Simulated Emergency Situations Research Articles

Analysis of heart rate variability during emergency flight simulator missions in fighter pilots

IntroductionManaging emergency situations in different simulated flight segments can entail a workload that could affect the performance of military pilots. The aim was to analyse the modifications in neurovegetative balance...

Exploring the most effective feedback system for training people in Earthquake emergency preparedness using immersive virtual reality serious games

Natural hazards, such as earthquakes, can cause enormous financial and human fatalities, particularly in congested public areas, such as shopping malls. To reduce the risk of injury or death in such situations, it is vital that people behave correctly and respond quickly. Due to the shortcomings and incapabilities of traditional training methods to simulate emergency situations, technology has provided opportunities to simulate real-life emergency scenarios, so that more effective training can be provided for users of public areas during disastrous events. As such, Immersive Virtual Reality (IVR) and Serious Games (SGs) are used in this study to investigate five methods in training system required for emergency conditions to rescue people. These methods include text-based immediate feedback, visual-based immediate feedback, audio-based immediate feedback, post-game assessment, and spiral feedback. An extensive experiment involving 145 trainees was conducted based on two approaches: 1) safety knowledge, and 2) self-efficacy. According to the findings, the IVR SG training system with the spiral feedback method was more effective in acquiring knowledge than visual- and audio-based immediate feedback. However, there was no significant difference between groups' performance in improving self-efficacy. In addition, the research investigated the impact of five different methods on improving self-efficacy statements individually, yielding intriguing results. Finally, the findings of this study provide significant practical implications for safety and emergency awareness for users, and preparedness for facility managers to provide better training during emergencies.

The effect of verbal pressure on students’ performance during simulated emergency situation—a randomized pilot study

The effect of verbal pressure on students’ performance during simulated emergency situation—a randomized pilot study

Enhancing surgeons' gaze strategies in endoscopic surgery during simulated surgical emergency situations thanks to computer vision.

Deficient visualization in minimally invasive surgery often causes misperceptions, which can lead to an increase of iatrogenic lesions and complications. This is especially critical for novice surgeons, who are prone to adopt inadequate switching gaze strategies, thereby increasing the chance of unforeseen complications. In this paper the use of an additional computer-aided vision system was tested for improvement of the reaction of the surgeons to unforeseen complications. Gaze patterns were analyzed using a gaze tracker, as well as other metrics such as task completion time or reaction time to sudden bleeding. While completion time did not show significant difference between tested modalities (p<0.1), the reaction time showed a downward trend as more auxiliary computer-aided vision systems were added (p<0.005). These results support the benefits of including additional vision systems for minimally invasive surgery processes.Clinical Relevance- This work assesses the advantages of including an additional computer vision system to prevent unforeseen complications during minimally invasive surgeries.

Effects of the Six C's Psychological First Aid Model on Acute Stress Responses in a Simulated Emergency Situation

Introduction:Arrival to the emergency room (ER) can increase stress levels in patients and family members. Thus, there is a need for a short and effective form of PFA provided by ER staff members, to reduce acute stress responses (ASR). Past studies have shown that psychological interventions based on emotional expression do not help to regulate extreme emotional expressions nor does it prevent post-traumatic stress disorder (PTSD). Alternatively, the Six C's model adopts a neuropsychological approach that focuses on cognitive communication, challenging for efficient activation, organizing the event's chronological order and reduction in loneliness by committing to stay with them. This experimental design study examined the effectiveness of the Six C's model on reducing signs of ASR.Method:Sixty-three participants (mean age 41.8 years) voluntarily took part. They were randomly assigned to the Six C's intervention (experimental condition) or to supportive emotional expression (control condition). They listened to a three minute audio recording of a real emergency 911 phone call. Interventions (SIX C's or emotional) were provided before and after listening to the recording. Before, immediately after, and five minutes after the recording, participants' anxiety, heart-rate variability (HRV) and mental resilience levels were measured.Results:For all three outcomes, the Time x Group interactions were statistically significant. Following "simple effects", analysis revealed that The Six Cs participants showed lower anxiety and less reductions in HRV and resilience than controls immediately after the stressor. Furthermore, the Six C's participants recovered faster on all three outcomes compared to controls, five minutes after the stressor.Conclusion:This study showed the Six C's model moderates people's ASR. Furthermore, the Six C's method helps people to "bounce back" faster psychologically and neuro-physiologically. These findings support using the Six C's model to reduce ASR and increase resilience, which is highly relevant to ER staff.

The Integration of Live Video Tools to Help Bystanders During an Emergency Call: Protocol for a Mixed Methods Simulation Study

Early action by bystanders is particularly important for the survival of individuals in need of emergency care, especially those experiencing a cardiac arrest or an airway obstruction. However, only a few bystanders are willing to perform cardiopulmonary resuscitation. The use of a live video during emergency calls appears to have a positive effect on the number of cardiopulmonary resuscitations performed by bystanders. The objective of this study is to propose and evaluate the relevance of a living lab methodology involving video calls in simulated life-threatening emergency situations. The first study aimed at analyzing the process of dealing with out-of-hospital cardiac arrest at a dispatch center and identifying the needs of the dispatchers. The second study is a pretest of a living lab. The third study focuses on a living lab in which 16 situations of cardiac arrest and airway obstruction are simulated. The simulation includes both a live video and transmission of a video demonstration of emergency procedures. The measures focus on 3 areas: the impact of video tools, development of collaboration within the community, and evaluation of the method. The results of the first study show that dispatchers have an interest in visualizing the scene with live video and in broadcasting a live demonstration video when possible. The initial results also show that collaboration within the community is enhanced by the shared simulation and debriefing experiences, clarifying regulation procedures, and improving communication. Finally, an iterative development based on the lessons learned, expectations, and constraints of each previous study promotes the existence of a living lab that aims to determine the place of live video tools in the sequence of care performed by dispatchers. Living labs offer the opportunity to grasp previously undetected insights and refine the use of the applications while potentially developing a sense of community among the stakeholders. DERR1-10.2196/40699.

Experiences and perceptions of final-year nursing students of using a chatbot in a simulated emergency situation: A qualitative study.

The aim of this study is to explore the experiences and perceptions of final-year nursing students on the acceptability and feasibility of using a chatbot for clinical decision-making and patient safety. The effective and inclusive use of new technologies such as conversational agents or chatbots could support nurses in increasing evidence-based care and decreasing low-quality services. A descriptive qualitative study was used through focus group interviews. The data analysis was conducted using a thematic analysis. This study included 114 participants. After our data analysis, two main themes emerged: (i) experiences in the use of a chatbot service for clinical decision-making and and (ii) integrating conversational agents into the organizational safety culture. The findings of our study provide preliminary support for the acceptability and feasibility of adopting SafeBot, a chatbot for clinical decision-making and patient safety. Our results revealed substantial recommendations for refining navigation, layout and content, as well as useful insights to support its acceptance in real nursing practice. Leaders and managers may well see artificial intelligence-based conversational agents like SafeBot as a potential solution in modern nursing practice for effective problem-solving resolution, innovative staffing and nursing care delivery models at the bedside and criteria for measuring and ensure quality and patient safety.

Guiding Attention via a Cognitive Aid During a Simulated In-Hospital Cardiac Arrest Scenario: A Salience Effort Expectancy Value Model Analysis.

To investigate the effect of a cognitive aid on the visual attention distribution of the operator using the Salience Effort Expectancy Value (SEEV) model. Cognitive aids aim to support an operator during the execution of a task. The effect of cognitive aids on performance is frequently evaluated but whether a cognitive aid improved, for example, attention distribution has not been considered. We built the Expectancy Value (EV) model version which can be considered to indicate optimal attention distribution for a given event. We analyzed the eye tracking data of emergency physicians while using a cognitive aid application versus no application during a simulated in-hospital cardiac arrest scenario. The EV model could fit the attention distribution in such a simulated emergency situation. Partially supporting our hypothesis, the cognitive aid application group showed a significantly better EV model fit than the no application group in the first phases of the event, but a worse fit in the last phase. We demonstrated that a cognitive aid affected attention distribution and that the SEEV model provides the means of capturing these effects. We suggest that the aid supported and improved visual attention distribution in the stressful first phases of a cardiopulmonary resuscitation but may have focused attention on objects that are relevant for lower priority goals in the last phase. The SEEV model can provide insights into expected and unexpected effects of cognitive aids on visual attention distribution and may help to design better artifacts.

Needs Assessment for a VR-Based Adult Nursing Simulation Training Program for Korean Nursing Students: A Qualitative Study Using Focus Group Interviews.

Virtual reality programs are being actively utilized in various education fields, but not many have been developed/used in nursing. This study aimed to explore the essential components and improvements needed in an adult nursing VR-based simulation training program for nursing students through focus group interviews (FGIs). This was a qualitative study. Fourteen nursing students from three cities in Korea who had experienced clinical practice and simulation training participated. They were divided into three FGIs. Data were collected from February–March 2020. We analyzed the data from the FGIs using Colaizzi’s phenomenological methodology. In total, 40 themes emerged, divided into 13 theme clusters and the following four categories. When developing an adult nursing VR-based simulation training program, the development should focus on addressing the limitations of conventional clinical practice, and these should be analyzed; it should also reflect students’ needs, including the following: provide an array of scenarios/skills to be trained; difficulty-specific learning scenarios; immediate feedback (e.g., those in computerized games); simulate emergency situations; simulate clinical cases that are difficult to experience in clinical practice; and allow for the training of patient–nurse communication skills.

Evaluation of four supraglottic devices used by paramedical staff for securing airway in simulated emergency airway management

BackgroundPrehospital emergency airway management challenges every paramedic. Emergencies evacuated from difficult areas by armed forces need airway maintenance throughout evacuation. Effective use of supraglottic airway (SGA) devices during prehospital transfer is life saving. This study compared use of four commonly available SGAs by Armed Forces paramedics in simulated emergency situations. MethodsThis prospective observational study conducted in a tertiary care institution, included 58 volunteer paramedics. They were trained on manikins before the study in basic airway skills and insertion of the four SGA devices under study viz. Classic laryngeal mask airway (cLMA), laryngeal tube (LT), I-gel, and Combitube. SGA device insertions were performed on 474 patients scheduled for short elective surgical procedures under general anesthesia. All volunteers inserted and assessed the four SGA devices equal number of times in different patients. Overall success rate, time for successful insertion, first attempt success rate, number of attempts for successful insertion, oro-pharyngeal leak pressures, ease of insertion, durability of device, and complications were recorded. ResultsDifferences among the four groups were statistically significant in all parameters. Intergroup comparison revealed that both I-gel and LT were comparable to each other, however superior to cLMA and Combitube in all outcome measures except ease of insertion and durability of device where I-gel was better and oro-pharyngeal seal pressures where Combitube was better. ConclusionConsidering all parameters, I-gel proved superior with minimal complications compared with other SGA devices tested. I-gel may be recommended for emergency airway rescue use in patients by military paramedics.

An observational study using eye tracking to assess resident and senior anesthetists' situation awareness and visual perception in postpartum hemorrhage high fidelity simulation.

BackgroundThe postpartum hemorrhage (PPH) is the leading cause of maternal mortality in the world. Human factors and especially situation awareness has primarily responsibility to explain suboptimal cares. Based on eye tracking and behavior analysis in high fidelity simulation of PPH management, the goal of this study is to identify perceptual and cognitive key parameters of the expertise.MethodsTwo groups of fifteen anesthetists (residents and experienced anesthetists) watched the beginning of a severe simulated PPH management. During this first experimental phase, situation awareness was assessed using SAGAT (Situation Awareness Global Assessment Technique) questionnaire and visual behavior was analyzed with eye tracking. In the continuity of the video sequence, they have to step in the PPH situation and to provide care to the simulated patient. Performance of cares was evaluated and self-assessed as well as cognitive load.ResultsNo statistical difference between the residents and experienced anesthetists was observed on performance of simulated PPH management. The mean expected practice score was 76.9 ± 13.9%). Assessment of situation awareness (65 ± 7%), cognitive load (74.4 ± 11.3%) and theoretical knowledge of PPH (52.4 ± 3.5%) were also not statistically different between the two groups. Only results of self-assessed performance (respectively 66.1 ± 16.6 and 47.0 ± 20.8 for experts and residents) and eye-tracking data revealed that experts tended to get accurate evaluation of their performance and to monitor more the blood loss of the patient. Experts have in average 8.28% more fixating points than Novices and gazed the blood loss region longer (865 ms ± 439 vs. 717 ms ± 362).ConclusionsThis study pointed out the limits of classical assessment of performance, and human factors based on questionnaires to identify expertise in simulated PPH care. A neuroscientific approach with new technology like eye tracking could provide new objective and more sensitive insights on human factors in simulated medical emergency situations.

The Concept of a Pneumatic Parachute Rescue System for Vertical Take-Off and Landing UAVs

Abstract This publication addresses the proposed structural solution for a system, of which the conceptual essence involves a rescue parachute being ejected from an accumulator using compressed carbon dioxide. The suggested rescue system is intended for unmanned multicopter aircraft. The article presents a developed digital solid model and the results of its simulation tests. The paper also contains results of basic calculations of the pneumatic supply system energy balance and the power balance of the electric control system. It also presents the results of first in-flight tests with a simulated emergency situation and the use of a technology demonstrator in operating conditions. Simulational and experimental methods were chosen to solve the research problem.

A Strategy for Selecting Points of Interest on Mobile Devices for Emergency Situations

&#x0D; &#x0D; &#x0D; The need to use mobile technology in urban emergency response processes has recently been identified, given the importance of having relevant information to make decisions in these scenarios. The data visualization on small mobile devices, such as PDAs or smartphones, is a critical aspect to make appropriate and on-time decisions. This criticality particularly occurs due to the small size of their screens to show geographical data. This article presents a strategy to select and display the most relevant “Points of Interest” on a digital map, according to the emergency influence area. This strategy was implemented on the MobileMap tool, and then it was evaluated through simulated emergency situations. Commanders of various Chilean Fire Companies participated in this evaluation.&#x0D; &#x0D; &#x0D;

Estimating the Weight of Children During Simulated Emergency Situations Using the Broselow Tape: Are We Underestimating the Risks of Errors?

The objective of this study was to evaluate whether residents can accurately estimate children's weight using the Broselow tape. We conducted a preplanned secondary analysis from an experimental trial. Participants were residents in pediatrics, family medicine, and emergency medicine rotating in the ED. Residents were randomly assigned to 2 sets of paired scenarios during 2 sessions. They were asked to estimate the weight of a manikin using the Broselow tape at the beginning of each scenario. The first scenario from the initial session and the last scenario from the second session were used for the current study. The primary analysis was the proportion of participants who accurately estimated manikin weight within a 10% margin of error. Forty residents were recruited. Thirty-two (80%) reported knowledge of the Broselow tape and 13 (32.5%) reported previous use. Weight estimation was accurate in 60% (24/40; 95% confidence interval [CI], 45%-74%) during the first scenarios. Error in weight estimation differed by greater than 25% in 28% (11/40). Error in estimation was not associated with previous knowledge (odds ratio, 6.2; 95% CI, 0.68-56) or previous use (odds ratio, 0.9; 95% CI, 0.23-3.5) of the Broselow tape. In the last scenario, 88% accurately estimated manikin weight (35/40; 95% CI, 73%-95%). Although most residents reported knowledge of the Broselow tape, 40% made erroneous weight estimations by at least 10% with the first use in this simulation study. With repeated use, they improved significantly over time. Teaching appropriate use of the Broselow tape should be part of residency-training curricula and pediatric advanced life support course.

The heuristic version of Cognitive Work Analysis: A first application to medical emergency situations

Cognitive Work Analysis is an original method that seeks to describe work systems made up of nested sets of constraints, from ecological constraints imposed by the work domain to cognitive constraints. This top-down approach starts with a work domain model in order to analyze and specify contexts of activity. To complement this method, we propose a bottom-up version of Cognitive Work Analysis focusing on contexts of activity and depicting how operators adapt to the ecological constraints. Based on Rasmussen's Dynamic Safety Model, the ecological constraints involved are those bounding the workspace in which operators dynamically navigate with control loops, strategies, work organization, and competencies. This analysis relies on the simulation of specific contexts of activity. A first illustrative application of this framework to a simulated medical emergency situation with a team of nurses and nursing aids shows that this framework can help identify design issues.

Reliability and performance of the Swiss Emergency Triage Scale used by paramedics.

ObjectivesNo general emergency department triage scale has been evaluated for prehospital triage. The objective of this study was to evaluate the reliability and the performance of the Swiss Emergency Triage Scale (SETS) used by paramedics to determine the emergency level and orientation of simulated patients.Patients and methodsIn a prospective cross-sectional study, 23 paramedics evaluated 28 clinical scenarios with the SETS using interactive computerized triage software simulating real-life triage. The primary outcome was inter-rater reliability regarding the triage level among participants measured by intraclass correlation coefficient (ICC). Secondary outcomes were the accuracy of triage level and the reliability and accuracy of orientation of patients of at least 75 years to a dedicated geriatric emergency centre.ResultsTwenty-three paramedics completed the evaluation of the 28 scenarios (644 triage decisions). Overall, ICC for triage level was 0.84 (95% confidence interval: 0.77–0.99). Correct emergency level was assigned in 89% of cases, overtriage rate was 4.8%, and undertriage was 6.2%. ICC regarding orientation in the subgroup of simulated patients of at least 75 years was 0.76 (95% confidence interval: 0.61–0.89), with 93% correct orientation.ConclusionReliability of paramedics rating simulated emergency situations using the SETS was excellent, and the accuracy of their rating was very high. This suggests that in Switzerland, the SETS could be safely used in the prehospital setting by paramedics to determine the level of emergency and guide patients to the most appropriate hospital.

Comparative Analysis of Motorcycle Braking Performance in Emergency Situation

This study was conducted to assess motorcycle braking performance in simulated emergency situation. Braking distances and G- force values (peak) during the braking test of 6 distinct underbone motorcycles of 100-150cc were measured and compared based on different test conditions namely type of brake system (disc and drum), method of braking operation (front and rear brakes) and test load (rider only and rider with pillion). The results indicate that type of braking system and method of braking operation significantly influenced braking distance and G-force value. However, test load was found insignificant. The shortest braking distance and highest deceleration rate were 12.48 meters and 8.52 m/s2, respectively. The lowest G-force value (peak) was recorded 0.39 throughout the test. It is to be noted that this study is unique on its own due to certain limitations although some of the methods were adopted from the established international braking test standards. Even though this study is considered fundamental, the findings could provide vital information on the braking performance of underbone motorcycles especially to the motorcycle manufacturers and OEMs, as well as to the relevant authorities (driving institutes and Road Transport Department).

Validity of Broselow tape for estimating weight of Indian children.

Background & objectives:The Broselow tape has been validated in both ambulatory and simulated emergency situations in the United States and is believed to reduce complications arising from inaccurate drug dosing and equipment sizing in paediatric population. This study was conducted to determine the relationship between the actual weight and weight determined by Broselow tape in the Indian children and to derive an equation for determination of weight based on height in the Indian children.Methods:This cross-sectional study was conducted at a tertiary care hospital in Mumbai, India. The participants’ weights were divided into three groups <10 kg, 10-18 kg and >18 kg with a total sample size estimated to be 210 (70 in each group). Using the tape, the measured weight was compared to Broselow-predicted weight and percentage weight was calculated. Accuracy was defined as agreement on Broselow colour-coded zones, as well as agreement within 10 per cent between the measured and Broselow-predicted weights. The resulting data were compared with weights estimated by advanced paediatric life support (APLS) and updated APLS formulae using Pearson's correlation coefficient.Results:The mean percentage differences were −11.78, −17.09 and −14.27 per cent for <10, 10-18 and >18 kg weight-based groups, respectively. The Broselow colour-coded zone agreement was 33.3 per cent in children weighing <10 kg, but only 7.4 per cent in the 10-18 kg group and 33.9 per cent in the >18 kg group. Agreement within 10 per cent was 53.13 per cent for the <10 kg group, but only 21.08 per cent for the 10-18 kg group and 33.9 per cent for the >18 kg group. Application of 10 per cent weight correction factor improved the percentages to 79.2 per cent for the <10 kg category, to 55.70 per cent for the 10-18 kg group and to 61.0 per cent for the >18 kg group. The correlation coefficient between actual weight and weights estimated by Broselow tape (r=0.89) was higher than that between actual weight and weight estimated by APLS method or updated APLS formulae (r=0.68) in 12-60 months age group as well as in >60 months age group (r=0.76).Interpretation & conclusions:Broselow weight overestimated weight by >10 per cent in majority of Indian children. The weight overestimation was greater in children belonging to over 18 and 10-18 kg weight groups. Applying 10 per cent weight correction factor to the Broselow-predicted weight may provide a more accurate estimation of actual weight in children attending public hospital. Weights estimated using Broselow tape correlated better with actual weights than those calculated using APLS and updated APLS formulae.

Team talk and team activity in simulated medical emergencies: a discourse analytical approach.

BackgroundCommunication errors can reduce patient safety, especially in emergency situations that require rapid responses by experts in a number of medical specialties. Talking to each other is crucial for utilizing the collective expertise of the team. Here we explored the functions of “team talk” (talking between team members) with an emphasis on the talk-work relationship in interdisciplinary emergency teams.MethodsFive interdisciplinary medical emergency teams were observed and videotaped during in situ simulations at an emergency department at a university hospital in Norway. Team talk and simultaneous actions were transcribed and analysed. We used qualitative discourse analysis to perform structural mapping of the team talk and to analyse the function of online commentaries (real-time observations and assessments of observations based on relevant cues in the clinical situation).ResultsStructural mapping revealed recurring and diverse patterns. Team expansion stood out as a critical phase in the teamwork. Online commentaries that occurred during the critical phase served several functions and demonstrated the inextricable interconnections between team talk and actions.DiscussionDiscourse analysis allowed us to capture the dynamics and complexity of team talk during a simulated emergency situation. Even though the team talk did not follow a predefined structure, the team members managed to manoeuvre safely within the complex situation. Our results support that online commentaries contributes to shared team situation awareness.ConclusionsDiscourse analysis reveals naturally occurring communication strategies that trigger actions relevant for safe practice and thus provides supplemental insights into what comprises “good” team communication in medical emergencies.

Enacting simulation: A sociomaterial perspective on students’ interprofessional collaboration

ABSTRACTFull-scale simulation exercises are becoming more common as an educational feature of the undergraduate training of health professionals. This study explores how interprofessional collaboration is enacted by the participating students. Practice theory is used as the theoretical framework for a field study of two naturalistic educational settings, when medical and nursing students come together to practice in a simulated emergency situation, where a manikin is replacing the patient. Eighteen sessions of simulations were observed, and data were collected through standardised video recordings that were analysed collaboratively. To ensure transparency and scientific rigour, a stepwise constant comparative analysis was conducted, in which individual observations within and across single video recordings were compared, negotiated and eventually merged. The findings show that the student teams relate to the manikin as a technical, medical, and human body, and that interprofessional knowings and enactments emerge as a fluid movement between bodily positioning in synchrony and bodily positioning out of synchrony in relation to the sociomaterial arrangements. The findings are related to contemporary theorisations of practice comprising an integrated view of body and mind, and it is discussed how the findings can be used in simulation exercises to support participants’ learning in new ways.