Simulated Emergency Scenarios Research Articles

Leadership Lingo: Developing a Shared Language of Leadership Behaviors to Enrich Debriefing Conversations.

Leadership in medical emergencies is variable and frequently suboptimal, contributing to poor patient care and outcomes. Simulation training can improve leadership in both simulated practice and real clinical emergencies. Thoughtful debriefing is essential. However, unclear language around leadership limits facilitators' capacity for transformative reflective discussion. Internal medicine trainees participated in simulated medical emergency scenarios. Video recordings of consenting participants were analyzed using template analysis. A priori codes from existing literature formed an initial coding template. This was modified with inductive codes from the observed behaviors to develop a taxonomy of leadership behaviors in simulated medical emergencies. The taxonomy was then transformed into an infographic, to be used as a leadership debriefing tool. The taxonomy of leadership behaviors consisted of the following 4 themes: Structuring, Decision making, Supporting, and Communicating. Structuring behaviors shaped the team, ensuring that the right people were in the right place at the right time. Decision-making behaviors steered the team, setting a direction and course of action. Communicating behaviors connected the team, sharing valuable information. Supporting behaviors nurtured the team, guiding team members to perform at their optimum level. Debriefing-as-imagined is not always debriefing-as-done. A shared language of leadership can connect educators and learners, advancing critical debriefing conversations and enabling facilitators to drive meaningful reflective discussion. The use of infographics in simulation offers an opportunity to support educators in facilitating complex debriefing conversations.

Be prepared! Impact of structured video-assisted coaching on performance in a simulated bleeding exercise during laparoscopic surgery

BackgroundBleeding during laparoscopic surgery is stressful and requires immediate efficient management. Skills for complication management are rarely trained. This study aims to investigate the impact of video-assisted coaching on laparoscopic skills acquisition and performance in emergency bleeding situations.MethodsParticipants faced simulated emergency scenarios during laparoscopy involving bleeding management in porcine aorta/kidney specimens. Four sequences were conducted over two days, with a structured video-assisted coaching provided between sequences. Performance was assessed using the Global Operative Assessment of Laparoscopic Skills (GOALS) score. The study involved 27 participants attending the advanced colorectal surgery module at the 40th Annual Davos Course in 2023.Results54 video sequences were analyzed. Structured video-assisted coaching improved the GOALS sum score by 0.36 (95%CI: 0.21–0.50, P < 0.001) in contrast to simple repetition (0.05 with 95%CI: −0.43 to 0.53, P = 0.826). This association was observed for depth of perception (P < 0.001), bimanual dexterity (P < 0.001), tissue handling (P < 0.001), overall performance (P < 0.001), and efficiency (P < 0.001). Autonomy did not significantly improve (P = 0.55). Findings were consistent regardless of age, gender, and overall laparoscopic experience of the participants. However, a weaker effect of structured video-assisted coaching was observed in participants with experience in laparoscopic surgery.ConclusionStructured video-assisted coaching improved performance in laparoscopic skills in complex and stress-inducing bleeding scenarios. The findings of this study support the incorporation of video-assisted coaching and complication management exercises into surgical training curricula.

Exploring differences in patient participation in simulated emergency cases in co-located and distributed rural emergency teams – an observational study with a randomized cross-over design

BackgroundIn northern rural Sweden, telemedicine is used to improve access to healthcare and to provide patient-centered care. In emergency care during on-call hours, video-conference systems are used to connect the physicians to the rest of the team – creating ‘distributed teams’. Patient participation is a core competency for healthcare professionals. Knowledge about how distributed teamwork affects patient participation is missing.The aim was to investigate if and how teamwork affecting patient participation, as well as clinicians’ perceptions regarding shared decision-making differ between co-located and distributed emergency teams.MethodsIn an observational study with a randomized cross-over design, healthcare professionals (n = 51) participated in authentic teams (n = 17) in two scripted simulated emergency scenarios with a standardized patient: one as a co-located team and the other as a distributed team. Team performances were filmed and observed by independent raters using the PIC-ET tool to rate patient participation behavior. The participants individually filled out the Dyadic OPTION questionnaire after the respective scenarios to measure perceptions of shared decision-making. Scores in both instruments were translated to percentage of a maximum score. The observational data between the two settings were compared using linear mixed-effects regression models and the self-reported questionnaire data were compared using one-way ANOVA. Neither the participants nor the observers were blinded to the allocations.ResultsA significant difference in observer rated overall patient participation behavior was found, mean 51.1 (± 11.5) % for the co-located teams vs 44.7 (± 8.6) % for the distributed teams (p = 0.02). In the PIC-ET tool category ‘Sharing power’, the scores decreased from 14.4 (± 12.4) % in the co-located teams to 2 (± 4.4) % in the distributed teams (p = 0.001). Co-located teams scored in mean 60.5% (± 14.4) when self-assessing shared decision-making, vs 55.8% (± 15.1) in the distributed teams (p = 0.03).ConclusionsTeam behavior enabling patient participation was found decreased in distributed teams, especially regarding sharing power with the patient. This finding was also mirrored in the self-assessments of the healthcare professionals. This study highlights the risk of an increased power asymmetry between patients and distributed emergency teams and can serve as a basis for further research, education, and quality improvement.

“Emergency Decisions”: The Choice of a Simulated Emergency Scenario to Reproduce a Decision-Making Condition in an Emergency Context as Close to Reality as Possible

Decisions are a crucial aspect of human life, especially when made in emergency contexts. This research involved 348 subjects, evaluating the relationship between socio-demographic variables and the choice of one of the proposed emergency scenarios suitable for reproducing a decision-making condition in an emergency. Three scenarios were presented: one on climate change, one on pandemics, and one on seismic events. The survey captured individuals’ perceptions of the scenarios for dimensions such as realism (present, past, and future), emotions, risk, worry, emergency, catastrophe, immediate choice, and immediate decision. The results suggest that age, gender, education, and previous experience are predictive factors for subjects’ preferences regarding the chosen scenario and their evaluation of the related dimensions. To optimize decisions in emergencies by institutional decision makers and crisis managers, it is useful to expand knowledge and have data relevant to this area. This research provides a basis in terms of data and tools for designing future research and studies on decision making in emergency contexts.

Enhancing unmanned ground vehicle performance in SAR operations: integrated gesture-control and deep learning framework for optimised victim detection.

In this study, we address the critical need for enhanced situational awareness and victim detection capabilities in Search and Rescue (SAR) operations amidst disasters. Traditional unmanned ground vehicles (UGVs) often struggle in such chaotic environments due to their limited manoeuvrability and the challenge of distinguishing victims from debris. Recognising these gaps, our research introduces a novel technological framework that integrates advanced gesture-recognition with cutting-edge deep learning for camera-based victim identification, specifically designed to empower UGVs in disaster scenarios. At the core of our methodology is the development and implementation of the Meerkat Optimization Algorithm-Stacked Convolutional Neural Network-Bi-Long Short Term Memory-Gated Recurrent Unit (MOA-SConv-Bi-LSTM-GRU) model, which sets a new benchmark for hand gesture detection with its remarkable performance metrics: accuracy, precision, recall, and F1-score all approximately 0.9866. This model enables intuitive, real-time control of UGVs through hand gestures, allowing for precise navigation in confined and obstacle-ridden spaces, which is vital for effective SAR operations. Furthermore, we leverage the capabilities of the latest YOLOv8 deep learning model, trained on specialised datasets to accurately detect human victims under a wide range of challenging conditions, such as varying occlusions, lighting, and perspectives. Our comprehensive testing in simulated emergency scenarios validates the effectiveness of our integrated approach. The system demonstrated exceptional proficiency in navigating through obstructions and rapidly locating victims, even in environments with visual impairments like smoke, clutter, and poor lighting. Our study not only highlights the critical gaps in current SAR response capabilities but also offers a pioneering solution through a synergistic blend of gesture-based control, deep learning, and purpose-built robotics. The key findings underscore the potential of our integrated technological framework to significantly enhance UGV performance in disaster scenarios, thereby optimising life-saving outcomes when time is of the essence. This research paves the way for future advancements in SAR technology, with the promise of more efficient and reliable rescue operations in the face of disaster.

Translation and psychometric validation of the Thai version of TeamSTEPPS® team performance observation tool

ABSTRACT In healthcare, effective communication and teamwork are pivotal in reducing medical errors. Integrating team training into health professions education is crucial. Accurate measurement of team performance during training requires reliable assessment tools. The TeamSTEPPS® Team Performance Observation Tool (TPOT), recently updated by the Agency for Healthcare Research and Quality, serves this purpose. However, it had not been translated and validated for use in Thailand. We aimed to translate and assess the psychometric properties of the Thai version of TPOT. Employing a back-translation process, TPOT was adapted to the Thai context. The resulting Thai TPOT instrument was administered to 518 healthcare professionals who had undergone TeamSTEPPS® training. Participants were asked to evaluate two prerecorded, 7-minute simulated team emergency scenarios using the Thai TPOT instrument. Results exhibited high internal consistency (Cronbach’s alpha = .96) and inter-rater reliability (ICC = .98). Confirmatory factor analysis affirmed the construct validity of the Thai TPOT. These findings establish the Thai TPOT as useful for evaluating teamwork within healthcare teams.

Exploring the Intersection of Psychological Features and Language Proficiency in Seamen's Activity: A Qualitative Analysis of Maritime Cadets at Maritime Institute Jakarta (STIP Jakarta)

This research delves into the psychological features of seamen's activity during emergency situations as perceived by 240 cadets in their third semester at the Maritime Institute Jakarta (STIP Jakarta). The study employs a qualitative descriptive approach to unravel the cognitive, emotional, and behavioural responses exhibited by cadets in simulated emergency scenarios. The findings underscore the transformative journey of cadets, transitioning from initial stress and anxiety to a controlled sense of urgency, showcasing the efficacy of the institution's training methodologies. A significant aspect of this research is the examination of the correlation between language proficiency, particularly in English, and effective emergency communication. Cadets recognise English as a shared language that enhances communication efficiency during emergencies. The study reveals the pivotal role of linguistic skills in coordinating actions seamlessly, highlighting the practical implications of language proficiency in emergency management within the global maritime context. The implications for maritime education are profound, emphasising the need for a holistic approach that integrates psychological preparedness and targeted language development initiatives. The research recommends continuous professional development, global collaboration among maritime institutions, and industry partnerships to ensure the adaptability and relevance of education to evolving industry standards. In conclusion, this research contributes valuable insights to the discourse on maritime education, emphasising the importance of cultivating a well-rounded skill set among cadets. The findings inform curriculum development, training methodologies, and strategies to enhance the psychological resilience and linguistic proficiency of future seafaring professionals, positioning them as adept and globally competent officers.

Insights into rural generalist therapeutic reasoning using a simulated multi-patient emergency scenario.

Therapeutic reasoning focuses on the decisions related to patient disposition and management. This is in contrast to diagnostic reasoning, which is the focus of much of the current discourse in the medical literature. Few studies relate to therapeutic reasoning, and even fewer relate to the rural and remote context. This project sought to explore the therapeutic reasoning used by rural generalists working in a small rural hospital setting in Australia, caring for patients for whom it was unclear if escalation of care, including admission or interhospital transfer, was needed. This study was conducted using an interpretivist approach. A simulation scenario was developed with rural generalists and experts in medical simulation to use as a test bed to explore the reasoning of the rural generalist participants. The simulation context was a small rural Australian hospital with resources and treatment options typical of those found in a similar real-life setting. A simulated patient and a registered nurse were embedded in the scenario. Participants needed to make decisions throughout the scenario regarding the simulated patient and two anticipated patients who were said to be coming to the department. The scenario was immediately followed by a semi-structured interview exploring participants' therapeutic reasoning when planning care for these three patients. An inductive content analysis approach was used to analyse the data, and a mental model was developed. The researchers then tested this mental model against the recordings of the participants' simulation scenarios. Eight rural generalists, with varying levels of experience, participated in this study. Through the semi-structured interviews, participants described five themes: assessing clinician capacity to manage patient needs; availability of local physical resources and team members; considering options for help when local management was not enough; patients' wishes and shared decision making; and anticipating future requirements. The mental model developed from these themes consisted of seven questions: 'What can I do for this patient locally and what are my limits?'; 'Who is in my team and who can I rely on?'; 'What are the advantages and disadvantages of local management vs transfer?'; 'Who else needs to be involved and what are their limits?;' 'How can we align the patient's wants with their needs?'; 'How do we adapt to the current and future situation?'; and 'How do I preserve the capacity of the health service to provide care?' This study explored the therapeutic reasoning of rural generalists using a simulated multi-patient emergency scenario. The mental model developed serves as a starting point when discussing therapeutic reasoning and is likely to be useful when providing education to medical students and junior doctors who are working in rural and remote contexts where resources and personnel may be limited.

CARD1: Human Factors Evaluation of HeartMate 3 LVAD Peripherals: Insights gained from an Eye Tracking based Simulation Study

Background: Although left ventricular assist devices (LVADs) have demonstrated excellent clinical outcomes and design improvements over the past decade, human factors issues including limited usability and unintuitive handling continue to challenge this therapy. The aim of this study was to evaluate user experience of former LVAD patients and laypersons (LP) with the HeartMate 3 (HM3) LVAD peripherals in simulated everyday and emergency scenarios. Methods: This cross sectional, single center cohort study included former non-HM3 LVAD patients post heart transplantation (HTX) and LP without any previous LVAD peripherals handling experience. Seven predefined everyday and emergency scenarios, including battery exchanges (without alarm, in response to alarm, in dim light, within carry bag), power supply change to AC power, driveline dis- and reconnection and controller exchange were simulated. Subjects’ gaze behavior was recorded using eye tracking (ET) technology (Tobii Pro Glasses 2, Tobii Pro Lab), whereas areas of interest (AOIs) were defined for LVAD components used. Completion rate, duration to success (DTS), pump-off time, and percental fixation duration per AOI were defined as outcome measures to identify differences between initially successful and unsuccessful subjects and to correlate subject performances with demographics. Results: Thirty gender and age matched, untrained subjects (15 HTX vs. 15 LP, median age: 64 (IQR=11) vs. 63 (10) yrs., p=0.84), 20 vs. 20% female, p=1.00) completed 210 scenarios, whereas 82.9 vs. 81.9% (p=1.00) could be solved at first attempt. Changing power supply from batteries to AC power revealed highest complexity for both groups (DTS=251±93s, p=0.76): only 26.7% of subjects succeeded at first attempt (33.3% vs. 20.0%, p=0.68) and 56.7% at second attempt (66.7% vs. 46.7%, p=0.04) with significantly more LP failing. The first attempt resulted in 10 unnecessary hazards from disconnecting the driveline (5 HTX vs. 5 LP, pump-off time 2-118 s, p=0.25) and significant differences in percental fixation durations for five AOIs in participants with vs. without initial success (p<0.029, see Figure). Significantly decreased DTS during battery exchange (no alarm 32.5 (18.8)s vs. alarm 26.5 (20.8)s and dim light 21.0 (19.0)s, p<0.001, without group differences, p>0.34) indicate a high level of learnability and routine establishment. Exchanging batteries in the bag was more time consuming (75.0 (45.0) s, p=0.09), especially in elderly patients (r=0.61, p<0.001). Conclusion: This ET based human factors study provides insights into user experiences of untrained former non-HM3 LVAD patients and LP in handling HM3 peripherals in simulated everyday and emergency scenarios. It highlights unintuitive and potentially hazardous handling characteristics and provides guidance for future user centered design of LVAD wearables.

(789) The Patients’ Point of View: Eye Tracking Based Human Factors Analysis of Simulated Everyday and Emergency Scenarios with HeartMate 3 LVAD Peripherals

(789) The Patients’ Point of View: Eye Tracking Based Human Factors Analysis of Simulated Everyday and Emergency Scenarios with HeartMate 3 LVAD Peripherals

Cracking The Code: Redesigning EHR Interfaces to Clarify Patients’ End of Life Wishes for Code Situations

Across various healthcare systems, serious patient safety issues occur where patients who express Do-Not-Resuscitate (DNR) wishes receive resuscitative measures in error. Our Patient Safety team conducted a common cause analysis and identified contributing factors to such errors, including the unclear display of patients’ code status in the electronic health record (EHR). Our team proposed updated wording for the code status in the EHR and evaluated the proposed design via remote usability testing. Eleven physician and nurse end users participated in 30-minute one-on-one sessions where they consulted EHR screens to respond to simulated patient emergency scenarios. All participants successfully interpreted the updated screens and responded positively to the changes. Following these results, a multidisciplinary team used a Failure Modes and Effects Analysis (FMEA) to guide the successful implementation of the updated design.

Improving emergency airway cart efficiency in compliance with Joint Commission standards

Background and objectiveEmergency Airway Carts (EAC) are essential for pediatric otolaryngologists to provide rapid bedside care for emergent airway scenarios. At many institutions, EAC bronchoscopy equipment is individually peal-packaged due to Joint Commission (JC) standards, creating significant inefficiency in equipment assembly during time sensitive clinical settings. The objective of this quality improvement initiative was to improve the efficiency of use of our emergency airway cart equipment. MethodsIndividually peel-packaged bronchoscope equipment was replaced with JC compliant sets. Otolaryngology trainees (N = 8) and pediatric otolaryngology attending physicians (N = 11) were tested in a simulated airway emergency scenario, requiring bronchoscope assembly. Complete bronchoscope assembly and time to tracheal visualization (TTV) was measured for each participant, which started with initial clinical scenario presentation and ended with successful visualization of the trachea using the rigid bronchoscope. ResultsPre-airway cart interventions, 68.4% of participants built a complete bronchoscope with no missing pieces, which improved to 100% with the new cart organization. Post-EAC interventions, all 19 participants reduced TTV significantly by a mean of 177.7 s (p < 0.001). Trainees reduced TTV by a mean of 251.2 s (46.2%, p < 0.0001) and attendings by 124.2 s (31.5%, p < 0.0022). All participants found the new airway cart sets easier to use and improved equipment setup efficiency. ConclusionsCompiling bronchoscope equipment into sterile sets allowed for improved TTV and bronchoscope quality for trainees and attending physicians while maintaining JC standards. Simulation improved confidence among both trainees and attending surgeons in providing optimal patient care in airway emergencies.

User Perceptions of Different Vital Signs Monitor Modalities During High-Fidelity Simulation: Semiquantitative Analysis.

BackgroundPatient safety during anesthesia is crucially dependent on the monitoring of vital signs. However, the values obtained must also be perceived and correctly classified by the attending care providers. To facilitate these processes, we developed Visual-Patient-avatar, an animated virtual model of the monitored patient, which innovatively presents numerical and waveform data following user-centered design principles. After a high-fidelity simulation study, we analyzed the participants’ perceptions of 3 different monitor modalities, including this newly introduced technique.ObjectiveThe aim of this study was to collect and evaluate participants’ opinions and experiences regarding 3 different monitor modalities, which are Visual-Patient-avatar, Split Screen (avatar and Conventional monitor alongside each other), and Conventional monitor after using them during simulated critical anesthetic events.MethodsThis study was a researcher-initiated, single-center, semiquantitative study. We asked 92 care providers right after finishing 3 simulated emergency scenarios about their positive and negative opinions concerning the different monitor modalities. We processed the field notes obtained and derived the main categories and corresponding subthemes following qualitative research methods.ResultsWe gained a total of 307 statements. Through a context-based analysis, we identified the 3 main categories of “Visual-Patient-avatar,” “Split Screen,” and “Conventional monitor” and divided them into 11 positive and negative subthemes. We achieved substantial interrater reliability in assigning the statements to 1 of the topics. Most of the statements concerned the design and usability features of the avatar or the Split Screen mode.ConclusionsThis study semiquantitatively reviewed the clinical applicability of the Visual-Patient-avatar technique in a high-fidelity simulation study and revealed the strengths and limitations of the avatar only and Split Screen modality. In addition to valuable suggestions for improving the design, the requirement for training prior to clinical implementation was emphasized. The responses to the Split Screen suggest that this symbiotic modality generates better situation awareness in combination with numerical data and accurate curves. As a subsequent development step, a real-life introduction study is planned, where we will test the avatar in Split Screen mode under actual clinical conditions.

Implementation and Evaluation of Resuscitation Training for Childcare Workers.

Background and ObjectiveChildren spend a large amount of time in daycare centers or schools. Therefore, it makes sense to train caregivers well in first-aid measures in children. The aim of this study is to evaluate whether a multimodal resuscitation training for childcare workers can teach adherence to resuscitation guidelines in a sustainable way.Materials and MethodsCaregivers at a daycare center who had previously completed a first-aid course received a newly developed multimodal resuscitation training in small groups of 7–8 participants by 3 AHA certified PALS instructors and providers. The 4-h focused retraining consisted of a theoretical component, expert modeling, resuscitation exercises on pediatric manikins (Laerdal Resusci Baby QCPR), and simulated emergency scenarios. Adherence to resuscitation guidelines was compared before retraining, immediately after training, and after 6 months. This included evaluation of chest compressions per round, chest compression rate, compression depth, full chest recoil, no-flow time, and success of rescue breaths. For better comparability and interpretation of the results, the parameters were evaluated both separately and summarized in a resuscitation score reflecting the overall adherence to the guidelines.ResultsA total of 101 simulated cardiopulmonary resuscitations were evaluated in 39 participants. In comparison to pre-retraining, chest compressions per round (15.0 [10.0–29.0] vs. 30.0 [30.0–30.0], p < 0.001), chest compression rate (100.0 [75.0–120.0] vs. 112.5 [105–120.0], p < 0.001), correct compression depth (6.7% [0.0–100.0] vs. 100.0% [100.0–100.0], p < 0.001), no-flow time (7.0 s. [5.0–9.0] vs. 4.0 s. [3.0–5.0], p < 0.001), success of rescue breaths (0.0% [0.0–0.0] vs. 100.0% [100.0–100.0], p < 0.001), and resuscitation score were significantly improved immediately after training (3.9 [3.2–4.9] vs. 6.3 [5.6–6.7], p < 0.001). At follow-up, there was no significant change in chest compression rate and success of rescue breaths. Chest compressions per round (30.0 [15.0–30.0], p < 0.001), no-flow time (5.0 s. [4.0–8.0], p < 0.001), compression depths (100.0% [96.7–100.0], p < 0.001), and resuscitation score worsened again after 6 months (5.7 [4.7–6.4], p = 0.03). However, the results were still significantly better compared to pre-retraining.ConclusionOur multimodal cardiopulmonary resuscitation training program for caregivers is effective to increase the resuscitation performance immediately after training. Although the effect diminishes after 6 months, adherence to resuscitation guidelines was significantly better than before retraining.

The Impact of a Mobile Phone Application for Retention of Bleeding Control Skills

The American College of Surgeons Bleeding Control Course (B-Con) empowers bystanders with hemorrhage control skills to manage prehospital emergencies, but demonstrates poor skill retention. The point of care use of a free Stop the Bleed mobile phone application on the retention of hemorrhage control skills from the B-Con Course was explored. Convenience sample of college students previously trained in B-Con were randomized into mobile application (MA) or control groups. The use of a mobile application during a simulated emergency scenario with tourniquet and situational awareness skills was assessed. Wound packing skill retention without intervention was also assessed. Survey data allowed for comparison of participant perceptions of skills with actual performances. MA (n = 30) was superior to control (n = 32) in correct tourniquet application (62.5% versus 30.0%; P = 0.01) with longer placement times (163 sec versus 95 sec; P < 0.001) and in calling 911 (31.3% versus 3.3%, P = 0.004). Participants maintain inflated perceptions of their skills, but generally feel underprepared for a future bleeding emergency. Mobile apps improve tourniquet and situational awareness skills and may serve as potential aids to improve bystander hemorrhage control skills in real-time, but require further prospective investigation into its use.

Effects of prior exposure to a visual airway cognitive aid on decision-making in a simulated airway emergency: A randomised controlled study.

Decision-making deficits in airway emergencies have led to adverse patient outcomes. A cognitive aid would assist clinicians through critical decision-making steps, preventing key action omission. We aimed to investigate the effects of a visual airway cognitive aid on decision-making in a simulated airway emergency scenario. Randomised controlled study. Single-institution, tertiary-level hospital in Toronto, Canada from September 2017 to March 2019. Teams consisting of a participant anaesthesia resident, nurse and respiratory therapist were randomised to intervention (N = 20 teams) and control groups (N = 20 teams). Participants in both groups received a 15-min didactic session on crisis resource management which included teamwork communication and the concepts of cognitive aids for the management of nonairway and airway critical events. Only participants in the intervention group were familiarised, oriented and instructed on a visual airway cognitive aid that was developed for this study. Within 1 to 4 weeks after the teaching session, teams were video-recorded managing a simulated 'cannot intubate-cannot oxygenate' scenario with the aid displayed in the simulation centre. Decision-making time to perform a front-of-neck access (FONA), airway checklist actions, teamwork performances and a postscenario questionnaire. Both groups performed similar key airway actions; however, the intervention group took a shorter decision-making time than the control group to perform a FONA after a last action [mean ± SD, 80.9 ± 54.5 vs. 122.2 ± 55.7 s; difference (95% CI) -41.2 (-76.5 to -6.0) s, P = 0.023]. Furthermore, the intervention group used the aid more than the control group (63.0 vs. 28.1%, P < 0.001). Total time of scenario completion, action checklist and teamwork performances scores were similar between groups. Prior exposure and teaching of a visual airway cognitive aid improved decision-making time to perform a FONA during a simulated airway emergency.

Rapid Cycle Deliberate Practice Versus Traditional Simulation for Training Extracorporeal Membrane Oxygenation Specialists in Circuit Air Emergency Management: A Randomized Trial.

Extracorporeal membrane oxygenation (ECMO) is a highly complex therapy used to support critically ill patients. Simulation-based training of ECMO specialists in the management of ECMO emergencies has been described in the literature, but optimal methods are not currently established. The objective of this study was to compare rapid cycle deliberate practice (RCDP) simulation versus traditional simulation (TS) with reflective debriefing for training ECMO specialists in the management of arterial air emergencies. A prospective, randomized, pre-post interventional design was used to compare the impact of RCDP training with that of TS training on ECMO specialist performance during a simulated ECMO circuit emergency. Participants were divided into 2 training groups-RCDP and TS. Each participant completed a simulated arterial air emergency scenario before training, immediately after training, and again 3 months later. The primary outcome was the time required by individual participants to complete critical clinical actions. Twenty-four ECMO specialists completed the study. Immediately after the training, the RCDP group had faster times to dissociate the patient from the ECMO circuit (11-seconds RCDP vs. 16-seconds TS, P = 0.03) and times to re-establish ECMO support (59-seconds RCDP vs. 82.5-seconds TS, P = 0.01). Follow-up testing at 3 months showed persistence in faster times to re-establish ECMO support in the RCDP group (114-seconds RCDP vs. 199-seconds TS, P = 0.01). Rapid cycle deliberate practice simulation provides a superior curriculum and method of training ECMO specialists in the management of arterial air emergencies in comparison with traditional simulation.

A simulation-based pilot study of crisis checklists in the emergency department

Checklists can improve adherence to standardized procedures and minimize human error. We aimed to test if implementation of a checklist was feasible and effective in enhancing patient care in an emergency department handling internal medicine cases. We developed four critical event checklists and confronted volunteer teams with a series of four simulated emergency scenarios. In two scenarios, the teams were provided access to the crisis checklists in a randomized cross-over design. Simulated patient outcome plus statement of the underlying diagnosis defined the primary endpoint and adherence to key processes such as time to commence CPR represented the secondary endpoints. A questionnaire was used to capture participants’ perception of clinical relevance and manageability of the checklists. Six teams of four volunteers completed a total of 24 crisis sequences. The primary endpoint was reached in 8 out of 12 sequences with and in 2 out of 12 sequences without a checklist (Odds ratio, 10; CI 1.11, 123.43; p = 0.03607, Fisher’s exact test). Adherence to critical steps was significantly higher in all scenarios for which a checklist was available (performance score of 56.3% without checklist, 81.9% with checklist, p = 0.00284, linear regression model). All participants rated the checklist as useful and 22 of 24 participants would use the checklist in real life. Checklist use had no influence on CPR quality. The use of context-specific checklists showed a statistically significant influence on team performance and simulated patient outcome and contributed to adherence to standard clinical practices in emergency situations.

Validation of a Dose Assessment Method to be Used in 18F FDG Loose Contamination Exercises.

Radiological emergency response may require responders to operate in contaminated environments. To provide more realistic training to these individuals, it has been proposed to disperse low amounts of short-lived radioactive material in simulated emergency scenarios. To demonstrate the applicability and safety of such activities, a limited exercise was conducted where 18F was sprayed in a small area and survey activities were executed. A pre-job external radiation exposure dose assessment was performed in preparation for this training. The research presented here compares participant external recorded doses to assessment results in order to validate the dose estimates. Two individuals were used during the dispersion, search, and survey activities. First, a radiation worker mixed 200 MBq Fludeoxyglucose 18F with 470 mL H2O in a weed sprayer and distributed it over a 3 m × 3 m area. After evaporation, an exercise participant performed search and survey activities in the area. Actual whole-body doses measured with optically stimulated luminescence dosimeters were 10 ± 1 μSv for both personnel. Whole-body digital dosimeters read 4.3 ± 0.2 μSv and 3.3 ± 0.5 μSv for the radiation worker and exercise participant, respectively. Actual extremity doses were below the dosimeters' minimum detectable limits for the radiation worker (thermoluminescence dosimeter) and exercise participant (optically stimulated luminescence dosimeter). The dose assessment-predicted whole-body doses were 2.8 ± 0.4 μSv and 3.2 ± 0.1 μSv for the radiation worker and exercise participant, respectively. The estimated dose to the radiation worker's hand was 21.8 ± 3.8 μSv, and the estimated dose to the exercise participant's knee was 13.4 ± 0.6 μSv. The study provided substantial evidence for the validity of the dose assessment method, supporting its use for a larger training exercise.

Ocena umiejętności praktycznych w zakresie resuscytacji wśród studentów ostatniego roku kierunku lekarskiego Warszawskiego Uniwersytetu Medycznego

Introduction. One of the basic skills acquired during medical studies is the ability to lead and participate in cardiopulmonary resuscitation. Education of sudden states diagnosis and technical activities during resuscitation is based on the Advanced Life Support (ALS) protocol in accordance with the Guidelines of the European Resuscitation Council. The last-year students of medical faculties took part in simulated Medical Emergency Teams (METs) scenario of cardiac arrest. Analysis of audiovisual recordings of activities undertaken during resuscitation was performed to evaluate the practical skills required for resuscitation. Material and methods. The studied group of students took part in a simulated emergency scenario during which there was an irreversible cardiac arrest. The instructor assessed selected parameters of the work of 37 METs. Results. The first element of scenario was to treat bradycardia which occurred at the beginning. 17 METs (less than 49%) took any action to treat it, 12 METs (slightly over 32%) administered atropine. The next step was to diagnoses and treat adequately cardiac arrest. 15 of METs (40.5%) reacted within 10 s, 10 METs (67.5%) in 11–20 s, and 9 METs (13.51%) took any activity during 21–40 s. Among the therapeutic measures required by the ALS protocol, at the moment of cardiac arrest 12 METs — just over 32% checked the presence of the breath, the most METs (100%) gave adrenaline, 29 METs (slightly more than 78%) performed airway, 27 METs (less than 73%) called the resuscitation team. Conclusion. The lack of students‘ skills of the proceedings in accordance with the guidelines of the ALS protocol in terms of treatment of bradycardia and during cardiopulmonary resuscitation suggests to put greater emphasis on teaching both basic and advanced life support activities as general medical skills, gradually throughout the undergraduate training during the whole medical education.