Emergency Care Research Articles

Assessing the frontline competency gap: Emergency care perceptions among nurses in Yemen's conflict zone.

Nursing competencies in armed conflict situations are critical for effective response and recovery. This study explores nurses' perceptions regarding their competencies in armed conflict zones to identify areas of proficiency and those requiring further emphasis in training. This cross-sectional descriptive study adhered to the STROBE reporting guidelines. It used a validated questionnaire examining 47 different competencies for nursing in armed conflict zones, which were subsequently ranked to identify those that were valued most and least. In total, 102 questionnaires were returned (85% response rate). The highest-ranked competencies focused on immediate life-saving interventions and personal safety. In contrast, competencies involving broader disaster management, such as understanding organizational disaster plans, post-death care, and risk identification, ranked lower. This observation may indicate a tendency to prioritize direct clinical care over strategic planning and long-term recovery in disaster nursing education. This study highlights the critical need to strengthen emergency care competencies among nurses working in armed conflict zones in Yemen. Its findings underscore the importance of targeted training programs, particularly in complex trauma management and psychological first aid, to address nurses' self-identified competency gaps. Policy implications include prioritizing resource allocation for emergency care infrastructure, implementing competency-based deployment strategies, and ensuring access to mental health support for nurses in working conflict zones. These actions are essential for building a resilient nursing workforce capable of providing quality care amidst the unique challenges of armed conflict.

Retrospective Review of the Image Quality of Monoplane Transesophageal Echocardiography in Prehospital Out-Of-Hospital Cardiac Arrest: A Single Center Pilot Study

ABSTRACT OBJECTIVES Out of Hospital Cardiac Arrest (OHCA) is a frequently encountered pathology with resultant poor outcomes in the majority of patients. Echocardiography has been utilized to help guide clinical decision making and monitor effectiveness of resuscitative efforts. Transthoracic echocardiography (TTE) the mainstay of point-of-care ultrasound (POCUS) real time resuscitative imaging has limitations, most notably is the disruption of closed chest compressions. Trans-esophageal echocardiography (TEE) is an emerging technology in emergency care and can potentially overcome these limitations but image quality and accuracy of use in the prehospital environment remains unknown. Our primary objective is to identify the accuracy of Emergency Medical Services (EMS) fellow physicians in performing TEE via the identification of key cardiac structures. Secondarily we assess image quality as well as accuracy on cardiac activity interpretation as compared to TEE-experienced cardiologists. METHODS A pilot study using descriptive analysis of a retrospective case-series with specific focus on inter-rater reliability as well as pragmatic management alterations based on real-time image interpretation by EMS physicians. After focused education, 13 patients were eligible for prehospital TEE who suffering OHCA from July 2022-June 2023. Ultrasound (US) images were interpreted by EMS fellow physicians and over-read by cardiologists with specific focus on inter-rater reliability. After collection of patients presenting data and US images, analysis was performed. RESULTS Of 13 patients initially screened, 10 patients were included in a study with a median age of 50 years old (41-70). Three patients were excluded due to equipment malfunction or insufficient image capture. An interrater reliability identified a kappa of 0.96 with respect to identification of cardiac structures and a kappa of 0.65 for identification of cardiac activity. CONCLUSIONS In this small study of prehospital TEE, EMS fellow physicians had high inter-rater reliability in image interpretation pertaining to anatomy and cardiac activity when compared with cardiologists. Further research is needed to determine its efficacy, safety, and widespread application in the prehospital setting.

Patient satisfaction using handheld ultrasound at emergency department in Jordan University Hospital

IntroductionThe use of portable ultrasound equipment in emergency medicine has shown the capacity to greatly improve patient care in the swiftly changing field. This research evaluates the influence of the Butterfly POCUS device on patient contentment in the Emergency Department at Jordan University Hospital.Materials and MethodsWe conducted a cross-sectional survey of 98 patients to examine their satisfaction levels after undergoing an ultrasound examination. We then evaluated these levels in relation to demographic and clinical characteristics.ResultsSeventy eight percent of the patients expressed a high level of satisfaction with their evaluation. This satisfaction level was consistent across all patient demographics, with no notable differences. Significantly, there was a clear correlation between greater satisfaction levels and higher first pain ratings, indicating that the technology effectively addresses patient concerns and enhances the diagnostic experience.ConclusionThe findings of our study support the wider use of portable ultrasound technology in emergency care settings, emphasizing its ability to greatly enhance patient satisfaction and outcomes. Further investigation should include multicenter trials to authenticate these results and investigate the long-term effects on clinical practice.

Recent advances in the influenza virus vaccine landscape: a comprehensive overview of technologies and trials.

SUMMARYIn the United Kingdom (UK) in 2022/23, influenza virus infections returned to the levels recorded before the COVID-19 pandemic, exerting a substantial burden on an already stretched National Health Service (NHS) through increased primary and emergency care visits and subsequent hospitalizations. Population groups ≤4 years and ≥65 years of age, and those with underlying health conditions, are at the greatest risk of influenza-related hospitalization. Recent advances in influenza virus vaccine technologies may help to mitigate this burden. This review aims to summarize advances in the influenza virus vaccine landscape by describing the different technologies that are currently in use in the UK and more widely. The review also describes vaccine technologies that are under development, including mRNA, and universal influenza virus vaccines which aim to provide broader or increased protection. This is an exciting and important era for influenza virus vaccinations, and advances are critical to protect against a disease that still exerts a substantial burden across all populations and disproportionately impacts the most vulnerable, despite it being over 80 years since the first influenza virus vaccines were deployed.

Diagnostic accuracy of point-of-care tests for acute respiratory infection: a systematic review of reviews.

Acute respiratory infections are a common reason for consultation with primary and emergency healthcare services. Identifying individuals with a bacterial infection is crucial to ensure appropriate treatment. However, it is also important to avoid overprescription of antibiotics, to prevent unnecessary side effects and antimicrobial resistance. We conducted a systematic review to summarise evidence on the diagnostic accuracy of symptoms, signs and point-of-care tests to diagnose bacterial respiratory tract infection in adults, and to diagnose two common respiratory viruses, influenza and respiratory syncytial virus. The primary approach was an overview of existing systematic reviews. We conducted literature searches (22 May 2023) to identify systematic reviews of the diagnostic accuracy of point-of-care tests. Where multiple reviews were identified, we selected the most recent and comprehensive review, with the greatest overlap in scope with our review question. Methodological quality was assessed using the Risk of Bias in Systematic Reviews tool. Summary estimates of diagnostic accuracy (sensitivity, specificity or area under the curve) were extracted. Where no systematic review was identified, we searched for primary studies. We extracted sufficient data to construct a 2 × 2 table of diagnostic accuracy, to calculate sensitivity and specificity. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 tool. Where possible, meta-analyses were conducted. We used GRADE to assess the certainty of the evidence from existing reviews and new analyses. We identified 23 reviews which addressed our review question; 6 were selected as the most comprehensive and similar in scope to our review protocol. These systematic reviews considered the following tests for bacterial respiratory infection: individual symptoms and signs; combinations of symptoms and signs (in clinical prediction models); clinical prediction models incorporating C-reactive protein; and biological markers related to infection (including C-reactive protein, procalcitonin and others). We also identified systematic reviews that reported the accuracy of specific tests for influenza and respiratory syncytial virus. No reviews were found that assessed the diagnostic accuracy of white cell count for bacterial respiratory infection, or multiplex tests for influenza and respiratory syncytial virus. We therefore conducted searches for primary studies, and carried out meta-analyses for these index tests. Overall, we found that symptoms and signs have poor diagnostic accuracy for bacterial respiratory infection (sensitivity ranging from 9.6% to 89.1%; specificity ranging from 13.4% to 95%). Accuracy of biomarkers was slightly better, particularly when combinations of biomarkers were used (sensitivity 80-90%, specificity 82-93%). The sensitivity and specificity for influenza or respiratory syncytial virus varied considerably across the different types of tests. Tests involving nucleic acid amplification techniques (either single pathogen or multiplex tests) had the highest diagnostic accuracy for influenza (sensitivity 91-99.8%, specificity 96.8-99.4%). Most of the evidence was considered low or very low certainty when assessed with GRADE, due to imprecision in effect estimates, the potential for bias and the inclusion of participants outside the scope of this review (children, or people in hospital). Currently evidence is insufficient to support routine use of point-of-care tests in primary and emergency care. Further work must establish whether the introduction of point-of-care tests adds value, or simply increases healthcare costs. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR159948.

A-324 Performance and Turnaround Time of Plasma Lactate Assay on POCT, Blood Gas Instrument, and Chemistry Analyzer

Abstract Background Time is a critical factor of plasma lactate testing in the management of patients with sepsis. To best serve these patients, we must optimize testing methods to provide a turnaround time (TAT) that guides efficient patient care. Point of care tests (POCTs) provide rapid results for emergency department and medical intensive care unit but are not feasible for all hospital settings. Laboratory testing methods on an automation line provide greater efficiency but result slowly due to need of specimen preparation and longer analytical time. The goal of this study is to provide detailed TATs of plasma lactate testing among the methods of POCT, chemistry analyzer in an automation line, and blood gas analyzer. Methods Plasma lactate testing was performed by three methods, GEM Premier ChemSTAT (POCT in ER only), Beckman AU5800 (chemistry analyzer), and Radiometer ABL800 (blood gas instrument). The TAT of lactate for each method was measured and include the time from specimen collection to laboratory receipt (except for POCT method), and time from specimen receipt to resulting (including specimen preparation for Beckman AU5800). Results The average TATs of lactate testing for each method in all hospital sites are detailed with respect to each event and subcategorized (Table 1). The average TAT of 12.0 min on Radiometer ABL800 is higher than the TAT of 2.5 on GEM Premier ChemSTAT method but is greatly reduced compared to the TAT of 35.4 min on Beckman AU5800. Conclusions Radiometer ABL800 method could be the optimal laboratory method for plasma lactate testing fulfilling the TAT (average 12 min), with less test cancellation due to specimen stability issue, and combines testing with blood gases. Using three Radiometer ABL800 instruments, we manage the performance of around 70 plasma lactate tests daily.

Routine outcomes to investigate differences between ethnic minorities and White British people presenting to emergency services for injury: the stakeholder consultation.

Research has found differences in processes and outcomes of care between people in ethnic minorities and White British populations in some clinical conditions, although findings have been mixed. The Building an understanding of Ethnic minority people's Service Use Relating to Emergency care for injuries study is investigating differences in presentation, experience and health outcomes between people from ethnic minorities and White British people who seek emergency health care for injury. Our aim was to consult with stakeholders to define measurable outcomes available in routine ambulance and emergency department data; to assess the appropriateness of existing outcome measures for ethnic minorities and White British people; and to identify any gaps. Clinicians, public contributors, researchers, people from the third sector, public health, healthcare inclusion were invited to join an online workshop to discuss routine outcomes. Twenty participants attended the stakeholder consultation, with only one being a public contributor, a limitation. Eleven were from a minority ethnic background and seven were female. The integrated list of outcomes included 25 items, combining routine outcomes from the Building an understanding of Ethnic minority people's Service Use Relating to Emergency care for injuries protocol and literature (n = 17) with additional outcomes (n = 8). Notably, the initial list lacked provisions for safeguarding referrals and cases of treatment refusal, which were new additions. Safety concerns arose due to the lack of safeguarding referrals, treatment refusal and self-discharge. Factors such as pre-existing health conditions, injury location and experiences of discrimination were identified as possible influences on care quality and waiting times for ethnic minority patients. Although the number of stakeholders taking part in our consultation was low, their participation identified outcomes not found in routine data, supporting the adoption of a mixed-methods approach to answer our research questions. A future consultation could look to include more public members and wider range of clinicians including those who work in safeguarding and rehabilitation services. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR132744.

Respiratory viral testing for young febrile infants presenting to emergency care: a planned secondary analysis of the Febrile Infants Diagnostic assessment and Outcome (FIDO) prospective observational cohort study

ObjectiveTo describe the association of respiratory viral test results and the risk of invasive bacterial infection (IBI) for febrile young infants presenting to emergency care.DesignA planned secondary analysis within the...

Paramedic management of patients with mental health issues: a scoping review

Background: Since the COVID-19 pandemic and the introduction of the National Partnership Agreement: Right Care, Right Person in the UK, paramedics spend about 1.8 million hours per year managing people with mental health issues. The UK health service needs to address the urgent training requirements for paramedics to provide mental healthcare in emergency care provision. Aims: To identify and examine current research on how paramedics manage people with mental health issues. Methods: A scoping review was carried out using the five stages of Arksey and O'Malley's framework. A research question—’How do paramedics manage patients with mental health issues?’—was developed, databases searched, studies identified and data charted, summarised and reported. Findings: Fifteen papers were included, and five themes identified: perceptions and expectations; call triage and inter-service collaboration; communication skills; lack of education and training; and assessment and evidence-based interventions. Conclusions: There is global evidence of the deficiencies in paramedic education around mental health presentation and a need for evidence-based education and interventions to improve patient outcomes.

A-192 Effectiveness in Communicating Critical Results: impact of technology and consultive actions on improving performance indicators in a laboratory in Northeast Brazil

Abstract Background Critical results consist of laboratory test results that require immediate intervention or decision-making by the responsible medical team, as they pose a risk to the patient's life. To manage the process of communicating critical results, it is also necessary to define the indicators, goals and systematic comparability through benchmarking. Methods The performance of the indicators measuring the critical results process for the year 2023 was analyzed. Performance indicators such as resolution time, success and failure rate in communication, delay rate in communication and the rate of open incidents related to the communication of critical results were monitored using a Business Intelligence tool. Results In the first two months of 2023 the results reflected the absence of parameters in the LIS for effective communication of critical results. September and October there was a high turnover rate in the laboratory in addition to the change in the hospital care profile in which the laboratory medicine service was inserted. These causes culminated in a number of 122 (1.48%) communication failures, representing an increase of 1,120% compared to the first two months of the year. On the other hand, there was a significant improvement in the average communication time for critical results, decreasing from approximately 736 hours to 184 hours(reduction of around 75%). There was also a reduction in communication delay of approximately 67%. These numbers corroborate the parameterization actions in the system aimed at speeding up the process. As a continuation of the improvement actions, the laboratory implemented goal setting for the resolution time indicator and also the periodic meeting for critical analysis of the results.In addition to these actions, the laboratory approached the hospital's clinical staff, making it possible to provide clarity on the difference between compulsory notification and critical results. This clarification allowed for the establishment of a list of exams considered critical, in order to meet the hospital profile, as well as to define the communication flow. For the success indicator in communicating critical results, there was a 22% improvement when comparing the last two months of 2023 with the first two months of the same year. In the last two months of the year, this indicator performed at 99.4%, corroborating the study published by Noronha et al., (2016), where the effectiveness rate in critical results communication was 96.1%. Comparing with the study by Noronha et al., (2016), where the biochemistry sector had the highest rate of critical results communication failures (73.8%), followed by the Emergency Room (78.6% ) and ICU (16.7%), the findings of this study highlighted the top 3 detracting sectors: Biochemistry (68%), “UPA” - Emergency Care Unit (42.1%) and ICU (21.4%), making data superimposable. Conclusions The communication of critical results has challenges related to its effectiveness, especially in hospital contexts. As a critical and high-impact activity, constant actions are necessary to continuously improve the process. Actions should take into account: interactions with attending physicians, the development and training of the internal team, and constant checks of the LIS, as technology can support the process management.

Implementation of Postpartum Hemorrage Emergency Care Using Bundle Approach at a Tertiary Care Hospital in Bangladesh

Implementation of Postpartum Hemorrage Emergency Care Using Bundle Approach at a Tertiary Care Hospital in Bangladesh

Total body weight estimation by 3D camera systems: Potential high-tech solutions for emergency medicine applications? A scoping review.

Weight estimation is required in adult patients when weight-based medication must be administered during emergency care, as measuring weight is often not possible. Inaccurate estimations may lead to inaccurate drug dosing, which may cause patient harm. High-tech 3D camera systems driven by artificial intelligence might be the solution to this problem. The aim of this review was to describe and evaluate the published literature on 3D camera weight estimation methods. A systematic literature search was performed for articles that studied the use of 3D camera systems for weight estimation in adults. Data on the study characteristics, the quality of the studies, the 3D camera methods evaluated, and the accuracy of the systems were extracted and evaluated. A total of 14 studies were included, published from 2012 to 2024. Most studies used Microsoft Kinect cameras, with various analytical approaches to weight estimation. The 3D camera systems often achieved a P10 of 90% (90% of estimates within 10% of actual weight), with all systems exceeding a P10 of 78%. The studies highlighted a significant potential for 3D camera systems to be suitable for use in emergency care. The 3D camera systems offer a promising method for weight estimation in emergency settings, potentially improving drug dosing accuracy and patient safety. Weight estimates were satisfactorily accurate, often exceeding the reported accuracy of existing weight estimation methods. Importantly, 3D camera systems possess characteristics that could make them very appropriate for use during emergency care. Future research should focus on developing and validating this methodology in larger studies with true external and clinical validation.

Nurse Perceptions of Pediatric Mental Health Emergency Care: A Qualitative Study

The key goal of the mental health nurse practicing in emergency mental health care services is ensuring that their patients have access to best practice mental health care. The aim of this study was to examine mental health nurses’ perceptions of their role in and preparation for providing mental health care services for pediatric emergency department patients. A qualitative constructivist method was employed. Inductive data were gathered using a focus group discussion model employing open-ended questions as probes. The participants were nine experienced practicing mental health nurses. Discussion was facilitated through detailed probing of the nurses’ experiences in providing care for clients in emergency departments. Four principal themes emerged from the data about mental health nurses’ experiences during the provision of emergency care: (i) barriers to adequate care provision; (ii) problems among populations; (iii) pediatric special needs; and (iv) the general need for improvements to mental health care. Each participant in this study asserted that they endorse the introduction of care by specialized mental health nurses in emergency care departments to better serve this population in Saudi Arabia. Inclusion and acceptance of psychiatric mental health nurses as full members of the multidisciplinary emergency department team, improved education and training opportunities, standards-based evaluation by collegial supervisors, availability of tools for assessment, and recognition of the role of pediatric psychiatric mental health nurses in emergency department care were goals expressed by the focus group members.

Key steps and barriers in the journey of patients with epilepsy through the National Healthcare System in Spain: The EPIPASS qualitative study.

Epilepsy requires continuous medical attention from multiple healthcare specialists, specialized facilities, and community-based care. In Spain, there is no standardized approach to epilepsy care. The aim of this study was to identify the factors impacting on the delivery of high-quality care by exploring key steps and barriers along the patient journey through the Spanish National Healthcare System (NHS). A qualitative study was conducted using opinions and experiences of neurologists, nurses, patients, and caregivers shared in discussion meetings. Using thematic content analyses, relevant aim-focused statements were coded according to prespecified issues in a discussion map (i.e., key steps and barriers), and sub-coded according to emerging issues. Thematic saturation and co-occurrence of key steps/barriers were evaluated to identify the most relevant factors impacting on the delivery of high-quality care. Sixty-five stakeholders took part in discussion meetings (36 neurologists, 10 nurses, 10 patients, and nine caregivers). Six key steps on the patient journey were identified: emergency care, diagnosis, drug therapy, follow-up, referral, and interventional treatment. Of these, follow-up was the most relevant step impacting on the delivery of high-quality patient care, followed by drug therapy and diagnosis. Emergency care was considered a hot-spot step with impact throughout the patient journey. Communication (among HCPs and between HCPs and patients) was a barrier to the delivery of high-quality care at several stages of the patient journey, including drug therapy, follow-up, referral, and interventional treatment. Resource availability was a barrier for diagnosis (especially for confirmation), drug therapy (drug availability), and referral (lack of professionals and specialized centers, and long waiting lists). This is the first study capturing perspectives of four key stakeholders involved in epilepsy care in Spain. We provide an overview of the patient journey through the Spanish NHS and highlight opportunities to improve the delivery of patient-centered care with a chronicity perspective. Patients with epilepsy may require prolonged medical care. In Spain, care is provided by a range of specialist and non-specialist centers. In this study, a team of Spanish neurologists, nurses, patients and caregivers identified barriers that affect the delivery of high-quality care for patients with epilepsy at each stage of their journey through the Spanish NHS. Specific epilepsy training for healthcare providers, appropriate resources for diagnosing and treating patients, and good communication between healthcare workers and patients were identified as important factors in providing high-quality care for patients with epilepsy.

Healthcare Resource Utilization and Associated Costs in Patients With Chronic Graft-Versus-host Disease Postallogeneic Hematopoietic Stem Cell Transplantation in England

Limited evidence suggests chronic graft-versus-host disease (cGvHD) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) increases healthcare resource utilization (HCRU) and costs. However, this burden has not been well characterized in England. This study assesses secondary care HCRU and costs for patients following allo HSCT in England with cGvHD and patients who did not develop graft-versus-host disease (GvHD). Further stratification was performed among patients who did or did not subsequently receive high-cost therapies for the treatment of cGvHD. This descriptive, retrospective cohort study used Hospital Episode Statistics (HES) data from April 2017 to March 2022. HES data captures information on reimbursed diagnoses and procedures from all National Health Service (NHS) secondary care admissions and attendances in England. High-cost drugs as defined by NHS England are recorded in HES, these drugs and other procedures including plasma exchange, were used to identify patients with cGvHD who were in receipt of high-cost therapies. HCRU and costs were described for patients with cGvHD following allo-HSCT (n = 721) and were matched with patients with no evidence of GvHD following allo-HSCT (n = 718). HCRU and costs were also described for the subset of patients with cGvHD (n = 198) following receipt of high-cost therapies and patients with cGvHD prior to or without such therapies (n = 523). A higher proportion of patients with cGvHD had at least one inpatient or intensive care unit (ICU) admission or emergency care attendance than patients without GvHD (inpatient: 74.6% versus 66.6%; emergency care: 39.3% versus 30.5%; ICU: 7.4% versus 4.7%; respectively); whilst the proportion of patients with an outpatient attendance were similar for both groups (outpatient: 80.3% versus 84.1%; respectively). The cost across all secondary care settings was higher for patients with cGvHD than patients without GvHD, with a mean cost of inpatient admissions of £17,339 ppy for those with cGvHD versus £8548 ppy in patients without GvHD. A higher proportion of patients who received high-cost therapies for the treatment of cGvHD had at least one secondary care admission or attendance, than patients who did not (inpatient: 85.4% versus 66.4%; ICU: 7.1% versus 5.4%; outpatient: 87.9% versus 76.7%; emergency care: 44.4% versus 36.5%; respectively). Patients who were treated with high-cost therapies for the treatment of cGvHD had a greater mean number (14.6 versus 8.2 ppy, respectively) for all-cause inpatient admissions after treatment than patients who did not. In all secondary care settings, the total cost ppy was higher for patients who received high-cost therapies for the treatment of cGvHD, than for those who did not. Patients who were treated with high-cost therapies for the treatment of cGvHD had a greater mean cost (£21,137 versus £15,956 ppy, respectively) for all-cause inpatient admissions than patients who did not. This study demonstrates that cGvHD and the use of associated high-cost therapies impacts healthcare activity and costs across various secondary care settings in England more than patients without GvHD and patients with cGvHD who received no high-cost therapies.

The Efficacy of High-Fidelity Telesimulation in Preparing Nursing Students for Emergency and Critical Patient Care: A Prospective Study.

High-fidelity telesimulation can address the gap in nursing education caused by the pandemic by providing a simulated environment for students to practice skills that closely mimic real-life scenarios. This study was designed to determine the effect of a high-fidelity telesimulation teaching program on emergency and critical patient care-related knowledge, self-confidence, and critical thinking skills in nursing students. This randomized, single-blind controlled study was conducted on a sample of 84 nursing students who were evaluated using pretest and posttest measurements. The participants were randomized into a control group ( n = 43) and an experimental group ( n = 41). The control group received an in-person traditional teaching program, and the experimental group was taught using a high-fidelity telesimulation program. During the high-fidelity telesimulation, synchronous online tutorial learning and telesimulation were conducted every 100 and 300 minutes. The experimental group program included a lecture, simulation teaching videos, and demonstrations related to endotracheal intubation, 12-lead electrocardiography, protective clothing, and hybrid telesimulation learning. In each subgroup, the students executed a single high-fidelity telesimulation scenario in which they were assigned individual roles. The students in the other subgroups served as observers and engaged in the synchronous online debriefing. Teaching efficacy was evaluated using an objective structured clinical examination and a questionnaire designed for emergency and critical patient care. In the experimental group, levels of knowledge and self-confidence as well as critical thinking skills related to emergency and critical patient care were significantly higher than in the control group ( p < .05). High-fidelity telesimulation teaching is a feasible and reliable alternative to conventional in-person simulation for nursing students, particularly in situations where traditional clinical experiences are not possible.

Совершенствование правового регулирования использования лекарственных препаратов при оказании первой помощи: проблемные и дискуссионные вопросы

Summary. Investigation purpose – based on the analysis of the range of medicines approved for medical use in the Russian Federation and their practical application in certain types of medical care, identify groups and a list of medicines for their possible use in providing first aid to victims by certain categories of first aid participants, as well as related problems requiring legislative regulation. Material and methods of the investigation. Research materials – normative legal acts reflecting the provision of first aid and medical, including emergency and primary health care, emergency and urgent care, namely: 5 federal laws; 4 Decrees of the President of the Russian Federation; 3 administrative documents of the Government of the Russian Federation; 26 administrative documents of the Ministry of Health of the Russian Federation; 1 administrative document of the Department of Health Moscow; 31 instructions for the use of medicines for medical use. Research methods: analytical, logical and information modeling. Investigation results and their analysis. Groups and a list of medicines that can be used in providing first aid to victims are proposed for consideration and discussion. Problematic issues requiring legislative regulation in the use of medicines at the stage of first aid have been identified. Groups and a list of medicines for first aid to victims are offered for consultations and discussions with representatives of scientific institutions of the medical community and government agencies that determine health policy in the Russian Federation in order to develop management decisions aimed at achieving a high level of preservation of human life and health in emergency situations.

Implementing Task Substitution for Doctors and Nurses as a Key Element of Healthcare Reform

The ongoing global shortage of healthcare professionals, particularly doctors and nurses, presents a critical challenge to the efficiency and accessibility of healthcare systems. This manuscript reviews the concept of task substitution between doctors and nurses, emphasizing the role of Advanced Nursing Practitioners (ANPs) in addressing workforce deficits. Drawing on examples from the United States, Canada, the United Kingdom, and Australia, the study explores how ANPs have been integrated into various healthcare settings, including primary care, geriatrics, mental health, and emergency care. The manuscript also discusses the potential for implementing similar practices in Poland, offering a strategic framework for enhancing nursing education, expanding ANP roles, and improving patient outcomes through healthcare reform. By examining the educational requirements, scope of practice, and existing models of ANP integration, this article provides a comprehensive analysis of how advanced nursing roles can alleviate pressures on healthcare systems and suggests actionable steps for policymakers.

435 Assessing the MIAHTAPS Protocol for Workplace Violence Prevention in Emergency Care

435 Assessing the MIAHTAPS Protocol for Workplace Violence Prevention in Emergency Care

Performance replication of the Hospital Mental Health Risk Screen in ethnoracially diverse U.S. patients admitted through emergency care.

Patients admitted to hospitals after emergency care for injury or acute illness are at risk for later mental health problems. The American College of Surgeons Committee on Trauma Standards for care of injured patients call for mental health risk screening, and the Hospital Mental Health Risk Screen (HMHRS) accurately identified at-risk patients in a developmental study that included patients from five ethnoracial groups. Replication of these findings is essential, because initial positive results for predictive screens can fail to replicate if the items were strongly related to outcomes in the development sample but not in a new sample from the population the screen was intended for. Replication of the predictive performance of the 10-item HMHRS was studied prospectively in ethnoracially diverse patients admitted after emergency care for acute illness or injury in three hospitals across the U.S. Risk screen scores and follow-up mental health outcomes were obtained for 452 of 631 patients enrolled (72%). A cut score of 10 on the HMHRS correctly identified 79% of the patients who reported elevated levels of depression, anxiety, and PTSD symptoms two months post-admission (sensitivity) and 72% of the patients whose symptoms were not elevated (specificity). HMHRS scores also predicted well for patients with acute illness, for patients with injuries, and for patients who reported an Asian American/Pacific Islander, Black, Latinx, Multirace, or White identity. Predictive performance of the HMHRS was strong overall and within all five ethnoracial subgroups. Routine screening could reduce suffering and health care costs, increase health and mental health equity, and foster preventive care research and implementation. The performance of the HMHRS should be studied in other countries and in other populations of recent trauma survivors, such as survivors of disaster or mass violence.