 0.710). They reported increased understanding of procedures discussed, and they were likely to recommend the session (M = 4.301, SD = 0.606; M = 4.808, SD = 0.394). Conclusion: The ongoing evaluation of our mentor guided hands-on low-fidelity and hybrid simulation-based procedural skills sessions facilitates meaningful programmatic changes to best meet the needs of EM learners. Sessions also provide a forum for EM resident mentorship of junior learners. Feedback indicates learners enjoyed the sessions and found this to be an engaging and effective instructional modality.
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Sneath, P. E., D. Tsoy, J. Rempel, M. Mercuri, A. Pardhan, and T. M. Chan. "LO13: GridlockED: an emergency medicine game and teaching tool." CJEM 19, S1 (May 2017): S31—S32. http://dx.doi.org/10.1017/cem.2017.75.
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Introduction/Innovation Concept: In the controlled chaos of the emergency department (ED) it can be difficult for medical trainees similarly recognize that there is definite order to the chaos, and many may never truly appreciate its complexity. How should medical learners develop this skill? Didactic teaching cannot effectively portray the complexities of managing the ED. Much like education in cardiac arrest, trauma, and multi-casualty incident management, it is our belief that the management of patient flow through the ED is best learned through simulation. Thus, we developed GridlockED, a board game that requires players to work cooperatively to manage a simulated ED to win the game. Methods: GridlockED development took place over a six-month period during which iterative cycles of gameplay and redevelopment were used to optimize game mechanics and improve player engagement. The patient cases were created by medical students (PS, DT, JR) and subsequently reviewed for content validity by two attending emergency physicians (TC, AP). Input from attending emergency physicians, residents, medical students, and laypeople was integrated into the game through a Plan-Do-Study-Act (PDSA) model. Curriculum, Tool, or Material: Our game includes: 1) The game board; 2) Patient cards, which describe a patient, their level of acuity, and the tasks that must be completed in order to disposition the patient; 3) Event cards, which cause random positive or negative events to occur-much like random events occur in real life that change the dynamics of the ED; 4) Game Characters, which move around the board to denote where tasks are being completed; 5) A tracking sheet to follow how many tasks each character has performed in each turn; 6) A shift-time clock, which is used to track the ‘hours’ of your shift; 7) A ‘Gridlock counter’, which tracks how many ED backups or adverse patient outcomes occur (‘Gridlocks’). The goal of the game is to work cooperatively with your teammates to complete patient tasks and move patients through the ED to an ultimate disposition (e.g. admission, discharge). The game is won if you finish your shift before reaching the maximum number of ‘Gridlocks’ allowed. Conclusion: Initial responses to GridlockED have been very positive, supporting it as both an engaging board game and potential teaching tool. We are excited to see it validated through research trials and possibly incorporated into emergency medicine training at both student and postgraduate training levels.
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Besserer, F., M. Hogan, T. Oliver, and J. Froh. "LO094: Mass casualty incident training for rural Canadian municipalities: a mobile education unit initiative." CJEM 18, S1 (May 2016): S62—S63. http://dx.doi.org/10.1017/cem.2016.131.
Full textAbstract:
Introduction / Innovation Concept: The Shock Trauma Air Rescue Society (STARS®) is a charitable, non-profit organization that is dedicated to providing a safe, rapid, highly specialized emergency medical transport system for the critically ill and injured. The STARS® Mobile Education Unit (MEU) is comprised of a high fidelity simulation suite that mimics a hospital emergency room, installed in a specially equipped motorhome (SEM) that can wirelessly operate a high fidelity human mannequin. The MEU provides an excellent opportunity to combine continuing medical education for resuscitation and MCI management. At present, no formal MCI education process exists in Saskatchewan. Curriculum, Tool, or Material: The Saskatchewan STARS® MEU delivers a phased MCI education initiative to rural and regional centers within the province. The educational initiative is sub-divided into three stages: 1. pre-exercise knowledge translation using a flipped classroom approach, 2. on-site tabletop exercise (TTX) and, 3. high-fidelity simulation session with a review of MCI management principles . Sites perform a Hazard Vulnerability Analysis (HVA) following stage 2 and the highest identified site-specific risks are utilized during the development of the simulated scenarios for stage 3. During stage 2, participants also complete a pre and post-exercise survey. The survey evaluates the educational component, the tabletop exercise component and the perceived pre and post tabletop exercise competencies for the management of MCI. In the pilot project, two regional sites completed the tabletop exercise. The pre-exercise survey evaluated perceived MCI and disaster preparedness for the region. Only 8% and 25% of participants at each site respectively, reported that their disaster plan had been trialed in tabletop, full exercise or real activation within the past three years. Participants strongly agreed that the tabletop exercise was a valuable experience (86% and 88% respectively). More robust data will become available as the initiative transitions out of the pilot stage to formal operations. Conclusion: A formal MCI training program implemented through the STARS® MEU for rural Saskatchewan municipalities enables participants and their organizations to both review and enhance their current emergency management plans. This initiative will aim to establish a foundation for future collaboration at the provincial and national level for rural MCI training and preparedness.