Emergency Situations Research Articles

How to improve medical students’ ECG interpretation skills ? Multicenter survey and results of a comparative study evaluating a new educational approach

BackgroundLearning to interpret electrocardiograms (ECGs) is a crucial objective in medical education. Despite its importance, errors in ECGs interpretation are common, and the optimal teaching methods have not yet been clearly established.ObjectivesTo evaluate students’ confidence in ECGs analysis and their opinion on current teaching methods, and to assess the effectiveness of a new ECG educational approach.MethodsFirst, we conducted a survey on ECG learning among fourth to sixth-year medical students. Second, a 5-week multicenter comparative study was conducted with fourth-year medical students during their cardiology internship. Two different teaching methods were used, assigned by center. The first group participated in 5-minutes workshops 4 times a week using a “reversed classroom” method, supervised by a cardiologist, where students took turns selecting, presenting and discussing ECGs. The control group attended a single 2-hour face-to-face ECG course. All participants completed a 30-minute ECGs analysis test at baseline and after 5 weeks.ResultsOut of 401 survey respondents, the confidence levels in ECG interpretation were 3/5 (IQR 2–3) for routine situations and 2/5 (IQR 1–3) for emergency situations. Satisfaction with ECG teaching was low (2/5, IQR 1–3) and 96.3% of respondents favored more extensive ECG training. In the comparative study, 52 students from 3 medical schools were enrolled (control group: n = 27; workshop group: n = 25). Both groups showed significant improvement in exam scores from baseline to 5-week (33/100 ± 12/100 to 44/100 ± 12/100, p < 0.0001 for the control group and 36/100 ± 13/100 to 62/100 ± 12/100, p < 0.0001 for the workshop group). The improvement was significantly greater in the workshop group compared to the control group (+ 26 ± 11 vs. + 11 ± 6, p < 0.001).ConclusionsAmong French medical students who initially reported low confidence and insufficient skills in ECG interpretation, the workshop approach using a “reversed classroom” method was found to be more effective than conventional lecture-based teaching during cardiology internship.Graphical abstract

Withdrawal/Withholding of Life-Sustaining Therapies: Limitation of Therapeutic Effort in the Intensive Care Unit.

Background/Objectives: The change in critically ill patients makes limitation of therapeutic effort (LTE) a widespread practice when therapeutic goals cannot be achieved. We aimed to describe the application of LTE in a post-surgical Intensive Care Unit (ICU), analyze the measures used, the characteristics of the patients, and their evolution. Methods: Retrospective observational study, including all patients to whom LTE was applied in a postsurgical ICU between January 2021 and December 2022. The LTE defined were brain death, withdrawal of measures, and withholding. Withholding limitations included orders for no cardiopulmonary resuscitation, no orotracheal intubation, no reintubation, no tracheostomy, no renal replacement therapies, and no vasoactive support. Patient and ICU admission data were related to the applied LTE. Results: Of the 2056 admitted, LTE protocols were applied to 106 patients. The prevalence of LTE in the ICU was 5.1%. Data were analyzed in 80 patients. A total of 91.2% of patients had been admitted in an emergency situation, and 56.2% had been admitted after surgery. The most widespread limitation was treatment withholding (83.8%) compared to withdrawal (13.8%). No differences were found regarding who made the decision and the type of limitation employed. However, patients with the limitation of no intubation had a longer stay (p = 0.025). Additionally, the order of not starting or increasing vasopressor support resulted in a longer hospital stay (p = 0.007) and a significantly longer stay until death (p = 0.044). Conclusions: LTE is a frequent measure in critically ill patient management and is less common in the postoperative setting. The most widespread measure was withholding, with the do-not-resuscitate order being the most common. The decision was made mainly by the medical team and the family, respecting the wishes of the patients. A joint patient-centered approach should be made in these decisions to avoid futile treatment and ensure end-of-life comfort.

Enhancing emergency competencies in healthcare professionals via murder mystery games: An innovative gamification learning-based approach

BackgroundEnhancing the emergency competencies of healthcare professionals is essential for ensuring patient safety, optimizing emergency response efficiency, and fostering effective team collaboration. However, traditional simulation-based methods often struggle to accurately replicate real-life emergencies, resulting in outcomes that may not fully reflect actual performance, thereby undermining their effectiveness in training and developing the critical skills needed for emergency situations. ObjectiveThis study evaluated the effectiveness of using murder mystery games (MMGs) as a gamified learning method to enhance the emergency competencies of healthcare professionals. MethodsTwelve scripts of emergency scenarios were developed for the MMGs, and five assessment scales were established, covering emergency response, scenario decision-making, team collaboration, emotional support, and human care. Questionnaire data were analyzed between the experimental and control groups using Chi-square tests for five dimensions and nineteen indicators of emergency competencies. ResultsThe performance of the experimental group in emergency response and emotional support was significantly higher than that of the control group (P<0.001). The experimental group also showed notable excellence in scenario decision-making, team collaboration, and human care (P<0.005). ConclusionsEmergency capabilities can be significantly enhanced through murder mystery games, providing robust support for improving the quality of medical services.

Spatial Analysis with Detailed Indoor Building Models for Emergency Services

This paper presents a systematic approach to perform spatial analysis with detailed indoor building models for emergency service decision supports. To achieve a more realistic spatial application, this research integrates three-dimensional (3D) indoor building models and their attributes to simulate an emergency evacuation scenario. Indoor building models of a complicated train station with different levels of detail are generated from two-dimensional (2D) floor plans and Building Information Model (BIM) datasets. In addition to the 3D building models, spatial and non-spatial attributes are also associated with the created building models and the objects within them. The ant colony optimization (ACO) algorithm is modified to analyze the indoor building models for emergency service decision support applications. The detailed indoor models and the proposed spatial analysis algorithms are tested in simulated emergency evacuation scenarios to select the best routes during emergency services. The experimental results demonstrate that the proposed system is helpful for selecting the optimal route with the least cost at varying time stamps. Together with the developed spatial analysis framework, they have a great potential for effective decision support during emergency situations.

A Comparative Analysis of the Impact of Two Different Cognitive Aid Bundle Designs on Adherence to Best Clinical Practice in Simulated Perioperative Emergencies.

Background: Stress and human error during perioperative emergency situations can significantly impact patient morbidity and mortality. Previous research has shown that cognitive aid bundles (CABs) minimize critical misses by 75%. This study aimed to compare the effectiveness of two different CAB designs with the same content in reducing missed critical management steps for simulated perioperative emergencies. Methods: A multicenter randomized controlled simulation-based study was conducted including 27 teams, each consisting of three participants; each team performed four simulation scenarios. In the first scenario for each team (Scenario 1), no CAB was used. Scenarios 2 and 3 were randomly allocated to the groups, with either a branched, clustered design (CAB-1) or a linear, step-by-step design (CAB-2) of the cognitive aid. In Scenario 4, the groups used one of the previously mentioned CABs according to their own preference. The primary outcome was the difference in the percentage of missed critical management steps between the two different CABs. Secondary outcomes included user preference for one CAB design and the reduction in percentage of missed critical management steps using any CAB versus no CAB. Results: Twenty-seven teams simulated 108 perioperative emergency situations. The percentage of missed critical management steps was similar between CAB-1 and CAB-2 (27% [interquartile range (IQR) 20-29] versus 29% [IQR 20-35], p = 0.23). However, most participants favored the branched, clustered design CAB-1 (77.8%). Additionally, employing any CAB reduced the percentage of missed critical management steps by 36% (33% missed steps vs. 21% missed steps, p = 0.003). Conclusions: While the two CAB designs did not differ significantly in reducing missed critical management steps, the branched, clustered design was perceived as more user-friendly. Importantly, using any CAB significantly reduced the percentage of missed critical management steps compared to not using a cognitive aid, emphasizing the need for CAB use in the operating room.

Systematization of a toxicity screening method based on a combination of chemical analysis and the delayed fluorescence algal growth inhibition test for use in emergency environmental surveys.

In recent years, heavy rainfall disasters linked to climate change have become more frequent, raising concerns about the release of chemicals stored in factories. Assessing chemical contamination during such emergencies therefore necessitates the development of a quick and easy method for evaluating hazardous contaminants in combination with toxicity testing. This study proposes a "toxicity screening" method that combines biological response testing and chemical analysis to systematically evaluate hazardous contaminants in emergency situations. The toxicity screening method evaluates the water quality in three steps, including water quality measurements and a delayed fluorescence (DF) assay, metal content measurements and a DF assay, and targeted screening analysis and a DF assay. The efficacy of this method was tested using industrial wastewater from 14 locations. Seven of the samples were non-toxic, while the other seven samples were toxic, displaying no observed effect concentration (NOEC) values ranging from 0.625 to 20%. Two toxic samples in the first phase possessed high total chlorine concentrations (0.4mg L-1) and conductivities (2200 mS m-1), indicating that the main sources of toxicity were residual chlorine and a high salt concentration. In the second phase, metal content analysis identified metals as the toxicity cause in four samples. In the third phase, the organic contaminants were analyzed, and tri-n-octyl phosphate (TNOP) was detected at a concentration of 0.00027mg L-1. The results of solid-phase extraction experiments and exposure tests with TNOP alone indicated that the contribution of TNOP to the toxicity was negligible and that chemicals not adsorbed on the solid-phase extraction cartridges were the cause of toxicity. The proposed method can therefore be considered effective for disaster-related water quality assessment, delivering results within 12days.

Assessment of Doctors' Readiness to Provide Emergency and Urgent Care

A doctor of any specialty must be able to provide medical care to a patient in urgent and emergency situations. The abstract presents the results of a study that compared groups of specialists who had and had not undergone accreditation, who had and had not been trained in specialized cycles. Knowledge of algorithms and organizational issues of providing these types of care in institutions was revealed. Based on the results obtained, measures were proposed to improve the quality of training doctors to provide urgent and emergency medical care.

Ethical and legal aspects in anesthesiology, ethical and legal issues, an overview

Introduction: The practice of anesthesiology plays a crucial role in medicine, ensuring the comfort and safety of patients during medical and surgical procedures. However, this specialty faces a series of ethical and legal challenges. This article provides an overview of these issues, considering the importance of respecting patient autonomy and compliance with legal standards. Methods: To conduct this review, the following descriptors were used to search the PubMed and MEDLINE databases: "Anesthesiology", "Ethical", "Questions", "Aspects", "Legal". These descriptors were combined using the boolean operator AND to ensure search accuracy. Initially, 165 relevant studies were identified. After excluding duplicates, editorials, and incomplete articles, 122 articles were considered for analysis. The final selection included the full reading of 24 articles, of which 13 were considered relevant to compose this review. Results: Anesthesiologists face complex ethical dilemmas, from obtaining informed consent to making decisions in emergency situations. Additionally, there are concerns about fair resource allocation and balancing risks and benefits. In the legal realm, there are comprehensive regulations related to professional liability, documentation of procedures, and the use of medications and equipment. Conclusion: The practice of anesthesiology requires a solid understanding of the ethical and legal aspects involved. It is essential to respect patient autonomy by obtaining their informed consent. Constant ethical reflection and compliance with legal regulations are fundamental to ensuring the delivery of high-quality care.

Cardiac arrhythmias in adults with congenital heart disease

In patients with congenital heart disease, cardiac arrhythmias are complex and require athorough understanding of the anatomy, past surgical and interventional procedures, and the specific electric processes. Supraventricular tachycardias commonly present as emergency situations and should be treated immediately, particularly when there is an underlying complex malformation. Establishing sinus rhythm is usually superior to pure frequency control for hemodynamic reasons. Catheter ablation should be preferred over medical treatment, even though several procedures are often necessary. In addition, bradycardia is seen more frequently in congenital heart defects; this could be aggravated by antiarrhythmic drugs. There are significant differences between the indications and techniques used for pacemaker implantation in patients with congenital heart defects and those without. Patients with complex congenital heart diseases have an increased risk of thromboembolism; therefore, an individual and early indication for low-threshold oral anticoagulation is necessary; direct oral anticoagulants can also be used for this purpose. In risk stratification for sudden cardiac death, the principles of general guidelines are often not applicable, and individualized decisions are required. Recently, anew general risk score for congenital heart disease has been developed. The treatment of cardiac arrhythmias in patients with congenital heart disease should always be performed in close cooperation with specialized centers.

Proposal of a Cost-Effective and Adaptive Customized Driver Inattention Detection Model Using Time Series Analysis and Computer Vision

Advanced Driver Assistance Systems, such as Forward Collision Warning and Lane Departure Warning, play a crucial role in accident prevention by alerting drivers to potential hazards. With the advent of fully autonomous driving technology that requires no driver input, there is now a greater emphasis on monitoring the state of vehicle occupants. This is particularly important because, in emergency situations where control must suddenly be transferred to an unprepared occupant, the risk of accidents increases significantly. To mitigate this risk, new monitoring technologies are being developed to analyze driver behavior and detect states of inattention or drowsiness. In response to the emerging demands of driver monitoring technology, we have developed the Customized Driver Inattention Detection Model (CDIDM). This model employs video analysis and statistical techniques to accurately and rapidly classify information on drivers’ gazes. The CDIDM framework defines the components of inattentive or drowsy driving based on the Driver Monitoring System (DMS) safety standards set by the European New Car Assessment Programme (EuroNCAP). By defining six driving behavior-related scenarios, we have improved the accuracy of driver inattention assessment. The CDIDM estimates the driver’s gaze while simultaneously analyzing data in real-time. To minimize computational resource usage, this model incorporates a series of preprocessing steps that facilitate efficient time series data analysis, utilizing techniques such as DTW Barycenter Averaging (DBA) and K-means clustering. This results in a robust driver attention monitoring model based on time series classification.

Ajna: A Wearable Shared Perception System for Extreme Sensemaking

This paper introduces the design and prototype of Ajna, a wearable shared perception system for supporting extreme sensemaking in emergency scenarios. Ajna addresses technical challenges in Augmented Reality (AR) devices, specifically the limitations of depth sensors and cameras. These limitations confine object detection to close proximity and hinder perception beyond immediate surroundings, through obstructions, or across different structural levels, impacting collaborative use. It harnesses the Inertial Measurement Unit (IMU) in AR devices to measure users’ relative distances from a set physical point, enabling object detection sharing among multiple users across obstacles like walls and over distances. We tested Ajna's effectiveness in a controlled study with 15 participants simulating emergency situations in a multi-story building. We found that Ajna improved object detection, location awareness, and situational awareness, and reduced search times by 15%. Ajna's performance in simulated environments highlights the potential of artificial intelligence (AI) to enhance sensemaking in critical situations, offering insights for law enforcement, search and rescue, and infrastructure management.

Genetic Algorithm-based Optimization Model for Emergency Shelters Location Allocation in Public Health Emergency Situations

Deploying emergency resources after a disaster is crucial for reducing the event’s impact. A multi-objective (MO) resource allocation (RA) method is developed to achieve efficient distribution of relief items and the best choice of transportation routes, taking into account the variable and persistent nature of rescue operations. The MO Cellular Genetical Approach (MOC-GA) addresses the concept by incorporating auxiliary populations and neighborhood architecture into the cellular automaton. The comparative experiment conclusively demonstrates that MOC-GA performs favorably compared to Particle Swarm Optimisation (PSO), Ant Colony Optimisation (ACO), and Dragon Fly Optimisation (DFO) in several metrics such as the Pareto Front (PF), hypervolume, mean objective function value, and PF ratios. The findings demonstrate that MOC-GA effectively addresses the MO dynamical emergency RA approach, offering decision-makers a more comprehensive range of superior and diversified candidate rescue strategies than alternative methods. This research analyzes the existing rescue methods and proposes a theoretical rescue strategy to aid decision-makers in making scientifically informed decisions.

Insights into decision‐maker's perceptions of good versus bad decisions in emergency services—A modified Delphi study

AbstractDecision‐making in emergency situations, such as those faced by fire, police, and health service personnel, presents unique challenges due to the high‐stakes and time‐pressured environment. Here we aim to better understand what emergency responders regard as constituting ‘good’ and ‘bad’ decisions in emergency situations. We administered a modified Delphi study, eliciting opinions from decision‐makers across all these sectors towards consensus around the key elements of good and bad decision‐making. Participants were first asked to define what makes a ‘good’ and a ‘bad’ decision, and subsequently to identify the top five most important elements of each. While consensus was not found, important insights were identified that can assist improve the standard of decision making at all levels of emergency response and management. We observed (i) a lack of a common understanding between participants of what a decision is, and how a decision differs from pre‐decision and postdecision components; (ii) responses varied according to whether a free text description or the identification of separate elements was requested; (iii) respondents valued ‘goodness’ across different and at times unrelated components a scaled measure of decision quality as opposed to a binary evaluation of ‘rightness’; and (iv) pre‐ and postdecision elements are considered more important than the decision itself when determining the quality of a decision. To address the issues highlighted by the study we recommend improvements in training, and improvements to organization doctrine related to decision making, risk tolerance, assessment of decision quality and development of intent‐based or principle‐based operational guidance. Ultimately, incident controllers from all services must remain cognizant that they will face considerable scrutiny if they cannot explain how they arrived at the decision they made.

Open Fractures of the Hand: is there No Alternative to Definitive Osteosynthetic Treatment in an Emergency Situation?

There is an emergency indication for the treatment of open fractures. Fracture stabilisation and soft tissue care are equal prerequisites for an uncomplicated course of treatment and a good functional result. However, challenges arise in cases of extensive wound contamination and compromised perfusion, limiting options for stable osteosynthesis in emergency situations. Furthermore, resource constraints may pose a challenge to adhering strictly to the six-hour time window. This prompts deliberations on whether, under certain circumstances, a deviation from the conventional approach is feasible by exploring the possibility of prioritising immediate surgical wound care during emergencies, with definitive fracture care deferred to a later point in time. Between 2019 and 2021, 301 patients with open fractures of the hand skeleton were treated (median age 44 years, 85% male, 15% female). Definitive treatment was carried out as a primary emergency procedure in 215 patients (group A), whereas it was performed at an interval after an average of 3 days in 86 patients (group B), who had received surgical wound care, splint placement, and antibiotic coverage on the day of the injury. In a retrospective study, the following criteria were analysed: comorbidities, injury patterns, injury location, timing of treatment, number of follow-up procedures, infection rate, and duration of hospitalisation. The course was complicated by infection in six patients (1.9%). Five of these patients were in group A (infection rate 2.3%), and only one patient was in group B (infection rate 1.1%). All six infections occurred after crush injuries, all at the fingertip or end joint. These numbers underscore the relevance of soft tissue trauma and primary stump formation. Comorbidities were not statistically significant in our study with a view to the occurrence of infection. In conclusion, it can be stated that, with antibiotic protection, definitive treatment of an open fracture in an interval is possible if it is preceded by initial emergency surgical wound care with subsequent immobilisation.

Implementation of Evacuation Training in Emergency Situations to Improve Ship Passenger Safety on KMP Jatra 2

The incidence of accidents and occupational diseases is still quite high. Various ship incidents include sinking, collision, fire, aground, people falling overboard, steering damage, and pollution at sea. as well as work accidents during duty on the ship, generally caused by human factors or human error. The purpose of this study is to find out the emergency drills on the ship, based on SOLAS on the KMP Jatra 2 ship and to find out how to handle problems in maximizing job training to each crew member according to SOLAS and SOP regulations. The results of this study found that emergency training on board KMP Jatra 2 is not running properly due to lack of consistency in following the SOP and SOLAS standards that have been set. To deal with this problem, several steps need to be taken, namely good HR policies, implementation of a punishment system for undisciplined crew members, regular training and realistic simulation of emergency situations, continuous supervision and evaluation of training implementation.

Expert management consensus for the application of point-of-care testing in emergency and critical care (2024)

Point-of-care testing (POCT) is a testing approach that can be completed promptly, and for patients with acute and severe diseases, it can help clinicians identify changes in patients' conditions early and save patients' lives. Currently, the application of POCT in critical and emergency situations lacks a comprehensive clinical management consensus, leading to a lack of standardized guidance for its practical application. In order to standardize the application of POCT in critical and emergency situations, Emergency Medicine Association of Wuhan Medical Association organized multiple experts in the field of emergency and critical care to discuss and identify the current clinical issues that require standardized consensus in the application of POCT in emergency and critical care. Furthermore, a comprehensive literature search of domestic and international literature was conducted, and discussions and modifications were organized among emergency and critical care medicine experts. Ultimately, the Expert management consensus for the application of point-of-care testing in emergency and critical care (2024), which involves personnel management, equipment management and data management was formed. This consensus aims to provide more comprehensive standards and guidance for the application of POCT in critical care, thereby improving the quality of patient care and medical efficiency.

Secure Fingerprint Identification for Unconscious Personal Health Record Users During an Emergency Situation

Secure Fingerprint Identification for Unconscious Personal Health Record Users During an Emergency Situation

HAC-SAGIN: High-altitude computing enabled space–air–ground integrated networks for 6G

The space–air–ground integrated networks (SAGINs) provide a new paradigm for the development of the Internet of Things (IoT) networks by enhancing coverage and deploying computing resources near IoT devices, especially in emergency situations and disaster-hit regions. In the context of the IoT networks, aerial platforms such as unmanned aerial vehicles (UAVs) and high-altitude platforms (HAPs) present in the air layer of SAGINs with access and aerial computing (AC) capabilities have the potential to significantly expand coverage, enhance performance, reduce delay and handle complex computation tasks for IoT devices. Seeking the stated prospect, we propose a high-altitude computing (HAC)-enabled SAGIN leveraging millimeter waves (mmWave) frequency range in which the IoT devices are provided access services by low-earth orbit satellites (LEO-SATs) and HAPs while the HAPs offer AC facility as well. Non-orthogonal multiple access (NOMA) is used as a multiple-access technique with different clustering mechanisms in uplink (UL) and downlink (DL) communication. We aim to establish high-rate data transmission in DL along with minimizing the execution time of IoT devices offloading their data to the HAPs in UL communication. The mmWaves range is targeted to have high-rate data transmissions and NOMA implementation further enhances the bandwidth available for an individual IoT device. For efficient offloading in UL communication, we formulate an optimization problem aiming to minimize the execution time by using the Lagrangian function-based approach. Execution time is minimized by reducing the transmission and computation time, which is attained by the optimization of allocated power and computation resources. Simulation results demonstrate that the proposed HAC-SAGIN is able to establish high-rate transmissions in DL and exhibits a significant decrease in execution time in UL in contrast to the no optimization case. Optimum power assignment improves the achievable rate, leading to reduced transmission times, while optimum core assignment efficiently reduces the computation time. In addition, the offloaded data size-driven NOMA implementation in UL prominently improves the system effective throughput.

Optimization of personnel evacuation routes for sudden nuclear accidents based on hybrid genetic-grey wolf optimizer algorithm

To address the emergency situation resulting from a sudden nuclear accident, it is imperative to develop an optimal emergency response plan that ensures the prompt and safe evacuation of affected individuals from the hazardous area.The paper proposed the hybrid genetic-grey wolf optimizer algorithm (GA-GWO).This algorithm integrated radiation environment and road network to plan evacuation paths that minimizes the radiation dose. This algorithm enhanced the convergence and search capabilities of the genetic algorithm (GA) by incorporating wolf pack characteristics and internal competitive behavior. This improvement allowed for more efficient exploration of potential evacuation routes. The feasibility of GA-GWO was validated through a visualization simulation utilizing Web Geographic Information Systems (WebGIS). The findings indicated that GA-GWO generated evacuation paths that minimize radiation dose, providing safe routes for the affected population. This approach demonstrates significant potential for application in emergency response planning for sudden nuclear accidents, ensuring both prompt and safe evacuations.

Evaluation of the Effectiveness of Ship Guiding Services at Tanjung Perak Port Surabaya

The efficiency and effectiveness of vessel piloting services at ports play a crucial role in ensuring smooth maritime operations and enhancing maritime safety. This study aims to evaluate the effectiveness of vessel piloting services at Tanjung Perak Port, Surabaya, Indonesia. The evaluation encompasses various aspects of piloting services, including navigational guidance, maneuver assistance, and response to emergency situations. By employing qualitative methodologies, data will be collected from stakeholders, including port authorities, vessel operators, and piloting personnel. Key performance indicators such as response time, safety record, and customer satisfaction will be analyzed to assess the current state of piloting services. Additionally, potential areas for improvement will be identified to enhance the efficiency and effectiveness of vessel piloting services at Tanjung Perak Port. The findings of this study are expected to provide valuable insights for port authorities and stakeholders to optimize piloting services and ensure safe and efficient maritime operations at Tanjung Perak Port, Surabaya.