scholarly journals Trauma Simulation Training Increases Confidence Levels in Prehospital Personnel Performing Life-Saving Interventions in Trauma Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Christine M. Van Dillen ◽  
Matthew R. Tice ◽  
Archita D. Patel ◽  
David A. Meurer ◽  
Joseph A. Tyndall ◽  
...  
Keyword(s):  
Confidence Level ◽  
Simulation Training ◽  
Prehospital Care ◽  
Tension Pneumothorax ◽  
Trauma Patients ◽  
Care Providers ◽  
Confidence Levels ◽  
Life Saving ◽  
Before And After ◽  
Needle Decompression

Introduction. Limited evidence is available on simulation training of prehospital care providers, specifically the use of tourniquets and needle decompression. This study focused on whether the confidence level of prehospital personnel performing these skills improved through simulation training.Methods. Prehospital personnel from Alachua County Fire Rescue were enrolled in the study over a 2- to 3-week period based on their availability. Two scenarios were presented to them: a motorcycle crash resulting in a leg amputation requiring a tourniquet and an intoxicated patient with a stab wound, who experienced tension pneumothorax requiring needle decompression. Crews were asked to rate their confidence levels before and after exposure to the scenarios. Timing of the simulation interventions was compared with actual scene times to determine applicability of simulation in measuring the efficiency of prehospital personnel.Results. Results were collected from 129 participants. Pre- and postexposure scores increased by a mean of 1.15 (SD 1.32; 95% CI, 0.88–1.42;P<0.001). Comparison of actual scene times with simulated scene times yielded a 1.39-fold difference (95% CI, 1.25–1.55) for Scenario 1 and 1.59 times longer for Scenario 2 (95% CI, 1.43–1.77).Conclusion. Simulation training improved prehospital care providers’ confidence level in performing two life-saving procedures.

Clinical suspicion regarding needle decompression for patients with chest trauma

2019 ◽  
Vol 11 (8) ◽  
pp. 330-334
Author(s):  
Alastair Beaven ◽  
James Harrison ◽  
Keith Porter ◽  
Richard Steyn
Keyword(s):  
Chest Trauma ◽  
Prehospital Care ◽  
Tension Pneumothorax ◽  
Trauma Team ◽  
Trauma Network ◽  
Trauma Patients ◽  
Care Providers ◽  
Trauma Population ◽  
The Uk ◽  
Needle Decompression

Background: Needle decompression of the chest is indicated for patients in a critical condition with rapid deterioration who have a life-threatening tension pneumothorax. Aim: To reassure UK prehospital care providers that needle decompression of the chest is not commonly required in chest trauma patients, and most can be safely managed without it. Methods: Case studies as part of a major trauma network continuous review process have revealed instances of needle decompression in the absence of tension pneumothorax. Images are presented where needle decompression was attempted in the absence of tension pneumothorax. Context: Expert opinion from our network's multidisciplinary trauma team discuss the occurrence of tension pneumothorax in self-ventilating patients, and the idea that tension pneumothorax is rare in the UK civilian trauma population is acknowledged. Other causes of chest hypoventilation are discussed.

Cadaveric comparison of the optimal site for needle decompression of tension pneumothorax by prehospital care providers

2015 ◽  
Vol 79 (6) ◽  
pp. 1044-1048 ◽  
Author(s):  
Kenji Inaba ◽  
Efstathios Karamanos ◽  
Dimitra Skiada ◽  
Daniel Grabo ◽  
Peter Hammer ◽  
...  
Keyword(s):  
Prehospital Care ◽  
Tension Pneumothorax ◽  
Care Providers ◽  
Needle Decompression ◽  
Optimal Site

Opportunity for Seatbelt Usage by ALS Providers

1991 ◽  
Vol 6 (4) ◽  
pp. 469-471 ◽  
Author(s):  
Richard T. Cook ◽  
Steven A. Meador ◽  
Barry D. Buckingham ◽  
Lee V. Groff
Keyword(s):  
Cardiac Arrest ◽  
Time Management ◽  
Prehospital Care ◽  
Seat Belt ◽  
Cardiac Arrest Patient ◽  
Trauma Patients ◽  
Care Providers ◽  
Seat Belts ◽  
Additional Information ◽  
The Mean

AbstractPurpose:Prehospital care providers commonly indicate that they cannot wear seat belts owing to their need to be unrestrained while delivering care to the patient in the back of the ambulance. Each year, providers are injured in situations in which seat belts have been shown to be protective. Are ALS providers able to wear a seat belt and provide care in an ambulance?Methods:The ALS providers were asked to complete a form following calls during which they rode with a patient in the back of an ambulance. They indicated the amount of time which they felt they would have needed to have been unrestrained by seat belts and the reasons. There were no attempts to regulate or quantify seat belt usage. Additional information was gathered from the trip report.Results:The percentage of the time of each trip during which they felt they needed to be unrestrained was calculated for each trip. The mean was 41%. The mean transport time was 14.7 minutes. Sub-groupings by protocol type, showed that for cardiac arrest patients, providers felt they needed to be unrestrained for 82% of the duration of transport, for patients with “chest pain or cardiac dysrhythmia” 63%, for “shortness of breath” 38%, and for trauma patients 41%. Excluding cardiac arrest patients, the nine patients were assigned by the providers to have the most critical level of case severity required unrestrained time of 72%. Those nine patients with the lowest severity level requires that the provider by unrestrained only 18% of the time. Management of intravenous line and patient assessments most frequently were cited as reasons for needing to be unrestrained.Conclusion:Perceived need of ALS providers to be unrestrained varied with respect to the type of call, with cardiac arrest patient transports having the greatest need to be unrestrained. However, on the average, providers felt they needed to be unrestrained only 41% of the time; markedly less on some types of call, with cardiac arrest patient transports having the greatest need to be unrestrained. However, on the average, providers felt they needed to be unrestrained only 41% of the time; markedly less on some types of calls. The ALS providers should be able to wear seat belts for at least part of the time, on most ALS calls.

scholarly journals Improving the confidence and competence of junior doctors in conducting seclusion reviews

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S156-S157
Author(s):  
Mostafa Shalaby ◽  
Mehtab Rahman
Keyword(s):  
High Risk ◽  
Junior Doctor ◽  
Simulation Training ◽  
Junior Doctors ◽  
List Type ◽  
Confidence Levels ◽  
Effective Interventions ◽  
Before And After ◽  
Average Confidence ◽  
Quality Improvement Interventions

Aims•To improve the quality and consistency of medical seclusion reviews at St Charles Hospital and across the Trust.•To ensure at least 80% compliance with minimum standards for seclusion review documentation by the end of December 2020.•To increase doctors' mean perceived competence and confidence scores to 4.5/5 by the end of December 2020MethodSeclusion is commonly used to manage patients at high risk of aggression or violence, but is a high risk and very restrictive intervention. As such, it requires regular nursing and medical reviews. Work has been done recently at St Charles to improve the timeliness and effectiveness of nursing reviews including detailed guidance. Medical reviews are usually performed by junior doctors, many with limited experience in psychiatry. There is •A lack of consistent local or national guidance for junior doctors undertaking seclusion reviews•The quality and scope of these reviews is not consistent•There may be a need to ensure that there is more standardization and to improve junior doctors' confidence – and therefore patient safety and experience – overall.•The following interventions were used to improve the quality of seclusion reviews at the hospital:•Minimum standard guidelines•Presenting in Restrictive interventions meeting.•Feedback from PICU consultants for guidelines•Changing guidelinesFuture plans: •Guidelines teaching (Early November)•Re-audit and new survey (Early November)•Simulation training (Mid November)•Seclusion teaching video (Early December- to be ready for Induction)•Re-audit and new survey (Beginning of April)ResultSurveys were conducted before and after quality improvement interventions were put in place. The average confidence levels of junior doctors increased from 38.5% to 87% following these interventions.ConclusionRevision of seclusion guidelines, junior doctor teaching and simulation training are effective interventions to improve junior doctor confidence levels in conducting seclusion reviews.

scholarly journals Challenges in the PREHOSPITAL emergency management of geriatric trauma patients – a scoping review

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Michael Eichinger ◽  
Henry Douglas Pow Robb ◽  
Cosmo Scurr ◽  
Harriet Tucker ◽  
Stefan Heschl ◽  
...  
Keyword(s):  
Older People ◽  
Scoping Review ◽  
Prehospital Care ◽  
Descriptive Analysis ◽  
Traumatic Injury ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Care Providers ◽  
Age Bias ◽  
Prehospital Management

Abstract Background Despite a widely acknowledged increase in older people presenting with traumatic injury in western populations there remains a lack of research into the optimal prehospital management of this vulnerable patient group. Research into this cohort faces many uniqu1e challenges, such as inconsistent definitions, variable physiology, non-linear presentation and multi-morbidity. This scoping review sought to summarise the main challenges in providing prehospital care to older trauma patients to improve the care for this vulnerable group. Methods and findings A scoping review was performed searching Google Scholar, PubMed and Medline from 2000 until 2020 for literature in English addressing the management of older trauma patients in both the prehospital arena and Emergency Department. A thematic analysis and narrative synthesis was conducted on the included 131 studies. Age-threshold was confirmed by a descriptive analysis from all included studies. The majority of the studies assessed triage and found that recognition and undertriage presented a significant challenge, with adverse effects on mortality. We identified six key challenges in the prehospital field that were summarised in this review. Conclusions Trauma in older people is common and challenges prehospital care providers in numerous ways that are difficult to address. Undertriage and the potential for age bias remain prevalent. In this Scoping Review, we identified and discussed six major challenges that are unique to the prehospital environment. More high-quality evidence is needed to investigate this issue further.

scholarly journals (A17) Epidemiology of Non-Vehicular Trauma Patients in the Prehospital Setting in India

2011 ◽  
Vol 26 (S1) ◽  
pp. s5-s5
Author(s):  
N.A. Lodhia ◽  
M. Strehlow ◽  
E. Pirrotta ◽  
B.N.V. Swathi ◽  
A. Gimkala ◽  
...  
Keyword(s):  
Prehospital Care ◽  
Initial Study ◽  
Prehospital Emergency Care ◽  
Trauma Patients ◽  
Care Providers ◽  
Elderly Age ◽  
Post Injury ◽  
Lower Socioeconomic ◽  
Prehospital Emergency

BackgroundNon-vehicular trauma (NVT) accounts for 8% of all calls to the GVK Emergency Management and Research Institute (EMRI), which provides prehospital emergency care to 85 million residents of Andhra Pradesh, India. This study describes the characteristics and outcomes of patients with NVT transported by GVK EMRI.MethodsAll patients with NVT were prospectively enrolled over 28 12-hour periods (equally distributed over each hour of the day and day of the week) during July/August 2010. Patients not found at the scene, refusing service, or reporting self-inflicted injuries were excluded. Real-time demographic and clinical data were collected from prehospital care providers using a standardized questionnaire. Follow-up patient information was collected at 48-hours and 30-days following injury.ResultsA total of 1,569 patients were enrolled. Follow-up rates were 72% at 48 hours and 71% at 30 days. The mean patient age was 40 (SD = 18) and 67% were male. Adults (ages 18–64) accounted for most patients (80%), followed by elderly (age > 64, 12%) and children (age < 18, 8%). Of the patients, 71% were from rural/tribal areas and 89% from lower socioeconomic strata. Eighty-two percent called within 1 hour of injury. Median call-to-scene time was 19 minutes (SD = 15) and scene-to-hospital time was 25 minutes (SD = 21). Most patients suffered blunt injuries (85%) with falls accounting for 43% of all injuries. Of the injuries, 56% were accidents and 43% assaults. Most injuries involved head/neck (48%) and extremities (44%). Cumulative mortality rates prior to hospital arrival, at 48-hours and at 30-days were 1.1%, 3.2%, and 4.9% respectively. Falls accounted for 69% of all deaths. Falls and age > 65 were predictors of mortality (p < 0.0001). Of NVT survivors, 56% returned to baseline function and 28% were in significant pain or bed bound at 30-days post-injury.ConclusionThis initial study of prehospital NVT patients in India reveals that falls and elderly age were highly associated with death.

Abstract 322: Prehospital Care From Emergency Life-Saving Technicians Promotes the Survival of Trauma Patients

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Tsuyoshi Nojima ◽  
Hiromichi Naito ◽  
Tetsuya Yumoto ◽  
Atsunori Nakao
Keyword(s):  
Logistic Regression ◽  
Trauma Care ◽  
Injury Severity ◽  
Prehospital Care ◽  
Prehospital Emergency Care ◽  
Trauma Patients ◽  
Multivariable Logistic Regression Model ◽  
Full Field ◽  
Multivariable Logistic Regression ◽  
Life Saving

Introduction: Optimal trauma care strategies remain a matter of debate. Prehospital trauma care protocols for paramedics range from no intervention to full field stabilizations. In Japan, emergency life-saving technicians (ELSTs) are certified specialists trained to provide advanced techniques and knowledge for prehospital emergency care. They can give fluid resuscitation and inform the receiving hospital for definitive surgery. However, the effectiveness of ELSTs over basic emergency medical technicians (BEMTs) regarding trauma transport remains unclear. Hypothesis: We tested whether the presence of an ELST improves the outcomes of trauma patients. Methods: We retrospectively studied 2004- 2017 data from the Japan Trauma Data Bank (JTDB). Inclusion criteria were patients age ≥ 16 with at least one Abbreviated Injury Scale (AIS) score ≥ 3 trauma. Exclusion criteria were patients with burns, AIS score = 6 in any region, and missing data. We compared two trauma patient groups. ELST group: patients transported by EMS including at least one ELST. BEMT group: patients transported only by basic EMS personnel. The primary outcome measure was survival at discharge. A multivariable logistic regression model was used to adjust for patient baseline characteristics. Results: Included were 124,563 patients, with 119,352 patients in the ELST group and 5,211 patients in the BEMT group. Patients’ ages (ELST vs. BEMT [Mean ± SD]: 57 ± 22 vs. 59 ± 22 years, p < 0.01) were lower and transportation time (15 ± 12 vs. 17 ± 14 min, p < 0.01) was shorter in the ELST group. Gender (male: 64 vs. 64 %, p = 0.66), proportion of blunt trauma (96 vs. 96 %, p = 0.10), proportion of blood transfusion (15 vs. 14 %, p = 0.11) and Injury Severity Score (16 ± 11 vs. 16 ± 11, p = 0.28) were similar between groups. Revised Trauma Score (7.0 ± 1.9 vs. 7.1± 1.7, p < 0.01) was lower in the ELST group and proportion of emergency surgery (12 vs. 11 %, p < 0.01) was higher in the ELST group, indicating that ELSTs treat more severe cases. In the multivariable logistic regression, the ELST group had higher odds for survival (adjusted OR: 1.18, 95% CI: 1.01-1.37). Conclusions: ELSTs encountered more severe cases than BEMTs. After adjustment, transport by the ELST group was associated with improved survival of trauma patients.

Failure Rate of Prehospital Needle Decompression for Tension Pneumothorax in Trauma Patients

2018 ◽  
Vol 84 (11) ◽  
pp. 1750-1755 ◽  
Author(s):  
Richard N. Lesperance ◽  
Colin M. Carroll ◽  
James K. Aden ◽  
Jason B. Young ◽  
Timothy C. Nunez
Keyword(s):  
Chest Wall ◽  
Failure Rate ◽  
Wall Thickness ◽  
Cardiac Injury ◽  
Tension Pneumothorax ◽  
Pleural Space ◽  
Ct Scans ◽  
Trauma Patients ◽  
High Failure Rate ◽  
Needle Decompression

Tension pneumothorax is commonly treated with needle decompression (ND) at the 2nd intercostal space midclavicular line (2nd ICS MCL) but is thought to have a high failure rate. Few studies have attempted to directly measure the failure rate in patients receiving the intervention. We performed a retrospective analysis of 10 years of patients receiving prehospital ND. CT scans were reviewed to record the location of catheters left indwelling and the proportion of patients who did not have any pneumothorax. Chest wall thickness was measured on both injured and uninjured sides at the 2nd ICS MCL and compared with the recommended alternative, the 5th ICS anterior axillary line (5th ICS AAL). We identified 335 patients that underwent prehospital ND who had CT scans performed. Using our two different radiologic methods of assessing failure, 39 per cent and 76 per cent of attempts at ND failed to reach the pleural space. In addition, at least 39 per cent of patients did not have a tension pneumothorax. Injured chest walls were significantly thicker than uninjured chest walls at both the 2nd ICS MCL and the 5th ICS AAL (both P < 0.005.) Increasing chest wall thickness correlated with the failure of the catheter to reach the pleural space. Using an 8-cm catheter at the 5th ICS AAL, iatrogenic cardiac injury was at risk in 42 per cent of patients. This series confirms the high failure rate of ND at the 2nd ICS MCL, but further studies are needed to assure the safety of using larger catheters at the 5th ICS AAL.

scholarly journals Advanced Paramedic Delivered Finger Thoracostomy

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
David Menzies ◽  
Stephen O'Neill ◽  
Jim Leonard ◽  
Paul Butcher ◽  
Paul Creevy ◽  
...  
Keyword(s):  
Major Trauma ◽  
Tension Pneumothorax ◽  
Hospital Treatment ◽  
Trauma Patients ◽  
Medical Team ◽  
Care Services ◽  
Traumatic Cardiac Arrest ◽  
Road Racing ◽  
Practical Instruction ◽  
Needle Decompression

<p><strong>Introduction &amp; Aims</strong></p><p>Tension pneumothorax is a potentially fatal but reversible injury encountered in major trauma and traumatic cardiac arrest. Needle decompression has been the standard treatment approach pre hospital in Ireland and internationally. However, concerns exist regarding the effectiveness of this approach due to anatomy and body habitus. We aim to describe the training, introduction and experience of finger thoracostomy by advanced paramedics within a pre hospital service in Ireland.</p><p><strong>Methods</strong></p><p>Finger thoracostomy has been advocated as an alternative pre hospital treatment which is both diagnostic and therapeutic. Paramedic delivered thoracostomy is commonplace in pre hospital critical care services internationally. The MCI Medical Team (as part of Motorsport Rescue Services) is a PHECC-registered multidisciplinary team which provides medical cover at motorcycle road racing events in Ireland. The MCI Medical Team has significant experience of major trauma and routinely performs pre hospital anaesthesia for trauma patients. We introduced a training module on finger thoracostomy, comprising: theory, practical instruction and assessment for advanced paramedic members of the team.</p><p><strong>Results &amp; Conclusions</strong></p><p>Advanced paramedic members of the team we trained to deliver finger thoracostomy in predefined circumstances when operating as part of the MCI medical team. To date, advanced paramedic delivered finger thoracostomy has been utilised on three occasions. Introduction of advanced paramedic delivered thoracostomy is a feasible and effective technique for the treatment of tension pneumothorax within a closely governed system.</p>

Evaluating the Effectiveness of the General Surgery Intern Boot Camp

2016 ◽  
Vol 82 (3) ◽  
pp. 243-250 ◽  
Author(s):  
Clint S. Schoolfield ◽  
Navdeep Samra ◽  
Roger H. Kim ◽  
Runhua Shi ◽  
Wayne W. Zhang ◽  
...  
Keyword(s):  
General Surgery ◽  
Confidence Level ◽  
Interpersonal Skills ◽  
Postgraduate Training ◽  
Medical Knowledge ◽  
Boot Camp ◽  
Technical Skill ◽  
Confidence Levels ◽  
Home Institution ◽  
Before And After

The aim of our study is to evaluate the effectiveness of newly implemented general surgery intern boot camp. A 2-day didactic and skills-based intern boot camp was implemented before the start of clinical duties. Participants who did not attend all boot camp activities and had prior postgraduate training were excluded. A survey utilizing a 5-point Likert scale scoring system was used to assess the participants’ confidence to perform intern-level tasks before and after the boot camp. Subgroup analyses were performed comparing changes in confidence among graduates from home institution versus others and general surgery versus other subspecialties. In the analysis, 21 participants over two years were included. Among them, 7 were graduates from home institution (4 general surgery, 3 subspecialty) and 14 were from other institutions (6 general surgery and 8 subspecialty). There were significant increases in overall confidence levels (pre = 2.79 vs post = 3.43, P < 0.001) after the boot camp. Additionally, there were improvements for all subcategories including medical knowledge (2.65 vs 3.36, P < 0.001), technical skill (3.02 vs 3.51, P < 0.001), interpersonal skills and communication (3.04 vs 3.53, P = 0.001), and practice-based learning (2.65 vs 3.41, P = 0.001). There was an improvement in confidence level for both home institution graduates (2.89 vs 3.53, P = 0.022) and other graduates (2.74 vs 3.34, P < 0.001). Similarly, participants from general surgery (2.78 vs 3.46, P = 0.001) and other specialties (2.74 vs 3.34, P < 0.001) reported significant improvement in confidence. General surgery intern boot camp before the start of official rotation is effective in improving confidence level in performing level-appropriate tasks of the incoming new interns.

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