Time-critical Emergency Research Articles

Impact of a New 9-1-1 Dispatch System on Call-Processing Times for Time-Critical Emergencies in the City of Los Angeles

Objective: To determine the impact of a new emergency medical services (EMS) 9-1-1 dispatch system on call-processing times for field-confirmed time-critical emergencies. Methods: An interrupted time series study compared 9-1-1 calls for field-confirmed emergencies processed by Los Angeles Fire Department (LAFD)-telecommunicators using either the Medical Priority Dispatch System® (January 1 - September 30, 2014) or the new Los Angeles Tiered Dispatch System (January 1 - September 30, 2015). Prior to the study, authors identified seven categories of time-critical emergencies. Cases meeting inclusion criteria were systematically identified using LAFD electronic health records, and the elapsed time from call receipt to key events were obtained. The primary outcome was call-processing time (CPT), defined as time from 9-1-1 call receipt to when resources were dispatched. Results: During the study period, 12,439 incidents met inclusion criteria: 6,208 using MPDS and 6,231 using LA-TDS. Among all unique time-critical incidents, the mean CPT was 16 seconds faster using LA-TDS (M = 68.5) compared to MPDS (M = 84.4; p < 0.001). CPT was significantly (p < 0.01) lower using LA-TDS for: cardiac arrests with attempted resuscitation, patients requiring ventilation support, seizures requiring prehospital benzodiazepines, gunshot wounds with hypotension, automobile vs. pedestrian accidents, and long falls. There was no difference in CPT for drownings requiring resuscitation (p = 0.60). The elapsed time to arrival of first responders on scene improved from 370.1 seconds using MPDS to 354.8 seconds using LA-TDS (p < 0.001). Conclusion: The new Los Angeles Tiered Dispatch System significantly improved 9-1-1 call-processing times and total response times for nearly all identified time-critical emergencies under study.

Out-of-Hospital Cardiopulmonary Resuscitation

With an incidence of 50 - 70 resuscitations attempted per 100000 inhabitants and year Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death in adults in the developed world. Thus, cardiac arrest is a common emergency situation attended by emergency medical services (EMS). Due to the pathophysiology it is one of the most time-critical emergencies: after 3 - 5 minutes of cardiac arrest without resuscitation efforts the likelihood of neurological impairments is significantly increased once the patient survives the initial event. Therefore, the immediate start of basic life support (BLS) with high quality chest compressions is paramount. Advanced life support comprises defibrillation, if indicated, airway management, the application of selected drugs and the treatment of reversible causes. After return of spontaneous circulation (ROSC) a structured post-resuscitation care in EMS and in dedicated hospitals is essential to achieve the best neurological outcome for the patient. The universal resuscitation algorithm has to be adapted for special circumstances of OHCA (e. g. a traumatic cause, cardiac arrest in pregnancy, …).

Overcoming language barriers in paramedic care: a study protocol of the interventional trial \u2018DICTUM rescue\u2019 evaluating an app designed to improve communication between paramedics and foreign-language patients

BackgroundIt is essential for medical treatment that patients and medical staff can communicate about acute complaints, pre-existing conditions, and the treatment procedure. Misunderstandings can have far-reaching consequences, particularly in time-critical emergencies, which require rapid assessments and decision-making and in which interpreters are rarely available.In this study, we aim to develop a digital communication tool that is to help paramedics communicate with patients who speak hardly any or no German, to monitor its implementation, and to investigate its effect on communication between foreign-language patients and staff. Furthermore, a large amount of data on patients that are cared for in emergency medical services in Germany are collected for the first time.MethodsTo consider the complex situations of paramedic care and to meet paramedics’ demands, we use an action-oriented research approach to develop the tool. We include the staff of the participating emergency medical service stations and software designers in our approach. The tool is then used and evaluated within an open interventional, non-randomised study with two control groups. Control group 1 (German-speaking patients) and control group 2 (non-German-speaking patients treated without the tool) are recruited starting from the first study phase. In the second study phase, an intervention group is additionally recruited, i.e. non-German-speaking patients with whom the tool is used.The primary outcome of the clinical trial is improved communication with non-German-speaking patients in emergencies by means of the communication tool. The secondary outcome is an improved quality and quantity of the collected information. We exploratively observe on-scene times, demands for emergency physicians, and the usage of the intervention. By recording patients’ clinical parameters, we consider the severity of the health restrictions.DiscussionOur study is an innovative research project in paramedic healthcare comprising the development of a digital communication tool to overcome language barriers in emergency medical services and investigating its usability, acceptance, and effect on communication, in short, its usefulness and value for paramedic care. Additonally, we expect to gain comprehensive information on rescue operations.Trial registrationGerman Clinical Trials Register, DRKS00016719, registered 08 February 2019, World Health Organization Trial Registration Data Set, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00016719

A dedicated cerebrovascular anesthesia team is a critical component of a comprehensive stroke center

There has been a long-standing debate regarding the optimal approach to the anesthetic management of patients undergoing mechanical thrombectomy. While the vast majority of intracranial neurointerventional procedures are performed under...

Pathognomonic imaging signs in abdominal radiology.

The imaging evaluation of the abdomen is of crucial importance for every radiologist. In addition to ultrasound, conventional radiographs and contrast-enhanced computed tomography (CT) are the most common imaging procedures in the abdominal region. Numerous pathognomonic signs should be known in this context by everyradiologist. Radiographs of the abdomen are an often used first step in radiologic imaging, while CT examinations are carried out for further differentiation, in oncological settings and in time-critical emergency situations. A fast and clear assignment of these signs to a specific disease is the basis for a correct diagnosis. This pictorial review describes the most common pathognomonic signs in abdominal imaging. The knowledge of these pictograms is therefore essential for radiologists interested in abdominal medicine and should also be addressed in training and further education.

Understanding the potential of mixed reality simulation training for the management of ‘can’t intubate–can’t oxygenate’ emergencies

The management of an unanticipated difficult airway resulting in a ‘can’t intubate–can’t oxygenate’ (CICO) emergency is a rare time-critical and life-threatening emergency that is highly stressful, and the associated stress...

Portable Microwave Head Imaging System Using Software-Defined Radio and Switching Network

Head imaging plays an imperative role in the detection and localization of conditions affecting the brain, such as strokes, cancerous tumors, and hemorrhages caused by trauma. Current systems require the patient to be transported to the imaging device that increases the time taken to apply treatments, allowing the patient's condition to worsen. This paper proposes a portable microwave head imaging system that can easily be taken to the patient. The system utilizes a novel combination of a software-defined radio and solid-state switching network to collect the imaging data and operates in the frequency band of 0.85–2 GHz. It can capture input signals over a range of approximately 106 dB, which is suitable for detecting realistic brain injuries. The concept has been validated through experimental data collection and confocal image generation and was capable of producing images in less than 1 min. A simplified head phantom was developed for gathering the verification data and proved that the system was capable of locating targets with dielectric properties similar to brain tumors and bleeds. The presented design is highly accessible and achieved through being small, light, and inexpensive, which are key factors that could help save lives in time-critical medical emergencies.

Safety of Tiered-Dispatch for 911 Calls for Abdominal Pain.

IntroductionMany dispatch systems send Advanced Life Support (ALS) resources to patients complaining of abdominal pain even though the majority of these incidents require only Basic Life Support (BLS). With increasing 911-call volume, resource utilization has become more important to ensure that ALS resources are available for time-critical emergencies. In 2015, a large, urban fire department implemented an internally developed, tiered-dispatch system. Under this system, patients reporting a chief complaint of abdominal pain received the closest BLS ambulance dispatched alone emergency if located within three miles of the incident. The objective of this study was to determine the safety of BLS-only dispatch to abdominal pain by determining the frequency of time-sensitive events.MethodsThis was a retrospective review of electronic health records of one emergency medical service provider agency from May 2015–2018. Inclusion criteria were a chief complaint of abdominal pain from a first- or second-party caller, age over 15, and the patient was reported to be alert and breathing normally. The primary outcome was the prevalence of time-sensitive events, including cardiopulmonary resuscitation (CPR), defibrillation, or airway management. Secondary outcomes were hypotension (systolic blood pressure < 90 mmHg); or a prehospital 12 lead-electrocardiogram (ECG) demonstrating ST-elevation myocardial infarction (STEMI) criteria or a wide complex arrhythmia. Descriptive statistics were used.ResultsDuring the study period, there were 1,220,820 EMS incidents, of which 33,267 (2.72%) met inclusion criteria. The mean age was 49.9 years (range 16–111, standard deviation [SD] 19.6); 14,556 patients (56.2%) were female. Time-sensitive events occurred in seven cases (0.021%), mean age was 75.3 years (range 30–86, SD18.7); 85.7% were female. Airway management was required in seven cases (0.021%), CPR in six cases (0.018%), and defibrillation in one case (0.003%). Two of the seven (28.6%) cases involved dispatch protocol deviations. Hypotension was present in 240 (0.72%) cases; six (0.018%) cases had 12-lead ECGs meeting STEMI criteria; and no cases demonstrated wide complex arrhythmia.ConclusionAmong adult 911 patients with a dispatch chief complaint of abdominal pain, time-sensitive events were exceedingly rare. Dispatching a BLS ambulance alone appears to be safe.

A case report of cardiac tamponade following blunt chest trauma

Traumatic cardiac tamponade due to blunt chest injury is a life threatening and time-critical emergency that requires early recognition and prompt management often alongside other resuscitative considerations. We present here a case of 25 year old male with history of blunt chest trauma with hypotension and raised central pressures. The patient was taken up for exploratory laparotomy which proved negative and the central tendon bulge of diaphragm was seen. Hence, the decision was made to examine the pericardial space via thoracotomy to find cardiac tamponade of 400 cc. Immediate intra- operative stabilization of vitals was seen on relieving the intra pericardial pressures. Any patient with severe blunt chest trauma, disproportionate hypotension that is not responding to fluid resuscitation along with elevated central venous pressures should be thoroughly evaluated for cardiac tamponade.

Development of a Clinical Interface for a Novel Newborn Resuscitation Device: Human Factors Approach to Understanding Cognitive User Requirements.

BackgroundA novel medical device has been developed to address an unmet need of standardizing and facilitating heart rate recording during neonatal resuscitation. In a time-critical emergency resuscitation, where failure can mean death of an infant, it is vital that clinicians are provided with information in a timely, precise, and clear manner to capacitate appropriate decision making. This new technology provides a hands-free, wireless heart rate monitoring solution that easily fits the clinical pathway and procedure for neonatal resuscitation.ObjectiveThis study aimed to understand the requirements of the interface design for a new device by using a human factors approach. This approach combined a traditional user-centered design approach with an applied cognitive task analysis to understand the tasks involved, the cognitive requirements, and the potential for error during a neonatal resuscitation scenario.MethodsFourteen clinical staff were involved in producing the final design requirements. Two pediatric doctors supported the development of a visual representation of the activities associated with neonatal resuscitation. This design was used to develop a scenario-based workshop. Two workshops were carried out in parallel and involved three pediatric doctors, three neonatal nurses, two advance neonatal practitioners, and four midwives. Both groups came together at the end to reflect on the findings from the separate sessions.ResultsThe outputs of this study have provided a comprehensive description of information requirements during neonatal resuscitation and enabled product developers to understand the preferred requirements of the user interface design for the device. The study raised three key areas for the designers to consider, which had not previously been highlighted: (1) interface layout and information priority, as heart rate should be central and occupy two-thirds of the screen; (2) size and portability, to enable positioning of the product local to the baby’s head and allow visibility from all angles; and (3) auditory feedback, to support visual information on heart rate rhythm and reliability of the trace with an early alert for intervention while avoiding parental distress.ConclusionsThis study demonstrates the application of human factors and the applied cognitive task analysis method, which identified previously unidentified user requirements. This methodology provides a useful approach to aid development of the clinical interface for medical devices.

Cross-sectional study on emergency department management of sepsis.

Emergency departments (EDs) play an important role in the early identification and management of sepsis. Little is known about local EDs' processes of care for sepsis, adoption of international recommendations, and the impact of the new Sepsis-3 definitions. Structured telephone interviews based on the United Kingdom Sepsis Trust 'Exemplar Standards for the Emergency Management of Sepsis' were conducted from January to August 2017 with nominated representatives of all responding public hospital EDs in Hong Kong, followed by a review of hospital/departmental sepsis guidelines by the investigators. Sixteen of the 18 public EDs in Hong Kong participated in the study. Among various time-critical medical emergencies such as major trauma, sepsis was perceived by the interviewees to be the leading cause of in-hospital mortality and the second most important preventable cause of death. However, only seven EDs reported having departmental guidelines on sepsis care, with four adopting the Quick Sequential Organ Failure Assessment score or its modified versions. All responding EDs reported that antibiotics were stocked within their departments, and all EDs with sepsis guidelines mandated early intravenous antibiotic administration within 1 to 2 hours of detection. Reported major barriers to optimal sepsis care included lack of knowledge and experience, nursing human resources shortages, and difficulty identifying patients with sepsis in the ED setting. There are considerable variations in sepsis care among EDs in Hong Kong. More training, resources, and research efforts should be directed to early ED sepsis care, to improve patient outcomes.

Neonatologist performed point-of-care bowel ultrasound: Is the time right?

This review acquaints neonatal clinicians using point-of-care ultrasound with a range of pathological bowel ultrasound findings, with the aim to promote utility of this skill as a diagnostic assessment tool in diseased neonatal intestinal states. A range of normal and pathological bowel ultrasound findings are illustrated with case examples from our neonatal intensive care unit. The technical challenges of lack of familiarity with sonographic appearance of bowel (healthy and diseased), occurrence of gas artefacts and requirements of high-resolution linear transducer probes are described to allow the development of skills amongst neonatologists trained in point-of-care ultrasound. Plain abdominal radiography continues to remain the standard investigation to differentiate benign bowel states such as continuous positive airway pressure (CPAP) belly syndrome in preterm infants from life-threatening pathological intestinal states such as necrotising enterocolitis. Although plain radiography is the gold standard modality in the evaluation of neonatal diseased bowel states, real-time point-of-care bowel ultrasound performed in conjunction can provide valuable information on bowel peristalsis, bowel wall thickness and bowel vascularity. Abnormal configuration of superior mesenteric vessels on colour Doppler can alert the clinician to the diagnosis of neonatal intestinal malrotation-a time critical emergency. Further research is needed to explore true-negative and true-positive predictive values of bowel ultrasound. However, with expansion of knowledge, appropriate training of techniques, neonatologists will be able to enhance their diagnostic acumen by performing point-of-care bowel ultrasound in conjunction with plain radiography in the evaluation of broad array of neonatal intestinal states.

TMED: A Spider-Web-Like Transmission Mechanism for Emergency Data in Vehicular Ad Hoc Networks

The vehicular ad hoc network (VANET) is an emerging mobile ad hoc network, which is an important component of the Internet of Things and has been widely applied in intelligent transportation systems in recent years. For large-scale VANETs, it is important to design efficient transmission schemes for time critical emergency data. Greedy perimeter stateless routing protocol is a typical geographic-based routing protocol and greedy perimeter coordinator routing protocol is typical for map-based but they do not consider the QoS of the transmission link and hence are not suitable for emergency data transmissions. Some bioinspired protocols and situation-aware protocols are more suitable for emergency situations. However, they have some limitations in terms of the computational complexity and convergence rate which can cause large time delays. In this paper, we propose a novel spider-web-like transmission mechanism for emergency data (TMED) in vehicular ad hoc networks, in which a spider-web-like transmission model combining geographic information system and electronic maps is established. In this mechanism, the request-spiders and confirmed-spiders are sent out to obtain the transmission path from a source vehicle to a destination vehicle to improve the packet delivery ratio and average transmission delay of emergency data. TMED combines a dynamic multipriority message queue management method with a restricted greedy forwarding strategy based on position prediction to significantly reduce the end-to-end delay of packets. We use SUMO and NS2 to simulate TMED in a city scenario and compare its performance with GPSR, GPCR, and ACAR based on the packet delivery ratio, average transmission delay, and routing overhead. The simulation results show that TMED outperforms these previously proposed protocols.

Simulation education for lower limb fasciotomy: improving surgical trainee confidence in executing a time-critical limb-saving procedure.

Acute extremity compartment syndrome is a relatively rare but well-recognised complication seen in a wide variety of clinical situations from acute trauma to snakebites. Local swelling within a muscle compartment results in increasing tissue pressure resulting in critical ischaemia, severe pain and altered sensation. There is only one effective treatment and that is timely surgical decompression of the osteofascial compartments involved.1 Failure to do so results in crippling ischaemic muscle contractures and in extreme cases, death. The surgical treatment is technically simple, however the stumbling blocks to success lie in recognition along with the speed and completeness of the surgery. Each of the four osteofascial compartments in the leg (anterior, peroneal, deep and superficial posterior) must be fully decompressed.1 The development of the Management of Surgical Emergencies (MSE) course was supported by the Department for International Development with the International Federation of Surgical Colleges, Association of Surgeons of Great Britain and Ireland, and College of Surgeons of East, Central and Southern Africa.2 Following an initial pilot course, the need for integration of compartment syndrome education was identified by one of the authors (YN). In Africa, although a huge proportion of the clinical workload is obstetrics and general surgery, a surgeon is expected to deal with all conditions requiring surgery. There are parallels between this truly time-critical emergency and cardiac arrest for which simulation training is well established, as it is …

On the performance of cognitive internet-of-vehicles with unlicensed user-mobility and licensed user-activity

Internet of Vehicles (IoV) is regarded as an emerging concept for intelligent transportation cyber-physical systems. Due to the limited number of channels available in IEEE 802.11p DSRC/WAVE standard for vehicular communications, time-critical emergency messages in IoV could suffer from delays. Thus, cognitive radio enabled IoV has potential to overcome this problem, where vehicles (i.e., unlicensed vehicular users aka unlicensed secondary users) access RF spectrum other than 802.11p spectrum in an opportunistic manner by sensing and identifying the idle channels licensed to primary users without causing any harmful interference to primary users. In cognitive IoV, unlicensed vehicular users rely on spectrum sensing to find idle bands for opportunistic IoV communications. Existing spectrum sensing algorithms either consider low mobility or stationary (no mobility) of unlicensed vehicular users. Furthermore, joint impact of unlicensed vehicular user mobility and primary user activity have not considered while evaluating the performance of spectrum sensing for opportunistic communications. In this paper, we analyze and evaluate the combined impact of unlicensed vehicular user mobility and licensed user activity for cognitive IoV where each vehicle is assumed to be equipped with a wireless device capable of communication and spectrum sensing for wide-band spectrum regime including IEEE 802.11p. We formally study the performance of the proposed approach for cognitive IoV using mathematical analysis by considering a speed of the vehicles, activities of the primary users and distance between licensed and unlicensed users. Then, numerical results obtained from simulations are used to evaluate the performance of the proposed approach. Results show that the unlicensed vehicular user mobility and primary user activity have a higher impact on misdetection probability than that on false alarm probability. Furthermore, communication range, speed, travel direction and distance between unlicensed vehicular users and licensed primary users affect the overlapping time period for spectrum sensing to find idle channels for opportunistic communications. We also study the dynamic spectrum access for opportunistic communications in terms of expected transmission time, achievable per-user rate and expected transmission count for successful communications.

Sim-sepsis: improving sepsis treatment in the emergency department?

Sepsis is a time-critical medical emergency that is estimated to account for 37 000 deaths annually in the UK. It is an adverse systemic host response to infection that can lead to multiple organ failure and death where timely administration of specific clinical interventions reduces mortality.1 Despite internationally focused awareness campaigns and clinician-friendly bundles of care, compliance with all six steps (sepsis 6) within the first hour of admission remains poor.2 Simulation-based education (SBE) uses high-fidelity-guided patient experiences to develop learnt behaviours for unexpected critical incidents. While SBE has been shown to improve participant satisfaction and knowledge, there is limited evidence that demonstrates a change in participants’ behaviour and patient outcome. Such evidence is key as it demonstrates translation of learning into practice. Our study, assessing the effectiveness of an in-house SBE programme using the Kirkpatrick learning evaluation model3 in a cohort of emergency department (ED) physicians, indicates such a change may be achievable. Using a locally written sepsis teaching programme, participants attended two didactic seminar sessions covering the fundamentals of sepsis management and human factors. Focused multiple choice and short answer pre-seminar and post-seminar assessment were completed by attendees (Kirkpatrick level …

Late Window Paradox.

The mantra of acute stroke therapy, time is brain is a call to arms that motivates both the public and medical practitioners to treat stroke as a time-critical emergency. Countless articles have documented inexorable declines in favorable clinical outcomes associated with delayed administration of thrombolytic or endovascular therapies. Therefore, one would naturally anticipate that the benefits of endovascular therapy would be markedly more modest if treatment is delayed many hours beyond the guideline-recommended 6-hour therapeutic window. How then do we explain the remarkably robust results of DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) and DAWN (DWI or CTP Assessment With Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention With Trevo), 2 recently published trials of endovascular therapy initiated up to 16 to 24 hours after patients were last known well? DAWN randomized patients at a median of 12.5 hours from onset and documented the largest absolute increase in functional independence ever reported in any acute stroke treatment trial, 35.5%.1 DEFUSE 3 randomized patients at a median of 11 hours after onset and documented a 28% increase in functional independence and an additional 20% absolute reduction in death or severe disability, which represents the largest reduction in mortality/severe disability ever achieved.2 By comparison, the pooled analysis of 5 modern early window thrombectomy trials (HERMES [Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials]) revealed an absolute increase in functional independence of 19.5% and a reduction in mortality/severe disability of 11%3 (Figure 1). Both early and late window studies included patients of similar ages, baseline National Institutes of Health Stroke Scale scores, and vessel occlusion sites. Patients were treated with the same modern thrombectomy devices and reperfusion was achieved in similar proportions of patients in the endovascular arms of the …

Paediatric Anaesthetic Emergency Data Manual

A special challenge for healthcare practitioners is the emergency resuscitation of infants and children. James Armstrong and Hannah King have published the Paediatric Anaesthetic Emergency Data Manual as a guide specifically directed to the treatment of a life-threatening crisis. Its main audience are those involved in anesthetizing pediatric patients; however, the guide would be useful for anyone facing an in-hospital pediatric emergency.The guide is small, light, and composed of water-resistant paper; however, it is not small enough to fit into a pocket. It is sectioned by arrest, trauma, anesthetic, and medical flowcharts, most of which are emergency treatment algorithms, but some are management guidelines. Pain treatment, fluid management, and congenital heart diseases are examples. The information is helpful; however, to be useful it would need to be attached or located at the site of care. It appears that there is only a hard copy of the information available and no electronic version of the flowcharts that come with the book.Much of the information is available as a Pediatric Critical Events Checklist on the Society for Pediatric Anesthesia (SPA) website for printing and through a free iTunes app that is managed by the Children’s Hospital of Philadelphia. The guide, however, provides more detailed information than the SPA checklists in many sections, and the guide starts with age-appropriate charts from neonate to teen, which are especially useful for the infrequent pediatric practitioner.The guide succeeds as a single-source summary for a broad range of pediatric care. It is rare to find a compendium that tackles so many pediatric topics without becoming a textbook. The true utility of this text is that it is an excellent reference, so much so that one need not rely on memory during a life-threatening crisis or during the care of a child with one of the many identified congenital anomalies. The formulary at the end of the guide is also quite valuable.It is especially difficult to choose an organizational format for what is simply a list of medical conditions. The book’s division into four categories works; however, during a true time-critical emergency, a familiarity with the book would be required. There are a few informational boxes spread throughout the guide and attached to flowcharts, such as an informational box on the management of hyperkalemia. Because hyperkalemia may occur as a part of multiple separate emergencies, it might be better served to have a separate section devoted to it. I also had a little difficulty with the guide because the color scheme chosen for some of the backgrounds makes the text difficult to read, especially the dark blues and purples. The color coding seems to follow some of the safety labeling of anesthetic medication syringes, but serves more as a nuisance in this context.Overall, the content of this emergency manual is outstanding, and although the information can be found elsewhere, this book serves as a concise single source. It is definitely a practical, and likely a beneficial, tool for those who want a hard copy at hand in their operating, emergency, or intensive care suite. The authors were clearly thoughtful in including what would be the most effective information for their audience during a pediatric calamity.

The linguistic and interactional factors impacting recognition and dispatch in emergency calls for out-of-hospital cardiac arrest: a mixed-method linguistic analysis study protocol

IntroductionEmergency telephone calls placed by bystanders are crucial to the recognition of out-of-hospital cardiac arrest (OHCA), fast ambulance dispatch and initiation of early basic life support. Clear and efficient communication...

Learning and Treatment of Anaphylaxis by Laypeople: A Simulation Study Using Pupilar Technology.

An anaphylactic shock is a time-critical emergency situation. The decision-making during emergencies is an important responsibility but difficult to study. Eye-tracking technology allows us to identify visual patterns involved in the decision-making. The aim of this pilot study was to evaluate two training models for the recognition and treatment of anaphylaxis by laypeople, based on expert assessment and eye-tracking technology. A cross-sectional quasi-experimental simulation study was made to evaluate the identification and treatment of anaphylaxis. 50 subjects were randomly assigned to four groups: three groups watching different training videos with content supervised by sanitary personnel and one control group who received face-to-face training during paediatric practice. To evaluate the learning, a simulation scenario represented by an anaphylaxis' victim was designed. A device capturing eye movement as well as expert valuation was used to evaluate the performance. The subjects that underwent paediatric face-to-face training achieved better and faster recognition of the anaphylaxis. They also used the adrenaline injector with better precision and less mistakes, and they needed a smaller number of visual fixations to recognise the anaphylaxis and to make the decision to inject epinephrine. Analysing the different video formats, mixed results were obtained. Therefore, they should be tested to evaluate their usability before implementation.