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Background: First responders (i.e. police and ambulance staff) have increasingly become part of the mental health care system, often being the first port of call for those experiencing a crisis. Despite their frequent involvement in supporting those with mental health problems, there is evidence that mental health stigma is high amongst first responders. Aims: The aim of the present study was to evaluate a brief training video aimed at reducing mental health stigma amongst first responders. Methods: First responders watched a training video based on the cognitive behavioural model of mental health stigma, and involved contributions from people with lived experience, and first responders. Measures of mental health stigma were collected before and after viewing the training. Results: The training video produced small but significant improvements in mental health stigma, and these effects did not differ between police and ambulance staff. We were unable to determine what psychological constructs mediated this change in stigma. The feedback on the training video was generally positive, but also indicated some key areas for future development. Conclusions: The present study provides encouraging evidence that levels of mental health stigma can be improved using a resource-light training intervention. [ABSTRACT FROM AUTHOR]

Background: Literature indicates the need to prepare health professionals who are clinically competent and socially conscious. Engagement in community projects, as an extension of workplace learning, can build professional competence and social awareness. Aim: To interrogate one such engagement; an emergency first aid responder training course was orchestrated by undergraduate students studying Emergency Medical Care. Setting: The intervention was offered in response to a community need emerging from the research project being conducted in a community in the Western Cape, South Africa. Method: Qualitative data were gathered as narrative texts from participants in the intervention and student reports about their learning experience. The data were interrogated through the application of reflexive thematic analysis and the theoretical lens of asymmetrical reciprocity. Findings: The three themes that emerged were: from research to a student led intervention, deep authentic learning, and learning as a shared experience. Benefit accrued to the students and community through a partnership of asymmetrical participants. The community offered a learning experience while students offered desired skills acquisition to community members. Conclusion: Through this interaction, students learnt respect for local knowledges, and gained enhanced social awareness, in a transdisciplinary partnership, that aimed to create a learning environment where academics, students, and community members are partners in a project delivered with a core value of social justice. Contribution: A pedagogy of partnership describes an education model arising from community-based research that enabled a social programme intervention as a relevant learning project for health science students. [ABSTRACT FROM AUTHOR]

The purpose of this research was to develop and assess a targeted emergency first-aid and safety training program for professional loggers in Montana. There were two key objectives for the program: (1) participant demonstration of recall and retention of key concepts and (2) improved participant reception in comparison to the previous year's training program. The Systematic Approach to Training provided the overall model for the development and conduct of the training program. Qualitative and quantitative analyses were used to assess the effectiveness of the training program. The training program was administered to 873 loggers. Pre-, post-, and follow-up examinations were used to assess recall and retention of key learning objectives, while surveys were used to assess learner reception of the updated training program. Post-training survey data indicated increases in training applicability, understanding of learning objectives, and overall course enjoyment of the updated program in comparison to the previous year's training program. Participants scored significantly higher on the post-training exams, which demonstrated recall of key training objectives. The results obtained by the training evaluation will guide future research and the continued development of the training program to align with ongoing analysis activities and participant suggestions. [ABSTRACT FROM AUTHOR]

Little is known about first responders' knowledge of radiation exposure and the training they receive regarding radiological events. Firefighters and emergency medical services (EMS) personnel were surveyed in July 2018 to February 2019 regarding their knowledge of radiation exposure and the radiological event training they had received. Knowledge was assessed using 15 true-false questions. Five types of radiological event training were assessed. A Mann-Whitney test assessed differences in training received by occupation. A linear regression identified predictors of knowledge scores. A total of 433 individuals completed the survey (response rate = 82.9%). Knowledge scores ranged from 5 to 13, with an average of 8.6. Predictors of knowledge included having received more training on radiological transportation incidents or improvised nuclear devices, and being a firefighter. About a quarter (23.6%, n = 102) had not received any of the 5 types of radiological event training. Firefighters received more training than EMS personnel except on nuclear reactor incidents. Only 14% had participated in a radiological event exercise. First responders' knowledge of radiation exposure and prevention measures is low, and many have received either no or very little training on radiological events. The lack of radiation exposure knowledge and radiological event training received, as identified in this study, could result in increased mortality rates. First responder agencies should provide additional radiological event training and exercise opportunities. Firefighters and emergency medical services personnel were surveyed in July 2018 to February 2019 regarding their knowledge of radiation exposure and the radiological event training they had received. Knowledge was assessed using 15 true-false questions. First responders' knowledge of radiation exposure and prevention measures is low, and many have received either no or very little training on radiological events. The lack of radiation exposure knowledge and radiological event training received as identified in this study could result in increased mortality rates. [ABSTRACT FROM AUTHOR]

Introduction: Tactical Combat Casualty Care (TCCC) training imposes psychophysiological stress on medics. It is unclear whether these stress levels vary with the training modalities selected. It is also unclear how stress levels could have an impact on medical performance and skill uptake.Materials and Methods: We conducted a pilot study to compare the effects of live tissue (LT) with a high-fidelity patient simulator (SIM) on the level of stress elicited, performance, and skill uptake during battlefield trauma training course in an operating room (OR) and in a simulated battlefield scenario (field). In the report, we studied the effects of training modalities and their changes on stress levels by measuring different biomarkers (salivary amylase, plasma catecholamines, and neuropeptide Y) at various time points during the trauma training course.Results: We found that the training resulted in significant psychophysiological stress as indicated by elevated levels of various biomarkers relative to baseline immediately after both OR and field assessment (p < 0.05). Compared with pre-OR levels, the LT training in the OR resulted in significant increases in the plasma levels of epinephrine, norepinephrine, and neuropeptide (p = 0.013, 0.023, 0.004, respectively), whereas the SIM training in the OR resulted in significant increases in the plasma levels of norepinephrine and neuropeptide (p = 0.003 and 0.008). Compared with pre-field levels, we found significant increases in plasma epinephrine concentration in the SIM group (p = 0.016), plasma norepinephrine concentration in the LT group (p = 0.015), and plasma neuropeptide Y concentration in both LT (p = 0.006) and SIM groups (p = 0.029). No differences in the changes of biomarker levels were found between LT and SIM groups in the OR and field. Compared with pre-field levels, the testing on the same modality as that in the OR in the simulated battlefield resulted in significant increases in norepinephrine and neuropeptide levels (p = 0.013 and 0.015), whereas the testing on different modalities resulted in significant increases in amylase, epinephrine, and neuropeptide levels (p = 0.016, 0.05, 0.018, respectively). There was a significantly larger increase in plasma norepinephrine concentration (p = 0.031) and a trend toward a greater increase in the salivary amylase level (p = 0.052) when the field testing involved a different modality than the OR compared with when OR and field testing involved the same modality. Although most of the biomarkers returned to baseline levels after 24 h, plasma norepinephrine levels remained significantly higher regardless of whether field testing occurred on the same or different modality compared with OR (p = 0.040 and 0.002).Conclusion: TCCC training led to significant increase in psychophysiological stress, as indicated by elevated levels of various biomarkers. The training modalities did not result in any differences in stress levels, whereas the switch in training modalities appeared to elicit greater stress as evidenced by changes in specific biomarkers (amylase and norepinephrine). A comparative study with a larger sample size is warranted. [ABSTRACT FROM AUTHOR]

Introduction: Military prehospital and en route care (ERC) directly impacts patient morbidity and mortality. Provider knowledge and skills are critical variables in the effectiveness of ERC. No Navy doctrine defines provider choice for patient transport or requires standardized provider training. Frequently, Search and Rescue Medical Technicians (SMTs) and Navy Nurses (ERC RNs) are tasked with this mission though physicians have also been used. Navy ERC provider training varies greatly by professional role. Historically, evaluations of ERC and patient outcomes have been based on retrospective analyses of incomplete data sets that provide limited insight on ERC practices. Little evidence exists to determine if current training is adequate to care for the most common injuries seen in combat trauma patients.Materials and Methods: Simulation technology facilitates a standardized patient encounter to enable complete, prospective data collection while studying provider type as the independent variable. Information acquired through skill performance observation can be used to make evidence-based recommendations to improve ERC training. This IRB approved multi-center study funded through a Congressionally Directed Medical Research Program grant from the Combat Casualty Care Intramural Research Joint En Route Care portfolio evaluated Navy ERC providers. The study evaluated 84 SMT, ERC RN, and physician participants in the performance of critical and secondary actions during an immersive, high-fidelity, patient transport simulation scenario focused on the care during an interfacility transfer. Simulation evaluators with military ERC expertise, blinded to participant training and background, graded each participant's performance. Inter-rater reliability was calculated using Cohen's Kappa to evaluate concordance between evaluator assessments. Categorical data were reported as frequencies and percentages. Performance attempt and accuracy rates were compared with likelihood ratio chi-square or Fisher's exact test where appropriate. Tests were two-tailed and we considered results significant, that is, a difference not likely due to chance exists between groups, if p < 0.05. Confidence intervals were used to present overlap in performance between provider types.Results: Critical and secondary actions were assessed. A majority of providers completed at least one of the critical life-saving actions; only one participant completed all critical actions. Evaluation of critical actions demonstrated that a tourniquet was applied by 64% of providers, blood products administered by 46%, needle decompression performed by 51%, and a complete handoff report performed by 48%. Assessment of secondary actions demonstrated analgesic was accurately administered by 24% of all providers, and 44% reinforced the "hemorrhaging amputation site dressing."Conclusion: Over 98% of participants failed to properly perform all critical actions during the interfacility transfer scenario, which in a real-life combat casualty transport scenario could result in a preventable death. Study results demonstrate serious skill deficits among all types of Navy ERC providers. These data can be used to improve the training of Navy ERC providers, ultimately improving care to injured soldiers, sailors, airmen, and marines. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of a single day Crisis Resource Management (CRM) oriented team training, combining didactic and simulation sessions, on work satisfaction of the healthcare staff working in an Emergency Department. Methods: Seventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. After enrollment, participants were asked to complete a work satisfaction questionnaire and to choose a day for the training session according to their availability. Each training session took place in the simulation center and consisted of several elements: didactic session and simulation session, followed by instructor facilitated debriefing. The lecture was focused on medical errors and CRM principles. Two months after, they were asked to complete again the work satisfaction questionnaire. Results: There were no significant improvements on the items evaluated through the work satisfaction questionnaire for none of the professional categories involved, except for 'the possibility to refer the patient to a specialist whenever was considered necessary' for the doctors. Improvements were seen for the same professional category on the following items: workload, leisure time, level of stress at work, time and energy spent on administrative tasks. Conclusions: The findings of this study do not support the effectiveness of a single day CRM training as a tool to improve the work satisfaction among medical staff in ED. Further research is necessary. [ABSTRACT FROM AUTHOR]

BACKGROUND: We compare educational environments (i.e. physical, emotional and intellectual experiences) of emergency medicine (EM) residents training in the United States of America (USA) and Saudi Arabia (SA). METHODS: A cross-sectional survey study was conducted using an adapted version of the validated Postgraduate Hospital Educational Environment Measure (PHEEM) survey instrument from April 2015 through June 2016 to compare educational environments in all emergency medicine residency programs in SA and three selected programs in the USA with a history of training Saudi physicians. Overall scores were compared across programs, and for subscales (autonomy, teaching, and social Support), using chi-squared, t-tests, and analysis of variance. RESULTS: A total of 219 surveys were returned for 260 residents across six programs (3 SA, 3 USA), with a response rate of 84%. Program-specific response rates varied from 79%-100%. All six residencies were qualitatively rated as "more positive than negative but room for improvement". Quantitative PHEEM scores for the USA programs were significantly higher: 118.7 compared to 109.9 for SA, P=0.001. In subscales, perceptions of social support were not different between the two countries (P=0.243); however, role autonomy (P<0.001) and teaching (P=0.005) were better in USA programs. There were no significant differences by post-graduate training year. CONCLUSION: EM residents in all three emergency medicine residency programs in SA and the three USA programs studied perceive their training as high quality in general, but with room for improvements. USA residency programs scored higher in overall quality. This was driven by more favorable perceptions of role autonomy and teaching. Understanding how residents perceive their programs may help drive targeted quality improvement efforts. [ABSTRACT FROM AUTHOR]

Background: House-officers and medical officers are at the forefront during medical emergencies in the ward and casualty which impose cognitive, communication, social and system challenges and yet, training in this area is commonly lacking. A workshop was conducted using simulation to provide training on some acute medical emergencies like cord prolapse, post-partum haemorrhage with collapse, poly-trauma and acute exacerbation of asthma. Objective: To determine the effectiveness of simulation in developing competency in managing selected clinical emergencies. Methodology: There were 22 participants consisting of house-officers, junior medical officers and nursing clinical instructors. Only doctors were included in the study. Four medical emergencies were chosen viz.: Cord prolapse; post-partum haemorrhage with collapse; poly-trauma and acute exacerbation of asthma. The simulated sessions were conducted using high fidelity manikins and simulated patients. Simulated patients were trained and moulage was applied accordingly. The skills stations were on airway equipment and techniques of application, latest cardiac life support algorithm and hands on chest compression using manikins. Results: A 5 point Likert scale used to rate the sessions. The skills station had 65% (n=13) rating as excellent and 35% (n=7) good. The skills simulation was rated excellent by 75% (n=15) and good by 25% (n=5) of participants. Verbal feedback was that it was very refreshing, informative, and helpful in terms of improving their skills. Conclusion: The simulated skills training for the junior doctors was very well received and maybe beneficial for work preparedness and in the long run address patient safety. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to analyse factors influencing perceptions of preparedness in the response to terrorist attacks of operational personnel in Swedish emergency organizations. Design/methodology/approach – Data were collected using a questionnaire distributed to operational personnel from the police, rescue and ambulance services in eight Swedish counties; 864 responses were received and analysed. Findings – Three aspects of the perception of preparedness for terrorist attacks among Swedish emergency responders were studied: willingness to respond; level of confidence with tasks; and estimated management capability. Factors which positively influenced these perceptions were male sex, training in first aid and dealing with mass casualty incidents, terrorism-related management training (MT), table-top simulations, participation in functional exercises, and access to personal protective equipment (PPE); work experience was inversely related. Occupation in police or rescue services was positively associated with willingness to respond whereas occupation within the emergency medical services was positively associated with estimated management capability. Practical implications – These findings show that terrorism-related MT and access to PPE increase the perceptions of preparedness for terrorism among the emergency services, aiding judgements about investments in preparedness by crisis management planners. Originality/value – Limited research in disaster management and hazard preparedness has been conducted in a European context, especially regarding terrorism. Little is known about aspects of preparedness for terrorism in Sweden, particularly from the perspective of the emergency responders. [ABSTRACT FROM AUTHOR]

Many graduates will take up junior roles in accident and emergency (A&E) departments to which a large proportion of patients present with facial injuries caused by interpersonal violence. However, it is widely recognised that undergraduates and postgraduates have few opportunities for training in oral and maxillofacial surgery. We aimed to assess the impact of a specifically designed maxillofacial emergencies virtual learning environment (VLE) on the knowledge and confidence of junior doctors in two A&E departments. They were given free access to the VLE for one month, and were asked to complete multiple choice questions and to rate their confidence to deal with 10 common situations on visual analogue scales (VAS) at baseline and one month after training. A total of 29 doctors agreed to pilot the website, 21 (72%) completed both sets of questions, and 18 (62%) completed both VAS assessments. The mean (SD) multiple choice score improved from 10 (2.52) to 13 (3.56) out of a maximum of 20 (p=0.004) and the mean (SD) VAS improved from 29.2 (19.2) mm to 45.7 (16.6) mm out of a maximum of 100 mm (p=0.007). This was a small pilot study with limited numbers, but it showed improvements in the knowledge of maxillofacial emergencies and in confidence, although the latter remained low. Further work is needed to examine how these brief educational interventions affect the attitudes of frontline staff to maxillofacial emergencies. [ABSTRACT FROM AUTHOR]

Introduction: Resuscitation of the critically ill in the emergency department can be stressful and at times, chaotic. We believe that simulation training for emergency teams (STET) will help improve team performance during actual resuscitation, thus synonymously leading to better patient outcomes. We aim to evaluate the effectiveness of STET for resuscitation team training. . Method: Eight sessions of STET using low fidelity simulation were conducted during March to April 2015. Doctors and nurses participated in the sessions, as they would work together in teams on a day to day basis. The participants evaluated the effectiveness of the training after the sessions on a 5-point Likert Scale. The following were assessed: benefits of simulation training; realism and appropriateness of scenarios; enhancement of medical knowledge and practical skills, thereby improving patient outcomes; and teamwork, with a focus on leadership and communications. Results: Twenty doctors and 13 nurses participated in STET. The doctors were residents (Emergency Medicine, Internal Medicine, Family Medicine, Orthopaedics) in their first to third year of training. STET received a mean score of 4.3 across all domains. Participants scored the benefit of STET with a mean of 4.5. Though the scenarios were appropriate (mean score = 4.4), the low fidelity simulation lacked realism (mean score = 3.8). With the right training objectives, STET could enhance both medical knowledge and practical skills (mean score 4.4 versus 4.3 respectively). Participants believe that learning points from STET could improve patient outcomes (mean score 4.4). Finally, STET provides an avenue for team training (mean score = 4.4) with development of team leadership and communication. Conclusion: STET was effective for the purpose of resuscitation team training. However, the limitation of this educational intervention was that we do not know the directness and extent of its impact on actual patient outcomes. This would be the subject of a future follow=up study of this nature. [ABSTRACT FROM AUTHOR]

Introduction: The Accreditation Council for Graduate Medical Education requires that residency programs ensure resident competency in performing safe, effective handoffs. Understanding resident, attending, and nurse perceptions of the key elements of a safe and effective emergency department (ED) handoff is a crucial step to developing feasible, acceptable educational interventions to teach and assess this fundamental competency. The aim of our study was to identify the essential themes of ED-based handoffs and to explore the key cultural and interprofessional themes that may be barriers to developing and implementing successful ED-based educational handoff interventions. Methods: Using a grounded theory approach and constructivist/interpretivist research paradigm, we analyzed data from three primary and one confirmatory focus groups (FGs) at an urban, academic ED. FG protocols were developed using open-ended questions that sought to understand what participants felt were the crucial elements of ED handoffs. ED residents, attendings, a physician assistant, and nurses participated in the FGs. FGs were observed, hand-transcribed, audio- recorded and subsequently transcribed. We analyzed data using an iterative process of theme and subtheme identification. Saturation was reached during the third FG, and the fourth confirmatory group reinforced the identified themes. Two team members analyzed the transcripts separately and identified the same major themes. Results: ED providers identified that crucial elements of ED handoff include the following: 1) Culture (provider buy-in, openness to change, shared expectations of sign-out goals); 2) Time (brevity, interruptions, waiting); 3) Environment (physical location, ED factors); 4) Process (standardization, information order, tools). Conclusion: Key participants in the ED handoff process perceive that the crucial elements of intershift handoffs involve the themes of culture, time, environment, and process. Attention to these themes may improve the feasibility and acceptance of educational interventions that aim to teach and assess handoff competency. [ABSTRACT FROM AUTHOR]

EMERGENZA (emergency in Italian) is a 'serious' game, developed in the context of the RIMSI project and designed to improve the training of emergency medicine operators. To achieve this goal, it adopts natural interaction paradigms in immersive environments. Virtual reality systems have been used recently in combination with natural interface systems for enhancing patients' rehabilitation procedures though are proving especially effective in the development of clinical decision support and medical training systems. The use of immersive simulations in medical training is extremely useful to confront emergency operators with scenarios that range from usual (e.g. unconscious person on the ground) to extreme (car accident with several injured people) without exposing the simulation participants in any harm. It is critical to exploit 3D virtual worlds in order to provide as much contextual information as possible to the operators. In fact, each emergency procedure needs to be adapted depending on the environmental threats and the presence of multiple injured people in need of assistance or bystanders. EMERGENZA allows to simulate a first-aid scenario with a configurable virtual environment using interactive 3D graphics. Users can interact through a natural interface for navigation and interaction with the virtual environment. In order to evaluate the prototype, several heuristics have been chosen and tested to measure the overall system usability. Results show that the adoption of natural interaction in immersive virtual environments receives good feedback from users. [ABSTRACT FROM AUTHOR]

Background: Stroke is a time-dependent medical emergency in which early presentation to specialist care reduces death and dependency. Up to 70% of all stroke patients obtain first medical contact from the Emergency Medical Services (EMS). Identifying 'true stroke' from an EMS call is challenging, with over 50% of strokes being misclassified. The aim of this study was to evaluate the impact of the training package on the recognition of stroke by Emergency Medical Dispatchers (EMDs).Methods: This study took place in an ambulance service and a hospital in England using an interrupted time-series design. Suspected stroke patients were identified in one week blocks, every three weeks over an 18 month period, during which time the training was implemented. Patients were included if they had a diagnosis of stroke (EMS or hospital). The effect of the intervention on the accuracy of dispatch diagnosis was investigated using binomial (grouped) logistic regression.Results: In the Pre-implementation period EMDs correctly identified 63% of stroke patients; this increased to 80% Post-implementation. This change was significant (p=0.003), reflecting an improvement in identifying stroke patients relative to the Pre-implementation period both the During-implementation (OR=4.10 [95% CI 1.58 to 10.66]) and Post-implementation (OR=2.30 [95% CI 1.07 to 4.92]) periods. For patients with a final diagnosis of stroke who had been dispatched as stroke there was a marginally non-significant 2.8 minutes (95% CI -0.2 to 5.9 minutes, p=0.068) reduction between Pre- and Post-implementation periods from call to arrival of the ambulance at scene.Conclusions: This is the first study to develop, implement and evaluate the impact of a training package for EMDs with the aim of improving the recognition of stroke. Training led to a significant increase in the proportion of stroke patients dispatched as such by EMDs; a small reduction in time from call to arrival at scene by the ambulance also appeared likely. The training package has been endorsed by the UK Stroke Forum Education and Training, and is free to access on-line. [ABSTRACT FROM AUTHOR]

Purpose: Intensive care clinicians play a central role in the co-ordination and treatment of patients that develop life-threatening emergencies. This review evaluates the effect of debriefing after life-threatening emergencies and considers the implications for intensive care training and practice. Methods: Studies were identified by searching electronic databases, citation tracking, and contact with subject specialists. Studies evaluating the effect of debriefing after life-threatening emergencies on clinician performance (process) and/or patient outcomes were eligible for inclusion. Study quality was assessed and summarised using the GRADE system. Results: The search identified 2,720 studies. After detailed review, 27 studies were included of which 20 supported the use of debriefing. Debriefing was viewed positively ( n = 3), improved learning ( n = 1), enhanced non-technical performance ( n = 4) and technical performance ( n = 16), and improved patient outcomes ( n = 2). Four cardiac arrest studies were suitable for meta-analysis. This found evidence of improved resuscitation process outcomes [compression fraction (mean difference 6.80, 95 % CI 4.19-9.40, p < 0.001)] and short-term patient outcome [return of spontaneous circulation (OR 1.46, 95 % CI 1.01-2.13, p = 0.05)]. There was no effect on survival to hospital discharge (OR 0.80, 95 % CI 0.38-1.67, p = 0.55). Conclusions: This review supports the use of structured debriefing as an educational strategy to improve clinician knowledge and skill acquisition and implementation of those skills in practice. However, the effect of debriefing on long-term patient outcomes is uncertain. There remains a need for further high-quality research, which seeks to identify the optimal method for debriefing delivery and effect on patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Legal regulations often limit the medical care that paramedics can provide. Telemedical solutions could overcome these limitations by remotely providing expert support. Therefore, a mobile telemedicine system to support paramedics was developed. During the implementation phase of this system in four German emergency medical services (EMS), the feasibility and possible limitations of this system were evaluated. Methods: After obtaining ethical approval and providing a structured training program for all medical professionals, the system was implemented on three paramedic-staffed ambulances on August 1st, 2012. Two more ambulances were included subsequently during this month. The paramedics could initiate a consultation with EMS physicians at a teleconsultation centre. Telemedical functionalities included audio communication, real-time vital data transmission, 12-lead electrocardiogram, picture transmission on demand, and video streaming from a camera embedded into the ceiling of each ambulance. After each consultation, telephone-based debriefings were conducted. Data were retrieved from the documentation protocols of the teleconsultation centre and the EMS. Results: During a one month period, teleconsultations were conducted during 35 (11.8%) of 296 emergency missions with a mean duration of 24.9 min (SD 12.5). Trauma, acute coronary syndromes, and circulatory emergencies represented 20 (57%) of the consultation cases. Diagnostic support was provided in 34 (97%) cases, and the administration of 50 individual medications, including opioids, was delegated by the teleconsultation centre to the paramedics in 21 (60%) missions (range: 1-7 per mission). No medical complications or negative interpersonal effects were reported. All applications functioned as expected except in one case in which the connection failed due to the lack of a viable mobile network. Conclusion: The feasibility of the telemedical approach was demonstrated. Teleconsultation enabled early initiation of treatments by paramedics operating under the real-time medical direction. Teleconsultation can be used to provide advanced care until the patient is under a physician's care; moreover, it can be used to support the paramedics who work alone to provide treatment in non-life-threatening cases. Non-availability of mobile networks may be a relevant limitation. A larger prospective controlled trial is needed to evaluate the rate of complications and outcome effects. [ABSTRACT FROM AUTHOR]

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There are deficiencies in trauma leader performance. Simulation training and videobased feedback can lead to durable changes in behavior. A trauma resuscitation team leader training curriculum was developed. The curriculum consisted of eight simulated trauma scenarios with a mix of acuities and injury patterns using patient simulators. Other team members included a surgeon, an anesthesiologist, a chief resident, a trauma nurse, a medical student, and presenting emergency medicine staff. Each scenario was followed by video-based feedback. Attitudes regarding this curriculum were evaluated before and after the intervention with Likert-based surveys. Eight residents completed the curriculum. On a seven-point Likert scale, the median overall curriculum rating, the video discussion quality, the plan to apply leadership skills, and the plan to apply learned knowledge and behaviors was 7/7. A Wilcoxon Sign-Rank test showed improved confidence for leading Level 1 trauma resuscitations, improved beliefs in adequate training, and improved attitudes regarding team leader training (P<0.05). There was reduced nervousness of being the team leader (P=0.048). Qualitative analyses showed that the learners valued the feedback process and scenario realism. This pilot curriculum was well-received by trauma residents and offers insight into meta-cognition of trauma team leaders. [ABSTRACT FROM AUTHOR]

Major trauma is a leading cause of death and disability in the UK, particularly in the young. Pre-hospital emergency medicine (PHEM) involves provision of immediate medical care to critically ill and injured patients, across all age ranges, often in environments that may be remote and are not only physically challenging but also limited in terms of time and resources. PHEM is now a GMC-recognised subspecialty of anaesthesia or emergency medicine and the first recognised training program in the UK commenced in August 2012. This article discusses subspeciality development in PHEM, the competency based framework for training in PHEM, and the provision of pre-hospital emergency anaesthesia. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates whether instructional methods used by excellent emergency medicine residency teachers change with changing conditions of learner level of training, patient acuity and department census. Methods: Four excellent, purposively selected, emergency medicine teachers consented to participate in this non-participant observational study. Teachers were observed for 32 hours in the emergency department, using a structured observation form focused on: teaching methods used, context learner level of training, emergency department patient census and patients' illness severity. Data was analyzed qualitatively using constant comparative analysis. Results: Fifteen (15) categories of teaching methods were observed. The 4 most frequently observed methods were: Questioning (used in 47% of teaching encounters), Advice Giving (33%), Limited Teaching Points (31%) and Patient Updates (22%). Patient Updates were more often used with senior residents. Multiple methods were used in most encounters. Teaching methods did not vary significantly with increased emergency department volume, but faculty and residents relied more heavily on a single method of teaching per encounter as patient acuity increased to Triage levels One and Two. Conclusions: Excellent emergency medicine teachers teaching methods were classified into 15 categories. They typically rely heavily on four methods, adapting to resident training level and patient illness severity, rather than patient volume. The observed teaching methods provide teachers who have high clinical productivity expectations and/or demanding emergency care settings with an enriched repertoire of teaching strategies. [ABSTRACT FROM AUTHOR]

The article outlines the Australian Medical Assistance Team (AUSMAT) training programme held in Darwin, The New Zealand Ministry of Health secured training with AUSMAT to develop a New Zealand Medical Assistance Team (NZMAT) to assist in the event of a major emergency within New Zealand or the Pacific. The course format, challenges and rewards are explored. [ABSTRACT FROM AUTHOR]

Objectives The aim of our study was to investigate the perceptions of t he emergency medicine residents regarding their skill level for interventional procedures. Methods A questionnaire with 17 questions was given between June 2011 and October 2011 to all emergency medicine residents who had been working in university hospitals (UHs) and training and educational hospitals (ETHs). A visual analogous scale was used to determine perception of skills, where closed-end questions were used in order to determine the number of skills made during the education. Results A total of 493 residents were enrolled in the study which included subjects from 31 UHs and 18 ETHs. Emergency medicine residents in UHs indicated that the number of interventions performed for acquiring skills during theeducation of emergency medical proficiency (UH VAS=5.60±2.86, ETH VAS=4.55±2.99, p<0.001), and the skill level for performing these interventions (UH VAS=6.61±2.40, ETH VAS=6.01 ±2.83, p=0.01) were superior when compared to the emergency medicine residents in ETHs. The three most successful interventions for all emergency medicine residents were found to be defibrillation/cardioversion (VAS=6.85±3.07), endotracheal intubation (VAS=6.80±3.19) and paracentesis (VAS=6.31±3.78) respectively. Measurement of intraocular pressure (VAS=0.91±1.93), emergent thoracotomy (VAS=1.10±2.09), extracting foreign body with biomicroscope (VAS=1.18±2.41), cricothyrotomy (VAS=1.44±3.36), retrograde intubation (VAS=1.46±2.57), repairing of extensor tendon (VAS=1.80±2.56), emergent labor (VAS=1.89±2.65), administration of thrombolytic treatment (VAS=2.44±3.26) and arthrocentesis (VAS=2.61±3.34) were determined as the most inadequate interventional procedures. Conclusions It was discovered that emergency medicine residents feel incompetent for many interventions in the training program for emergeny medicine. The number ofinterventions performed for acquiring the adequate skills during the education of emergency medical proficiency and the skill level for performing these interventions for the emergency medicine residents in UHs were superior compared to the emergency medicine residents in ETHs. [ABSTRACT FROM AUTHOR]

Abstract: The death is a part of the everyday life of the emergency medical teams, but to announce the death and to take care in immediate of the saddened close relations rest a testing experience for which the professionals of the emergency care are not still prepared. Our comment aims from the experience of care of families, saddened in immediate and also recorded within the framework of a specialized consultation, to pass on what the saddened persons can feel during the intervention of the help and the confrontation in the death of their close. Our objective being to bring to the professionals of the tracks of reflection to limit the risks of survictimisation. [Copyright &y& Elsevier]

The article offers the author's insights regarding her fascination with the nature of emergency medicine that has led her to the creation of her own emergency management training business. The author states that practical skills should be reassessed to remain on the community first responders (CFRs) list. The author says that the training session in her business covers medical emergencies and cardiopulmonary resuscitation (CPR).

Objective: To evaluate the activity of the Cardiac Arrest Team (CAT) from the Emergency Department, called to perform resuscitation for patients admitted in different departments of the Clinical County Hospital. Methods: We conducted a prospective study between 01/01-12/31/2009. We included all the patients we performed CPR on, regardless of indication. Results: We had a total of 110 cases, representing 0.28% of the 39,074 patients assisted by the department in 2009. We noticed an in­creased incidence of calls in internal medicine and surgery departments, with 50% and 17% of the cases respectively. The most frequent diagnosis was cardiac arrest for respiratory failure and malignant tumors, each representing 17%, even though malignancy does not have an indication for resuscitation. There was no causal relationship between the outcome of resuscitation and age groups (p = 0.552), type of wards (p = 0.36), or the Basic Life Support (BLS) performed by the staff, before the CAT arrived (p = 0.76). Medical staff from wards started BLS in 40.1% of cases, in 32% of these cases only chest compressions were performed, without ventilation.The proportion of resuscitated versus deceased cases is 49.1% to 50.9%, so immediate results are good, unfortunately the late outcome is bad, 52 cases out of the 54 died later in ICU, 2 patients being discharged in good condition. Conclusions: CAT should be called according to Do Not resuscitate criteria. Medical staff from the wards should be trained to start CPR and have basic equipment. The early outcome is comparable with the international data, the poor late results binds to resuscitation without indication. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim of the study reported here was to address the need to assess and train teamwork and non-technical skills in the context of Resuscitation. Specifically, we sought to develop a tool that is feasible to use and psychometrically sound to assess team behaviours during cardiac arrest resuscitation attempts. Methods: To ensure validity, reliability, and feasibility, the Observational Skill based Clinical Assessment tool for Resuscitation (OSCAR) was developed in 3 phases. A review of the literature leading to initial tool development was followed by an assessment of face and content validity, and finally a thorough reliability assessment, using Cronbach''s α to assess internal consistency and intraclass correlation to assess inter-rater reliability. Results: OSCAR was developed methodically, and tested for face and content validity. Cronbach''s α results ranged from 0.736 to 0.965 demonstrating high internal consistency, and intraclass correlation results ranged from 0.652 to 0.911, all of which are strongly significant and indicate good inter-rater reliability. Conclusion: On the basis of our results, we conclude that OSCAR is psychometrically robust, scientifically sound, and clinically relevant. We have developed the Observational Skill-based Clinical Assessment tool for Resuscitation (OSCAR) for the assessment of non-technical skills in Resuscitation teams. We propose the use of this tool in simulation and real Cardiac Arrest Resuscitation attempts to assess, guide and train non-technical skills to team members, to improve patient safety and maximise the chances of successful resuscitation. [Copyright &y& Elsevier]

Rural-dwelling older adults experience unique challenges related to accessing medical and social services. This article describes the development, implementation, and experience of a novel, community-based program to identify rural-dwelling older adults with unmet medical and social needs that leveraged the existing emergency medical services (EMS) system. The program specifically included geriatrics training for EMS providers; screening of older adult EMS patients for falls, depression, and medication management strategies by EMS providers; communication of EMS findings to community-based case managers; in-home evaluation by case managers; and referral to community resources for medical and social interventions. Measures used to evaluate the program included patient needs identified by EMS or the in-home assessment, referrals provided to patients, and patient satisfaction. EMS screened 1,231 of 1,444 visits to older patients (85%). Of those receiving specific screens, 45% had fall-related, 69% medication management-related, and 20% depression-related needs identified. One hundred and seventy-one eligible EMS patients who could be contacted accepted the in-home assessment. Of the 153 individuals completing the assessment, 91% had identified needs and received referrals or interventions. This project demonstrated that screening by EMS during emergency care for common geriatric syndromes and linkage to case managers is feasible in this rural community, although many will refuse the services. Further patient evaluations by case managers, with subsequent interventions by existing service providers as required, can facilitate the needed linkages between vulnerable rural-dwelling older adults and needed community-based social and medical services. [ABSTRACT FROM AUTHOR]

Abstract: Background: In Hungary, prehospital emergency medical services are provided by the National Ambulance Service. The 60th anniversary of the National Ambulance Service provides a good opportunity to give an overview of the current trends in prehospital emergency medical care in Hungary. Objectives: In this report, a description of the organizational structure and the latest developments in the National Ambulance Service are described with the intention to highlight future directions in emergency medical services, as well as the influence of international trends in emergency patient care. Results: In Hungary, the ambulance cars are staffed by two or three crew members trained in rescue, stabilization of the patient''s status, transport, and advanced care of traumatic and medical emergencies. There are three major levels of care provided by ambulance personnel: a basic level ambulance crew (Emergency Medical Technician Unit), a second level (Ambulance Officer Unit), and the highest level (Emergency Physician Unit). The personnel on the latter two units are trained in all aspects of Basic Life Support and Advanced Life Support procedures for prehospital emergency care. Following the latest international developments in medical rescue devices and guidelines, all staff are retrained yearly. Recently, private services for transportation for non-acute illnesses have been introduced, allowing the National Ambulance Service to concentrate on emergencies only. Conclusions: Although the Hungarian Ambulance Service has a very long and meaningful past and a respected professional development, new challenges facing prehospital emergency care are inevitable and continuous development is necessary. [Copyright &y& Elsevier]

Failure to work as an effective team is commonly cited as a cause of adverse events and errors in emergency medicine. Until recently, individual knowledge and skills in managing emergencies were taught, without reference to the additional skills required to work as part of a team. Team training courses are now becoming commonplace, however their strategies and modes of delivery are varied. Just as different delivery methods of traditional education can result in different levels of retention and transfer to the real world, the same is true in team training of the material in different ways in traditional forms of education may lead to different levels of retention and transfer to the real world, the same is true in team training. As team training becomes more widespread, the effectiveness of different modes of delivery including the role of simulation-based education needs to be clearly understood. This review examines the basis of team working in emergency medicine, and the components of an effective emergency medical team. Lessons from other domains with more experience in team training are discussed, as well as the variations from these settings that can be observed in medical contexts. Methods and strategies for team training are listed, and experiences in other health care settings as well as emergency medicine are assessed. Finally, best practice guidelines for the development of team training programs in emergency medicine are presented. [ABSTRACT FROM AUTHOR]

The article discusses the importance of academic development of emergency medical services (EMS) professionals. It focuses on the realities of education versus training, how education relates to present and future reward, and professional against nonprofessional development. It cites that the future of EMS systems depends on the development of a new breed of EMS provider who is trained in the art and science of EMS to lead and participate in the operation of the new system. INSETS: Paying for School;The Educational Payoff.

The article discusses the effectiveness of Internet-based emergency medical services (EMS) training for EMS personnel. It states the availability of online learning and portability of Internet as an option to assist in getting the required courses and deliver learning materials in the workplace or home. It also notes that online has become a fundamental strategy to training efforts as it can save both time and money. INSET: Checklist for Evaluating an Online Learning Provider.

Introduction: It is not currently known how accurately emergency medicine (EM) doctors interpret arterial blood gases (ABG). The present study explores this question. Methods: A prospective, cross-sectional study of EM doctors was undertaken. An ABG interpretation test was completed by participants. Scores were compared with ‘expert level’ scores. Confidence with ABG interpretation and satisfaction with ABG training was investigated using a 10 cm visual analogue scale. Results: A total of 37 consultants and 43 EM trainees were analysed. Consultant's and trainee's ABG interpretation scores were 31 (95% CI 29–32.8) and 29.4 (95% CI 27.6–31.2), respectively (‘expert level’= 40). Consultants scored better than trainees for knowledge of ABG equations; with mean scores of 3.65 (95% CI 3.08–4.22) and 2.51/6 (95% CI 1.87–3.15), respectively, P= 0.01. Trainee satisfaction with ABG training was moderate. Consultants were more confident with ABG interpretation than trainees, but their confidence was not correlated to their score on the test ( r= 0.15, P= 0.38). Conclusion: Neither group performed to the predefined ‘expert level’. There was a trend to improved interpretation with progression through ACEM training. There is scope to improve the training given to EM trainees in ABG interpretation and to incorporate ABG interpretation into consultant continuing education. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Poor communication and teamwork may contribute to errors during neonatal resuscitation. Our objective was to evaluate whether interns who received a 2-hour teamwork training intervention with the Neo-natal Resuscitation Program (NRP) demonstrated more teamwork and higher quality resuscitations than control subjects. METHODS: Participants were noncertified 2007 and 2008 incoming interns for pediatrics, combined pediatrics and internal medicine, family medicine, emergency medicine, and obstetrics and gynecology (n = 98). Pediatrics and combined pediatrics/internal medicine interns were eligible for 6-month follow-up (n = 34). A randomized trial was conducted in which half of the participants in the team training arm practiced NRP skills by using high-fidelity simulators; the remaining practiced with low-fidelity simulators, as did control subjects. Blinded, trained observers viewed video recordings of high-fidelity-simulated resuscitations for teamwork and resuscitation quality. RESULTS: High-fidelity training (HFT) group had higher teamwork frequency than did control subjects (12.8 vs 9.0 behaviors per minute; P < .001). Intervention groups maintained more workload management (control subjects: 89.3%; low-fidelity training [LFT] group: 98.0% [P< .001]; HFT group: 98.8%; HFT group versus control subjects [P < .001]) and completed resuscitations faster (control subjects: 10.6 minutes; LET group: 8.6 minutes [P = .040]; HFT group: 7.4 minutes; HFT group versus control subjects [P< .001]). Overall, intervention teams completed the resuscitation an average of 2.6 minutes faster than did control subjects, a time reduction of 24% (95% confidence interval: 12%-37%). Intervention groups demonstrated more frequent teamwork during 6-month follow-up resuscitations (11.8 vs 10.0 behaviors per minute; P = .030). CONCLUSIONS: Trained participants exhibited more frequent teamwork behaviors (especially the HFT group) and better workload management and completed the resuscitation more quickly than did control subjects. The impact on team behaviors persisted for at least 6 months. Incorporating team training into the NRP curriculum is a feasible and effective way to teach interns teamwork skills. It also improves simulated resuscitation quality by shortening the duration. [ABSTRACT FROM AUTHOR]

The Dutch health-care system provides high-quality inpatient care, but emergency care apart from trauma is poorly developed. A model for emergency medicine based on Anglo-American and Australasian principles was introduced in 2000, and a national integrated training curriculum was introduced in 2007. There exist many impediments and opposition to the acceptance of emergency medicine as a defined discipline. Despite this emergency medicine became a recognized specialty this year (2009). The present paper gives an overview of the Dutch health-care system and the history, current status, training and future development of emergency medicine in the Netherlands. [ABSTRACT FROM AUTHOR]

The article discusses the crucial role played by emergency managers and decision makers in reduction of unpleasant disaster consequences. It states that the measures used for planning and implementing issues on earthquake emergency response training for emergency managers were clarified. It emphasizes that specific experience and knowledge of emergency issues are needed for successful emergency management. It mentions that the challenges faced by emergency managers and decision makers include insufficient time for training, lack of required technical supporting tools, and lack of adequate experience.

Main sources in medical emergencies in dental office are lacunar evaluations of the patients constants, spontaneously neuro-psychical reactions or a lack of special training of the medical staff. Our study was performed on 1680 patients. The level of installed medical emergencies was 3.85% distributed as follows: 38% vaso-vagal sincopa, 35% cardio-vascular emergencies, 11 % alergic emergencies, 9% neurologic emergencies, 7% other emergencies. [ABSTRACT FROM AUTHOR]

The article presents a study to assess the effectiveness of the medical emergency team (MET) program in the reduction of cardiac arrest prevalence and mortality. It explores the intervention of MET program from 2002-2003 in which results show that reduced cardiac arrest prevalence is linked to the effectiveness of the program. Moreover, it concludes that the effectiveness can be attributed to staff education, awareness, and responsiveness to the needs of the patients.

Diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar state (HHS) are both diabetic emergencies associated with hyperglycaemia and can be fatal if healthcare professionals fail to recognize and intervene appropriately. While many students and qualified nurses may be able to recall common signs and symptoms related to DKA and HHS -- for example polyuria, polydipsia and elevated blood sugars -- understanding the physiological mechanisms behind abnormal observations and restoring homeostasis through appropriate management is far more complex. Health educators can play a significant role in contextualizing difficult concepts, such as DKA and HHS, so that these complex conditions can be recognized with greater confidence and competence in clinical practice. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim of this survey was to establish prevalence of cardiopulmonary resuscitation (CPR) training within the last 5 years and reasons preventing training and initiation of CPR in Ireland as well as awareness of the emergency numbers. Methods: An in-home omnibus survey was undertaken in 2008 with quota sampling reflecting the age, gender, social class and geography of Ireland. Results: Of the 974 respondents, 23.5% had undergone CPR training in the previous 5 years with lower social class and age 65 years and older significantly less likely to be trained. The workplace was both a major source of awareness as well as training for those trained. In the untrained group lack of awareness of the need for CPR training was the most significant reason for non-training. Cost was not cited as a barrier. 88.9% of people gave a correct emergency number with geographical variation. Notably, the European emergency number 112 was not well known. Conclusion: Previous Irish and American population targets for CPR training have been surpassed in Ireland in 2008. New internationally agreed targets are now required. Meanwhile older people and those in lower socio-economic groups should be targeted for training. Awareness of at least one emergency number is very high in Ireland. Some geographical variation was found and this should be studied further. [Copyright &y& Elsevier]

Objective: Insertion of central venous catheters (CVCs) is an essential competency for emergency physicians. Ultrasound-guided (USG) insertion of CVCs has been shown to be safer than the traditional landmark technique. There is no clear consensus on effective methods for training physicians in USG insertion of CVCs. We developed and evaluated a novel educational training program in the USG technique for insertion of CVCs. Methods: Sixteen emergency medicine residents volunteered for a pre- and postprogram evaluation study, which was approved by our research ethics board. After their previous experience was determined, each participant was videotaped inserting a USG CVC in the right internal jugular vein on models. Participants then reviewed a Web-based instructional module and had a practical session. Participants were again videotaped inserting a USG CVC. The primary outcome was the change in score before and after the training program, using an expert-validated performance evaluation tool used to review the videotaped performances in a blinded fashion. Participants also completed a questionnaire to measure their satisfaction with the training program and any change in their perceived competence. Results: Participants ranged from residency year 1 to 5. Thirteen of 16 (81%) had never attempted USG insertion of a CVC. Participants reported that the models were realistic. Performance scores (12/19 to 13.2/19) and global ratings assessments (3.5/7 to 5.5/7) improved significantly (p < 0.01; the effect size, Cohen d = 1.12 before and 1.28 after) after the instruction. There was good interrater reliability between evaluators of the videotaped performances regarding performance scores (r = 0.68) and global rating scores (r = 0.75). All participants felt their confidence and technical skills were improved (p < 0.01) and all felt satisfied with the training program. Conclusion: This brief innovative multimethod training program was effective in enhancing emergency medicine resident competence in USG insertion of CVCs. [ABSTRACT FROM AUTHOR]

Objective: We assessed the self-reported theoretical and practical preparedness training of Canadian emergency medical services (EMS) providers in chemical, biological, radiological and nuclear (CBRN) events. Methods: We designed an online survey to address the theoretical and practical CBRN training level of prehospital providers. Emergency medical services staff in British Columbia and Ontario were invited to participate. Results: Of the 1028 respondents, 75% were male, and the largest demographic groups were front-line personnel with more than 15 years of experience. Only 63% of respondents indicated they had received either theoretical or practical training to work in a contaminated environment, leaving 37% who indicated they had received neither type of training. Of those that had received any training, 61% indicated they had received "hands-on" or practical training and 82% indicated they had received some training in identification of a possibly contaminated scene. Only 42% had received training for symptoms of nerve agents, 37% had received training for symptoms of blister agents and 46% had received training for symptoms of asphyxiants. Thirty-two percent had received training for the treatment of patients exposed to nerve agents, and 30% had received training for the treatment of patients exposed to blister agents. Only 31% of all respondents had received training for detecting radiation. Conclusion: CBRN events involve unique hazards and require specific education and training for EMS providers. A large proportion of Canadian EMS providers report not having received the training to identify and work in contaminated environments. [ABSTRACT FROM AUTHOR]

Objective: To assess the perception of leaders of the academic medical institutions regarding the need for specialty training in emergency medicine. Methods: A cross-sectional survey was conducted in all medical colleges of Pakistan in September 2005. Our sample included all academic leaders of recognized medical colleges in Pakistan. A questionnaire was designed and sent (mailed and faxed) to vice chancellors, deans, principals or medical directors of the institutions. Reminders were sent through faxes and emails wherever available, followed by phone calls if responses were not available after several attempts. Results: At the time of study, there were 39 medical colleges recognized by Pakistan Medical and Dental Council. Of these, responses were received from 26 teaching institutions in the country. A majority of the respondents (85%) were not satisfied with the care provided in the ED of their primary teaching hospital, and three-fourth (74%) thought that doctors specialized in other disciplines, like internal medicine and family medicine, cannot adequately manage all emergencies. When asked if Pakistan should have a separate residency training programme in emergency medicine, 96% responded in affirmative, and many (85%) thought that they will start a residency programme in emergency medicine if it was approved as a separate specialty. Conclusion: This survey shows significant support for a separate local training programme for emergency medicine in the country. [ABSTRACT FROM AUTHOR]

Introduction: Emergency department (ED) resuscitation requires the coordinated efforts of an interdisciplinary team. Human errors are common and have a negative impact on patient safety. Although crisis resource management (CRM) skills are utilized in other clinical domains, most emergency medicine (EM) caregivers currently receive no formal CRM training. Objectives: The objectives were to compile and compare attitudes toward CRM training among EM staff physicians, nurses, and residents at two Canadian academic teaching hospitals. Methods: Emergency physicians (EPs), residents, and nurses were asked to complete a Web survey that included Likert scales and short answer questions. Focus groups and pilot testing were used to inform survey development. Thematic content analysis was performed on the qualitative data set and compared to quantitative results. Results: The response rate was 75.7% ( N = 84). There was strong consensus regarding the importance of core CRM principles (i.e., effective communication, team leadership, resource utilization, problem-solving, situational awareness) in ED resuscitation. Problems with coordinating team actions (58.8%), communication (69.6%), and establishing priorities (41.3%) were among factors implicated in adverse events. Interdisciplinary collaboration (95.1%), efficiency of patient care (83.9%), and decreased medical error (82.6%) were proposed benefits of CRM training. Communication between disciplines is a barrier to effective ED resuscitation for 94.4% of nurses and 59.7% of EPs (p = 0.008). Residents reported a lack of exposure to (64.3%), yet had interest in (96.4%) formal CRM education using human patient simulation. Conclusions: Nurses rate communication as a barrier to teamwork more frequently than physicians. EM residents are keen to learn CRM skills. An opportunity exists to create a novel interdisciplinary CRM curriculum to improve EM team performance and mitigate human error. [ABSTRACT FROM AUTHOR]

Objectives: A descriptive study was performed to better understand the possible utility of immersive virtual reality simulation for training first responders in a mass casualty event. Methods: Utilizing a virtual reality cave automatic virtual environment (CAVE) and high-fidelity human patient simulator (HPS), a group of experts modeled a football stadium that experienced a terrorist explosion during a football game. Avatars (virtual patients) were developed by expert consensus that demonstrated a spectrum of injuries ranging from death to minor lacerations. A group of paramedics was assessed by observation for decisions made and action taken. A critical action checklist was created and used for direct observation and viewing videotaped recordings. Results: Of the 12 participants, only 35.7% identified the type of incident they encountered. None identified a secondary device that was easily visible. All participants were enthusiastic about the simulation and provided valuable comments and insights. Conclusions: Learner feedback and expert performance review suggests that immersive training in a virtual environment has the potential to be a powerful tool to train first responders for high-acuity, low-frequency events, such as a terrorist attack. [ABSTRACT FROM AUTHOR]

Current health care literature cites communication breakdown and teamwork failures as primary threats to patient safety. The unique, dynamic environment of the emergency department (ED) and the complexity of patient care necessitate the development of strong interdisciplinary team skills among emergency personnel. As part of the 2008 Academic Emergency Medicine Consensus Conference on “The Science of Simulation in Healthcare,” our workshop group identified key theory and evidence-based recommendations for the design and implementation of team training programs. The authors then conducted an extensive review of the team training literature within the domains of organizational psychology, aviation, military, management, and health care. This review, in combination with the workshop session, formed the basis for recommendations and need for further research in six key areas: 1) developing and refining core competencies for emergency medicine (EM) teams; 2) leadership training for emergency physicians (EPs); 3) conducting comprehensive needs analyses at the organizational, personnel, and task levels; 4) development of training platforms to maximize knowledge transfer; 5) debriefing and provision of feedback; and 6) proper implementation of simulation technology. The authors believe that these six areas should form an EM team training research platform to advance the EM literature, while leveraging the unique team structures present in EM to expand team training theory and research. [ABSTRACT FROM AUTHOR]

The patient safety literature from the past decade emphasizes the importance of teamwork skills and human factors in preventing medical errors. Simulation has been used within aviation, the military, and now health care domains to effectively teach and assess teamwork skills. However, attempts to expand and generalize research and training principles have been limited due to a lack of a well-defined, well-researched taxonomy. As part of the 2008 Academic Emergency Medicine Consensus Conference on “The Science of Simulation in Healthcare,” a subset of the group expertise and group assessment breakout sections identified evidence-based recommendations for an emergency medicine (EM) team taxonomy and performance model. This material was disseminated within the morning session and was discussed both during breakout sessions and via online messaging. Below we present a well-defined, well-described taxonomy that will help guide design, implementation, and assessment of simulation-based team training programs. [ABSTRACT FROM AUTHOR]

Across health care, teamwork is a critical element for effective patient care. Yet, numerous well-intentioned training programs may fail to achieve the desired outcomes in team performance. Hope for the improvement of teamwork in health care is provided by the success of the aviation and military communities in utilizing simulation-based training (SBT) for training and evaluating teams. This consensus paper 1) proposes a scientifically based methodology for SBT design and evaluation, 2) reviews existing team performance metrics in health care along with recommendations, and 3) focuses on leadership as a target for SBT because it has a high likelihood to improve many team processes and ultimately performance. It is hoped that this discussion will assist those in emergency medicine (EM) and the larger health care field in the design and delivery of SBT for training and evaluating teamwork. [ABSTRACT FROM AUTHOR]

Enhanced and extended roles proliferate in nursing today. This is, in part, due to changes in doctors' working hours and nursing becoming increasingly specialized. Ophthalmology has always had enhanced roles for nurses and the boundaries continue to evolve and widen. Accredited education in emergency ophthalmic nursing practice is essential to enhance safe practice, peer recognition and professional development in keeping with the Nursing and Midwifery Council's Code of Professional Conduct. Finding no appropriate educational and practice programme available, locally or nationally, the authors decided to devise their own module in conjunction with their ophthalmic department, their hospital's continuing professional practice development department, and Queen Margaret University. This article describes the authors' experience and the progression from inception, planning and organization to completion, and, finally, piloting the module themselves. [ABSTRACT FROM AUTHOR]