A Novel Approach for More Effective Emergency Equipment Storage: The Task-Based Package-Organized Neonatal Emergency Backpack

Objectives: To evaluate a new task-based package-organized (TPO) neonatal emergency backpack and to compare it to the classical (ABC- and material-based) backpack.Methods: Simulation-based assessment of time to retrieve equipment for three different tasks [intraosseous access (IO), intubation and adrenaline administration] using the TPO and the classical emergency backpack was compared.Results: Equipment retrieval times for the three tasks were assessed for 24 nurses (12 intermediate care, 12 intensive care) and were significantly faster in the TPO than in the classical backpack (IO 33 vs. 75 s, p < 0.001; intubation 53 vs. 70 s, p = 0,001; adrenaline 22 vs. 45 s, p < 0.001). The number of missing items was significantly lower using the TPO backpack for IO and adrenaline retrieval (IO 0,9 vs. 2,3 items, p < 00001, adrenaline 0.04 vs. 1, p < 0.001) but not for intubation equipment (0.9 vs. 1, not significant). The subjective rating of overall clearness was significantly higher for the TPO compared with the classical backpack (5,9 vs. 3,5, p < 0.001).Conclusion: Task-based package organization of neonatal emergency backpacks is feasible and might be superior to ABC-/material-oriented storage.

Cyber Risks Prediction and Analysis in Medical Emergency Equipment for Situational Awareness

In light of the COVID-19 pandemic, the Medicines and Healthcare products Regulatory Agency administered the standards for producing a Rapidly Manufactured Ventilator System (RMVS) free of charge due to the United Kingdom’s shortfall of ventilator systems throughout health centers. The standards delineate the minimum requirements in which a Rapidly Manufactured Ventilator System must encompass to be admissible for usage within hospitals. This work commences by evaluating the standards provided by the government to identify any potential security vulnerabilities that may arise due to the succinct development standards provided by the MHRA. This research investigates what cyber considerations are taken to safeguard a patient’s health and medical data to improve situational awareness. A tool for a remotely accessible, low-cost ventilator system is developed to reveal what a malicious actor may be able to inflict on a modern ventilator and its adverse impact.

No time to die: improving response to emergency scenarios in the 136 suite

AimsImprove confidence and experience of trainees performing preliminary medical reviews in the 136 suite.Improve patient safety by increasing trainee's confidence in responding to emergency scenarios, including crash calls of patients in the 136 Suite.To orientate trainees to the 136 suite and the emergency crash equipment, in order to better prepare trainees for emergency scenarios.BackgroundThe authors encountered a crash call in the 136 suite, in which a patient had concealed an opiate overdose. The patient was successfully resuscitated but concerns were raised by the junior doctors that they were unaware of what or where the emergency equipment was kept in the 136 suite. Following a debrief session, we established that junior doctors needed more orientation to the 136 suite and more teaching on performing preliminary medical reviews and responding to emergency situations.MethodTrainees, were asked to complete an anonymous, qualitative questionnaire with 16 questions asking about their confidence to respond to emergency situations in the 136 suite.Based on the feedback, an interactive teaching session was delivered two weeks later. The session covered a structured approach on how to perform a preliminary medical review and scenario-based teaching on emergency situations. Trainees were then shown the 136 facility, introduced to the lead nurse and shown the emergency crash equipment and drugs stores.Trainees were then re-consulted, with the same questionnaire to ascertain whether confidence and knowledge had increased.ResultFollowing initial induction, only 25% of trainees felt confident performing 136 Suite preliminary reviews. 50% of trainees had encountered crash calls at Park House Hospital, however 93% did not receive orientation of emergency equipment locations. Only 44% of trainees felt confident managing a crash call; reasons included feeling ‘rusty, little recent experience, not being familiar with the equipment’.Post-interactive teaching session, 89% now felt confident performing 136 Suite preliminary reviews. 100% knew where the crash equipment was located in the 136 Suite.ConclusionTrainees should receive a robust induction on how to perform 136 preliminary reviews and have orientation of the facility, including crash equipment during inductionTrainees require refresher training in addition to their basic life support training on common emergency scenarios encountered in psychiatric hospitals.A resuscitation skills training session is being organised for new trainees and hopefully incorporated into each forthcoming rotation.

Anaesthetic Considerations in Gastrointestinal Endoscopies

Gastrointestinal endoscopy has become fundamental procedure for diagnosis and treatment of gastrointestinal tract diseases. Generally, the gastrointestinal endoscopy is minimally invasive procedure. However, it can cause considerable amount of discomfort and pain which make the procedure unsafe, complicated and refusal of follow up procedures if done without safe sedation. The sedation is required to alleviate anxiety, provide analgesia, amnesia and to improve endoscopic performance specifically in therapeutic procedures. The safe administration of sedative and analgesic medications, irrespective of the regimen used, requires knowledge of the individual needs of patients. The combination of benzodiazepines and opioids is now the most widely used sedation regimen for sedation in gastrointestinal endoscopic procedures. Generally, sedation for gastrointestinal endoscopy is considered safe, however, it has the potential for serious complications. Therefore, endoscopist should assess the patients properly before the endoscopy as well as should be aware of all possible complications and the risk factors. Furthermore, skilled staff and emergency equipment should be available in endoscopy suit. This chapter discuss in details all the aspects of safe procedural sedation during GI endoscopies.

Prepare for the Rare: Innovation Simulation for Managing Abdominal Wall Defects

The incidence of abdominal wall defects like gastroschisis and omphalocele are relatively rare. Gastroschisis occurs approximately in 2 to 3 births in every 5,000, and omphalocele occurs in fewer than 2 births in every 10,000. However, our Level III NICU was informed that we were going to receive 2 infants with gastroschisis and one infant with an omphalocele in the same year. Because of the infrequency of these defects, our novice NICU nurses expressed concern about their lack of exposure to and familiarity with these defects. It became apparent that a thorough review of the clinical care and emergency interventions was needed before the anticipated deliveries. The challenge, however, was to develop an innovative, interactive learning experience for the NICU nurse that would provide both a didactic review and hands-on education to care for these patients. We opted to employ simulation. Infant mannequins were used along with moulage to create realistic-looking loops of bowel, herniated bowel segments, and umbilical cord. Scenarios were created that covered the various unpredictable clinical directions these cases could take. These scenarios included the emergency equipment, maneuvers, and interventions that could be required for the anticipated deliveries. Ten sessions for each abdominal wall defect were held; 51 NICU nurses participated in each simulation. NICU nurses reported increased comfort and readiness to care for each infant.

Service Improvement Priorities of The Economy-Premium Train in Indonesia

Service quality is an important factor that affects the long-term growth and operation of a service-oriented transportation system. The excellent service quality provided by The Indonesian Railway Company (PT KAI) to its passengers is able to help the company to have sustainable growth. This is an empirical study that utilizes an online questionnaire to collect data. The determination of the sample was conducted by using judgment sampling and the target sampling was conducted by incidental sampling method. This study applied Importance-Performance Analysis (IPA) to identify service attributes that have strong influence and priority for improvement with maximum resources. Research results show that passengers, in general, felt satisfied by the service of the economy-premium train in Indonesia, particularly with the completeness of emergency equipment, security and safety during the trip, and professional train staff. Passengers are not satisfied with the service attributes of TV show content, the price of food and beverage, and the leg space for rest. However, according to the IPA result, it is found that the service priorities that should be improved by PT KAI are the availability of internet access during the trip, cellphone signal strength, noise level in trains, and the affordability of ticket prices.

Non-destructive testing methods of assemblies and units of fire and emergency technique

Purpose. The substantiation of the use of modern methods for assessing and monitoring the state of fire and emergency equipment in order to ensure its trouble-free operation. Methods. Non-destructive methods, computer simulation, tensometry. Findings. The review of methods existing for assessment and control of assemblies and units of fire and rescue vehicles technical state is performed. Some results of their application are presented. The application possibility of non-destructive testing methods is assessed. Application field of research. Fire rescue equipment, welded joints of technical objects.

Recovery room procedures

Airway protection, laryngeal masks, and intubation are described as well as gas delivery circuits. Emergency equipment required for reintubation, and the technique for this procedure, are outlined. Instructions for intravenous and intramuscular injections are clearly explained.