Real-life Emergencies Research Articles

Assessing the psychobiological demands of high-fidelity training in pre-hospital emergency medicine

BackgroundIndividuals who provide critical emergency care mount rapid psychobiological responses when faced with an incident. These responses are adaptive and ensure resources at time of demand; however, frequent activation with minimal opportunity for recovery can have negative consequences for health and wellbeing. Monitoring individuals in real emergency situations would provide an understanding of their stress responses during the provision of critical care; however, this presents logistical challenges. An alternative is to assess individuals during high-fidelity training scenarios. This is the first comprehensive assessment of psychobiological responding during continuous high-fidelity training in pre-hospital emergency medicine.MethodsA sample of doctors and paramedics (N = 27) participated during 10 days of training and a weekend of no activities. Training involved the acquisition of human factors, non-technical and surgical skills, and their application in complex high-fidelity scenarios including road-traffic accidents, firearms incidents, and swift water rescue operations. On each day participants reported levels of state, cognitive, and somatic anxiety, and self-confidence following waking and before sleep, and their anticipated (at wake) and experienced (before sleep) demands of the day. Saliva samples were obtained each day for assessment of diurnal cortisol indices and the Cortisol Awakening Response (CAR). Garmin smartwatches were worn throughout for the collection of heart rate and HRV-derived stress.ResultsThere were significant (p < 0.001) differences across days for state, cognitive, and somatic anxiety; self-confidence; anticipated and experienced demands; aggregated measures of heart rate and HRV-derived stress; levels of cortisol at waking (p = 0.002) and for the CAR (p < 0.001). Measures of psychobiological responding during training were distinct from the weekend and the highest levels of psychobiological responding occurred on days characterised by greater anticipated and experienced demands.DiscussionThis high-fidelity training is typical of the day-to-day requirements of emergency services and these observations are representative of functioning during real-life critical care emergencies. Increased responding during times of demand is adaptive; however, frequent and sustained responding increases allostatic load and is a contributor to burnout. As burnout is a significant concern in emergency medicine, this study identifies patterns of responding and recovery that may impact upon longer-term health and wellbeing.

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.

Summarising in medical emergencies: The role of the discourse marker so

This article is concerned with the in situ negotiation of epistemic authority through the mobilisation of summaries in the context of medical emergencies. It focuses on the use of the discourse marker so in prefacing summaries as a strategy for claiming epistemic primacy, with particular attention being paid to so's multimodal accomplishment. Taking an interactional sociolinguistic approach, we bring together simulated and real-life trauma emergencies and zoom in on the role of the institutionally defined team leader.Our findings illustrate that summarising in this context is almost exclusively reserved for team leaders, with so being an integral part in this process, consistently prefacing team leaders’ summaries. These summary acts, in turn, contribute to the summarisation process, which is part and parcel of role performance and doing leadership. We unpack the spatiotemporal dimensions of so, highlighting the systematicity of its use in the material space of the emergency room, and make a case for the need to capture discourse markers in the situated spatiolinguistic context.

Pharmacy residency training program increases residents' confidence in inpatient medical emergency response.

The benefits of pharmacists' involvement in medical emergencies are well established, but optimal methods of training pharmacists for emergency response are unknown. The primary objective of this report is to describe the design and evaluation of a pharmacy resident medical emergency response training (PR-MERT) program for preparing trainees to respond to hospital medical emergencies, including cardiac arrest and rapid sequence intubation (RSI). The PR-MERT program was a year-long longitudinal experience designed to prepare postgraduate year 1 pharmacy residents for medical emergency response. During the first month, the residents completed an orientation session that encompassed several lectures, certification by the American Heart Association in basic life support and advanced cardiovascular life support, standardized simulation scenarios, and mock medical emergencies. The trainees continued to utilize these skills and clinical knowledge through a longitudinal didactic lecture series, resident case conferences, and practice-based application by responding to real-life medical emergencies. Residents were assessed and coached throughout the program by clinical pharmacy preceptors and a "code coach" with extensive medical emergency response experience. After the year-long training, residents completed an anonymous survey assessing self-confidence and the structure of the program. The results showed improved confidence in medication selection and dosing, as well as anticipating the needs of the team and speaking up in cardiac arrest and RSI situations. Residents were satisfied with the training offered and structure of the program. The development of a PR-MERT program at an academic medical center was successful in achieving longitudinal learning objectives and improving residents' confidence in responding to medical emergencies. The implementation of a similar medical emergency training curriculum in inpatient pharmacy residency programs may be beneficial.

Enriching nursing knowledge and practice in Jordanian government hospitals through basic life support simulation training: A randomized controlled trial.

Healthcare providers must possess the necessary knowledge and skills to perform effective cardiopulmonary resuscitation (CPR). In the event of cardiopulmonary arrest, basic life support (BLS) is the initial step in the life-saving process before the advanced CPR team arrives. BLS simulation training using manikins has become an essential teaching methodology in nursing education, enhancing newly employed nurses' knowledge and skills and empowering them to provide adequate resuscitation. This study aimed to evaluate the potential effect of BLS simulation training on knowledge and practice scores among newly employed nurses in Jordanian government hospitals. A total of 102 newly employed nurses were randomly assigned to two groups: the control group (n = 51) received standard training, and the experimental group (n = 51) received one full day of BLS simulation training. The training program used the American Heart Association (AHA)-BLS-2020 guidelines and integrated theoretical models such as Miller's Pyramid and Kolb's Cycle. Both groups were homogeneous in inclusion characteristics and pretest results. Knowledge and practice scores were assessed using 23 multiple-choice questions (MCQs). Data were analyzed using one-way repeated measures ANOVA. The results indicated significant differences in knowledge scores, F(2, 182) = 58.514, p <0.001, and practice scores, F(2, 182) = 20.134, p <0.001, between the control and experimental groups at all measurement times: pretest, posttest 1, and posttest 2. Moreover, Cohen's d reflected the effectiveness of BLS simulation training as an educational module, showing a large effect (Cohen's d = 1.568) on participants' knowledge levels and a medium effect (Cohen's d = 0.749) on participants' practice levels. The study concludes that BLS simulation training using the AHA-BLS-2020 guidelines and integrating theoretical models such as Miller's Pyramid and Kolb's Cycle significantly improves knowledge and practice scores among newly employed nurses, proving highly effective in enhancing their competencies in performing CPR. Implementing BLS simulation training in nursing education programs can significantly elevate the proficiency of newly employed nurses, ultimately improving patient outcomes during cardiopulmonary arrest situations. This training approach should be integrated into standard nursing curricula to ensure nurses are well-prepared for real-life emergencies. NCT06001879.

"Are we in this together?": embedding social identity detection in drones improves emergency coordination.

Autonomous systems, such as drones, are critical for emergency mitigation, management, and recovery. They provide situational awareness and deliver communication services which effectively guide emergency responders' decision making. This combination of technology and people comprises a socio-technical system. Yet, focusing on the use of drone technology as a solely operational tool, underplays its potential to enhance coordination between the different agents involved in mass emergencies, both human and non-human. This paper proposes a new methodological approach that capitalizes on social identity principles to enable this coordination in an evacuation operation. In the proposed approach, an adaptive drone uses sensor data to infer the group membership of the survivors it encounters during the operation. A corpus of 200 interactions of survivors' talk during real-life emergencies was computationally classified as being indicative of a shared identity or personal/no identity. This classification model, then, informed a game-theoretic model of human-robot interactions. Bayesian Nash Equilibrium analysis determined the predicted behavior for the human agent and the strategy that the drone needs to adopt to help with survivor evacuation. Using linguistic and synthetic data, we show that the identity-adaptive architecture outperformed two non-adaptive architectures in the number of successful evacuations. The identity-adaptive drone can infer which victims are likely to be helped by survivors and where help from emergency teams is needed. This facilitates effective coordination and adaptive performance. This study shows decision-making can be an emergent capacity that arises from the interactions of both human and non-human agents in a socio-technical system.

Healthcare providers’ perceptions and expectations of video-assisted debriefing of real-life obstetrical emergencies: a qualitative study from Denmark

ObjectivesVideo-assisted debriefing (VAD) of real-life obstetrical emergencies provides an opportunity to improve quality of care, but is rarely used in clinical practice. A barrier for implementation is the expected mental...

Review article: Use of the Team Emergency Assessment Measure in the rating of emergency teams' non-technical skills: A mapping review.

The present study aims to explore the utility of the Team Emergency Assessment Measure (TEAM) in relation to the enhancement of emergency team non-technical skills based on research conducted over the last decade. In this mapping review, a citation mining process identified 22 primary studies for inclusion, published between 2012 and 2022. It provides outcome data on emergency teams' non-technical skills following team training and/or real-life patient emergencies. Emergency team studies related to resuscitation teams (adult, paediatric, newborn and obstetric cases) and medical emergency team (MET) management of patient deterioration. Team performance ratings varied, ranging from approximately 90% for experienced clinical teams down to 38% for students. Statistically significant improvements in performance were notable following training and/or repeated practice. Validity evidence, across 11 studies that provided change data described positive learning outcomes and moderate intervention effects. However, according to Kirkpatrick's model of educational evaluation the studies were limited to professional development phases of learning and immediate post-training assessments rather than care quality improvement. The review highlights a lack of studies evidencing quality improvement or clinical impact such as change of patient care practice or health service performance. There is a need to conduct well-designed studies that explore both technical and non-technical skills of resuscitation teams and METs. Currently, non-technical skills training and repeated performance evaluations using the TEAM contribute immensely to the proficiency of emergency teams.

Understanding levels of compliance with emergency responder instructions for members of the Public involved in emergencies: Evidence from the Grenfell Tower fire

Purpose– It is essential to understand how members of the public make decisions during emergencies. Such understanding is crucial in order to understand how emergency services can best influence positive protective behaviours. Previous research in this area has indicated that members of the public will respond both to the threat from an incident such as a fire as well the way the threat is managed by emergency responders and that this management will be crucial in increasing public willingness to comply with emergency services instructions. AimsThe study aimed to identify factors that affected the way in which those involved in the Grenfell Tower Fire behaved and develop the understanding of factors that affect public behaviour during large scale emergencies. Design/methodology/approachThis paper used 72 transcripts from the Grenfell Tower Inquiry to examine how members of the public make decisions during emergencies. The study utilised a Framework Analysis to identify themes relating to how members of the public made decisions regarding protective actions and what factors influenced these decisions. FindingsThe study identifies several key factors which influenced individuals' decision making concerning protective actions:- Uncertainty and Anxiety.- Environmental Factors in Evacuation Decision Making.- Trust.- Helping and Co-Operative Behaviours in Emergencies. Originality/valueData involving real life emergencies is extremely useful in providing support to the development of emergency procedures and training for emergency services.The research identifies several key factors which can inform a better understanding of public behaviour during emergencies.

Physiologic Fidelity as a Domain in Assessing Mixed Reality Trauma Simulation.

Mixed reality has been used in trauma and emergency medicine simulation for more than a decade. As mixed reality potential in trauma simulation continues to expand, so too does the need to validate it as a surrogate for real-life emergency scenarios. Validation of these simulations can occur by measuring fidelity, or the degree to which a computing system can reproduce real-world experiences. After performing a literature review, we determined that most fidelity assessments of trauma and emergency simulations focus on how the user subjectively experiences the simulation. Although subjective user assessment is an important component of determining fidelity, we pose an introductory three-part framework that may assess mixed reality trauma simulation more adequately. A literature review was conducted using Google Scholar, PubMed, and the Uniformed Services University PowerER search database. Relevant articles were assessed to identify how studies measured fidelity in trauma simulation. We then designed the three-part framework to aid researchers in assessing the fidelity of mixed reality trauma simulations. The domains we determined to best assess mixed reality emergency simulation are as follows:1. Continue assessing fidelity via subjective user assessments. This allows the researcher to know how real the simulation looked and felt to the user based on their individual report.2. Determine whether the trauma simulation changes the medical decision-making capacity of the user. If the user's decision-making capacity changes with a stress-inducing trauma simulation versus a non-stress-inducing simulation, then the stress-inducing trauma environment would be approaching greater fidelity.3. Study the domain of our newly proposed concept: physiologic fidelity. We define physiologic fidelity as the degree to which the simulation elicits a measurable, autonomic response independent of observed emotion or perceived affect. Recreating objective autonomic arousal may be the best way to ensure a trauma simulation reaches fidelity. We propose a methodology to assess mixed reality trauma simulation fidelity. Once fidelity is more fully known to the researcher and the simulation user, adjustments can be made to approach reality more closely. Improved simulators may enrich the preparedness of both junior and senior learners for real-life emergencies. We believe assessing the three domains using the Wide Area Virtual Experience at the Val G. Hemming simulation center in Bethesda, MD, will validate mixed reality-trauma simulators as invaluable surrogates for real-life emergency scenarios and ultimately contribute to improved clinical outcomes for clinicians and their patients.

Integration of cumulative prospect theory in cellular automata model for building evacuation

An inefficient evacuation system can lead to high levels of fatalities arising from natural or anthropogenic disasters. As the movements of and interactions between evacuees can greatly affect the overall evacuation patterns and times, in-depth investigations of evacuees’ behaviours and interactions are warranted. The cellular automata (CA) model, widely used to simulate building evacuations, determines the moving direction of evacuees (i.e., they either remain stationary or move to a neighbouring cell) and provides agents in the model with rational decision-making choices. However, people are not always rational in real-life risk emergencies. Addressing this inconsistency, cumulative prospect theory (CPT) was developed to make the most prospective decision under risk or uncertainty by applying weighting functions to transform the outcomes and probabilities of the available options and combine them into prospects. This approach has been reported to realistically model human decision-making behaviour. At each time step of the evacuation, each evacuee is involved in the decision-making of the moving path, which critically affects the evacuation process and efficiency. Thus, CPT can be applied to model the movement direction. In our study, CPT was integrated with the CA model (CPT-CA) to mimic exit choices and route choice behaviours. Simulation results showed that the CPT-CA model can provide near-realistic evacuation patterns and evacuation times even when the sensitivity parameters are not adjusted. The proposed CPT-CA model can be helpful for logistical planning in evacuation design and emergency risk management.

Automated external defibrillators delivered by drones to patients with suspected out-of-hospital cardiac arrest

Abstract Background Early defibrillation is critical for the chance of survival in in out-of-hospital cardiac arrest (OHCA). Drones, used to deliver automated external defibrillators (AEDs), may shorten time to defibrillation, but this has never been evaluated in real-life emergencies. Purpose The aim of this study was to investigate the feasibility of AED-delivery by drones in real-life cases of OHCA. Methods In this prospective clinical trial, three AED-equipped drones were placed within controlled airspace in Sweden, covering approximately 80,000 inhabitants (125km2). Drones were integrated in the emergency medical services for automated deployment in beyond-visual-line-of-sight flights in; a) consecutive real-life suspected OHCAs b) test-flights from 06–01–20 to 09–30–20. Primary outcome was the proportion of successful AED-deliveries when drones were dispatched in cases of suspected OHCA. Among secondary outcomes were the proportion of cases where AED-drones arrived prior to ambulance and time benefit vs. ambulance. Results Totally 14 cases were eligible for dispatch during the study period in which AED-drones took off in 12 alerts to suspected OHCA; with a median distance to location 3,1 km (IQR:2,8–3,4). AED-delivery was feasible within 9 meters (IQR:7,5–10,5) from the location and successful in 11 alerts, 92%. AED-drones arrived prior to ambulances in 64%, with a median time benefit of 01:52 minutes (IQR:01:35–04:54). In an additional 61 test-flights the AED-delivery success rate was 90% (55/61). Conclusion In this pilot study, we have shown that AED-delivery by drones in real-life cases of OHCA is feasible with a substantial time benefit and a successful delivery rate of 92%. Further technological improvements are needed to increase dispatch rate and time gains. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Swedish heart-lung foundation

Usage of power by different types of trainers in the education of paramedics - evaluation by means of a validated questionnaire.

Objective: Emergency medical services are characterized by a high pressure to act. Dealing with trainees is a challenge. It is known, that the use of power in education subsists: power can be applied in a participative and restrictive way. We investigated the transferability of existing scales to the education system of Emergency medical service trainees. We hypothesized: a restrictive (a) and participative (b) use of power, can be demonstrated in Emergency medical service training, (c) the use of power by educators, who are responsible for theoretical learning, and instructors, who accompany trainees in real-life emergencies, are different and (d) the assessed participatory and restrictive use of power by trainers is negatively correlated.Methods: In a cross-sectional study, 206 trainees of Emergency medical service schools completed a questionnaire. The survey consists of 35 power related items regarding medical educators and practical instructors. Differences in the dimensions of power application were tested. The effect size and the correlation between power dimension were calculated.Results: The reliability of the scales was .92 (practical instructor) and .89 (medical educator) by removing one item. All subscales showed values with higher Cronbach’s alpha than .68. Application of participative power differs (p<.00) between practical instructors (mean 64.7; SD 20.3) and medical educators (mean 55.3; SD 17.8). The participatory and the restrictive use of power correlated for medical educators significant negatively (r=-.48; p<.01).Conclusion: In both educator and instructor groups the use of participative power had a greater agreement that the use of restrictive techniques. The practical instructors used participative power slightly more often that did educators due to the dependency on the trainee as a team member. The context of the scales partially overlaps with other descriptions such as leadership and instructor quality.

Does Danger Level Affect Bystander Intervention in Real-Life Conflicts? Evidence From CCTV Footage

In real-life violence, bystanders can take an active role in de-escalating conflict and helping others. Recent meta-analytical evidence of experimental studies suggests that elevated danger levels in conflicts facilitate bystander intervention. However, this finding may lack ecological validity because ethical concerns prohibit exposing participants to potentially harmful situations. Using an ecologically valid method, based on an analysis of 80 interpersonal conflicts unobtrusively recorded by public surveillance cameras, the present study confirms that danger is positively associated with bystander intervention. In the presence of danger, bystanders were 19 times more likely to intervene than in the absence of danger. It extends this knowledge by discovering that incremental changes in the severity level of the danger (low, medium, and high), however, were not associated with bystander intervention. These findings confirm the importance of further investigating the role of danger for bystander intervention, in larger samples, and involving multiple types of real-life emergencies.

267 Ascertain Impact of Using Low-Fidelity Simulation Scenarios in Preparation for Practical Surgical Finals

Abstract Introduction Simulation has become the new way of preparing doctors to deal with medical emergencies, we investigate it using in managing ward-based surgical emergencies. Method Final year medical students completed pre- and post-session questionnaires related to themes of preparedness, anxiousness, and confidence in management of acute surgical presentations versus post-operative complications. The intervention was divided into classroom based teaching and common surgical scenarios enacted using Sim-Man. Results Preparedness increased by a third following participation in surgical simulation scenarios among participants. Anxiousness related to surgical finals decreased by 9%. Confidence in managing acute patients increased by 25% compared to pre-session results. Moreover, 35% of participants felt more confident in managing post-operative complications after the session. On average, participants scored 8/10 for usefulness of the sessions in highlighting areas to concentrate focus upon during revision. Conclusions Simulation is slowly becoming a staple in undergraduate training and our results emphasise positive impact of using this as a revision tool. Kinaesthetic learning is more memorable during simulation which serves as a confidence boost in self-perception of managing both acute and post-operative surgical patients. Anxiety associated with exams and managing real-life emergencies can be dampened by rehearsing scenarios and following a structured approach as championed by medical simulation.

Evaluation of DeChoker, an Airway Clearance Device (ACD) Used in Adult Choking Emergencies Within the Adult Care Home Sector: A Mixed Methods Case Study

Foreign Body Airway Obstruction (FBAO) is a medical emergency that can result in death, particularly if swift, appropriate action is not taken. It can be a frightening experience for all involved. DeChoker, an Airway Clearance Device (ACD), might provide an additional alternative in the management of choking; however, limited evidence around its safety and effectiveness makes adoption controversial.Objectives: An independent evaluation to explore the experiences of health and care professionals who used DeChoker in real-life adult choking emergencies, focusing on the product's safety, efficacy and ease of application.Design: Retrospective mixed methods case study, with multiple embedded units of analysis.Setting: UK adult care homes.Participants: Twenty seven incidents of adult choking emergencies self-reported by care home staff where DeChoker was used. This data was augmented by an in-depth exploration of four individual choking incidences.Results: The choking victim's ages range: 45 to 101 years (mean 79.8 years). The device was reported to have successfully removed the obstruction in 26 of 27 cases, with very few complications or adverse events reported. In 21 of 27 incidents (78%) the victim was not required to visit Accident and Emergency. Qualitative data indicated nursing home staff found the DeChoker easy to use and valued its presence as an adjunct to current guideline procedures.Conclusion: There is a dearth of evidence surrounding the management of choking and little innovation in this area for five decades. This retrospective evaluation contributes to discussion regarding the role ACDs might play in the management of choking, particularly in cases where current choking management guidance are ineffective, insufficient, inappropriate or impractical (e.g., frail or movement restricted people). The interview data presents a view from care home staff that the DeChoker, as an ACD, contributed to saving the life of choking victims.

Evacuation from Healthcare Facilities in Poland: Legal Preparedness and Preparation.

Medical facilities, while providing both essential and demanding health care to society’s most vulnerable populations, also belong to the most demanding category of risk to human life if and when a crisis event occurs within its walls. The development of a safe evacuation plan for these facilities is extremely complicated, as the evacuation of medical facilities is much more complex than for other critical infrastructure. In this category, the evacuated patients constitute a specific risk group requiring specialized medical care. Hospitalized persons may be dependent on life-saving measures, are unconscious or immobile, are significantly restricted in movement or mentally unbalanced, being dependent on the continued assistance of trained third parties. Additionally, the medical transport of evacuated patients becomes more difficult due to the limited capacity of ambulances and available health care facilities to transport them to, which are increasingly limited due to their overcrowded census. The study aimed to analyze the requirements which are placed on hospitals in Poland to ensure the safety of patients in case of an evacuation. The research method used in the paper was retrospective analysis and evaluation of the media and literature. We have found, that Polish law imposes an obligation on the administrator of a medical facility to ensure the safety of both patients and employees. The regulations cover issues of technical conditions to be met by buildings and their location, prevention, and fire protection requirements, and the determination of which staff is responsible for the evacuation. However, available documents fail to describe what the hospital evacuation process itself should entail under emergency evacuation. Taking into account the complexity of the hospital evacuation process, health care facilities should have a well-developed plan of action that must be implemented at least once a year in the form of facility-wide training. Evacuation drills should not be avoided. Only trained procedures offer the possibility of later analysis to identify and eliminate errors and provide the opportunity to acquire skill sets and habits which promote the behaviors expected in real-life emergencies.

Автоматизация работы штаба по ликвидации чрезвычайной ситуации на объектах магистрального трубопровода

The efficiency of actions of emergency response personnel at major pipeline facilities is a key factor in minimizing accident consequences. In this paper the authors analyze command post exercises aimed at preparing for emergency responses (oil and petroleum products spill) with personnel working at Transneft enterprises. Shortcomings in organizing the operation of emergency response management groups have been identified. The main ones are as follows: lack of proper interaction and the necessary concurrence of actions of management group representatives; no algorithm for preparing reports and hence the failure to meet deadlines for submitting such reports to regulatory authorities. To some extent, these deficiencies have been minimized through the development and implementation of emergency reporting logs in routine practices of management groups. However, many processes have still been highly dependent on the human factor leading to errors, and the emergence and spread of false and contradictory information in the course of emergency response activities. An appropriate automated information system has been designed in order to minimize the effect of the human factor in organizing the work of emergency response management groups. The article presents its model, describing the algorithm of its operation and functionality. The system was introduced into production at Transneft Far East, LLC and was highly effective in terms of quality of document processing, optimizing time spent on report completion and submission, organizing data retrieval, and monitoring emergency response actions. The application of the developed information system has significantly reduced the number of demerits related to organizing the work of emergency response management groups. The system is unique in Russia: it can be used in real-life emergencies or for training personnel to act using the system’s training mode.

Social relations and presence of others predict bystander intervention: Evidence from violent incidents captured on CCTV.

Are individuals willing to intervene in public violence? Half a century of research on the “bystander effect” suggests that the more bystanders present at an emergency, the less likely each of them is to provide help. However, recent meta‐analytical evidence questions whether this effect generalizes to violent emergencies. Besides the number of bystanders present, an alternative line of research suggests that pre‐existing social relations between bystanders and conflict participants are important for explaining whether bystanders provide help. The current paper offers a rare comparison of both factors—social relations and the number of bystanders present—as predictors of bystander intervention in real‐life violent emergencies. We systematically observed the behavior of 764 bystanders across 81 violent incidents recorded by surveillance cameras in Copenhagen, Denmark. Bystanders were sampled with a case–control design, their behavior was observed and coded, and the probability of intervention was estimated with multilevel regression analyses. The results confirm our predicted association between social relations and intervention. However, rather than the expected reversed bystander effect, we found a classical bystander effect, as bystanders were less likely to intervene with increasing bystander presence. The effect of social relations on intervention was larger in magnitude than the effect of the number of bystanders. We assess these findings in light of recent discussions about the influence of group size and social relations in human helping. Further, we discuss the utility of video data for the assessment of real‐life bystander behavior.

The Use of Rapid Tranquilization in Aggressive Behavior.

Psychomotor agitation and aggressiveness in the context of mental illnessare medical emergencies. In a survey of six German psychiatric hospitals, 1.7 to 5 aggressive attacks per patient-year were reported. If talking to the patient has no calming effect, intervention with drugs is required. In this article, we review the evidence on tranquilizing drugs and discuss clinically relevant ethical and practical questions, e.g., with respect to involuntary medication. This review is based on pertinent articles retrieved by a selective search in MEDLINE, supplemented by a reference search. The evidence for the treatment of psychomotor agitation with antipsychotic drugs and benzodiazepines is relatively good. Randomized, controlled trials and a number of Cochrane reviews are available. These publications, however, contain data only on patients who were able to give informed consent. Their findings are often not applicable to real-life emergencies, e.g., when the patient is intoxicated with alcohol or suffers from a pre-existing disease. Haloperidol has a relatively weak effect on aggression when given alone and can also cause side effects such as early dyskinesia and epileptic seizures. It should, therefore, no longer be used as monotherapy. On the other hand, haloperidol combined with benzodiazepines or promethazine and monotherapy with lorazepam, olanzapine, ziprasidone, or aripiprazole intramuscular are effective options for the treatment of aggressive psychomotor agitation. All of these drugs, if accepted by the patient, can also have an additional, beneficial placebo effect, with the patient calming down more rapidly than could be explained on pharmacological grounds alone. It is, therefore, important in emergencies (as at other times) for the patient to be involved in treatment decisions to the greatest possible extent.