Moving toward New Horizons for Marketing Education: Designing a Marketing Training for the Poor in Developing and Emerging Markets

ERIC Educational Resources Information Center

Teklehaimanot, Mebrahtu L.; Ingenbleek, Paul T. M.; Tessema, Workneh K.; van Trijp, Hans C. M.

2017-01-01

In recent years, marketing education has broadened to poor people in developing and emerging countries. In this article, the authors use four empirical studies that apply well-established training design procedures to design a marketing training program for Ethiopian pastoralists. Because pastoralists operate in extremely remote, traditional, and…

Comparison of self-efficacy and its improvement after artificial simulator or live animal model emergency procedure training.

PubMed

Hall, Andrew B; Riojas, Ramon; Sharon, Danny

2014-03-01

The objective of this study is to compare post-training self-efficacy between artificial simulators and live animal training for the performance of emergency medical procedures. Volunteer airmen of the 81st Medical Group, without prior medical procedure training, were randomly assigned to two experimental arms consisting of identical lectures and training of diagnostic peritoneal lavage, thoracostomy (chest tube), and cricothyroidotomy on either the TraumaMan (Simulab Corp., Seattle, Washington) artificial simulator or a live pig (Sus scrofa domestica) model. Volunteers were given a postlecture and postskills training assessment of self-efficacy. Twenty-seven volunteers that initially performed artificial simulator training subsequently underwent live animal training and provided assessments comparing both modalities. The results were first, postskills training self-efficacy scores were significantly higher than postlecture scores for either training mode and for all procedures (p < 0.0001). Second, post-training self-efficacy scores were not statistically different between live animal and artificial simulator training for diagnostic peritoneal lavage (p = 0.555), chest tube (p = 0.486), and cricothyroidotomy (p = 0.329). Finally, volunteers undergoing both training modalities indicated preference for live animal training (p < 0.0001). We conclude that artificial simulator and live animal training produce equivalent levels of self-efficacy after initial training, but there is a preference in using a live animal model to achieve those skills. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

14 CFR 91.1079 - Training program: Curriculum.

Code of Federal Regulations, 2010 CFR

2010-01-01

... and keep current a written training program curriculum for each type of aircraft for each crewmember... emergency maneuvers, procedures and functions that will be performed during each flight training phase or...

14 CFR 91.1079 - Training program: Curriculum.

Code of Federal Regulations, 2011 CFR

2011-01-01

... and keep current a written training program curriculum for each type of aircraft for each crewmember... emergency maneuvers, procedures and functions that will be performed during each flight training phase or...

3D force/torque characterization of emergency cricothyroidotomy procedure using an instrumented scalpel.

PubMed

Ryason, Adam; Sankaranarayanan, Ganesh; Butler, Kathryn L; DeMoya, Marc; De, Suvranu

2016-08-01

Emergency Cricothyroidotomy (CCT) is a surgical procedure performed to secure a patient's airway. This high-stakes, but seldom-performed procedure is an ideal candidate for a virtual reality simulator to enhance physician training. For the first time, this study characterizes the force/torque characteristics of the cricothyroidotomy procedure, to guide development of a virtual reality CCT simulator for use in medical training. We analyze the upper force and torque thresholds experienced at the human-scalpel interface. We then group individual surgical cuts based on style of cut and cut medium and perform a regression analysis to create two models that allow us to predict the style of cut performed and the cut medium.

Establishing Derived Equivalence Relations of Basic Geography Skills in Children with Autism

ERIC Educational Resources Information Center

Dixon, Mark R.; Stanley, Caleb; Belisle, Jordan; Galliford, Megan E.; Alholail, Amani; Schmick, Ayla M.

2017-01-01

The present study evaluated the efficacy of a stimulus-equivalence training procedure in teaching basic geography skills to two children with autism. The procedures were taken directly from a standardized training curriculum based in stimulus equivalence theory called "Promoting the Emergence of Advanced Knowledge Equivalence Module"…

Resource Conservation and Recovery Act Training Module about Treatment, Storage and Disposal Facilities

EPA Pesticide Factsheets

This training module describes:general requirements applicable to treatment, storage, and disposal facilitiesrequirements for waste analysis and personnel training purpose of a contingency plan and list the emergency notification procedures.

A PROTOTYPE MANUAL ON CIVIL DEFENSE ASPECTS OF WATERWORKS OPERATIONS

DTIC Science & Technology

survival and recovery in the event of a nuclear war; (2) to stimulate and assist water utilities i developing emergency plans to cope with a nuclear ... disaster ; (3) to provide a procedural guide for restoration and for training personnel in postattack emergency repair procedures, recovery techniques, and safety measures.

30 CFR 49.9 - Mine emergency notification plan.

Code of Federal Regulations, 2012 CFR

2012-07-01

... TRAINING MINE RESCUE TEAMS Mine Rescue Teams for Underground Metal and Nonmetal Mines § 49.9 Mine emergency... procedures to follow in notifying the mine rescue teams when there is an emergency that requires their...

30 CFR 49.9 - Mine emergency notification plan.

Code of Federal Regulations, 2014 CFR

2014-07-01

... TRAINING MINE RESCUE TEAMS Mine Rescue Teams for Underground Metal and Nonmetal Mines § 49.9 Mine emergency... procedures to follow in notifying the mine rescue teams when there is an emergency that requires their...

30 CFR 49.9 - Mine emergency notification plan.

Code of Federal Regulations, 2013 CFR

2013-07-01

... TRAINING MINE RESCUE TEAMS Mine Rescue Teams for Underground Metal and Nonmetal Mines § 49.9 Mine emergency... procedures to follow in notifying the mine rescue teams when there is an emergency that requires their...

The Effects of Listener Training on the Emergence of Tact and Mand Signs by Individuals with Intellectual Disabilities

PubMed Central

Ribeiro, Daniela M; Elias, Nassim C; Goyos, Celso; Miguel, Caio F

2010-01-01

The purpose of the current study was to assess whether individuals with intellectual disabilities would emit untrained speaker responses (i.e., signed tacts and mands) after being taught listener behaviors. Listener relations were trained via an automated matching-to-sample (MTS) procedure. Following mastery, the emergence of signed tacts, generalized tacts, and mands was tested. All participants met criterion in listener relations training and showed the emergence of almost all relations. Results suggest that teaching listener relations first, through MTS tasks, is a viable way to produce emergence of speaker relations. PMID:22477464

EMERGENCY VICTIM CARE AND RESCUE, TEXTBOOK FOR SQUADMEN.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Trade and Industrial Education Service.

DESIGNED FOR TRAINING EMERGENCY SQUAD PERSONNEL IN RESCUE PROCEDURES AND VICTIM CARE BEYOND BASIC FIRST AID, THIS TEXTBOOK WAS DEVELOPED BY A COMMITTEE OF SQUADMEN, DOCTORS, NURSES, FIREMEN, AND STATE TRADE AND INDUSTRIAL PERSONNEL TO BE USED IN ADULT TRAINING CLASSES OF FULL-TIME OR VOLUNTEER SQUADMEN. THE INSTRUCTIONAL MATERIAL INCLUDES 26…

Peace Corps Stateside Teacher Training for Volunteers in Liberia. Volume I: Evaluation Report. Final Report.

ERIC Educational Resources Information Center

PSI Associates, Inc., Washington, DC.

This report contains an evaluation of the Peace Corps stateside teacher training model for volunteers in Liberia. The first section lists recommendations stemming from the evaluation, concerning the pre-training questionnaire, deselection during training, emergency procedures, and the teacher training program. Section 2 describes the training…

Astronaut Curtis Brown on flight deck mockup during training

NASA Technical Reports Server (NTRS)

1994-01-01

Astronaut Curtis L. Brown, STS-66 pilot, mans the pilot's station during a rehearsal of procedures to be followed during the launch and entry phases of their scheduled November 1994 flight. This rehearsal, held in the crew compartment trainer (CCT) of JSC's Shuttle mockup and integration laboratory, was followed by a training session on emergency egress procedures.

Astronaut Scott Parazynski during egress training

NASA Technical Reports Server (NTRS)

1994-01-01

Astronaut Scott E. Parazynski looks at fellow STS-66 mission specialist Joseph R. Tanner, (foreground) during a rehearsal of procedures to be followed during the launch and entry phases of their scheduled November 1994 flight. This rehearsal, held in the crew compartment trainer (CCT) of JSC's Shuttle mockup and integration laboratory, was followed by a training session on emergency egress procedures.

Point-of-care ultrasonography by pediatric emergency physicians. Policy statement.

PubMed

Marin, Jennifer R; Lewiss, Resa E

2015-04-01

Point-of-care ultrasonography is increasingly being used to facilitate accurate and timely diagnoses and to guide procedures. It is important for pediatric emergency physicians caring for patients in the emergency department to receive adequate and continued point-of-care ultrasonography training for those indications used in their practice setting. Emergency departments should have credentialing and quality assurance programs. Pediatric emergency medicine fellowships should provide appropriate training to physician trainees. Hospitals should provide privileges to physicians who demonstrate competency in point-of-care ultrasonography. Ongoing research will provide the necessary measures to define the optimal training and competency assessment standards. Requirements for credentialing and hospital privileges will vary and will be specific to individual departments and hospitals. As more physicians are trained and more research is completed, there should be one national standard for credentialing and privileging in point-of-care ultrasonography for pediatric emergency physicians.

14 CFR 135.340 - Initial and transition training and checking: Flight instructors (aircraft), flight instructors...

Code of Federal Regulations, 2010 CFR

2010-01-01

... principles of the teaching-learning process; (ii) Teaching methods and procedures; and (iii) The instructor... certificate holder's policies and procedures. (3) The applicable methods, procedures, and techniques for... approved methods, procedures, and limitations for performing the required normal, abnormal, and emergency...

14 CFR 135.340 - Initial and transition training and checking: Flight instructors (aircraft), flight instructors...

Code of Federal Regulations, 2014 CFR

2014-01-01

... principles of the teaching-learning process; (ii) Teaching methods and procedures; and (iii) The instructor... certificate holder's policies and procedures. (3) The applicable methods, procedures, and techniques for... approved methods, procedures, and limitations for performing the required normal, abnormal, and emergency...

14 CFR 135.340 - Initial and transition training and checking: Flight instructors (aircraft), flight instructors...

Code of Federal Regulations, 2012 CFR

2012-01-01

... principles of the teaching-learning process; (ii) Teaching methods and procedures; and (iii) The instructor... certificate holder's policies and procedures. (3) The applicable methods, procedures, and techniques for... approved methods, procedures, and limitations for performing the required normal, abnormal, and emergency...

14 CFR 135.340 - Initial and transition training and checking: Flight instructors (aircraft), flight instructors...

Code of Federal Regulations, 2013 CFR

2013-01-01

... principles of the teaching-learning process; (ii) Teaching methods and procedures; and (iii) The instructor... certificate holder's policies and procedures. (3) The applicable methods, procedures, and techniques for... approved methods, procedures, and limitations for performing the required normal, abnormal, and emergency...

14 CFR 135.340 - Initial and transition training and checking: Flight instructors (aircraft), flight instructors...

Code of Federal Regulations, 2011 CFR

2011-01-01

... principles of the teaching-learning process; (ii) Teaching methods and procedures; and (iii) The instructor... certificate holder's policies and procedures. (3) The applicable methods, procedures, and techniques for... approved methods, procedures, and limitations for performing the required normal, abnormal, and emergency...

Hysteroscopic simulator for training and educational purposes.

PubMed

Lim, Fabian; Brown, Ian; McColl, Ryan; Seligman, Cory; Alsaraira, Amer

2006-01-01

Hysteroscopy is an extensively popular option in evaluating and treating women with infertility. The procedure utilizes an endoscope, inserted through the vagina and cervix to examine the intra-uterine cavity via a monitor. The difficulty of hysteroscopy from the surgeon's perspective is the visual spatial perception of interpreting 3D images on a 2D monitor, and the associated psychomotor skills in overcoming the fulcrum-effect. Despite the widespread use of this procedure, current qualified hysteroscopy surgeons have not been trained the fundamentals through an organized curriculum. The emergence of virtual reality as an educational tool for this procedure, and for other endoscopic procedures, has undoubtedly raised interests. The ultimate objective is for the inclusion of virtual reality training as a mandatory component for gynecological endoscopic training. Part of this process involves the design of a simulator, encompassing the technical difficulties and complications associated with the procedure. The proposed research examines fundamental hysteroscopic factors as well as current training and accreditation norms, and proposes a hysteroscopic simulator design that is suitable for educating and training.

Task analysis method for procedural training curriculum development.

PubMed

Riggle, Jakeb D; Wadman, Michael C; McCrory, Bernadette; Lowndes, Bethany R; Heald, Elizabeth A; Carstens, Patricia K; Hallbeck, M Susan

2014-06-01

A central venous catheter (CVC) is an important medical tool used in critical care and emergent situations. Integral to proper care in many circumstances, insertion of a CVC introduces the risk of central line-associated blood stream infections and mechanical adverse events; proper training is important for safe CVC insertion. Cognitive task analysis (CTA) methods have been successfully implemented in the medical field to improve the training of postgraduate medical trainees, but can be very time-consuming to complete and require a significant time commitment from many subject matter experts (SMEs). Many medical procedures such as CVC insertion are linear processes with well-documented procedural steps. These linear procedures may not require a traditional CTA to gather the information necessary to create a training curriculum. Accordingly, a novel, streamlined CTA method designed primarily to collect cognitive cues for linear procedures was developed to be used by medical professionals with minimal CTA training. This new CTA methodology required fewer trained personnel, fewer interview sessions, and less time commitment from SMEs than a traditional CTA. Based on this study, a streamlined CTA methodology can be used to efficiently gather cognitive information on linear medical procedures for the creation of resident training curricula and procedural skills assessments.

A visual graphic/haptic rendering model for hysteroscopic procedures.

PubMed

Lim, Fabian; Brown, Ian; McColl, Ryan; Seligman, Cory; Alsaraira, Amer

2006-03-01

Hysteroscopy is an extensively popular option in evaluating and treating women with infertility. The procedure utilises an endoscope, inserted through the vagina and cervix to examine the intra-uterine cavity via a monitor. The difficulty of hysteroscopy from the surgeon's perspective is the visual spatial perception of interpreting 3D images on a 2D monitor, and the associated psychomotor skills in overcoming the fulcrum-effect. Despite the widespread use of this procedure, current qualified hysteroscopy surgeons have not been trained the fundamentals through an organised curriculum. The emergence of virtual reality as an educational tool for this procedure, and for other endoscopic procedures, has undoubtedly raised interests. The ultimate objective is for the inclusion of virtual reality training as a mandatory component for gynaecologic endoscopy training. Part of this process involves the design of a simulator, encompassing the technical difficulties and complications associated with the procedure. The proposed research examines fundamental hysteroscopy factors, current training and accreditation, and proposes a hysteroscopic simulator design that is suitable for educating and training.

[Treatment of emergencies in the hospital--problems and management].

PubMed

Sablotzki, A; Schubert, S; Kuhn, C; Radke, J; Czeslick, E

2003-01-01

Due to the growing number of high-risk patients, the increasing proportion of geriatric patients and the expansion of surgical and invasive-diagnostic procedures, medical stuff in hospitals are confronted with a rising number of emergency situations. Nearly 50% are of cardio-circulatory origin and occur during surgical interventions or immediately afterwards. Another cause of life-threatening complications are side-effects of orally or intravenously administered agents, especially after treatment with antibiotics, anaesthetics, analgetics and sedatives. Due to a lack of emergency training and management in most hospitals, the survival rate after cardiopulmonary resuscitation in general wards lies between just two and 35%. Thus it seems necessary to perform special training in CPR procedures and emergency management at regular intervals for the entire medical stuff. In addition, a special infrastructure for giving sufficient treatment in emergencies has to be established (emergency team, emergency telephone number, intra-hospital emergency car). The second part of this review presents current diagnostic and therapeutic strategies for the most common emergency situations, e.g. anaphylaxis, myocardial infarction, pulmonary embolism, gastrointestinal bleeding, and heparin-induced thrombocytopenia (HIT).

STS-99 crewmembers bailout training in building 9

NASA Image and Video Library

1999-05-19

S99-05617 (19 May 1999) --- Astronaut Janet L. Kavandi, mission specialist, listens to a briefing about emergency egress procedures during a training session at the Johnson Space Center's Systems Integration Facility. Kavandi wears a training version of the partial pressure launch and entry garment.

14 CFR 121.422 - Aircraft dispatchers: Initial and transition ground training.

Code of Federal Regulations, 2011 CFR

2011-01-01

... computations; (iv) Basic airplane performance dispatch requirements and procedures; (v) Flight planning including track selection, flight time analysis, and fuel requirements; and (vi) Emergency procedures. (3... procedures, and other subjects having a bearing on dispatcher duties and responsibilities; (ii) Flight...

14 CFR 121.422 - Aircraft dispatchers: Initial and transition ground training.

Code of Federal Regulations, 2012 CFR

2012-01-01

... computations; (iv) Basic airplane performance dispatch requirements and procedures; (v) Flight planning including track selection, flight time analysis, and fuel requirements; and (vi) Emergency procedures. (3... procedures, and other subjects having a bearing on dispatcher duties and responsibilities; (ii) Flight...

14 CFR 121.422 - Aircraft dispatchers: Initial and transition ground training.

Code of Federal Regulations, 2013 CFR

2013-01-01

... computations; (iv) Basic airplane performance dispatch requirements and procedures; (v) Flight planning including track selection, flight time analysis, and fuel requirements; and (vi) Emergency procedures. (3... procedures, and other subjects having a bearing on dispatcher duties and responsibilities; (ii) Flight...

14 CFR 121.422 - Aircraft dispatchers: Initial and transition ground training.

Code of Federal Regulations, 2010 CFR

2010-01-01

... computations; (iv) Basic airplane performance dispatch requirements and procedures; (v) Flight planning including track selection, flight time analysis, and fuel requirements; and (vi) Emergency procedures. (3... procedures, and other subjects having a bearing on dispatcher duties and responsibilities; (ii) Flight...

14 CFR 121.422 - Aircraft dispatchers: Initial and transition ground training.

Code of Federal Regulations, 2014 CFR

2014-01-01

... computations; (iv) Basic airplane performance dispatch requirements and procedures; (v) Flight planning including track selection, flight time analysis, and fuel requirements; and (vi) Emergency procedures. (3... procedures, and other subjects having a bearing on dispatcher duties and responsibilities; (ii) Flight...

30 CFR 49.9 - Mine emergency notification plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

... TRAINING MINE RESCUE TEAMS § 49.9 Mine emergency notification plan. (a) Each underground mine shall have a mine rescue notification plan outlining the procedures to follow in notifying the mine rescue teams...

30 CFR 49.9 - Mine emergency notification plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... TRAINING MINE RESCUE TEAMS § 49.9 Mine emergency notification plan. (a) Each underground mine shall have a mine rescue notification plan outlining the procedures to follow in notifying the mine rescue teams...

Astronaut Scott Parazynski in hatch of CCT during training

NASA Technical Reports Server (NTRS)

1994-01-01

Astronaut Scott E. Parazynski, STS-66 mission specialist, poses near the hatchway of the crew compartment trainer (CCT) (out of frame) in JSC's Shuttle mockup and integration laboratory. Crew members were about to begin a rehearsal of procedures to be followed during the launch and entry phases of their flight. That rehearsal was followed by a training session on emergency egress procedures.

Astronaut Scott Parazynski during egress training

NASA Technical Reports Server (NTRS)

1994-01-01

Astronaut Scott E. Parazynski looks at fellow STS-66 mission specialist Joseph R. Tanner, (partially visible in foreground) during a rehearsal of procedures to be followed during the launch and entry phases of their scheduled November 1994 flight. This rehearsal, held in the crew compartment trainer (CCT) of JSC's Shuttle mockup and integration laboratory, was followed by a training session on emergency egress procedures.

Cosmonauts and astronauts during medical operations training

NASA Image and Video Library

1994-06-11

Mir 18 crewmember Gennadiy M. Strekalov, center, practicies an emergency medical procedure to maintain a patient airway during training at JSC. Looking on are Dave E. Ward (right), a JSC medical doctor, and an unidentified interpreter.

49 CFR 192.615 - Emergency plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... effective response to a notice of each type of emergency, including the following: (i) Gas detected inside... they are knowledgeable of the emergency procedures and verify that the training is effective. (3... public officials to: (1) Learn the responsibility and resources of each government organization that may...

49 CFR 192.615 - Emergency plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... effective response to a notice of each type of emergency, including the following: (i) Gas detected inside... they are knowledgeable of the emergency procedures and verify that the training is effective. (3... public officials to: (1) Learn the responsibility and resources of each government organization that may...

49 CFR 192.615 - Emergency plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... effective response to a notice of each type of emergency, including the following: (i) Gas detected inside... they are knowledgeable of the emergency procedures and verify that the training is effective. (3... public officials to: (1) Learn the responsibility and resources of each government organization that may...

49 CFR 192.615 - Emergency plans.

Code of Federal Regulations, 2011 CFR

2011-10-01

... effective response to a notice of each type of emergency, including the following: (i) Gas detected inside... they are knowledgeable of the emergency procedures and verify that the training is effective. (3... public officials to: (1) Learn the responsibility and resources of each government organization that may...

Defining our destiny: trainee working group consensus statement on the future of emergency surgery training in the United Kingdom.

PubMed

Sharrock, A E; Gokani, V J; Harries, R L; Pearce, L; Smith, S R; Ali, O; Chu, H; Dubois, A; Ferguson, H; Humm, G; Marsden, M; Nepogodiev, D; Venn, M; Singh, S; Swain, C; Kirkby-Bott, J

2015-01-01

The United Kingdom National Health Service treats both elective and emergency patients and seeks to provide high quality care, free at the point of delivery. Equal numbers of emergency and elective general surgical procedures are performed, yet surgical training prioritisation and organisation of NHS institutions is predicated upon elective care. The increasing ratio of emergency general surgery consultant posts compared to traditional sub-specialities has yet to be addressed. How should the capability gap be bridged to equip motivated, skilled surgeons of the future to deliver a high standard of emergency surgical care? The aim was to address both training requirements for the acquisition of necessary emergency general surgery skills, and the formation of job plans for trainee and consultant posts to meet the current and future requirements of the NHS. Twenty nine trainees and a consultant emergency general surgeon convened as a Working Group at The Association of Surgeons in Training Conference, 2015, to generate a united consensus statement to the training requirement and delivery of emergency general surgery provision by future general surgeons. Unscheduled general surgical care provision, emergency general surgery, trauma competence, training to meet NHS requirements, consultant job planning and future training challenges arose as key themes. Recommendations have been made from these themes in light of published evidence. Careful workforce planning, education, training and fellowship opportunities will provide well-trained enthusiastic individuals to meet public and societal need.

ISS emergency scenarios and a virtual training simulator for Flight Controllers

NASA Astrophysics Data System (ADS)

Uhlig, Thomas; Roshani, Frank-Cyrus; Amodio, Ciro; Rovera, Alessandro; Zekusic, Nikola; Helmholz, Hannes; Fairchild, Matthew

2016-11-01

The current emergency response concept for the International Space Station (ISS) includes the support of the Flight Control Team. Therefore, the team members need to be trained in emergencies and the corresponding crew procedures to ensure a smooth collaboration between crew and ground. In the case where the astronaut and ground personnel training is not collocated it is a challenging endeavor to ensure and maintain proper knowledge and skills for the Flight Control Team. Therefore, a virtual 3D simulator at the Columbus Control Center (Col-CC) is presented, which is used for ground personnel training in the on-board emergency response. The paper briefly introduces the main ISS emergency scenarios and the corresponding response strategy, details the resulting learning objectives for the Flight Controllers and elaborates on the new simulation method, which will be used in the future. The status of the 3D simulator, first experiences and further plans are discussed.

Astronaut Jean-Francois Clervoy in middeck during launch/entry training

NASA Technical Reports Server (NTRS)

1994-01-01

Wearing a training version of a partial pressure suit, Astronaut Jean-Francois Clervoy, STS-66 international mission specialist, secures himself on a collapsible seat on the middeck of a shuttle trainer during a rehearsal of procedures to be followed during launch and entry phases of the scheduled November flight of STS-66. This rehearsal, held in the crew compartment trainer (CCT) of JSC's Shuttle mockup and integration laboratory, was followed by a training session on emergency egress procedures.

Astronaut William McArthur prepares for a training exercise

NASA Image and Video Library

1993-07-20

S93-38686 (20 July 1993) --- Wearing a training version of the partial pressure launch and entry garment, astronaut William S. McArthur prepares to rehearse emergency egress procedures for the STS-58 mission. McArthur, along with the five other NASA astronauts and a visiting payload specialist assigned to the seven-member crew, later simulated contingency evacuation procedures. Most of the training session took place in the crew compartment and full fuselage trainers of the Space Shuttle mockup and integration laboratory.

Astronaut William McArthur prepares for a training exercise

NASA Image and Video Library

1993-07-20

S93-38679 (20 July 1993) --- Wearing a training version of the partial pressure launch and entry garment, astronaut William S. McArthur listens to a briefing on emergency egress procedures for the STS-58 mission. McArthur, along with five other NASA astronauts and a visiting payload specialist assigned to the seven member crew, later rehearsed contingency evacuation procedures. Most of the training session took place in the crew compartment and full fuselage trainers of the Space Shuttle mockup and integration laboratory.

44 CFR 360.4 - Administrative procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... of training as well as costs of delivery and student travel and per diem are to be estimated. Special.... 360.4 Section 360.4 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY...) Issuance of a request for application: Each State emergency management agency will receive a Request for...

Teaching and assessing procedural skills using simulation: metrics and methodology.

PubMed

Lammers, Richard L; Davenport, Moira; Korley, Frederick; Griswold-Theodorson, Sharon; Fitch, Michael T; Narang, Aneesh T; Evans, Leigh V; Gross, Amy; Rodriguez, Elliot; Dodge, Kelly L; Hamann, Cara J; Robey, Walter C

2008-11-01

Simulation allows educators to develop learner-focused training and outcomes-based assessments. However, the effectiveness and validity of simulation-based training in emergency medicine (EM) requires further investigation. Teaching and testing technical skills require methods and assessment instruments that are somewhat different than those used for cognitive or team skills. Drawing from work published by other medical disciplines as well as educational, behavioral, and human factors research, the authors developed six research themes: measurement of procedural skills; development of performance standards; assessment and validation of training methods, simulator models, and assessment tools; optimization of training methods; transfer of skills learned on simulator models to patients; and prevention of skill decay over time. The article reviews relevant and established educational research methodologies and identifies gaps in our knowledge of how physicians learn procedures. The authors present questions requiring further research that, once answered, will advance understanding of simulation-based procedural training and assessment in EM.

Evaluating the Emergency Notification Systems of the NASA White Sands Test

NASA Technical Reports Server (NTRS)

Chavez, Alfred Paul

2004-01-01

The problem was that the NASA Fire and Emergency Services did not know if the current emergency notification systems on the NASA White Sands Test Facility were appropriate for alerting the employees of an emergency. The purpose of this Applied Research Project was to determine if the current emergency notification systems of the White Sands Test Facility are appropriate for alerting the employees of an emergency. This was a descriptive research project. The research questions were: 1) What are similar facilities using to alert the employees of an emergency?; 2) Are the current emergency notification systems suitable for the community hazards on the NASA White Sands Test Facility?; 3) What is the NASA Fire and Emergency Services currently using to measure the effectiveness of the emergency notification systems?; and 4) What are the current training methods used to train personnel to the emergency notification systems at the NASA White Sands Test Facility? The procedures involved were to research other established facilities, research published material from credible sources, survey the facility to determine the facility perception of the emergency notification systems, and evaluate the operating elements of the established emergency notification systems for the facility. The results were that the current systems are suitable for the type of hazards the facility may endure. The emergency notification systems are tested frequently to ensure effectiveness in the event of an emergency. Personnel are trained and participate in a yearly drill to make certain personnel are educated on the established systems. The recommendations based on the results were to operationally improve the existing systems by developing and implementing one system that can overall notify the facility of a hazard. Existing procedures and training should also be improved to ensure that all personnel are educated on what to do when the emergency notification systems are activated.

General Employee Training Live, Course 15503

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gabel, Daniel Glen; Hughes, Heather

This training at Los Alamos National Laboratory contains the following sections: Introduction to the Laboratory, Institutional Quality Assurance, Facilities, Policies, Procedures, and Other Requirements, Safety Expectations, Worker Protection: Occupational Safety and Health, Industrial Hygiene and Safety, Lockout/Tagout, General Employee Radiological Training, Fire Protection, Security, Emergency Operations, Occupational Health, and Environment.

Matrix Training of Receptive Language Skills with a Toddler with Autism Spectrum Disorder: A Case Study

ERIC Educational Resources Information Center

Curiel, Emily S. L.; Sainato, Diane M.; Goldstein, Howard

2016-01-01

Matrix training is a systematic teaching approach that can facilitate generalized language. Specific responses are taught that result in the emergence of untrained responses. This type of training facilitates the use of generalized language in children with autism spectrum disorder (ASD). This study used a matrix training procedure with a toddler…

Traffic control procedures for emergency responders.

DOT National Transportation Integrated Search

2006-10-01

The objective of this study was to develop a training course and handbook to guide on-scene emergency responders responsible for controlling traffic during a roadway crash and subsequent clearance. : Traffic control is an essential component of incid...

75 FR 75532 - Shipping Coordinating Committee; Notice of Committee Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-03

...; --Validation of model training courses; --Unlawful practices associated with certificates of competency... Recommendations for entering enclosed spaces aboard ships; --Development of model procedures for executing shipboard emergency measures; --Development of training standards for recovery systems; --Development of...

Cricothyroidotomy In Situ Simulation Curriculum (CRIC Study): Training Residents for Rare Procedures.

PubMed

Petrosoniak, Andrew; Ryzynski, Agnes; Lebovic, Gerald; Woolfrey, Karen

2017-04-01

Technical skill acquisition for rare procedures can be challenging given the few real-life training opportunities. In situ simulation (ISS), a training technique that takes place in the actual workplace, is a promising method to promote environmental fidelity for rare procedures. This study evaluated a simulation-based technical skill curriculum for cricothyroidotomy using deliberate practice, followed by an ISS evaluation session. Twenty emergency medicine residents participated in a two-part curriculum to improve cricothryoidotomy performance. A pretest established participant baseline technical skill. The training session consisted of two parts, didactic teaching followed by deliberate practice using a task-training manikin. A posttest consisted of an unannounced, high-fidelity ISS, during an emergency department shift. The primary outcome was the mean performance time between the pretest and posttest sessions. Skill performance was also evaluated using a checklist scale and global rating scale. Cricothyroidotomy performance time improved significantly from pretest to posttest sessions (mean difference, 59 seconds; P < 0.0001). Both checklist and global rating scales improved significantly from the pretest to the posttest with a mean difference of 1.82 (P = 0.002) and 6.87 (P = 0.0025), respectively. Postcourse survey responses were favorable for both the overall curriculum experience and the unannounced ISS. This pilot study demonstrated that unannounced ISS is feasible and can be used to effectively measure cricothyroidotomy performance among EM residents. After a two-part training session consisting of didactic learning and deliberate practice, improved cricothyroidotomy skill performance was observed during an unannounced ISS in the emergency department. The integration of ISS in cricothyroidotomy training represents a promising approach; however, further study is needed to establish its role.

Using complex auditory-visual samples to produce emergent relations in children with autism.

PubMed

Groskreutz, Nicole C; Karsina, Allen; Miguel, Caio F; Groskreutz, Mark P

2010-03-01

Six participants with autism learned conditional relations between complex auditory-visual sample stimuli (dictated words and pictures) and simple visual comparisons (printed words) using matching-to-sample training procedures. Pre- and posttests examined potential stimulus control by each element of the complex sample when presented individually and emergence of additional conditional relations and oral labeling. Tests revealed class-consistent performance for all participants following training.

[Simulation-based training in anesthesia and emergency medicine: preparation for the unexpected: on the way to new standards of education in Germany].

PubMed

Issleib, Malte; Zöllner, C

2015-01-01

Medical expertise consists of knowledge, professional skills and individual attitudes. Training and education of this expertise starts in medical school and develops throughout the qualification process of anesthesists and emergency physicians. Medical decisions are not only rational but also intuitive. The combination of these characteristics cannot and should not be trained on patients. The implementation of modern simulation techniques offers the opportunity to train for emergency situations similar to training systems in the energy industry and aviation. Repetitive training of rare emergency situations brings routine to seldomly used procedures. In simulation training mistakes can be detected and systematically corrected. The team interactions and soft skills can also be focussed on. Video analysis gives the participant the opportunity for self-reflection and can lead to correction of individual behavior patterns. This dimension of education cannot be done in real patient care. This training goes far beyond the level of skills training. Through simulation training involves the whole team, the communication and the interaction between the team members in medically challenging situations. Crisis resource management leads to measurable improvements in patient safety and safety culture as well as personnel satisfaction.

Astronaut Jean-Francois Clervoy in middeck during launch/entry training

NASA Technical Reports Server (NTRS)

1994-01-01

Astronaut Jean-Francois Clervoy, STS-66 international mission specialist, sits securely on a collapsible seat on the middeck of a shuttle trainer during a rehearsal of procedures to be followed during launch and entry phases of the scheduled November flight of STS-66. This rehearsal, held in the crew compartment trainer (CCT) of JSC's Shuttle mockup and integration laboratory, was followed by a training session on emergency egress procedures.

Astronaut Ellen Ochoa in middeck during launch/entry training

NASA Technical Reports Server (NTRS)

1994-01-01

Secured in a collapsible seat on the middeck of the Shuttle trainer, astronaut Ellen Ochoa, STS-66 payload commander, participates in a rehearsal of procedures to be followed during launch and entry phases of the scheduled November flight of STS-66. This rehearsal, held in the crew compartment trainer (CCT) of JSC's Shuttle mockup and integration laboratory, was followed by a training session on emergency egress procedures.

Teaching Manual Signs to Adults With Mental Retardation Using Matching-to-Sample Procedures and Stimulus Equivalence

PubMed Central

Elias, Nassim Chamel; Goyos, Celso; Saunders, Muriel; Saunders, Richard

2008-01-01

The objective of this study was to teach manual signs through an automated matching-to-sample procedure and to test for the emergence of new conditional relations and imitative behaviors. Seven adults with mild to severe mental retardation participated. Four were also hearing impaired. Relations between manual signs (set A) and pictures (set B) were initially taught, followed by the training of corresponding printed words (set C) and pictures (set B). Further presentations of conditional discriminations tested for the emergence of AC, followed by tests for the emergence of imitative signing behavior (D) in the presence of either pictures (B) or printed words (C). Each stimulus set was comprised of 9 elements. The stimuli were still pictures, printed words, and dynamic presentations of manual signs. A pretest was conducted to determine which signs the participants could make pre-experimentally. Teaching was arranged in a multiple baseline design across 3 groups of 3 words each. The purpose of the present study was to determine whether participants would emit manual signs in expressive signs tests as a result of observation (video modeling) during match-to-sample training in the absence of explicit training. Five of the 7 subjects passed tests of emergence and emitted at least 50% of the signs. Two were hearing impaired with signing experience, and 3 were not hearing impaired and had no signing experience. Thus, observation of video recorded manual signs in a matching-to-sample training procedure was effective at establishing some signs by adults with mental retardation. PMID:22477400

STS-62 crew prepare for emergency egress training

NASA Image and Video Library

1993-11-05

S93-48458 (5 Nov. 1993) --- In the Johnson Space Center's (JSC) Shuttle mockup and integration laboratory, the five crew members training for NASA's next mission are assisted in donning their partial pressure launch and entry suits. From left to right are astronaut John H. Casper, Andrew M. Allen, Pierre J. Thuot, Charles D. (Sam) Gemar and Marsha S. Ivins. Minutes later the crew was in the crew compartment trainer (CCT) rehearsing their scheduled March 1994 mission aboard the Space Shuttle Columbia. Launch, landing and emergency egress procedures were covered in the training session.

Liability for Student Workers.

ERIC Educational Resources Information Center

Tryon, Jonathan S.

1994-01-01

Examines liability issues for academic libraries=FE student workers. Discussion includes staff training; hiring practices; supervision; negligence; emergency procedures; the use of reasonable care; and knowledge of library rules. Specific nonlibrary liability cases are cited as examples of the importance of employee screening, training, and danger…

Astronauts McMonagle and Brown on flight deck mockup during training

NASA Technical Reports Server (NTRS)

1994-01-01

Astronauts Donald R. McMonagle, STS-66 mission commander, left, and Curtis L. Brown, STS-66 pilot, man the commander's and pilot's stations, respectively, during a rehearsal of procedures to be followed during the launch and entry phases of their scheduled November 1994 flight. This rehearsal, held in the crew compartment trainer (CCT) of JSC's Shuttle mockup and integration laboratory, was followed by a training session on emergency egress procedures.

Human Factors in Training: Space Medical Proficiency Training

NASA Technical Reports Server (NTRS)

Byrne, Vicky E.; Barshi, I.; Arsintescu, L.; Connell, E.

2010-01-01

The early Constellation space missions are expected to have medical capabilities very similar to those currently on the Space Shuttle and the International Space Station (ISS). For Crew Exploration Vehicle (CEV) missions to the ISS, medical equipment will be located on the ISS, and carried into CEV in the event of an emergency. Flight surgeons (FS) on the ground in Mission Control will be expected to direct the crew medical officer (CMO) during medical situations. If there is a loss of signal and the crew is unable to communicate with the ground, a CMO would be expected to carry out medical procedures without the aid of a FS. In these situations, performance support tools can be used to reduce errors and time to perform emergency medical tasks. The space medical training work is part of the Human Factors in Training Directed Research Project (DRP) of the Space Human Factors Engineering (SHFE) Project under the Space Human Factors and Habitability (SHFH) Element of the Human Research Program (HRP). This is a joint project consisting of human factors team from the Ames Research Center (ARC) with Immanuel Barshi as Principal Investigator and the Johnson Space Center (JSC). Human factors researchers at JSC have recently investigated medical performance support tools for CMOs on-orbit, and FSs on the ground, and researchers at the Ames Research Center performed a literature review on medical errors. Work on medical training has been conducted in collaboration with the Medical Training Group at the Johnson Space Center (JSC) and with Wyle Laboratories that provides medical training to crew members, biomedical engineers (BMEs), and to flight surgeons under the Bioastronautics contract. One area of research building on activities from FY08, involved the feasibility of just-in-time (JIT) training techniques and concepts for real-time medical procedures. A second area of research involves FS performance support tools. Information needed by the FS during the ISS mission support, especially for an emergency situation (e.g., fire onboard ISS), may be located in many different places around the FS s console. A performance support tool prototype is being developed to address this issue by bringing all of the relevant information together in one place. The tool is designed to include procedures and other information needed by a FS during an emergency, as well as procedures and information to be used after the emergency is resolved. Several walkthroughs of the prototype with FSs have been completed within a mockup of an ISS FS console. Feedback on the current tool design as well as recommendations for existing ISS FS displays were captured. The tool could have different uses depending on the situation and the skill of the user. An experienced flight surgeon could use it during an emergency situation as a decision and performance support tool, whereas a new flight surgeon could use it as JITT, or part of his/her regular training. The work proposed for FY10 continues to build on this strong collaboration with the Space Medical Training Group and previous research.

Emergency medical personnel training: I. An historical perspective.

PubMed

Sytkowski, P A; Jacobs, L M; Meany, M

1983-01-01

The status of Emergency Medical Technicians has evolved from an undefined role with few rules, regulations, or standards to an established health care profession and a nationally administered program. The evolution of this profession received major impetus from the 1966 report by the National Academy of Science/National Research Council that provided recommended training standards. Development of a training course curriculum for basic life support (BLS) followed. The need for coordinated training of Emergency Medical Technical Technicians was recognized, and funds became available to aid in the national standardization of education, examination, certification, and recertification procedures for EMTs. Concomitant with the attempt to standardize BLS training, advanced life support (ALS) programs grew in number. By 1977 the National Standard Training Curriculum became available and was soon followed by a national certification exam. As states have the option to accept or reject the federal standards embodied in the national training course, there remains variation among programs offered by each state. Because of the difference in need for specific emergency services among the states at a time of increased professional mobility, arguments still exist regarding the desirability of federally mandated training and certification programs.

The basics of animal biosafety and biocontainment training.

PubMed

Pritt, Stacy; Hankenson, F Claire; Wagner, Ted; Tate, Mallory

2007-06-01

The threat of biocontamination in an animal facility is best subdued by training. 'Training' is an ambiguous designation that may not be adequately appreciated in all animal facilities. The authors set down concrete training topics and provide practical advice on incorporating the basic principles of facility biosafety training--as well as the precautions and procedures that employees must know in case of accident or emergency--into various training models. They also discuss the current biosafety publications and guidelines and their relationship to biosafety training.

Emergency Medical Care. A Manual for the Paramedic in the Field.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

This document is a textbook of emergency medical procedures to be used for training emergency medical technicians. The book is organized into 15 modules, each containing 1 to 10 units. Each module contains information illustrated with line drawings, a glossary, and references. The modules cover the following topics: the role of the emergency…

Emergency Procedure Training for Reactor Operators at the High Flux Beam Reactor for Brookhaven National Laboratory.

ERIC Educational Resources Information Center

Reyer, Ronald

A project was conducted to analyze, design, develop, implement, and evaluate an instructional unit intended to improve the diagnostic skills of operating personnel in responding to abnormal and emergency conditions at the High Flux Beam Reactor at Brookhaven National Laboratory. Research was conducted on the occurrence of emergencies at similar…

Novice to expert practice via postprofessional athletic training education: a grounded theory.

PubMed

Neibert, Peter J

2009-01-01

To discover the theoretic constructs that confirm, disconfirm, or extend the principles and their applications appropriate for National Athletic Trainers' Association (NATA)-accredited postprofessional athletic training education programs. Interviews at the 2003 NATA Annual Meeting & Clinical Symposia. Qualitative study using grounded theory procedures. Thirteen interviews were conducted with postprofessional graduates. Participants were purposefully selected based on theoretic sampling and availability. The transcribed interviews were analyzed using open coding, axial coding, and selective coding procedures. Member checks, reflective journaling, and triangulation were used to ensure trustworthiness. The participants' comments confirmed and extended the current principles of postprofessional athletic training education programs and offered additional suggestions for more effective practical applications. The emergence of this central category of novice to expert practice is a paramount finding. The tightly woven fabric of the 10 processes, when interlaced with one another, provides a strong tapestry supporting novice to expert practice via postprofessional athletic training education. The emergence of this theoretic position pushes postprofessional graduate athletic training education forward to the future for further investigation into the theoretic constructs of novice to expert practice.

40 CFR 170.130 - Pesticide safety training for workers.

Code of Federal Regulations, 2010 CFR

2010-07-01

... restricted-entry interval applies, including but not limited to, soil, water, or surfaces of plants, the..., soil, irrigation water, or drifting from nearby applications. (2) Prevent pesticides from entering your... poisonings. (vi) How to obtain emergency medical care. (vii) Routine and emergency decontamination procedures...

Suggested Guide for Fire Service Standard Operating Procedures.

ERIC Educational Resources Information Center

Gillett, Merl; Hertzler, Simon L.

Suggested guidelines for the development of fire service standard operating procedures are presented in this document. Section topics are as follow: chain of command; communications; emergency response; apparatus; fire service training; disaster response; aircraft fire safety; mutual aid; national reporting system (example reporting forms);…

Relational Discrimination by Pigeons in a Go/No-Go Procedure with Compound Stimuli: A Methodological Note

ERIC Educational Resources Information Center

Campos, Heloisa Cursi; Debert, Paula; Barros, Romariz da Silva; McIlvane, William J.

2011-01-01

A go/no-go procedure with compound stimuli typically establishes emergent behavior that parallels in structure and typical outcome that of conventional tests for symmetric, transitive, and equivalence relations in normally capable adults. The present study employed a go/no-go compound stimulus procedure with pigeons. During training, pecks to…

An hypnotic suggestion: review of hypnosis for clinical emergency care.

PubMed

Iserson, Kenneth V

2014-04-01

Hypnosis has been used in medicine for nearly 250 years. Yet, emergency clinicians rarely use it in emergency departments or prehospital settings. This review describes hypnosis, its historical use in medicine, several neurophysiologic studies of the procedure, its uses and potential uses in emergency care, and a simple technique for inducing hypnosis. It also discusses reasons why the technique has not been widely adopted, and suggests methods of increasing its use in emergency care, including some potential research areas. A limited number of clinical studies and case reports suggest that hypnosis may be effective in a wide variety of conditions applicable to emergency medical care. These include providing analgesia for existing pain (e.g., fractures, burns, and lacerations), providing analgesia and sedation for painful procedures (e.g., needle sticks, laceration repair, and fracture and joint reductions), reducing acute anxiety, increasing children's cooperation for procedures, facilitating the diagnosis and treatment of acute psychiatric conditions, and providing analgesia and anxiolysis for obstetric/gynecologic problems. Although it is safe, fast, and cost-effective, emergency clinicians rarely use hypnosis. This is due, in part, to the myths surrounding hypnosis and its association with alternative-complementary medicine. Genuine barriers to its increased clinical use include a lack of assured effectiveness and a lack of training and training requirements. Based on the results of further research, hypnosis could become a powerful and safe nonpharmacologic addition to the emergency clinician's armamentarium, with the potential to enhance patient care in emergency medicine, prehospital care, and remote medical settings. Copyright © 2014 Elsevier Inc. All rights reserved.

49 CFR 193.2717 - Training: fire protection.

Code of Federal Regulations, 2010 CFR

2010-10-01

... their immediate supervisors, must be trained according to a written plan of initial instruction... under § 193.2801. (b) A written plan of continuing instruction, including plant fire drills, must be... personnel hands-on experience in carrying out their duties under the fire emergency procedures required by...

44 CFR 206.171 - Crisis counseling assistance and training.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Crisis counseling assistance... Assistance § 206.171 Crisis counseling assistance and training. (a) Purpose. This section establishes the policy, standards, and procedures for implementing section 416 of the Act, Crisis Counseling Assistance...

44 CFR 206.171 - Crisis counseling assistance and training.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Crisis counseling assistance... Assistance § 206.171 Crisis counseling assistance and training. (a) Purpose. This section establishes the policy, standards, and procedures for implementing section 416 of the Act, Crisis Counseling Assistance...

44 CFR 206.171 - Crisis counseling assistance and training.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Crisis counseling assistance... Assistance § 206.171 Crisis counseling assistance and training. (a) Purpose. This section establishes the policy, standards, and procedures for implementing section 416 of the Act, Crisis Counseling Assistance...

44 CFR 206.171 - Crisis counseling assistance and training.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Crisis counseling assistance... Assistance § 206.171 Crisis counseling assistance and training. (a) Purpose. This section establishes the policy, standards, and procedures for implementing section 416 of the Act, Crisis Counseling Assistance...

Virtual reality and simulation: training the future emergency physician.

PubMed

Reznek, Martin; Harter, Phillip; Krummel, Thomas

2002-01-01

The traditional system of clinical education in emergency medicine relies on practicing diagnostic, therapeutic, and procedural skills on live patients. The ethical, financial, and practical weaknesses of this system are well recognized, but the alternatives that have been explored to date have shown even greater flaws. However, ongoing progress in the area of virtual reality and computer-enhanced simulation is now providing educational applications that show tremendous promise in overcoming most of the deficiencies associated with live-patient training. It will be important for academic emergency physicians to become more involved with this technology to ensure that our educational system benefits optimally.

Major incidents in Kenya: the case for emergency services development and training.

PubMed

Wachira, Benjamin W; Smith, Wayne

2013-04-01

Kenya's major incidents profile is dominated by droughts, floods, fires, terrorism, poisoning, collapsed buildings, accidents in the transport sector and disease/epidemics. With no integrated emergency services and a lack of resources, many incidents in Kenya escalate to such an extent that they become major incidents. Lack of specific training of emergency services personnel to respond to major incidents, poor coordination of major incident management activities, and a lack of standard operational procedures and emergency operation plans have all been shown to expose victims to increased morbidity and mortality. This report provides a review of some of the major incidents in Kenya for the period 2000-2012, with the hope of highlighting the importance of developing an integrated and well-trained Ambulance and Fire and Rescue service appropriate for the local health care system.

STS 61-A crew during emergency egress training

NASA Technical Reports Server (NTRS)

1985-01-01

STS 61-A crew during emergency egress training. Henry W. Hartsfield Jr., STS 61-A mission commander, uses a Sky-Genie to practice emergency egress from a Shuttle vehicle. This training was held in the Shuttle mockup and integration laboratory (41244); Ernst Messerschmid, German payload specialist, goes through a rehearsal of procedures involved in preparing for launch and landing aboard the Shuttle. Briefing Messerschmid is Alan N. Rochford (41245); Descending from a simulated Shuttle orbiter, using a Sky-Genie device, is Astronaut Henry M. Hartsfield, Jr. Watching in blue flight garments are other members of the crew. They are, left to right, Ernst Messerschmid, German payload specialist; James F. Buchli, mission specialist; Bonnie J. Dunbar, mission specialist; Wubbo J. Ockels, Dutch payload specialist.

Perceptions on the Impact of a Just-in-Time Room on Trainees and Supervising Physicians in a Pediatric Emergency Department.

PubMed

Thomas, Anita A; Uspal, Neil G; Oron, Assaf P; Klein, Eileen J

2016-12-01

Just-in-time (JIT) training refers to education occurring immediately prior to clinical encounters. An in situ JIT room in a pediatric emergency department (ED) was created for procedural education. We examined trainee self-reported JIT room use, its impact on trainee self-perception of procedural competence/confidence, and the effect its usage has on the need for intervention by supervising physicians during procedures. Cross-sectional survey study of a convenience sample of residents rotating through the ED and supervising pediatric emergency medicine physicians. Outcomes included JIT room use, trainee procedural confidence, and frequency of supervisor intervention during procedures. Thirty-one of 32 supervising physicians (97%) and 122 of 186 residents (66%) completed the survey, with 71% of trainees reporting improved confidence, and 68% reporting improved procedural skills ( P  < .05, +1.4-point average skills improvement on a 5-point Likert scale). Trainees perceived no difference among supervising physicians intervening in procedures with or without JIT room use ( P  = .30, paired difference -0.0 points). Nearly all supervisors reported improved trainee procedural confidence, and 77% reported improved trainee procedural skills after JIT room use ( P  < .05, paired difference +1.8 points); 58% of supervisors stated they intervene in procedures without trainee JIT room use, compared with 42% with JIT room use ( P  < .05, paired difference -0.4 points). Use of the JIT room led to improved trainee confidence and supervisor reports of less procedural intervention. Although it carries financial and time costs, an in situ JIT room may be important for convenient JIT training.

Perceptions on the Impact of a Just-in-Time Room on Trainees and Supervising Physicians in a Pediatric Emergency Department

PubMed Central

Thomas, Anita A.; Uspal, Neil G.; Oron, Assaf P.; Klein, Eileen J.

2016-01-01

Background  Just-in-time (JIT) training refers to education occurring immediately prior to clinical encounters. An in situ JIT room in a pediatric emergency department (ED) was created for procedural education. Objective  We examined trainee self-reported JIT room use, its impact on trainee self-perception of procedural competence/confidence, and the effect its usage has on the need for intervention by supervising physicians during procedures. Methods  Cross-sectional survey study of a convenience sample of residents rotating through the ED and supervising pediatric emergency medicine physicians. Outcomes included JIT room use, trainee procedural confidence, and frequency of supervisor intervention during procedures. Results  Thirty-one of 32 supervising physicians (97%) and 122 of 186 residents (66%) completed the survey, with 71% of trainees reporting improved confidence, and 68% reporting improved procedural skills (P < .05, +1.4-point average skills improvement on a 5-point Likert scale). Trainees perceived no difference among supervising physicians intervening in procedures with or without JIT room use (P = .30, paired difference −0.0 points). Nearly all supervisors reported improved trainee procedural confidence, and 77% reported improved trainee procedural skills after JIT room use (P < .05, paired difference +1.8 points); 58% of supervisors stated they intervene in procedures without trainee JIT room use, compared with 42% with JIT room use (P < .05, paired difference −0.4 points). Conclusions  Use of the JIT room led to improved trainee confidence and supervisor reports of less procedural intervention. Although it carries financial and time costs, an in situ JIT room may be important for convenient JIT training. PMID:28018542

14 CFR 91.1101 - Pilots: Initial, transition, and upgrade ground training.

Code of Federal Regulations, 2014 CFR

2014-01-01

... consumption and cruise control; (9) Flight planning; (10) Each normal and emergency procedure; and (11) The..., DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT... manager's flight locating procedures; (2) Principles and methods for determining weight and balance, and...

14 CFR 91.1101 - Pilots: Initial, transition, and upgrade ground training.

Code of Federal Regulations, 2013 CFR

2013-01-01

... consumption and cruise control; (9) Flight planning; (10) Each normal and emergency procedure; and (11) The..., DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT... manager's flight locating procedures; (2) Principles and methods for determining weight and balance, and...

14 CFR 91.1101 - Pilots: Initial, transition, and upgrade ground training.

Code of Federal Regulations, 2012 CFR

2012-01-01

... consumption and cruise control; (9) Flight planning; (10) Each normal and emergency procedure; and (11) The..., DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT... manager's flight locating procedures; (2) Principles and methods for determining weight and balance, and...

[Assessment of capacity for logisty, public education, and training in public health emergency management in China].

PubMed

Hu, Guo-qing; Rao, Ke-qin; Sun, Zhen-qiu; Yu, Ren-he

2008-10-01

To assess the capacity for logistics, public education, and training in managing public health emergency in China at present. Four provinces were selected using stratified sampling. All the municipalities of these 4 provinces were assessed using the 9th and 10th subscales (logistics, public education and training) of Preparedness and response capacity questionnaire for public health emergencies for provincial or municipal governments developed by the Center for Health Statistics and Information, Ministry of Health of China. Sixty of the 66 questionnaires (90.91%) were collected. Among the 60 investigated municipalities, 80% established a specific agency to take charge of emergency material storage, management and allocation, 65% developed standard for material storage, 35% developed standard of places for material storage, 25% built regulation for testing, maintaining, and updating the emergency materials regularly, 45% arranged budget for routine payment, 27% established standard of emergency fund, and 28% set up the procedure to initiate emergency fund. The average of standard score of subscale 9 was 43.33 (95% confidence interval, 35.65~51.01). 25% of the 60 municipalities conducted assessment for training in the past 2 years, 53% developed plan for emergency personnel training, 20% developed effectiveness assessment regulation of emergency personnel training, 80% assigned a specific agency to be responsible for public education, and 23% established regulation for public education. The average of standard score of subscale 10 was 47.43 (95% confidence interval, 40.69~54.17). Serious problems are found in logistics, public education, and training for public health emergency management in China. Measures should be taken immediately by the central and local government to improve these capacities.

STS-35 Commander Brand listens to trainer during water egress exercises

NASA Technical Reports Server (NTRS)

1990-01-01

STS-35 Commander Vance D. Brand listens to training personnel during launch emergency egress procedures conducted in JSC's Weightless Environment Training Facility (WETF) Bldg 29. Brand, wearing a launch and entry suit (LES) and launch and entry helmet (LEH), is seated on the pool side while reviewing instructions.

STS-35 MS Hoffman watches water egress exercises at JSC's WETF Bldg 29 pool

NASA Technical Reports Server (NTRS)

1990-01-01

STS-35 Mission Specialist (MS) Jeffrey A. Hoffman, wearing launch and entry suit (LES), comments on launch emergency egress procedures from the poolside of JSC's Weightless Environment Training Facility (WETF) Bldg 29. Hoffman awaits his turn to participate in the training activities.

Before the Emergency: A Framework for Evaluating Emergency Preparedness Alternatives at Higher Education Institutions

DTIC Science & Technology

2010-09-01

Operations and Procedures • Logistics and Facilities • Training • Exercises, Evaluation and Corrective Actions • Crisis Communications ...Assessment Team BCA Benefit-cost analysis CEO Chief Executive Officer CERT Community Emergency Response Team CFR Code of Federal Regulations...CHDS Center for Homeland Defense and Security CPG 101 Comprehensive Preparedness Guidelines 101 CPP Community Preparedness and Participation CPW

Neuromuscular blocking agent administration for emergent tracheal intubation is associated with decreased prevalence of procedure-related complications.

PubMed

Wilcox, Susan R; Bittner, Edward A; Elmer, Jonathan; Seigel, Todd A; Nguyen, Nicole Thuy P; Dhillon, Anahat; Eikermann, Matthias; Schmidt, Ulrich

2012-06-01

Emergent intubation is associated with a high rate of complications. Neuromuscular blocking agents are routinely used in the operating room and emergency department to facilitate intubation. However, use of neuromuscular blocking agents during emergent airway management outside of the operating room and emergency department is controversial. We hypothesized that the use of neuromuscular blocking agents is associated with a decreased prevalence of hypoxemia and reduced rate of procedure-related complications. Five hundred sixty-six patients undergoing emergent intubations in two tertiary care centers, Massachusetts General Hospital, Boston, MA, and the University of California Los Angeles, Ronald Reagan Medical Center, Los Angeles, CA, were enrolled in a prospective, observational study. The 112 patients intubated during cardiopulmonary resuscitation were excluded, leaving 454 patients for analysis. All intubations were supervised by attendings trained in Critical Care Medicine. We measured intubating conditions, oxygen saturation during and 5 mins following intubation. We assessed the prevalence of procedure-related complications defined as esophageal intubation, traumatic intubation, aspiration, dental injury, and endobronchial intubation. The use of neuromuscular blocking agents was associated with a lower prevalence of hypoxemia (10.1% vs. 17.4%, p = .022) and a lower prevalence of procedure-related complications (3.1% vs. 8.3%, p = .012). This association persisted in a multivariate analysis, which controlled for airway grade, sedation, and institution. Use of neuromuscular blocking agents was associated with significantly improved intubating conditions (laryngeal view, p = .014; number of intubation attempts, p = .049). After controlling for the number of intubation attempts and laryngoscopic view, muscle relaxant use is an independent predictor of complications associated with emergency intubation (p = .037), and there is a trend towards improvement of oxygenation (p = .07). The use of neuromuscular blocking agents, when used by intensivists with a high level of training and experience, is associated with a decrease in procedure-related complications.

Evaluating an australian emergency nurse practitioner candidate training program.

PubMed

Plath, Sharyn J; Wright, Mary; Hocking, Julia

2017-11-01

Nurse Practitioners (NPs) receive core clinical training at master's level, with their employer providing the opportunity to upskill in clinical and procedural competencies. It is increasingly recognised that this generic education requires supplementary training for operating effectively within a specific clinical environment. In this paper we describe a pilot program designed to train Australian NP Candidates to work effectively within the Emergency Department Fast Track model of care. The training program consisted of a 12-month period: four hours in-house training per week over two semesters, running concurrently with the NP candidate's University semesters, and 3 months' clinical practice to consolidate. The training team defined milestones for Semesters one and two, and developed a case review form to assess application of the candidate's knowledge in new clinical situations, as well as check for gaps in understanding. A clinical skills guide was developed for the candidate to work toward, and a comprehensive assessment was carried out at two time points in the training program. Feedback was obtained from the mentors and the candidate at the end point of the training program, and has been used to refine the program for 2017. This in-house training program provided specialised, evidence-based training for the emergency department environment, resulting in development of the nurse practitioner candidate as a high functioning team member. Copyright © 2017 College of Emergency Nursing Australasia. All rights reserved.

30 CFR 48.6 - Experienced miner training.

Code of Federal Regulations, 2011 CFR

2011-07-01

... mine; the check-in and checkout system in effect at the mine; the procedures for riding on and in mine... communication systems, warning signals, and directional signs. (5) Mine map; escapeways; emergency evacuation... escapeway system; the escape, firefighting, and emergency evacuation plans in effect at the mine; and the...

30 CFR 48.6 - Experienced miner training.

Code of Federal Regulations, 2013 CFR

2013-07-01

... mine; the check-in and checkout system in effect at the mine; the procedures for riding on and in mine... communication systems, warning signals, and directional signs. (5) Mine map; escapeways; emergency evacuation... escapeway system; the escape, firefighting, and emergency evacuation plans in effect at the mine; and the...

Evidence-based support for the all-hazards approach to emergency preparedness

PubMed Central

2012-01-01

Background During the last decade there has been a need to respond and recover from various types of emergencies including mass casualty events (MCEs), mass toxicological/chemical events (MTEs), and biological events (pandemics and bio-terror agents). Effective emergency preparedness is more likely to be achieved if an all-hazards response plan is adopted. Objectives To investigate if there is a relationship among hospitals' preparedness for various emergency scenarios, and whether components of one emergency scenario correlate with preparedness for other emergency scenarios. Methods Emergency preparedness levels of all acute-care hospitals for MCEs, MTEs, and biological events were evaluated, utilizing a structured evaluation tool based on measurable parameters. Evaluations were made by professional experts in two phases: evaluation of standard operating procedures (SOPs) followed by a site visit. Relationships among total preparedness and different components' scores for various types of emergencies were analyzed. Results Significant relationships were found among preparedness for different emergencies. Standard Operating Procedures (SOPs) for biological events correlated with preparedness for all investigated emergency scenarios. Strong correlations were found between training and drills with preparedness for all investigated emergency scenarios. Conclusions Fundamental critical building blocks such as SOPs, training, and drill programs improve preparedness for different emergencies including MCEs, MTEs, and biological events, more than other building blocks, such as equipment or knowledge of personnel. SOPs are especially important in unfamiliar emergency scenarios. The findings support the adoption of an all-hazards approach to emergency preparedness. PMID:23098065

Tube thoracostomy training with a medical simulator is associated with faster, more successful performance of the procedure

PubMed Central

Chung, Tae Nyoung; Kim, Sun Wook; You, Je Sung; Chung, Hyun Soo

2016-01-01

Objective Tube thoracostomy (TT) is a commonly performed intensive care procedure. Simulator training may be a good alternative method for TT training, compared with conventional methods such as apprenticeship and animal skills laboratory. However, there is insufficient evidence supporting use of a simulator. The aim of this study is to determine whether training with medical simulator is associated with faster TT process, compared to conventional training without simulator. Methods This is a simulation study. Eligible participants were emergency medicine residents with very few (≤3 times) TT experience. Participants were randomized to two groups: the conventional training group, and the simulator training group. While the simulator training group used the simulator to train TT, the conventional training group watched the instructor performing TT on a cadaver. After training, all participants performed a TT on a cadaver. The performance quality was measured as correct placement and time delay. Subjects were graded if they had difficulty on process. Results Estimated median procedure time was 228 seconds in the conventional training group and 75 seconds in the simulator training group, with statistical significance (P=0.040). The difficulty grading did not show any significant difference among groups (overall performance scale, 2 vs. 3; P=0.094). Conclusion Tube thoracostomy training with a medical simulator, when compared to no simulator training, is associated with a significantly faster procedure, when performed on a human cadaver. PMID:27752610

International Emergency Medical Teams Training Workshop Special Report.

PubMed

Albina, Anthony; Archer, Laura; Boivin, Marlène; Cranmer, Hilarie; Johnson, Kirsten; Krishnaraj, Gautham; Maneshi, Anali; Oddy, Lisa; Redwood-Campbell, Lynda; Russell, Rebecca

2018-04-26

The World Health Organization's (WHO; Geneva, Switzerland) Emergency Medical Team (EMT) Initiative created guidelines which define the basic procedures to be followed by personnel and teams, as well as the critical points to discuss before deploying a field hospital. However, to date, there is no formal standardized training program established for EMTs before deployment. Recognizing that the World Association of Disaster and Emergency Medicine (WADEM; Madison, Wisconsin USA) Congress brings together a diverse group of key stakeholders, a pre-Congress workshop was organized to seek out collective expertise and to identify key EMT training competencies for the future development of training programs and protocols. The future of EMT training should include standardization of curriculum and the recognition or accreditation of selected training programs. The outputs of this pre-WADEM Congress workshop provide an initial contribution to the EMT Training Working Group, as this group works on mapping training, competencies, and curriculum. Common EMT training themes that were identified as fundamental during the pre-Congress workshop include: the ability to adapt one's professional skills to low-resource settings; context-specific training, including the ability to serve the needs of the affected population in natural disasters; training together as a multi-disciplinary EMT prior to deployment; and the value of simulation in training. AlbinaA, ArcherL, BoivinM, CranmerH, JohnsonK, KrishnarajG, ManeshiA, OddyL, Redwood-CampbellL, RussellR. International Emergency Medical Teams training workshop special report.

75 FR 23785 - Assistance to Firefighters Grant Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-04

..., State, and Federal). Training related to coordinated incident response (i.e., bomb threat or Improvised... operations, or bomb threats), tactical emergency communications procedures, or similar types of...

KSC-2013-4384

NASA Image and Video Library

2013-12-13

CAPE CANAVERAL, Fla. – At a training location near Launch Complex 39 at NASA’s Kennedy Space Center in Florida, members of the Emergency Response Team, or ERT, participate in specialized training simulations in order to keep their skills current. They are wearing full protective gear and carrying non-lethal firearms, which are denoted in blue, for the training exercises. The ERT training supervisor, wearing a bright green vest, monitors the training exercise and reviews procedures. Recently, eight members of the ERT competed in the 31st Annual SWAT Roundup International competition in Orlando, Fla., and received recognition by placing in the top five overall. In keeping with NASA’s commitment to safety and security of workforce and assets, the ERT is part of Kennedy’s security team and is trained to respond in the event of an emergency at the center. Photo credit: NASA/Daniel Casper

KSC-2013-4385

NASA Image and Video Library

2013-12-13

CAPE CANAVERAL, Fla. – At a training location near Launch Complex 39 at NASA’s Kennedy Space Center in Florida, members of the Emergency Response Team, or ERT, participate in specialized training simulations in order to keep their skills current. They are wearing full protective gear and carrying non-lethal firearms, which are denoted in blue, for the training exercises. The ERT training supervisor, wearing a bright green vest, monitors the training exercise and reviews procedures. Recently, eight members of the ERT competed in the 31st Annual SWAT Roundup International competition in Orlando, Fla., and received recognition by placing in the top five overall. In keeping with NASA’s commitment to safety and security of workforce and assets, the ERT is part of Kennedy’s security team and is trained to respond in the event of an emergency at the center. Photo credit: NASA/Daniel Casper

Compliance of child care centers in Pennsylvania with national health and safety performance standards for emergency and disaster preparedness.

PubMed

Olympia, Robert P; Brady, Jodi; Kapoor, Shawn; Mahmood, Qasim; Way, Emily; Avner, Jeffrey R

2010-04-01

To determine the preparedness of child care centers in Pennsylvania to respond to emergencies and disasters based on compliance with National Health and Safety Performance Standards for Out-of-Home Child Care Programs. A questionnaire focusing on the presence of a written evacuation plan, the presence of a written plan for urgent medical care, the immediate availability of equipment and supplies, and the training of staff in first aid/cardiopulmonary resuscitation (CPR) as delineated in Caring for Our Children: National Health and Safety Performance Standards for Out-of-Home Child Care Programs, 2nd Edition, was mailed to 1000 randomly selected child care center administrators located in Pennsylvania. Of the 1000 questionnaires sent, 496 questionnaires were available for analysis (54% usable response rate). Approximately 99% (95% confidence interval [CI], 99%-100%) of child care centers surveyed were compliant with recommendations to have a comprehensive written emergency plan (WEP) for urgent medical care and evacuation, and 85% (95% CI, 82%-88%) practice their WEP periodically throughout the year. More than 20% of centers did not have specific written procedures for floods, earthquakes, hurricanes, blizzards, or bomb threats, and approximately half of the centers did not have specific written procedures for urgent medical emergencies such as severe bleeding, unresponsiveness, poisoning, shock/heart or circulation failure, seizures, head injuries, anaphylaxis or allergic reactions, or severe dehydration. A minority of centers reported having medications available to treat an acute asthma attack or anaphylaxis. Also, 77% (95% CI, 73%-80%) of child care centers require first aid training for each one of its staff members, and 33% (95% CI, 29%-37%) require CPR training. Although many of the child care centers we surveyed are in compliance with the recommendations for emergency and disaster preparedness, specific areas for improvement include increasing the frequency of practice of the WEP, establishing specific written procedures for external disasters and urgent medical emergencies, maintaining the immediate availability of potentially life-saving medications, and ensuring that all child care center staff are trained in first aid and CPR.

Astronaut Joseph Tanner checks gloves during during launch/entry training

NASA Technical Reports Server (NTRS)

1994-01-01

Astronaut Joseph R. Tanner, mission specialist, checks his gloves during a rehearsal for the launch and entry phases of the scheduled November 1994 flight of STS-66. This rehearsal, held in the crew compartment trainer (CCT) of JSC's Shuttle mockup and integration laboratory, was followed by a training session on emergency egress procedures.

THE MANPOWER DEVELOPMENT AND TRAINING ACT, PROGRAMS AND PROCEDURES.

ERIC Educational Resources Information Center

Division of Manpower Development and Training. , BAVT.

THE MANPOWER DEVELOPMENT AND TRAINING ACT (MDTA), AS AMENDED, IS DESIGNED TO DEAL WITH THE PROBLEMS OF WORKERS FACING JOB DISPLACEMENT, THE SPECIAL PROBLEMS OF THE HARDCORE UNEMPLOYED, OTHER UNEMPLOYED AND UNDEREMPLOYED, AND THE EMERGENCE OF SKILL SHORTAGE IN CERTAIN OCCUPATIONS. THE ACT IS JOINTLY ADMINISTERED BY THE SECRETARY OF HEALTH,…

Training and Transfer in Combinatorial Problem Solving: The Development of Formal Reasoning During Early Adolescence

ERIC Educational Resources Information Center

Barratt, Barnaby B.

1975-01-01

This study investigated the emergence of combinatorial competence in early adolescence and the effectiveness of a programmed discovery training procedure. Significant increases in combinatorial skill with age were shown; it was found that the expression of this skill was significantly facilitated if problems involved concrete material of low…

14 CFR 121.419 - Pilots and flight engineers: Initial, transition, and upgrade ground training.

Code of Federal Regulations, 2012 CFR

2012-01-01

...; (ix) Flight planning; (x) Each normal and emergency procedure; and (xi) The approved Airplane Flight... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Pilots and flight engineers: Initial... Program § 121.419 Pilots and flight engineers: Initial, transition, and upgrade ground training. (a...

14 CFR 121.419 - Pilots and flight engineers: Initial, transition, and upgrade ground training.

Code of Federal Regulations, 2011 CFR

2011-01-01

...; (ix) Flight planning; (x) Each normal and emergency procedure; and (xi) The approved Airplane Flight... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Pilots and flight engineers: Initial... Program § 121.419 Pilots and flight engineers: Initial, transition, and upgrade ground training. (a...

14 CFR 121.419 - Pilots and flight engineers: Initial, transition, and upgrade ground training.

Code of Federal Regulations, 2014 CFR

2014-01-01

...; (ix) Flight planning; (x) Each normal and emergency procedure; and (xi) The approved Airplane Flight... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Pilots and flight engineers: Initial... Program § 121.419 Pilots and flight engineers: Initial, transition, and upgrade ground training. Link to...

14 CFR 121.419 - Pilots and flight engineers: Initial, transition, and upgrade ground training.

Code of Federal Regulations, 2010 CFR

2010-01-01

...; (ix) Flight planning; (x) Each normal and emergency procedure; and (xi) The approved Airplane Flight... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Pilots and flight engineers: Initial... Program § 121.419 Pilots and flight engineers: Initial, transition, and upgrade ground training. (a...

14 CFR 121.419 - Pilots and flight engineers: Initial, transition, and upgrade ground training.

Code of Federal Regulations, 2013 CFR

2013-01-01

...; (ix) Flight planning; (x) Each normal and emergency procedure; and (xi) The approved Airplane Flight... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Pilots and flight engineers: Initial... Program § 121.419 Pilots and flight engineers: Initial, transition, and upgrade ground training. (a...

STS-99 crewmembers bailout training in building 9

NASA Image and Video Library

1999-05-19

S99-05616 (19 May 1999) --- Astronauts Gerhard P.J. Thiele and Janet L. Kavandi await a briefing about emergency egress procedures during a training session at the Johnson Space Center's Systems Integration Facility. Thiele represents the European Space Agency (ESA). Other STS-99 crew members are out of frame at right.

On the practicality of emergency surgery during long-duration space missions.

PubMed

Dawson, David L

2008-07-01

While discussions of the practicality of surgery in space often focus on technical issues, such as adapting instrumentation and procedures for use in microgravity, programmatic issues need to be addressed if meaningful capabilities for emergency surgery are to be considered for human exploration missions beyond low Earth orbit. Advanced technologies that have been evaluated, including simulation-enhanced training, telementoring, or robotic assistance, might help prepare or augment a crew medical officer, but a physician with advanced training and relevant experience will be needed if surgical capabilities beyond basic emergency aid are to be considered. Specific operational roles for physician-astronauts should be established.

Novice to Expert Practice via Postprofessional Athletic Training Education: A Grounded Theory

PubMed Central

Neibert, Peter J

2009-01-01

Objective: To discover the theoretic constructs that confirm, disconfirm, or extend the principles and their applications appropriate for National Athletic Trainers' Association (NATA)–accredited postprofessional athletic training education programs. Design: Interviews at the 2003 NATA Annual Meeting & Clinical Symposia. Setting: Qualitative study using grounded theory procedures. Patients and Other Participants: Thirteen interviews were conducted with postprofessional graduates. Participants were purposefully selected based on theoretic sampling and availability. Data Collection and Analysis: The transcribed interviews were analyzed using open coding, axial coding, and selective coding procedures. Member checks, reflective journaling, and triangulation were used to ensure trustworthiness. Results: The participants' comments confirmed and extended the current principles of postprofessional athletic training education programs and offered additional suggestions for more effective practical applications. Conclusions: The emergence of this central category of novice to expert practice is a paramount finding. The tightly woven fabric of the 10 processes, when interlaced with one another, provides a strong tapestry supporting novice to expert practice via postprofessional athletic training education. The emergence of this theoretic position pushes postprofessional graduate athletic training education forward to the future for further investigation into the theoretic constructs of novice to expert practice. PMID:19593420

Evaluation of pyramid training as a method to increase diagnostic sampling capacity during an emergency veterinary response to a swine disease outbreak.

PubMed

Canon, Abbey J; Lauterbach, Nicholas; Bates, Jessica; Skoland, Kristin; Thomas, Paul; Ellingson, Josh; Ruston, Chelsea; Breuer, Mary; Gerardy, Kimberlee; Hershberger, Nicole; Hayman, Kristen; Buckley, Alexis; Holtkamp, Derald; Karriker, Locke

2017-06-15

OBJECTIVE To develop and evaluate a pyramid training method for teaching techniques for collection of diagnostic samples from swine. DESIGN Experimental trial. SAMPLE 45 veterinary students. PROCEDURES Participants went through a preinstruction assessment to determine their familiarity with the equipment needed and techniques used to collect samples of blood, nasal secretions, feces, and oral fluid from pigs. Participants were then shown a series of videos illustrating the correct equipment and techniques for collecting samples and were provided hands-on pyramid-based instruction wherein a single swine veterinarian trained 2 or 3 participants on each of the techniques and each of those participants, in turn, trained additional participants. Additional assessments were performed after the instruction was completed. RESULTS Following the instruction phase, percentages of participants able to collect adequate samples of blood, nasal secretions, feces, and oral fluid increased, as did scores on a written quiz assessing participants' ability to identify the correct equipment, positioning, and procedures for collection of samples. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that the pyramid training method may be a feasible way to rapidly increase diagnostic sampling capacity during an emergency veterinary response to a swine disease outbreak.

No longer waiting for an accident to happen: Simulation in emergency medicine.

PubMed

Ellison, Stefanie; Sullivan, Christine; McCullough, Robert

2013-01-01

The practice of emergency medicine (EM) requires proficient and expert skills in multiple high risk procedures. The emergency physician in-training needs a safe and realistic environment in which to practice and perfect the skills necessary to care for patients ranging from the critically ill to the patient with difficult intravenous access. Undergraduate medical, education overall has a need for training that enables students to develop the knowledge, skills and attitudes to practice in a variety of specialties. This article provides an overview of simulation in a three-year emergency medicine residency at Truman Medical Center, in a required final year clerkship for all medical students at the University of Missouri-Kansas City, and discusses national trends for the use of simulation in emergency medicine.

Garrison Clinical Setting Inadequate for Maintenance of Procedural Skills for Emergency Medicine Physicians: A Cross-Sectional Study.

PubMed

Schauer, Steven G; Varney, Shawn M; Cox, Kristin L

2015-01-01

Emergency medicine physicians (EPs) are often placed in far-forward, isolated areas in theater. Maintenance of their emergency intervention skills is vital to keep the medical forces deployment ready. The US Army suggests that working at a Military Treatment Facility (MTF) is sufficient to keep emergency procedural skills at a deployment-ready level. We sought to compare the volume of emergency procedures that providers reported necessary to maintain their skills with the number available in the MTF setting. EPs were surveyed to quantify the number of procedures they reported they would need to perform yearly to stay deployment-ready. We obtained procedure data for their duty stations and compared the procedure volume with the survey responses to determine if working at an MTF is sufficient to keep providers' skills deployment ready. The reported necessary average numbers per year were as follows: tube thoracostomy (5.9), intubation (11.4), cricothyrotomy (4.2), lumbar puncture (5.2), central line (10.0), focused assessment with sonography for trauma (FAST) (21.3), reductions (10.6), splints (10.5), and sedations (11.7). None of the procedure volumes at MTFs met provider requirements with the exception of FAST examinations at the only trauma center. This suggests the garrison clinical environment is inadequate for maintaining procedure skills. Further research is needed to determine modalities that will provide adequate training volume. 2015.

Group 13 1990 ASCAN Sherlock during Vance AFB parachute drag training

NASA Image and Video Library

1990-08-14

S90-45883 (29-31 July 1990) --- Nancy J. Sherlock, one of 23 astronaut candidates who began a year's training and evaluation in July, participates in one of many sessions at a survival training course at Vance Air Force Base. Sherlock is about to take part in parachute drag training. The overall course is designed to familiarize the trainees with procedures to follow in the event of an emergency ejection from a jet aircraft.

75 FR 81 - Special Conditions: Boeing Model 787-8 Airplane; Overhead Flightcrew Rest Compartment Occupiable...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-04

..., explain the reason for any recommended change, and include supporting data. We ask that you send us two... changes to the approved OFCR compartment configuration that affect crewmember emergency egress or any other procedures affecting safety of the occupying crewmembers or related emergency training will...

Comparison of a percutaneous device and the bougie-assisted surgical technique for emergency cricothyrotomy: an experimental study on a porcine model performed by air ambulance anaesthesiologists.

PubMed

Nakstad, Anders R; Bredmose, Per P; Sandberg, Mårten

2013-07-26

A large number of techniques and devices for cricothyroidotomy have been developed. In this study, the Portex™ Cricothyroidotomy Kit (PCK, Smiths Medical Ltd, Hythe, UK) was compared with the bougie assisted emergency surgical cricothyrotomy technique (BACT). Twenty air ambulance anaesthesiologists performed emergency cricothyrotomy on a cadaveric porcine airway model using both PCK and BACT. Baseline performance and performance after the intensive training package were recorded. Success rate, time to secured airway and tracheal damage were the primary endpoints, and confidence rating was a secondary endpoint. During baseline testing, success rates for PCK and BACT were 60% and 95%, respectively. Tracheal injury rate with PCK was 60% while no such injury was found in BACT. A lecture was given and skills were trained until the participants were able to perform five consecutive successful procedures with both techniques. In the post-training test, all participants were successful with either technique. The mean time to successful insertion was reduced by 15.7 seconds (from 36.3 seconds to 20.6 seconds, p< 0.001) for PCK and by 7.8 seconds (from 44.9 seconds to 37.1 seconds, p=0.021) for BACT. In the post-training scenario, securing the airway with PCK was significantly faster than with BACT (p<0.001). Post-training tracheal laceration occurred in six (30%) of the PCK procedures and in none of the BACT procedures (p=0.028). Testing the base-line PCK skills of prehospital anaesthesiologists revealed low confidence, sub-optimal performance and a very high failure rate. The BACT technique demonstrated a significantly higher success rate and no tracheal damage. In spite of PCK being a significantly faster technique in the post-training test, the anaesthesiologists still reported a higher confidence in BACT. Limitations of the cadaveric porcine airway may have influenced this study because the airway did not challenge the clinicians with realistic tissue bleeding.

Value of Artisanal Simulators to Train Veterinary Students in Performing Invasive Ultrasound-Guided Procedures

ERIC Educational Resources Information Center

Hage, Maria Cristina F. N. S.; Massaferro, Ana Beatriz; Lopes, Érika Rondon; Beraldo, Carolina Mariano; Daniel, Jéssika

2016-01-01

Pericardial effusion can lead to cardiac tamponade, which endangers an animal's life. Ultrasound-guided pericardiocentesis is used to remove abnormal liquid; however, it requires technical expertise. In veterinary medical education, the opportunity to teach this procedure to save lives during emergencies is rare; therefore, simulators are…

Final Environmental Assessment for a Proposed Pararescue and Combat Rescue Officer Training Campus at Kirtland Air Force Base

DTIC Science & Technology

2006-09-01

tank with adjacent training structure and hoist for inflatable boat training. An indoor climbing wall, a weight/fitness room, and staff and student...climbing; rappelling/litter evacuation; Tyrolean traverses; suspended harness parachuting emergency procedures; aircraft hoist infiltration...characteristics in common. Bulldozers, backhoes, and front-end loaders would be on site throughout periods of excavation and/or site preparation. Dump

33 CFR 104.225 - Security training for all other vessel personnel.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (MARSEC) Levels, including emergency procedures and contingency plans; (c) Recognition and detection of dangerous substances and devices; (d) Recognition of characteristics and behavioral patterns of persons who...

33 CFR 104.225 - Security training for all other vessel personnel.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (MARSEC) Levels, including emergency procedures and contingency plans; (c) Recognition and detection of dangerous substances and devices; (d) Recognition of characteristics and behavioral patterns of persons who...

People and Plans: Training's Role in Homeland Security.

ERIC Educational Resources Information Center

Kaplan-Leiserson, Eva

2003-01-01

Describes how organizations and trainers are preparing for the unexpected in the wake of the September 11, 2001 terrorist attacks. Includes to-do lists, emergency procedures, and additional resources. (JOW)

45 CFR 1310.17 - Driver and bus monitor training.

Code of Federal Regulations, 2010 CFR

2010-10-01

... safe and efficient manner; (2) safely run a fixed route, including loading and unloading children... first aid in case of injury; (4) handle emergency situations, including vehicle evacuation procedures...

STS-32 MS Dunbar wearing LES floats in life raft during water egress training

NASA Image and Video Library

1989-11-15

STS-32 Mission Specialist (MS) Bonnie J. Dunbar, wearing a launch and entry suit (LES) and lauch and entry helmet (LEH), in a single-occupant (one man) lift raft enlists the aid of two SCUBA-equipped divers as she floats in 25 ft deep pool located in JSC's Weightless Environment Training Facility (WETF) Bldg 29. During the exercises the crew practiced the procedures to follow in the event of an emergency aboard the Space Shuttle and familiarized themselves with post-Challenger pole system of emergency egress.

STS-32 MS Dunbar wearing LES floats in life raft during water egress training

NASA Technical Reports Server (NTRS)

1989-01-01

STS-32 Mission Specialist (MS) Bonnie J. Dunbar, wearing a launch and entry suit (LES) and lauch and entry helmet (LEH), in a single-occupant (one man) lift raft enlists the aid of two SCUBA-equipped divers as she floats in 25 ft deep pool located in JSC's Weightless Environment Training Facility (WETF) Bldg 29. During the exercises the crew practiced the procedures to follow in the event of an emergency aboard the Space Shuttle and familiarized themselves with post-Challenger pole system of emergency egress.

Teaching children with autism spectrum disorder to tact olfactory stimuli.

PubMed

Dass, Tina K; Kisamore, April N; Vladescu, Jason C; Reeve, Kenneth F; Reeve, Sharon A; Taylor-Santa, Catherine

2018-05-28

Research on tact acquisition by children with autism spectrum disorder (ASD) has often focused on teaching participants to tact visual stimuli. It is important to evaluate procedures for teaching tacts of nonvisual stimuli (e.g., olfactory, tactile). The purpose of the current study was to extend the literature on secondary target instruction and tact training by evaluating the effects of a discrete-trial instruction procedure involving (a) echoic prompts, a constant prompt delay, and error correction for primary targets; (b) inclusion of secondary target stimuli in the consequent portion of learning trials; and (c) multiple exemplar training on the acquisition of item tacts of olfactory stimuli, emergence of category tacts of olfactory stimuli, generalization of category tacts, and emergence of category matching, with three children diagnosed with ASD. Results showed that all participants learned the item and category tacts following teaching, participants demonstrated generalization across category tacts, and category matching emerged for all participants. © 2018 Society for the Experimental Analysis of Behavior.

KSC-2013-4386

NASA Image and Video Library

2013-12-13

CAPE CANAVERAL, Fla. – At a training location near Launch Complex 39 at NASA’s Kennedy Space Center in Florida, members of the Emergency Response Team, or ERT, participate in specialized training simulations in order to keep their skills current. They are wearing full protective gear and carrying non-lethal firearms, which are denoted in blue, for the training exercises. In the background, the ERT training supervisor, wearing a bright green vest, monitors the training exercise and reviews procedures. Recently, eight members of the ERT competed in the 31st Annual SWAT Roundup International competition in Orlando, Fla., and received recognition by placing in the top five overall. In keeping with NASA’s commitment to safety and security of workforce and assets, the ERT is part of Kennedy’s security team and is trained to respond in the event of an emergency at the center. Photo credit: NASA/Daniel Casper

KSC-2013-4387

NASA Image and Video Library

2013-12-13

CAPE CANAVERAL, Fla. – At a training location near Launch Complex 39 at NASA’s Kennedy Space Center in Florida, members of the Emergency Response Team, or ERT, participate in specialized training simulations in order to keep their skills current. They are wearing full protective gear and carrying non-lethal firearms, which are denoted in blue, for the training exercises. In the background, the ERT training supervisor, wearing a bright green vest, monitors the training exercise and reviews procedures. Recently, eight members of the ERT competed in the 31st Annual SWAT Roundup International competition in Orlando, Fla., and received recognition by placing in the top five overall. In keeping with NASA’s commitment to safety and security of workforce and assets, the ERT is part of Kennedy’s security team and is trained to respond in the event of an emergency at the center. Photo credit: NASA/Daniel Casper

The Use of Simulators for Training In-Flight and Emergency Procedures,

DTIC Science & Technology

1980-06-01

statistical differences in performance between the two groups were found. Creelman (39) reported that students trained in the SNJ Link with a contact landing...isl . Project No. NM 00-5.7.01. Pensacola, FL: U.S. Naval School of Aviation MTdTici7US.Nval Air station, March 1952. 39. Creelman , J. A. Evaluation of

A simulator-based nuclear reactor emergency response training exercise.

PubMed

Waller, Edward; Bereznai, George; Shaw, John; Chaput, Joseph; Lafortune, Jean-Francois

Training offsite emergency response personnel basic awareness of onsite control room operations during nuclear power plant emergency conditions was the primary objective of a week-long workshop conducted on a CANDU® virtual nuclear reactor simulator available at the University of Ontario Institute of Technology, Oshawa, Canada. The workshop was designed to examine both normal and abnormal reactor operating conditions, and to observe the conditions in the control room that may have impact on the subsequent offsite emergency response. The workshop was attended by participants from a number of countries encompassing diverse job functions related to nuclear emergency response. Objectives of the workshop were to provide opportunities for participants to act in the roles of control room personnel under different reactor operating scenarios, providing a unique experience for participants to interact with the simulator in real-time, and providing increased awareness of control room operations during accident conditions. The ability to "pause" the simulator during exercises allowed the instructors to evaluate and critique the performance of participants, and to provide context with respect to potential offsite emergency actions. Feedback from the participants highlighted (i) advantages of observing and participating "hands-on" with operational exercises, (ii) their general unfamiliarity with control room operational procedures and arrangements prior to the workshop, (iii) awareness of the vast quantity of detailed control room procedures for both normal and transient conditions, and (iv) appreciation of the increased workload for the operators in the control room during a transient from normal operations. Based upon participant feedback, it was determined that the objectives of the training had been met, and that future workshops should be conducted.

33 CFR 105.215 - Security training for all other facility personnel.

Code of Federal Regulations, 2010 CFR

2010-07-01

... apply to them, including emergency procedures and contingency plans; (c) Recognition and detection of dangerous substances and devices; (d) Recognition of characteristics and behavioral patterns of persons who...

33 CFR 105.215 - Security training for all other facility personnel.

Code of Federal Regulations, 2011 CFR

2011-07-01

... apply to them, including emergency procedures and contingency plans; (c) Recognition and detection of dangerous substances and devices; (d) Recognition of characteristics and behavioral patterns of persons who...

How many training modalities are needed to obtain procedural confidence in intraosseous access? A questionnaire study.

PubMed

Hallas, Peter; Folkestad, Lars; Brabrand, Mikkel

2011-12-01

Participants in advanced resuscitation courses are often expected to learn to perform intraosseous access (IO). But how many learning modalities are needed to achieve procedural confidence in IO? We distributed an online questionnaire to members of emergency medicine, paediatric and anaesthesiology societies in Scandinavia. The responders without real-life experience with IO (n=322) were classified as 'not confident' or 'confident' in IO. Of total responders 22.8% without training felt confident. Confidence increased to 74.8% after one training modality, 87.9% after two modalities, 98.7% after three modalities and 100% after four modalities (P<0.0001). Of total responders 89.5% who had 'workshop or similar training with hands-on experience' as sole teaching method was confident. Confidence in IO increases with the number of learning modalities. 'Workshop or similar training with hands-on experience' as single training modality seemed as effective as the combination of two modalities.

Training medical assistants for surgery.

PubMed Central

Vaz, F.; Bergström, S.; Vaz, M. da l.; Langa, J.; Bugalho, A.

1999-01-01

A successful programme is reported from Mozambique for training middle-level health workers to perform fairly advanced surgical procedures in remote areas where the services of consultants are virtually unobtainable. Manpower and financial constraints obliged Mozambique to train medical assistants to perform surgical work in rural areas, where three broad priorities were identified: pregnancy-related complications, trauma-related complications, and emergency inflammatory conditions. Since 1984, 20 health workers have emerged from three-year courses to become técnicos de cirurgía (assistant medical officers), and it is expected that there will be 46 by 1999. The training comprises two years of lectures and practical sessions in the Maputo Central Hospital, and a practical internship lasting a year at a provincial hospital. Three workshops organized since 1989 suggest that the upgraded personnel are performing well. More detailed evaluation and follow-up are in progress. Throughout 1995 a follow-up was conducted on 14 assistant medical officers. They performed 10,258 surgical operations, some 70% of which were emergency interventions. Low rates of complication occurred and postoperative mortality amounted to 0.4% and 0.1% in emergency and elective interventions respectively. PMID:10516791

[Medical doctor in mountain rescue service - a profession's perspective].

PubMed

Putzke, Matthias

2008-01-01

Helicopter emergency services (HEMS) carrying doctors trained in emergency medicine represent a well established system for primary care with increasing professionalism since their implementation in the seventies until now. However, considerable differences persist in Europe concerning the structure as well as integration of the system in the entire organisation of area-wide demands. Based on the particular geographic conditions in the alps which are highly associated with challenges for man and material a dense network of helicopter airbases has been established. Hence, this system accounts for the social, economical and touristic requirements of this region in terms of providing sufficient emergency medical treatment. In addition to statutory and professional provisions qualification requirements for emergency doctors comprehend extensive alpine training. Primarily this provides personal safety as well as security for the entire team and the patient which particularly applies for technical rope rescue. Advanced all-season training is compulsory due to seasonal differences in casualties. Well harmonized training with cross-border validity is not available to-date. Hence, the development of obligatory standard operating procedures should be the major goal of medical associations and societies.

Knowledge, attitude and anxiety pertaining to basic life support and medical emergencies among dental interns in Mangalore City, India.

PubMed

Somaraj, Vinej; Shenoy, Rekha P; Panchmal, Ganesh Shenoy; Jodalli, Praveen S; Sonde, Laxminarayan; Karkal, Ravichandra

2017-01-01

This cross-sectional study aimed to assess the knowledge, attitude and anxiety pertaining to basic life support (BLS) and medical emergencies among interns in dental colleges of Mangalore city, Karnataka, India. The study subjects comprised of interns who volunteered from the four dental colleges. The knowledge and attitude of interns were assessed using a 30-item questionnaire prepared based on the Basic Life Support Manual from American Heart Association and the anxiety of interns pertaining to BLS and medical emergencies were assessed using a State-Trait Anxiety Inventory (STAI) Questionnaire. Chi-square test was performed on SPSS 21.0 (IBM Statistics, 2012) to determine statistically significant differences ( P <0.05) between assessed knowledge and anxiety. Out of 183 interns, 39.89% had below average knowledge. A total of 123 (67.21%) reported unavailability of professional training. The majority (180, 98.36%) felt the urgent need of training in basic life support procedures. Assessment of stress showed a total of 27.1% participants to be above high-stress level. Comparison of assessed knowledge and stress was found to be insignificant ( P =0.983). There was an evident lack of knowledge pertaining to the management of medical emergencies among the interns. As oral health care providers moving out to the society, a focus should be placed on the training of dental interns with respect to Basic Life Support procedures.

30 CFR 57.4362 - Underground rescue and firefighting operations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... MINES Fire Prevention and Control Firefighting Procedures/alarms/drills § 57.4362 Underground rescue and firefighting operations. Following evacuation of a mine in a fire emergency, only persons wearing and trained...

30 CFR 57.4362 - Underground rescue and firefighting operations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... MINES Fire Prevention and Control Firefighting Procedures/alarms/drills § 57.4362 Underground rescue and firefighting operations. Following evacuation of a mine in a fire emergency, only persons wearing and trained...

30 CFR 57.4362 - Underground rescue and firefighting operations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... MINES Fire Prevention and Control Firefighting Procedures/alarms/drills § 57.4362 Underground rescue and firefighting operations. Following evacuation of a mine in a fire emergency, only persons wearing and trained...

Cadaver-based training is superior to simulation training for cricothyrotomy and tube thoracostomy.

PubMed

Takayesu, James Kimo; Peak, David; Stearns, Dana

2017-02-01

Emergency medicine (EM) training mandates that residents be able to competently perform low-frequency critical procedures upon graduation. Simulation is the main method of training in addition to clinical patient care. Access to cadaver-based training is limited due to cost and availability. The relative fidelity and perceived value of cadaver-based simulation training is unknown. This pilot study sought to describe the relative value of cadaver training compared to simulation for cricothyrotomy and tube thoracostomy. To perform a pilot study to assess whether there is a significant difference in fidelity and educational experience of cadaver-based training compared to simulation training. To understand how important this difference is in training residents in low-frequency procedures. Twenty-two senior EM residents (PGY3 and 4) who had completed standard simulation training on cricothyrotomy and tube thoracostomy participated in a formalin-fixed cadaver training program. Participants were surveyed on the relative fidelity of the training using a 100 point visual analogue scale (VAS) with 100 defined as equal to performing the procedure on a real patient. Respondents were also asked to estimate how much the cadaveric training improved the comfort level with performing the procedures on a scale between 0 and 100 %. Open-response feedback was also collected. The response rate was 100 % (22/22). The average fidelity of the cadaver versus simulation training was 79.9 ± 7.0 vs. 34.7 ± 13.4 for cricothyrotomy (p < 0.0001) and 86 ± 8.6 vs. 38.4 ± 19.3 for tube thoracostomy (p < 0.0001). Improvement in comfort levels performing procedures after the cadaveric training was rated as 78.5 ± 13.3 for tube thoracostomy and 78.7 ± 14.3 for cricothyrotomy. All respondents felt this difference in fidelity to be important for procedural training with 21/22 respondents specifically citing the importance of superior landmark and tissue fidelity compared to simulation training. Cadaver-based training provides superior landmark and tissue fidelity compared to simulation training and may be a valuable addition to EM residency training for certain low-frequency procedures.

Go/No-Go Procedure with Compound Stimuli with Children with Autism

ERIC Educational Resources Information Center

Silva, Rafael Augusto; Debert, Paula

2017-01-01

The go/no-go with compound stimuli is an alternative to matching-to-sample to produce conditional and emergent relations in adults. The aim of this study was to evaluate the effectiveness of this procedure with two children diagnosed with autism. We trained and tested participants to respond to conditional relations among arbitrary stimuli using…

STS-39 MS Hieb prepares for emergency egress exercises in JSC's WETF Bldg 29

NASA Technical Reports Server (NTRS)

1990-01-01

STS-39 Mission Specialist (MS) Richard J. Hieb, wearing launch and entry suit (LES), parachute pack, and communications carrier assembly (CCA), listens to instructions prior to emergency egress bailout exercises in JSC's Weightless Environment Training Facility (WETF) Bldg 29. The WETF's 25 ft deep pool will simulate the ocean. Crewmembers will practice procedures necessary in the event of an emergency onboard the Space Shuttle requiring a water landing.

Restraint practices in Australasian emergency departments.

PubMed

Cannon, M E; Sprivulis, P; McCarthy, J

2001-08-01

The objective of this study was to estimate the use of restraint techniques and evaluate restraint policies and training in Australasian emergency departments A survey of 116 Australasian emergency departments was conducted to determine the type, indications/contraindications, training, policies, documentation and audit requirements for restraint. The overall estimated rate of patient restraint is 3.3 episodes per 1000 presentations. The commonest indications for restraint are violence or threatened violence (52%), psychosis (32%) and acute brain syndrome (10%). Major contraindications are medical instability, risk of harm to staff in applying restraint and the availability of alternatives to restraint. Chemical restraint is used in all emergency departments surveyed. The commonest agents used are haloperidol (93%), midazolam (82%) and diazepam (59%). At least one benzodiazepine and one major tranquilliser are used in 97% of emergency departments. Manual restraint (87%) is frequently used as a prelude to chemical or, less frequently, mechanical restraint (69%). Seclusion restraint is used in 23% of Australasian emergency departments. Formal training is most commonly undertaken for chemical restraint, being used in 33% of departments surveyed. Less than half of the departments have written policies guiding the use of restraint, and only 11% audit their use of restraint. A specific form for restraint documentation is used in only one emergency department. Patient restraint is a common procedure in Australasian emergency departments. There is little formal training in, or documentation or audit of, restraint practices in Australasian emergency departments, despite the important clinical, occupational health and medical legal issues associated with the use of restraint.

STS-62 Preflight training in Crew Compartment Trainer (CCT) in bldg 9A

NASA Image and Video Library

1993-11-01

S93-48462 (5 Nov. 1993) --- Astronaut Charles D. (Sam) Gemar, wearing a partial pressure launch and entry suit (LES), takes a break during a training exercise at the Johnson Space Center (JSC). The mission specialist and four crew mates rehearsed emergency egress procedures using the escape pole device in the trainer's hatchway (near right center frame).

Spaceflight Decompression Sickness Contingency Plan

NASA Technical Reports Server (NTRS)

Dervay, Joseph P.

2007-01-01

A viewgraph presentation on the Decompression Sickness (DCS) Contingency Plan for manned spaceflight is shown. The topics include: 1) Approach; 2) DCS Contingency Plan Overview; 3) Extravehicular Activity (EVA) Cuff Classifications; 4) On-orbit Treatment Philosophy; 5) Long Form Malfunction Procedure (MAL); 6) Medical Checklist; 7) Flight Rules; 8) Crew Training; 9) Flight Surgeon / Biomedical Engineer (BME) Training; and 10) DCS Emergency Landing Site.

Review of Flight Training Technology

DTIC Science & Technology

1976-07-01

the cockpit. They might be used to train pilots in procedures to cope with NOE-altitude emergencies; howeve-r, a combination of cinematic simulation...airplanes. Although cockpit motion adds realism , thereby i-nproving pilot performanc, in the simulater Fedderqon, Vil; Guercio and Wall, i7?. Ince...operations. Light aircraft, part-task trainers, motion pictures and video tares, cinematic simulators, and digital teaching machines are among the

RCRA Personnel Training, Course 7488

DOE Office of Scientific and Technical Information (OSTI.GOV)

Simpson, Lewis Edward

Federal and state regulations require hazardous and mixed waste facility workers at treatment and storage facilities (TSFs) and <90-day accumulation areas to be trained in hazardous and mixed waste management. This course will refamiliarize and update <90-day accumulation area workers, TSF workers, and supervisors of TSF workers regarding waste identification, pollution prevention, storage area requirements, emergency response procedures, and record-keeping requirements.

Ketamine versus Ketamine / magnesium Sulfate for Procedural Sedation and Analgesia in the Emergency Department: A Randomized Clinical Trial

PubMed Central

Azizkhani, Reza; Bahadori, Azadeh; Shariati, Mohammadreza; Golshani, Keyhan; Ahmadi, Omid; Masoumi, Babak

2018-01-01

Background: The present study was designed to evaluate the effectiveness of magnesium sulfate (MgSO4) in procedural sedation and analgesia (PSA) when combined with ketamine in patients with fractures in emergency departments and required short and painful emergency procedures. Materials and Methods: In this study, 100 patients with fractures and dislocations who were presented to the emergency departments and required PSA for short and painful emergency procedures were randomly allocated to groups of ketamine plus MgSO4 or ketamine alone. Train of four (TOF) stimulation pattern was assessed using nerve stimulator machine and compared between groups. Results: The mean age of studied patients was 46.9 ± 9.3 years old. 48% were male and 52% were female. No significant differences were noted between groups in demographic variables. The status of TOF, 2 min after the injection of ketamine (1.5 mg/kg), in both groups was similar. After the injection of the second dose of ketamine (1 mg/kg) the status of TOF in four patients in ketamine plus MgSO4 (0.45 mg/kg) group changed, it was three quarters but in ketamine group, the status of TOF in all patients was four quarters. The difference between groups was not statistically significant (P = 0.12). Conclusion: The findings revealed that for muscle relaxation during medical procedures in the emergency department, ketamine in combination with MgSO4 with this dose was not effective for muscle relaxation during procedures. PMID:29456990

Ketamine versus Ketamine / magnesium Sulfate for Procedural Sedation and Analgesia in the Emergency Department: A Randomized Clinical Trial.

PubMed

Azizkhani, Reza; Bahadori, Azadeh; Shariati, Mohammadreza; Golshani, Keyhan; Ahmadi, Omid; Masoumi, Babak

2018-01-01

The present study was designed to evaluate the effectiveness of magnesium sulfate (MgSO 4 ) in procedural sedation and analgesia (PSA) when combined with ketamine in patients with fractures in emergency departments and required short and painful emergency procedures. In this study, 100 patients with fractures and dislocations who were presented to the emergency departments and required PSA for short and painful emergency procedures were randomly allocated to groups of ketamine plus MgSO 4 or ketamine alone. Train of four (TOF) stimulation pattern was assessed using nerve stimulator machine and compared between groups. The mean age of studied patients was 46.9 ± 9.3 years old. 48% were male and 52% were female. No significant differences were noted between groups in demographic variables. The status of TOF, 2 min after the injection of ketamine (1.5 mg/kg), in both groups was similar. After the injection of the second dose of ketamine (1 mg/kg) the status of TOF in four patients in ketamine plus MgSO 4 (0.45 mg/kg) group changed, it was three quarters but in ketamine group, the status of TOF in all patients was four quarters. The difference between groups was not statistically significant ( P = 0.12). The findings revealed that for muscle relaxation during medical procedures in the emergency department, ketamine in combination with MgSO 4 with this dose was not effective for muscle relaxation during procedures.

Optimization of Simulation-Based Training Systems: Model Description, Implementation, and Evaluation

DTIC Science & Technology

1990-06-01

Taskcs01 for Instructional _______Cue ______ 0__ Fq’o~eturesResponse 1A I Analyze Tasks %Requirements 018 TaskfrFieiy0-m Learning fo ielt asl... academic instruction on aircraft systems, emergency procedures, and tactics. Although some Army aviators enter the AH-I AQC immediately after completing...from low to high fidelity, and (d) tasks could not be trained to standard using academic training only. The tasks that were chosen are enumerated in

STS-53 Commander Walker adjusts LES prior to JSC emergency egress training

NASA Technical Reports Server (NTRS)

1992-01-01

STS-53 Discovery, Orbiter Vehicle (OV) 103, Commander David M. Walker pulls at launch and entry suit (LES) neck ring and neck dam in an attempt to adjust it and/or loosen it. Walker appears uncomfortable and makes the adjustments in preparation for launch emergency egress bailout procedures in JSC's Mockup and Integration Laboratory (MAIL) Bldg 9NE.

Emergency medicine point-of-care ultrasonography: a national needs assessment of competencies for general and expert practice.

PubMed

Fischer, Lisa M; Woo, Michael Y; Lee, A Curtis; Wiss, Ray; Socransky, Steve; Frank, Jason R

2015-01-01

Emergency medicine point-of-care ultrasonography (EM-PoCUS) is a core competency for residents in the Royal College of Physicians and Surgeons of Canada and College of Family Physicians of Canada emergency medicine (EM) training programs. Although EM-PoCUS fellowships are currently offered in Canada, there is little consensus regarding what training should be included in a Canadian EM-PoCUS fellowship curriculum or how this contrasts with the training received in an EM residency.Objectives To conduct a systematic needs assessment of major stakeholders to define the essential elements necessary for a Canadian EM-PoCUS fellowship training curriculum. We carried out a national survey of experts in EM-PoCUS, EM residency program directors, and EM residents. Respondents were asked to identify competencies deemed either nonessential to EM practice, essential for general EM practice, essential for advanced EM practice, or essential for EM-PoCUS fellowship trained (‘‘expert’’) practice. The response rate was 81% (351 of 435). PoCUS was deemed essential to general EM practice for basic cardiac, aortic, trauma, and procedural imaging. PoCUS was deemed essential to advanced EM practice in undifferentiated symptomatology, advanced chest pathologies, and advanced procedural applications. Expert-level PoCUS competencies were identified for administrative, pediatric, and advanced gynecologic applications. Eighty-seven percent of respondents indicated that there was a need for EM-PoCUS fellowships, with an ideal length of 6 months. This is the first needs assessment of major stakeholders in Canada to identify competencies for expert training in EM-PoCUS. The competencies should form the basis for EM-PoCUS fellowship programs in Canada.

Integrated Modeling, Mapping, and Simulation (IMMS) framework for planning exercises.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Friedman-Hill, Ernest J.; Plantenga, Todd D.

2010-06-01

The Integrated Modeling, Mapping, and Simulation (IMMS) program is designing and prototyping a simulation and collaboration environment for linking together existing and future modeling and simulation tools to enable analysts, emergency planners, and incident managers to more effectively, economically, and rapidly prepare, analyze, train, and respond to real or potential incidents. When complete, the IMMS program will demonstrate an integrated modeling and simulation capability that supports emergency managers and responders with (1) conducting 'what-if' analyses and exercises to address preparedness, analysis, training, operations, and lessons learned, and (2) effectively, economically, and rapidly verifying response tactics, plans and procedures.

STS-39 MS Hieb floats in single person life raft in JSC's WETF Bldg 29 pool

NASA Technical Reports Server (NTRS)

1990-01-01

STS-39 Mission Specialist (MS) Richard J. Hieb, wearing launch and entry suit (LES) and launch and entry helmet (LEH), floats in single person life raft after landing in JSC's Weightless Environment Training Facility (WETF) Bldg 29 pool. During emergency egress bailout procedures, Hieb practiced procedures necessary for a water landing. Divers monitor Hieb's activity.

Astronauts Ochoa and Tanner during egress training

NASA Image and Video Library

1994-06-23

S94-40073 (23 June 1994) --- Wearing training versions of the launch and entry suits (LES), astronauts Ellen Ochoa, payload commander, and Joseph P. Tanner, mission specialist, await the beginning of a training session on emergency egress procedures. The STS-66 crew participated in the training, held in the Johnson Space Center's (JSC) Shuttle Mockup and Integration Laboratory. Ochoa and Tanner will join three other NASA astronauts and one international mission specialist aboard the Space Shuttle Atlantis in support of the Atmospheric Laboratory for Applications and Science (ATLAS-3) flight scheduled for November of this year.

Surface extra-vehicular activity emergency scenario management: Tools, procedures, and geologically related implications

NASA Astrophysics Data System (ADS)

Zea, Luis; Diaz, Alejandro R.; Shepherd, Charles K.; Kumar, Ranganathan

2010-07-01

Extra-vehicular activities (EVAs) are an essential part of human space exploration, but involve inherently dangerous procedures which can put crew safety at risk during a space mission. To help mitigate this risk, astronauts' training programs spend substantial attention on preparing for surface EVA emergency scenarios. With the help of two Mars Desert Research Station (MDRS) crews (61 and 65), wearing simulated spacesuits, the most important of these emergency scenarios were examined at three different types of locations that geologically and environmentally resemble lunar and Martian landscapes. These three platforms were analyzed geologically as well as topographically (utilizing a laser range finder with slope estimation capabilities and a slope determination software). Emergency scenarios were separated into four main groups: (1) suit issues, (2) general physiological, (3) attacks and (4) others. Specific tools and procedures were developed to address each scenario. The tools and processes were tested in the field under Mars-analog conditions with the suited subjects for feasibility and speed of execution.

STS-65 crewmembers don LES equipment for MAIL Bldg 9NE egress training

NASA Technical Reports Server (NTRS)

1994-01-01

Attired in partial pressure launch and entry suits (LESs), two mission specialists and a payload specialist for the STS-65 International Microgravity Laboratory 2 (IML-2) mission, prepare to rehearse emergency escape procedures and other flight tasks. Technicians help crewmembers (left to right) Mission Specialist (MS) Leroy Chiao, MS Donald A. Thomas, and Japanese Payload Specialist Chiaki Mukai don LES equipment. Mukai represents Japan's National Space Development Agency (NASDA). In addition to the emergency egress training, the seven crewmembers also simulated their duties for launch and entry phases of the scheduled 13-day flight aboard Columbia, Orbiter Vehicle (OV) 102. The training session was held in Johnson Space Center's (JSC's) Mockup and Integration Laboratory (MAIL) Bldg 9NE.

Astronaut Jean-Francois Clervoy in middeck during launch/entry training

NASA Image and Video Library

1994-06-23

S94-40081 (23 June 1994) --- Wearing a training version of a partial pressure suit, Jean-Francois Clervoy, STS-66 international mission specialist, secures himself on a collapsible seat on the middeck of a Shuttle trainer during a rehearsal of procedures to be followed during launch and entry phases of his scheduled November flight. This rehearsal, held in the Crew Compartment Trainer (CCT) of the Johnson Space Center's (JSC) Shuttle Mockup and Integration Laboratory, was followed by a training session on emergency egress procedures. Clervoy, a European astronaut, will join five NASA astronauts for a week and a half aboard the Space Shuttle Atlantis in Earth-orbit in support of the Atmospheric Laboratory for Applications and Science (ATLAS-3).

Conditional Relations with Compound Abstract Stimuli Using a Go/No-Go Procedure

ERIC Educational Resources Information Center

Debert, Paula; Matos, Maria Amelia; McIlvane, William

2007-01-01

The aim of this study was to evaluate whether emergent conditional relations could be established with a go/no-go procedure using compound abstract stimuli. The procedure was conducted with 6 adult humans. During training, responses emitted in the presence of certain stimulus compounds (A1B1, A2B2, A3B3, B1C1, B2C2, and B3C3) were followed by…

Should Advertising by Aesthetic Surgeons be Permitted?

PubMed Central

Nagpal, Neeraj

2017-01-01

Cosmetic, aesthetic and cutaneous surgical procedures require qualified specialists trained in the various procedures and competent to handle complications. However, it also requires huge investments in terms of infrastructure, trained staff and equipment. To be viable advertising is essential to any establishment which provides cosmetic and aesthetic procedures. Business men with deep pockets establish beauty chains which also provide these services and advertise heavily to sway public opinion in their favour. However, these saloons and spas lack basic medical facilities in terms of staff or equipment to handle any complication or medical emergency. To have a level playing field ethical advertising should be permitted to qualified aesthetic surgeons as is permitted in the US and UK by their respective organisations. PMID:28529421

Effect of the full implementation of the European Working Time Directive on operative training in adult cardiac surgery.

PubMed

Mahesh, Balakrishnan; Sharples, Linda; Codispoti, Massimiliano

2014-01-01

Surgical specialties rely on practice and apprenticeship to acquire technical skills. In 2009, the final reduction in working hours to 48 per week, in accordance with the European Working Time Directive (EWTD), has also led to an expansion in the number of trainees. We examined the effect of these changes on operative training in a single high-volume [>1500 procedures/year] adult cardiac surgical center. Setting: A single high-volume [>1500 procedures/year] adult cardiac surgical center. Design: Consecutive data were prospectively collected into a database and retrospectively analyzed. Procedures and Main Outcome Measures: Between January 2006 and August 2010, 6688 consecutive adult cardiac surgical procedures were analyzed. The proportion of cases offered for surgical training were compared for 2 non-overlapping consecutive time periods: 4504 procedures were performed before the final implementation of the EWTD (Phase 1: January 2006-December 2008) and 2184 procedures after the final implementation of the EWTD (Phase 2: January 2009-August 2010). Other predictors of training considered in the analysis were grade of trainee, logistic European system for cardiac operative risk evaluation (EuroSCORE), type of surgical procedure, weekend or late procedure, and consultant. Logistic regression analysis was used to determine the predictors of training cases (procedure performed by trainee) and to evaluate the effect of the EWTD on operative surgical training after correcting for confounding factors. Proportion of training cases rose from 34.6% (1558/4504) during Phase 1 to 43.6% (953/2184) in Phase 2 (p < 0.0001), despite higher mean logistic EuroSCORE [4.29 (6.8) during Phase 1 vs 4.95 (7.2) during Phase 2, p < 0.0001] and higher proportion of cases performed out of hours [153 (3.4) during Phase 1 vs 116 (5.3) during Phase 2, p < 0.0001]. During Phase 1, senior trainees (last 2 years of training) performed 803 (17.8%) procedures, whereas other trainees (first 4 years of training) performed 755(16.8%) cases. During Phase 2, senior trainees performed 763 (34.9%) procedures, whereas other trainees performed 190 (8.7%) cases (p < 0.0001). Independent positive predictors of training cases emerging from the multivariable logistic regression model included consultant in charge, final EWTD, and senior trainees. Independent negative predictors of training cases included logistic EuroSCORE, out-of-hours' procedures, and surgery other than coronary artery bypass grafts. Implementation of the final phase of EWTD has not decreased training in a high-volume center. The positive adjustment of trainers' attitudes and efforts to match trainees' needs allow maintenance of adequate training, despite reduction in working hours and increasing patients' risk profile. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Disaster behavioral health capacity: Findings from a multistate preparedness assessment.

PubMed

Peck, Megan; Mendenhall, Tai; Stenberg, Louise; Carlson, Nancy; Olson, Debra K

2016-01-01

To identify gaps in disaster behavioral health, the Preparedness and Emergency Response Learning Center (PERL) at the University of Minnesota's School of Public Health supported the development and implementation of a multistate disaster behavioral health preparedness assessment. Information was gathered regarding worker knowledge of current disaster behavioral health capacity at the state and local level, and perceived disaster behavioral health training needs and preferences. Between May and July 2015, 143 participants completed a 31-item uniform questionnaire over the telephone by a trained interviewer. Trained interviewers were given uniform instructions on administering the questionnaire. Participants included county and city-level public health leaders and directors from Minnesota, Wisconsin, and North Dakota. Findings demonstrate that across the three states there is a need for improved disaster behavioral health training and response plans for before, during, and after public health emergencies. This study identified perceived gaps in plans and procedures for meeting the disaster behavioral health needs of different atrisk populations, including children, youth, and those with mental illness. There was consistent agreement among participants about the lack of behavioral health coordination between agencies during emergency events. Findings can be used to inform policy and the development of trainings for those involved in disaster behavioral health. Effectively attending to interagency coordination and mutual aid agreements, planning for effective response and care for vulnerable populations, and targeted training will contribute to a more successful public health response to emergency events.

A Conceptual and Procedural Research on the Hierarchical Structure of Mathematics Emerging in the Minds of University Students: An Example of Limit-Continuity-Integral-Derivative

ERIC Educational Resources Information Center

Dane, Arif; Çetin, Ömer Faruk; Bas, Fatih; Sagirli, Meryem Özturan

2016-01-01

In this present study, it was aimed to investigate whether the hierarchical structure of mathematics emerged in university students' minds or not, considering the concepts of limit, continuity derivative and integral from the perspective of students in the department of secondary school mathematics teacher training and the department of…

STS-65 Mission Specialist Chiao in LES at pre-test WETF bailout briefing

NASA Technical Reports Server (NTRS)

1994-01-01

STS-65 Mission Specialist Leroy Chiao, outfitted in a launch and entry suit (LES) and launch and entry helmet (LEH), listens to a briefing on procedures that would become necessary in the event of an emergency egress situation from the Space Shuttle. The astronaut was in the Johnson Space Center's (JSC's) Weightless Environment Training Facility (WETF) Bldg 29 for the launch emergency egress training (bailout) exercise. Chiao will join five other NASA astronauts and a Japanese payload specialist for the second International Microgravity Laboratory 2 (IML-2) mission aboard the Space Shuttle Columbia, Orbiter Vehicle (OV) 102, later this year.

The three Rs of fire safety, emergency action, and fire prevention planning: promoting safety at the worksite.

PubMed

Thompson, Marcella R

2003-04-01

Fire safety is of paramount importance for everyone. In many workplaces, the occupational health nurse's scope of practice encompasses safety related activities. Included within this role is the responsibility for fire safety, emergency action, and fire prevention planning. The Three Rs of fire safety, emergency action, and fire prevention plans are rules, responsibilities, and resources. Myriad building and fire safety codes, regulations, and standards exist with which an employer must comply. An employer's responsibility for installing, testing, inspecting, and maintaining fire safety related equipment is extensive. Emergency action and fire prevention planning begins with conducting a detailed physical survey and preparing site maps. It includes making key policy decisions, writing procedures, and training employees in those procedures by practicing and executing site drills. The best resources available for emergency planning are the local fire department and the property insurer. Planning ahead means an efficient emergency response if disaster strikes. It saves lives, limits property damage, and preserves the environment.

Control Room Training for the Hyper-X Project Utilizing Aircraft Simulation

NASA Technical Reports Server (NTRS)

Lux-Baumann, Jesica; Dees, Ray; Fratello, David

2006-01-01

The NASA Dryden Flight Research Center flew two Hyper-X research vehicles and achieved hypersonic speeds over the Pacific Ocean in March and November 2004. To train the flight and mission control room crew, the NASA Dryden simulation capability was utilized to generate telemetry and radar data, which was used in nominal and emergency mission scenarios. During these control room training sessions personnel were able to evaluate and refine data displays, flight cards, mission parameter allowable limits, and emergency procedure checklists. Practice in the mission control room ensured that all primary and backup Hyper-X staff were familiar with the nominal mission and knew how to respond to anomalous conditions quickly and successfully. This report describes the technology in the simulation environment and the Mission Control Center, the need for and benefit of control room training, and the rationale and results of specific scenarios unique to the Hyper-X research missions.

Control Room Training for the Hyper-X Program Utilizing Aircraft Simulation

NASA Technical Reports Server (NTRS)

Lux-Baumann, Jessica R.; Dees, Ray A.; Fratello, David J.

2006-01-01

The NASA Dryden Flight Research Center flew two Hyper-X Research Vehicles and achieved hypersonic speeds over the Pacific Ocean in March and November 2004. To train the flight and mission control room crew, the NASA Dryden simulation capability was utilized to generate telemetry and radar data, which was used in nominal and emergency mission scenarios. During these control room training sessions, personnel were able to evaluate and refine data displays, flight cards, mission parameter allowable limits, and emergency procedure checklists. Practice in the mission control room ensured that all primary and backup Hyper-X staff were familiar with the nominal mission and knew how to respond to anomalous conditions quickly and successfully. This paper describes the technology in the simulation environment and the mission control center, the need for and benefit of control room training, and the rationale and results of specific scenarios unique to the Hyper-X research missions.

EMS-physicians' self reported airway management training and expertise; a descriptive study from the Central Region of Denmark

PubMed Central

2011-01-01

Background Prehospital advanced airway management, including prehospital endotracheal intubation is challenging and recent papers have addressed the need for proper training, skill maintenance and quality control for emergency medical service personnel. The aim of this study was to provide data regarding airway management-training and expertise from the regional physician-staffed emergency medical service (EMS). Methods The EMS in this part of The Central Region of Denmark is a two tiered system. The second tier comprises physician staffed Mobile Emergency Care Units. The medical directors of the programs supplied system data. A questionnaire addressing airway management experience, training and knowledge was sent to the EMS-physicians. Results There are no specific guidelines, standard operating procedures or standardised program for obtaining and maintaining skills regarding prehospital advanced airway management in the schemes covered by this study. 53/67 physicians responded; 98,1% were specialists in anesthesiology, with an average of 17,6 years of experience in anesthesiology, and 7,2 years experience as EMS-physicians. 84,9% reported having attended life support course(s), 64,2% an advanced airway management course. 24,5% fulfilled the curriculum suggested for Danish EMS physicians. 47,2% had encountered a difficult or impossible PHETI, most commonly in a patient in cardiac arrest or a trauma patient. Only 20,8% of the physicians were completely familiar with what back-up devices were available for airway management. Conclusions In this, the first Danish study of prehospital advanced airway management, we found a high degree of experience, education and training among the EMS-physicians, but their equipment awareness was limited. Check-outs, guidelines, standard operating procedures and other quality control measures may be needed. PMID:21303510

STS-35 MS Hoffman drains LES after water egress exercises in JSC's WETF

NASA Technical Reports Server (NTRS)

1990-01-01

STS-35 Mission Specialist (MS) Jeffrey A. Hoffman drains his launch and entry suit (LES) by propping himself upside down against a chair. Training personnel (left) and Pilot Guy S. Gardner watch as Hoffman's head stand forces water from his suit. Crewmembers were participating in launch emergency egress procedures in JSC's Weightless Environment Training Facility (WETF) Bldg 29. Various WETF mockups are visible in the background.

Promoting Inter-Agency Readiness through Standardized Training and Education of Front Line Responders

DTIC Science & Technology

2011-09-01

Management (Regular Basic Course Training Specifications, 2010). It synthesizes the knowledge , skills, and abilities necessary to interdict a terrorist...way of recognizing emergency managers for the work that they do and it certifies them for their knowledge , skills, and abilities. This certification... the same to provide a foundation that supports continuous output and feedback specific to knowledge , skills, and procedures. New York DCJS manages

Astronaut Scott Parazynski during egress training

NASA Image and Video Library

1994-06-23

S94-40083 (23 June 1994) --- Astronaut Scott E. Parazynski looks at fellow STS-66 mission specialist Joseph R. Tanner, (foreground) during a rehearsal of procedures to be followed during launch and entry phases of the their scheduled November flight. This rehearsal, held in the Crew Compartment Trainer (CCT) of the Johnson Space Center's (JSC) Shuttle Mockup and Integration Laboratory, was followed by a training session on emergency egress procedures. In November, Parazynski and Tanner will join three other NASA astronauts and a European mission specialist for a week and a half aboard the Space Shuttle Atlantis in Earth-orbit in support of the Atmospheric Laboratory for Applications and Science (ATLAS-3).

RCRA/UST, superfund, and EPCRA hotline training module. Introduction to: Treatment, storage, and disposal facilities (40 CFR parts 264/265, subparts A-E) updated as of July 1995

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1995-11-01

The module presents an overview of the general treatment, storage, and disposal facility (TSDF) standards found in 40 CFR parts 264/265, subparts A through E. It identifies and explains each exclusion from parts 264/265, and provides definitions of excluded units, such as wastewater treatment unit and elementary neutralization unit. It locates and describes the requirements for waste analysis and personnel training. It also describes the purpose of a contingency plan and lists the emergency notification procedures. It describes manifest procedures and responsibilities, and lists the unmanifested waste reporting requirements.

Improving Pediatric Basic Life Support Performance Through Blended Learning With Web-Based Virtual Patients: Randomized Controlled Trial.

PubMed

Lehmann, Ronny; Thiessen, Christiane; Frick, Barbara; Bosse, Hans Martin; Nikendei, Christoph; Hoffmann, Georg Friedrich; Tönshoff, Burkhard; Huwendiek, Sören

2015-07-02

E-learning and blended learning approaches gain more and more popularity in emergency medicine curricula. So far, little data is available on the impact of such approaches on procedural learning and skill acquisition and their comparison with traditional approaches. This study investigated the impact of a blended learning approach, including Web-based virtual patients (VPs) and standard pediatric basic life support (PBLS) training, on procedural knowledge, objective performance, and self-assessment. A total of 57 medical students were randomly assigned to an intervention group (n=30) and a control group (n=27). Both groups received paper handouts in preparation of simulation-based PBLS training. The intervention group additionally completed two Web-based VPs with embedded video clips. Measurements were taken at randomization (t0), after the preparation period (t1), and after hands-on training (t2). Clinical decision-making skills and procedural knowledge were assessed at t0 and t1. PBLS performance was scored regarding adherence to the correct algorithm, conformance to temporal demands, and the quality of procedural steps at t1 and t2. Participants' self-assessments were recorded in all three measurements. Procedural knowledge of the intervention group was significantly superior to that of the control group at t1. At t2, the intervention group showed significantly better adherence to the algorithm and temporal demands, and better procedural quality of PBLS in objective measures than did the control group. These aspects differed between the groups even at t1 (after VPs, prior to practical training). Self-assessments differed significantly only at t1 in favor of the intervention group. Training with VPs combined with hands-on training improves PBLS performance as judged by objective measures.

Preparedness of fire safety in underground train station: Comparison between train operators in Malaysia with other operators from the developed countries

NASA Astrophysics Data System (ADS)

Tajedi, Noor Aqilah A.; Sukor, Nur Sabahiah A.; Ismail, Mohd Ashraf M.; Shamsudin, Shahrul A.

2017-10-01

The purpose of this paper is to compare the fire evacuation plan and preparation at the underground train stations in the different countries. The methodology for this study was using the extended questionnaire survey to investigate the Rapid Rail Sdn Bhd, Malaysia's fire safety plan and preparation at the underground train stations. There were four sections in the questionnaire which included (i) background of the respondents, (ii) the details on the train stations, safety instruction and fire evacuation exercises (iii) technical systems, installation and equipment at the underground stations and (iv) procedures and technical changes related to fire safety that had been applied by the operators. Previously, the respondents from the different train operator services in the developed countries had completed the questionnaires. This paper extends the response from the Rapid Rail Sdn Bhd to compare the emergency procedures and preparation for fire event with the developed countries. As a result, this study found that the equipment and facilities that provided at the underground train stations that operated by Rapid Rail are relevant for fire safety procedures and needs. The main advantage for Rapid Rail is the underground stations were designed with two or more entrances/exits that may perform better evacuation compare to one main entrance/exit train stations in the other developed countries.

Simulation-based otolaryngology - head and neck surgery boot camp: 'how I do it'.

PubMed

Chin, C J; Chin, C A; Roth, K; Rotenberg, B W; Fung, K

2016-03-01

In otolaryngology, surgical emergencies can occur at any time. An annual surgical training camp (or 'boot camp') offers junior residents from across North America the opportunity to learn and practice these skills in a safe environment. The goals of this study were to describe the set-up and execution of a simulation-based otolaryngology boot camp and to determine participants' confidence in performing routine and emergency on-call procedures in stressful situations before and after the boot camp. There were three main components of the boot camp: task trainers, simulations and an interactive panel discussion. Surveys were given to participants before and after the boot camp, and their confidence in performing the different tasks was assessed via multiple t-tests. Participants comprised 22 residents from 12 different universities; 10 of these completed both boot camp surveys. Of the nine tasks, the residents reported a significant improvement in confidence levels for six, including surgical airway and orbital haematoma management. An otolaryngology boot camp gives residents the chance to learn and practice emergency skills before encountering the emergencies in everyday practice. Their confidence in multiple skillsets was significantly improved after the boot camp. Given the shift towards competency-based learning in medical training, this study has implications for all surgical and procedural specialties.

Modifications in endoscopic practice for pediatric patients.

PubMed

Lightdale, Jenifer R; Acosta, Ruben; Shergill, Amandeep K; Chandrasekhara, Vinay; Chathadi, Krishnavel; Early, Dayna; Evans, John A; Fanelli, Robert D; Fisher, Deborah A; Fonkalsrud, Lisa; Hwang, Joo Ha; Kashab, Mouen; Muthusamy, V Raman; Pasha, Shabana; Saltzman, John R; Cash, Brooks D

2014-05-01

We recommend that endoscopy in children be performed by pediatric-trained endoscopists whenever possible. We recommend that adult-trained endoscopists coordinate their services with pediatricians and pediatric specialists when they are needed to perform endoscopic procedures in children. We recommend that endoscopy be performed within 24 hours in symptomatic pediatric patients with known or suspected ingestion of caustic substances. We recommend emergent foreign-body removal of esophageal button batteries, as well as 2 or more rare-earth neodymium magnets. We recommend that procedural and resuscitative equipment appropriate for pediatric use should be readily available during endoscopic procedures. We recommend that personnel trained specifically in pediatric life support and airway management be readily available during sedated procedures in children. We recommend the use of endoscopes smaller than 6 mm in diameter in infants and children weighing less than 10 kg. We recommend the use of standard adult duodenoscopes for performing ERCP in children who weigh at least 10 kg. We recommend the placement of 12F or 16F percutaneous endoscopic gastrostomy tubes in children who weigh less than 50 kg.

Procedural wound geometry and blood flow generation for medical training simulators

NASA Astrophysics Data System (ADS)

Aras, Rifat; Shen, Yuzhong; Li, Jiang

2012-02-01

Efficient application of wound treatment procedures is vital in both emergency room and battle zone scenes. In order to train first responders for such situations, physical casualty simulation kits, which are composed of tens of individual items, are commonly used. Similar to any other training scenarios, computer simulations can be effective means for wound treatment training purposes. For immersive and high fidelity virtual reality applications, realistic 3D models are key components. However, creation of such models is a labor intensive process. In this paper, we propose a procedural wound geometry generation technique that parameterizes key simulation inputs to establish the variability of the training scenarios without the need of labor intensive remodeling of the 3D geometry. The procedural techniques described in this work are entirely handled by the graphics processing unit (GPU) to enable interactive real-time operation of the simulation and to relieve the CPU for other computational tasks. The visible human dataset is processed and used as a volumetric texture for the internal visualization of the wound geometry. To further enhance the fidelity of the simulation, we also employ a surface flow model for blood visualization. This model is realized as a dynamic texture that is composed of a height field and a normal map and animated at each simulation step on the GPU. The procedural wound geometry and the blood flow model are applied to a thigh model and the efficiency of the technique is demonstrated in a virtual surgery scene.

Virtual reality colonoscopy simulation: a compulsory practice for the future colonoscopist?

PubMed

Ahlberg, G; Hultcrantz, R; Jaramillo, E; Lindblom, A; Arvidsson, D

2005-12-01

As for any manual procedure, the learning curves for medical interventions can have undesirable phases, occurring mostly in the early experience of applying a technique. There have been impressive advances in endoscopic procedures during recent years, and there is an emerging trend that the number of procedures is increasing in parallel with these. In addition, the introduction of screening programs for colorectal cancer will also increase the numbers of procedures needed. Recent developments in medical simulation seem promising with regard to the possibility of "training out" undesirable parts of the learning curve outside the operating room. The aim of this study was to investigate whether the use of the AccuTouch flexible endoscopy simulator improves the early part of the learning curve in colonoscopy training. 12 endoscopy trainees, 10 surgeons and two medical gastroenterologists, all with experience in gastroscopy but with no specific colonoscopy experience, were randomly assigned to either simulator training or to a control group. They all received the same theoretical study package and the training group practiced with the AccuTouch colonoscopy simulator until a predefined expert level of performance was reached. All trainees performed their first ten individual colonoscopies described in detail in a separate protocol. Trainees in the simulator-trained group performed significantly better (P=0.0011) and managed to reach the cecum in 52% of their cases (vs. 19% in the control group), and were 4.53 times more likely to succeed compared with the controls. Additionally, there was a significantly shorter procedure time and less patient discomfort in the hands of the simulator-trained group. Skills acquired using the AccuTouch simulator transfer well into the clinical colonoscopy environment. The results of this trial clearly support the plan to integrate simulator training into endoscopic education curricula.

Operation Windshield and the simplification of emergency management.

PubMed

Andrews, Michael

2016-01-01

Large, complex, multi-stakeholder exercises are the culmination of years of gradual progression through a comprehensive training and exercise programme. Exercises intended to validate training, refine procedures and test processes initially tested in isolation are combined to ensure seamless response and coordination during actual crises. The challenges of integrating timely and accurate situational awareness from an array of sources, including response agencies, municipal departments, partner agencies and the public, on an ever-growing range of media platforms, increase information management complexity in emergencies. Considering that many municipal emergency operations centre roles are filled by staff whose day jobs have little to do with crisis management, there is a need to simplify emergency management and make it more intuitive. North Shore Emergency Management has accepted the challenge of making emergency management less onerous to occasional practitioners through a series of initiatives aimed to build competence and confidence by making processes easier to use as well as by introducing technical tools that can simplify processes and enhance efficiencies. These efforts culminated in the full-scale earthquake exercise, Operation Windshield, which preceded the 2015 Emergency Preparedness and Business Continuity Conference in Vancouver, British Columbia.

Endotracheal intubation: application of virtual reality to emergency medical services education.

PubMed

Mayrose, James; Myers, Jeffrey W

2007-01-01

Virtual reality simulation has been identified as an emerging educational tool with significant potential to enhance teaching of residents and students in emergency clinical encounters and procedures. Endotracheal intubation represents a critical procedure for emergency care providers. Current methods of training include working with cadavers and mannequins, which have limitations in their representation of reality, ethical concerns, and overall availability with access, cost, and location of models. This paper will present a human airway simulation model designed for tracheal intubation and discuss the aspects that lend itself to use as an educational tool. This realistic and dynamic model is used to teach routine intubations, while future models will include more difficult airway management scenarios. This work provides a solid foundation for future versions of the intubation simulator, which will incorporate two haptic devices to allow for simultaneous control of the laryngoscope blade and endotracheal tube.

Emergent conditional relations in a Go/No-Go procedure: figure-ground and stimulus-position compound relations.

PubMed

Debert, Paula; Huziwara, Edson M; Faggiani, Robson Brino; De Mathis, Maria Eugênia Simões; McIlvane, William J

2009-09-01

Past research has demonstrated emergent conditional relations using a go/no-go procedure with pairs of figures displayed side-by-side on a computer screen. The present study sought to extend applications of this procedure. In Experiment 1, we evaluated whether emergent conditional relations could be demonstrated when two-component stimuli were displayed in figure-ground relationships-abstract figures displayed on backgrounds of different colors. Five normally capable adults participated. During training, each two-component stimulus was presented successively. Responses emitted in the presence of some stimulus pairs (A1B1, A2B2, A3B3, B1C1, B2C2 and B3C3) were reinforced, whereas responses emitted in the presence of other pairs (A1B2, A1B3, A2B1, A2B3, A3B1, A3B2, B1C2, B1C3, B2C1, B2C3, B3C1 and B3C2) were not. During tests, new configurations (AC and CA) were presented, thus emulating structurally the matching-to-sample tests employed in typical equivalence studies. All participants showed emergent relations consistent with stimulus equivalence during testing. In Experiment 2, we systematically replicated the procedures with stimulus compounds consisting of four figures (A1, A2, C1 and C2) and two locations (left - B1 and right - B2). All 6 normally capable adults exhibited emergent stimulus-stimulus relations. Together, these experiments show that the go/no-go procedure is a potentially useful alternative for studying emergent conditional relations when matching-to-sample is procedurally cumbersome or impossible to use.

Tele-mentored damage-control and emergency trauma surgery: A feasibility study using live-tissue models.

PubMed

Dawe, Philip; Kirkpatrick, Andrew; Talbot, Max; Beckett, Andrew; Garraway, Naisan; Wong, Heather; Hameed, Syed Morad

2018-05-01

Damage-control and emergency surgical procedures in trauma have the potential to save lives. They may occasionally not be performed due to clinician inexperience or lack of comfort and knowledge. Canadian Armed Forces (CAF) non-surgeon Medical Officers (MOs) participated in a live tissue training exercise. They received tele-mentoring assistance using a secure video-conferencing application on a smartphone/tablet platform. Feasibility of tele-mentored surgery was studied by measuring their effectiveness at completing a set series of tasks in this pilot study. Additionally, their comfort and willingness to perform studied procedures was gauged using pre- and post-study surveys. With no pre-procedural teaching, participants were able to complete surgical airway, chest tube insertion and resuscitative thoracotomy with 100% effectiveness with no noted complications. Comfort level and willingness to perform these procedures were improved with tele-mentoring. Participants felt that tele-mentored surgery would benefit their performance of resuscitative thoracotomy most. The use of tele-mentored surgery to assist non-surgeon clinicians in the performance of damage-control and emergency surgical procedures is feasible. More study is required to validate its effectiveness. Copyright © 2018 Elsevier Inc. All rights reserved.

Simulator Sickness During Emergency Procedures Training in a Helicopter Simulator: Age, Flight Experience, and Amount Learned

DTIC Science & Technology

2007-09-01

Aircrew Training Research Division, Human Resources Directorate. Smart, L. J ., Stoffregen, T. A ., & Bardy , B. G. (2002). Visually induced motion sickness...Aviation, Space, and Environmental Medicine, 60, 1043-1048. Benson, A . J . (1978). Motion sickness. In G. Dhenin & J . Ernsting (Eds.), Aviation Medicine...pp. 468-493). London: Tri-Med Books. Benson, A . J . (1988). Aetiological factors in simulator sickness. In AGARD, Motion cues in flight simulation and

Retrospective evaluation of urological admissions to emergency service of a training and research hospital.

PubMed

Topaktaş, Ramazan; Altın, Selçuk; Aydın, Cemil; Akkoç, Ali; Yılmaz, Yakup

2014-12-01

Many patients consult emergency services with urological complaints. The aim of this study was to investigate the epidemiology, clinical presentation and treatments of urological emergency cases in a training and research hospital. We retrospectively evaluated urological emergency patients referred to the emergency unit between July 2012 and July 2013 according to age, gender, affected organ, radiological imaging techniques and treatment. Among 141.844 emergency cases, 3.113 (2.19%) were urological emergencies and 53.2% of the patients were male (mean age: 49.1), and 46.8% of them were female (median age: 42.8). The most frequent illness was genitourinary infection constituting 41.2% of the cases followed by renal colic (36.9%). Among the urological emergencies 483 (15.5%) patients were hospitalized and 152 surgical operations were performed. The mostly performed procedure was the placement of a suprapubic catheter in 34 patients constituting (22.3%) of the cases. Totally eight patients were referred to another experienced health center due to different reasons. Most of the urological emergency patients do not require emergency surgical interventions however, timely identification and management of urological emergencies with in-depth clinical evaluation are important to prevent late complications. Therefore the doctors working in emergency services must be heedful of urological emergencies.

41 CFR 102-192.80 - How do we develop written security policies and plans?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION...) Operating procedures; (d) Plan to provide a visible mail screening operation; (e) Training mail center...) Managing threats; (h) Communications plan; (i) Occupant Emergency Plan (OEP); (j) Continuity of Operations...

14 CFR 135.345 - Pilots: Initial, transition, and upgrade ground training.

Code of Federal Regulations, 2014 CFR

2014-01-01

...; (9) Flight planning; (10) Each normal and emergency procedure; and (11) The approved Aircraft Flight... following, as applicable to their duties: (a) General subjects— (1) The certificate holder's flight locating...., flight controls, electrical, and hydraulic), other systems, as appropriate, principles of normal...

14 CFR 135.345 - Pilots: Initial, transition, and upgrade ground training.

Code of Federal Regulations, 2013 CFR

2013-01-01

...; (9) Flight planning; (10) Each normal and emergency procedure; and (11) The approved Aircraft Flight... following, as applicable to their duties: (a) General subjects— (1) The certificate holder's flight locating...., flight controls, electrical, and hydraulic), other systems, as appropriate, principles of normal...

14 CFR 135.345 - Pilots: Initial, transition, and upgrade ground training.

Code of Federal Regulations, 2012 CFR

2012-01-01

...; (9) Flight planning; (10) Each normal and emergency procedure; and (11) The approved Aircraft Flight... following, as applicable to their duties: (a) General subjects— (1) The certificate holder's flight locating...., flight controls, electrical, and hydraulic), other systems, as appropriate, principles of normal...

14 CFR 135.345 - Pilots: Initial, transition, and upgrade ground training.

Code of Federal Regulations, 2011 CFR

2011-01-01

...; (9) Flight planning; (10) Each normal and emergency procedure; and (11) The approved Aircraft Flight... following, as applicable to their duties: (a) General subjects— (1) The certificate holder's flight locating...., flight controls, electrical, and hydraulic), other systems, as appropriate, principles of normal...

14 CFR 135.345 - Pilots: Initial, transition, and upgrade ground training.

Code of Federal Regulations, 2010 CFR

2010-01-01

...; (9) Flight planning; (10) Each normal and emergency procedure; and (11) The approved Aircraft Flight... following, as applicable to their duties: (a) General subjects— (1) The certificate holder's flight locating...., flight controls, electrical, and hydraulic), other systems, as appropriate, principles of normal...

76 FR 39132 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-05

... objects or materials for a variety of purposes in research, industry, and other fields. The subparts cover specific requirements for obtaining a license or license exemption, design and performance criteria for... training, written operating and emergency procedures, personnel monitoring, radiation surveys, inspection...

Associative symmetry in a spatial sample-response paradigm

PubMed Central

Vasconcelos, Marco; Urcuioli, Peter J.

2011-01-01

Symmetry has been difficult to observe in nonhumans mainly because they seem to perceive stimuli as a conjunction of visual, spatial, and temporal characteristics. When such characteristics are controlled, symmetry does emerge in nonhumans (cf. Frank and Wasserman 2005; Urcuioli 2008). Recently, however, Garcia and Benjumea (2006) reported symmetry in pigeons without controlling for temporal order. The present experiments explored their paradigm and the ingredients for their success. Experiments 1 and 2 sought to replicate their findings and to examine different symmetry measures. We found evidence for symmetry using non-reinforced choice probe tests, a latency-based test, and a reinforced consistent versus inconsistent manipulation. Experiment 3 adapted their procedure to successive matching to evaluate their contention that a choice between at least two comparisons is necessary for symmetry to emerge. Contrary to their prediction, symmetry was observed following go/no-go training. Our results confirm Garcia and Benjumea’s findings, extend them to other test and training procedures, and once again demonstrate symmetry in the absence of language. PMID:21238554

Reflections on work as done (WAD) and work as imagined (WAI) in an emergency response organization: A study on firefighters training exercises.

PubMed

Carvalho, Paulo Victor R de; Righi, Angela W; Huber, Gilbert J; Lemos, Caio de F; Jatoba, Alessandro; Gomes, José Orlando

2018-04-01

Emergency response organizations need to be resilient to cope with escalating events resulting from dynamic, unexpected, or complex situations. In Brazil, the Firefighter Corps are military hierarchal organizations with a culture based on fixed structures, well defined norms and procedures. These push against innovations which are necessary to be resilient. This research describes how firefighter captains in the 30-35-year age range managed an emergency response escalation in light of standard operating procedures (SOPs) during a training exercise. The study used ethnographic methods to find and discuss gaps between the instructions and the activities carried out during the exercise, highlighting the differences between work as done (WAD) and work as imagined (WAI), as it was instantiated in the SOP prescriptions. The aim was to produce reflections on WAI and WAD as a way to raise awareness of the need for a cultural change toward resilience in firefighter organizations. This was achieved through firefighter engagement with a comprehensive visualization of the analysis results which afforded easy interaction between the experts, the data, and the researchers. Copyright © 2017 Elsevier Ltd. All rights reserved.

Assessment of capacity for surgery, obstetrics and anaesthesia in 17 Ghanaian hospitals using a WHO assessment tool.

PubMed

Choo, Shelly; Perry, Henry; Hesse, Afua A J; Abantanga, Francis; Sory, Elias; Osen, Hayley; Fleischer-Djoleto, Charles; Moresky, Rachel; McCord, Colin W; Cherian, Meena; Abdullah, Fizan

2010-09-01

To survey infrastructure characteristics, personnel, equipment and procedures of surgical, obstetric and anaesthesia care in 17 hospitals in Ghana. The assessment was completed by WHO country offices using the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical Care, which surveyed infrastructure, human resources, types of surgical interventions and equipment in each facility. Overall, hospitals were well equipped with general patient care and surgical supplies. The majority of hospitals had a basic laboratory (100%), running water (94%) and electricity (82%). More than 75% had the basic supplies needed for general patient care and basic intra-operative care, including sterilization. Almost all hospitals were able to perform major surgical procedures such as caesarean sections (88%), herniorrhaphy (100%) and appendectomy (94%), but formal training of providers was limited: a few hospitals had a fully qualified surgeon (29%) or obstetrician (36%) available. The greatest barrier to improving surgical care at district hospitals in Ghana is the shortage of adequately trained medical personnel for emergency and essential surgical procedures. Important future steps include strengthening their number and qualifications. © 2010 Blackwell Publishing Ltd.

Cognitive rehabilitation in schizophrenia: a quantitative analysis of controlled studies.

PubMed

Krabbendam, Lydia; Aleman, André

2003-09-01

Cognitive rehabilitation is now recognized as an important tool in the treatment of schizophrenia, and findings in this area are emerging rapidly. There is a need for a systematic review of the effects of the different training programs. To review quantitatively the controlled studies on cognitive rehabilitation in schizophrenia for the effect of training on performance on tasks other than those practiced in the training procedure. A meta-analysis was conducted on 12 controlled studies of cognitive rehabilitation in schizophrenia taking into account the effects of type of rehabilitation approach (rehearsal or strategy learning) and duration of training. The mean weighted effect size was 0.45, with a 95% confidence interval from 0.26 to 0.64. Effect sizes differed slightly, depending on rehabilitation approach, in favor of strategy learning, but this difference did not reach statistical significance. Duration of training did not influence effect size. Cognitive rehabilitation can improve task performance in patients with schizophrenia and this effect is apparent on tasks outside those practiced during the training procedure. Future studies should include more real-world outcomes and perform longitudinal evaluations.

Stabilization and treatment of dental avulsions and fractures by emergency physicians using just-in-time training.

PubMed

McIntosh, Mark S; Konzelmann, Jason; Smith, Jeffrey; Kalynych, Colleen J; Wears, Robert L; Schneider, Howard; Wylie, Todd; Kaminski, Anne; Matar-Joseph, Madeline

2009-10-01

The objective of this investigation is to use a dental simulation model to compare splinting and bandaging methods for managing tooth avulsions and fractures, as measured by dentist evaluators for quality and time to complete each stabilization procedure. This was a randomized crossover study comparing 3 splinting techniques for managing a traumatically avulsed tooth (periodontal pack, wire, and bondable reinforcement ribbon) and 2 bandage techniques for managing a fractured tooth (calcium hydroxide paste and light-cured composite). After viewing a Just-in-Time training video, a convenience sample of emergency physicians performed the 5 stabilization techniques on dental models containing extracted teeth embedded in clay to simulate a segment of the human dentition. Data collected included time to complete each procedure, the evaluation of dentists about whether the procedure was performed satisfactorily or unsatisfactorily, and the ranking of dentists' and participants' preferred technique. Twenty-five emergency physicians participated in the study: 17 residents, 2 pediatric emergency medicine fellows, and 6 attending physicians. Reported median time, as well as minimum and maximum times to complete each splinting technique for an avulsed tooth, was as follows: periodontal pack 4.4 minutes (2.5 to 6.5 minutes), wire 8.6 minutes (5.8 to 12.9 minutes), and bondable reinforcement ribbon 8.9 minutes (5.6 to 15 minutes). Median time (and minimum and maximum times) to complete each protective bandaging technique for a fractured tooth was calcium hydroxide paste 4.6 minutes (3 to 9.6 minutes) and light-cured composite 7.1 minutes (5.5 to 14.1 minutes). When asked to choose a preferred splinting and bandaging technique according to the performance of the physicians, the dentists chose the bondable reinforcement ribbon 96% (24/25) and the light-cured composite 100% (25/25) of the time. Study participants had no measurable or agreeable preference for a particular splinting or bandaging technique. The results of this study suggest that of the stabilization procedures completed by emergency physicians, dentists preferred the bondable reinforcement ribbon for managing an avulsed tooth and the light-cured composite technique for managing a fractured tooth over the commonly taught and more frequently used procedures in emergency medicine.

Obstetric training in Emergency Medicine: a needs assessment.

PubMed

Janicki, Adam James; MacKuen, Courteney; Hauspurg, Alisse; Cohn, Jamieson

2016-01-01

Identification and management of obstetric emergencies is essential in emergency medicine (EM), but exposure to pregnant patients during EM residency training is frequently limited. To date, there is little data describing effective ways to teach residents this material. Current guidelines require completion of 2 weeks of obstetrics or 10 vaginal deliveries, but it is unclear whether this instills competency. We created a 15-item survey evaluating resident confidence and knowledge related to obstetric emergencies. To assess confidence, we asked residents about their exposure and comfort level regarding obstetric emergencies and eight common presentations and procedures. We assessed knowledge via multiple-choice questions addressing common obstetric presentations, pelvic ultrasound image, and cardiotocography interpretation. The survey was distributed to residency programs utilizing the Council of Emergency Medicine Residency Directors (CORD) listserv. The survey was completed by 212 residents, representing 55 of 204 (27%) programs belonging to CORD and 11.2% of 1,896 eligible residents. Fifty-six percent felt they had adequate exposure to obstetric emergencies. The overall comfort level was 2.99 (1-5 scale) and comfort levels of specific presentations and procedures ranged from 2.58 to 3.97; all increased moderately with postgraduate year (PGY) level. Mean overall percentage of items answered correctly on the multiple-choice questions was 58% with no statistical difference by PGY level. Performance on individual questions did not differ by PGY level. The identification and management of obstetric emergencies is the cornerstone of EM. We found preliminary evidence of a concerning lack of resident comfort regarding obstetric conditions and knowledge deficits on core obstetrics topics. EM residents may benefit from educational interventions to increase exposure to these topics.

Astronaut Curtis Brown on flight deck mockup during training

NASA Image and Video Library

1994-06-23

S94-40091 (23 June 1994) --- Astronaut Curtis L. Brown mans the pilot's station of a Shuttle trainer during a rehearsal of procedures to be followed during launch and entry phases of the scheduled November flight of STS-66. This rehearsal, held in the Crew Compartment Trainer (CCT) of the Johnson Space Center's (JSC) Shuttle Mockup and Integration Laboratory, was followed by a training session on emergency egress procedures. Making his second flight in space, Brown will join four other NASA astronauts and a European mission specialist for a week and a half aboard the Space Shuttle Atlantis in Earth-orbit in support of the Atmospheric Laboratory for Applications and Science (ATLAS-3).

Astronaut Jean-Francois Clervoy in middeck during launch/entry training

NASA Image and Video Library

1994-06-23

S94-40074 (23 June 1994) --- Astronaut Jean-Francois Clervoy, STS-66 international mission specialist, sits securely on a collapsible seat on the middeck of a Shuttle trainer during a rehearsal of procedures to be followed during launch and entry phases of his scheduled November flight. This rehearsal, held in the crew compartment trainer of the Johnson Space Center's (JSC) Shuttle Mockup and Integration Laboratory, was followed by a training session on emergency egress procedures. Clervoy, a European astronaut, will join five NASA astronauts for a week and a half aboard the Space Shuttle Atlantis in Earth-orbit in support of the Atmospheric Laboratory for Applications and Science (ATLAS-3).

Astronaut Ellen Ochoa in middeck during launch/entry training

NASA Image and Video Library

1994-06-23

S94-40061 (23 June 1994) --- Secured in a collapsible seat on the middeck of a Shuttle trainer, astronaut Ellen Ochoa, payload commander, participates in a rehearsal of procedures to be followed during launch and entry phases of the scheduled November flight of STS-66. This rehearsal, held in the crew compartment trainer of the Johnson Space Center's (JSC) Shuttle Mockup and Integration Laboratory, was followed by a training session on emergency egress procedures. In November Ochoa will join four other NASA astronauts and a European mission specialist for a week and a half aboard the Space Shuttle Atlantis in Earth-orbit in support of the Atmospheric Laboratory for Applications and Science (ATLAS-3).

Astronaut Scott Parazynski during egress training

NASA Image and Video Library

1994-06-23

S94-40079 (23 June 1994) --- Astronaut Scott E. Parazynski looks at fellow STS-66 mission specialist Joseph R. Tanner, (partially visible in foreground) during a rehearsal of procedures to be followed during launch and entry phases of the their scheduled November flight. This rehearsal, held in the Crew Compartment Trainer (CCT) of the Johnson Space Center's (JSC) Shuttle Mockup and Integration Laboratory, was followed by a training session on emergency egress procedures. In November, Parazynski and Tanner will join three other NASA astronauts and a European mission specialist for a week and a half aboard the Space Shuttle Atlantis in Earth-orbit in support of the Atmospheric Laboratory for Applications and Science (ATLAS-3).

Training of midwives in advanced obstetrics in Liberia.

PubMed

Dolo, Obed; Clack, Alice; Gibson, Hannah; Lewis, Naomi; Southall, David P

2016-05-01

The shortage of doctors in Liberia limits the provision of comprehensive emergency obstetric and neonatal care. In a pilot project, two midwives were trained in advanced obstetric procedures and in the team approach to the in-hospital provision of advanced maternity care. The training took two years and was led by a Liberian consultant obstetrician with support from international experts. The training took place in CB Dunbar Maternity Hospital. This rural hospital deals with approximately 2000 deliveries annually, many of which present complications. In February 2015 there were just 117 doctors available in Liberia. In the first 18 months of training, the trainees were involved with 236 caesarean sections, 35 manual evacuations of products of conception, 25 manual removals of placentas, 21 vaginal breech deliveries, 14 vacuum deliveries, four repairs of ruptured uteri, the management of four cases of shoulder dystocia, three hysterectomies, two laparotomies for ruptured ectopic pregnancies and numerous obstetric ultrasound examinations. The trainees also managed 41 cases of eclampsia or severe pre-eclampsia, 25 of major postpartum haemorrhage and 21 of shock. Although, initially they only assisted senior doctors, the trainees subsequently progressed from direct to indirect supervision and then to independent management. To compensate for a shortage of doctors able to undertake comprehensive emergency obstetric and neonatal care, experienced midwives can be taught to undertake advanced obstetric care and procedures. Their team work with doctors can be particularly valuable in rural hospitals in resource-poor countries.

Qualitative evaluation of just-in-time simulation-based learning: the learners' perspective.

PubMed

Kamdar, Gunjan; Kessler, David O; Tilt, Lindsey; Srivastava, Geetanjali; Khanna, Kajal; Chang, Todd P; Balmer, Dorene; Auerbach, Marc

2013-02-01

Just-in-time training (JITT) is an educational strategy where training occurs in close temporal proximity to a clinical encounter. A multicenter study evaluated the impact of simulation-based JITT on interns' infant lumbar puncture (LP) success rates. Concurrent with this multicenter study, we conducted a qualitative evaluation to describe learner perceptions of this modality of skills training. Eleven interns from a single institution participated in a face-to-face semistructured interview exploring their JITT experience. Interviews were audio-recorded and transcribed. Two investigators reviewed the transcripts, assigned codes to the data, and categorized the codes. Categories were modified by 4 emergency physicians. As a means of data triangulation, we performed focus groups at a second institution. Benefits of JITT included review of anatomic landmarks, procedural rehearsal, and an opportunity to ask questions. These perceived benefits improved confidence with infant LP. Deficits of the training included lack of mannequin fidelity and unrealistic context when compared with an actual LP. An unexpected category, which emerged from our analysis, was that of barriers to JITT performance. Barriers included lack of time in a busy clinical setting and various instructor factors. The focus group findings confirmed and elaborated the benefits and deficits of JITT and the barriers to JITT performance. Just-in-time training improved procedural confidence with infant LP, but work place busyness and instructor lack of support or unawareness were barriers to JITT performance. Optimal LP JITT would occur with improved contextual fidelity. More research is needed to determine optimal training strategies that are effective for the learner and maximize clinical outcomes for the patient.

Medical Considerations for Multiple-Handicapped Children in the Public Schools

ERIC Educational Resources Information Center

Bryan, Elizabeth; And Others

1978-01-01

The authors discuss concerns and practical suggestions involved in the education of multiply handicapped children in the following problem areas: first aid, emergency care and disaster planning; sanitation; environment; safety in routine and supplemental activities; therapy procedures; and staff protection, training, orientation, and special…

30 CFR 57.4362 - Underground rescue and firefighting operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Fire Prevention and Control Firefighting Procedures/alarms/drills § 57.4362 Underground rescue and firefighting operations. Following evacuation of a mine in a fire emergency, only persons wearing and trained...

Principles of hospital disaster management: an integrated and multidisciplinary approach.

PubMed

Hendrickx, C; Hoker, S D; Michiels, G; Sabbe, M B

Principles of hospital disaster management: an integrated and multidisciplinary approach. Hospitals play an important role during a disaster response, and are also at risk for internal incidents. We propose an integrated and multidisciplinary approach towards hospital disaster management and preparedness. In addition to response strategies, much attention is given to risk assessment and preparedness in the pre-incident phase and to business continuity planning (BCP) in the post-incident phase. It is essential to train key players and all personnel to understand the Hospital Incident Management System (HIMS) and to perform specific emergency procedures. All emergency procedures should be grounded in evidence-based practice resulting from essential disaster response research.

Human Factors in Training - Space Medicine Proficiency Training

NASA Technical Reports Server (NTRS)

Connell, Erin; Arsintescu, Lucia

2009-01-01

The early Constellation space missions are expected to have medical capabilities very similar to those currently on the Space Shuttle and International Space Station (ISS). For Crew Exploration Vehicle (CEV) missions to ISS, medical equipment will be located on ISS, and carried into CEV in the event of an emergency. Flight Surgeons (FS) on the ground in Mission Control will be expected to direct the Crew Medical Officer (CMO) during medical situations. If there is a loss of signal and the crew is unable to communicate with the ground, a CMO would be expected to carry out medical procedures without the aid of a FS. In these situations, performance support tools can be used to reduce errors and time to perform emergency medical tasks. Work on medical training has been conducted in collaboration with the Medical Training Group at the Space Life Sciences Directorate and with Wyle Lab which provides medical training to crew members, Biomedical Engineers (BMEs), and to flight surgeons under the JSC Space Life Sciences Directorate s Bioastronautics contract. The space medical training work is part of the Human Factors in Training Directed Research Project (DRP) of the Space Human Factors Engineering (SHFE) Project under the Space Human Factors and Habitability (SHFH) Element of the Human Research Program (HRP). Human factors researchers at Johnson Space Center have recently investigated medical performance support tools for CMOs on-orbit, and FSs on the ground, and researchers at the Ames Research Center performed a literature review on medical errors. The work proposed for FY10 continues to build on this strong collaboration with the Space Medical Training Group and previous research. This abstract focuses on two areas of work involving Performance Support Tools for Space Medical Operations. One area of research building on activities from FY08, involved the feasibility of just-in-time (JIT) training techniques and concepts for real-time medical procedures. In Phase 1, preliminary feasibility data was gathered for two types of prototype display technologies: a hand-held PDA, and a Head Mounted Display (HMD). The PDA and HMD were compared while performing a simulated medical procedure using ISS flight-like medical equipment. Based on the outcome of Phase 1, including data on user preferences, further testing was completed using the PDA only. Phase 2 explored a wrist-mounted PDA, and compared it to a paper cue card. For each phase, time to complete procedures, errors, and user satisfaction ratings were captured.

Trial by Fire (and Tornado) Taught Us to Plan for Crises.

ERIC Educational Resources Information Center

Caylor, Mary Jane

1991-01-01

Based on Huntsville (Alabama) schools' experience with a devastating fire, the superintendent later ensured adequate fire insurance coverage, promoted regular fire drills, and developed an emergency response plan that delineated staff responsibilities, communication modes, and training and updating procedures. The plan served the district well…

Indirect Measures of Learning Transfer between Real and Virtual Environments

ERIC Educational Resources Information Center

Garrett, Michael; McMahon, Mark

2013-01-01

This paper reports on research undertaken to determine the effectiveness of a 3D simulation environment used to train mining personnel in emergency evacuation procedures, designated the Fires in Underground Mines Evacuation Simulator (FUMES). Owing to the operational constraints of the mining facility, methods for measuring learning transfer were…

Establishing Verbal Repertoires in Children with Autism Using Function-Based Video Modeling

ERIC Educational Resources Information Center

Plavnick, Joshua B.; Ferreri, Summer J.

2011-01-01

Previous research suggests that language-training procedures for children with autism might be enhanced following an assessment of conditions that evoke emerging verbal behavior. The present investigation examined a methodology to teach recognizable mands based on environmental variables known to evoke participants' idiosyncratic communicative…

Pediatric emergency care in europe: a descriptive survey of 53 tertiary medical centers.

PubMed

Mintegi, Santiago; Shavit, Itai; Benito, Javier

2008-06-01

To examine determinants of quality of care provided by pediatric emergency departments (PEDs) in tertiary European centers. Analysis of questionnaires was sent to directors of PEDs. Questionnaires were sent through the pediatric research group of the European Society for Emergency Medicine. Three major descriptive categories were included in a 28-point questionnaire: institution's pediatric inpatient capabilities, scope of services, and medical staff education and structure. Sixty-five questionnaires were completed in full. Fifty-three tertiary medical centers from 14 countries were included in the study. In 86.8% of these institutions, the PED is separated from the adult emergency department; 91% have a pediatric intensive care unit, and 72% have an in-patient pediatric trauma service. Eighty-eight percent of the PEDs have incorporated triage protocols. Social service was not available in 17% of the departments. Sedation for painful procedures is provided by the staff in 77% of the PEDs. Only 24% of the PED medical directors have been formally trained in pediatric emergency medicine. In 17% of the departments, there is a 24-hour 7-day residents' coverage with no attending pediatrician or pediatric emergency medicine-trained physician. According to this pilot study, the basic services provided by tertiary PEDs in Europe appear to be appropriate. Physicians training level and staffing may not be adequate to achieve optimal patient outcome.

Emergency medical support system for extravehicular activity training held at weightless environment test building (WETS) of the Japan Aerospace Exploration Agency (JAXA) : future prospects and a look back over the past decade.

PubMed

Nakajima, Isao; Tachibana, Masakazu; Ohashi, Noriyoshi; Imai, Hiroshi; Asari, Yasushi; Matsuyama, Shigenori

2011-12-01

The Japan Aerospace Exploration Agency (JAXA) provides extravehicular activity (EVA) training to astronauts in a weightless environment test building (WETS) located in Tsukuba City. For EVA training, Tsukuba Medial Center Hospital (TMCH) has established an emergency medical support system, serving as operations coordinator. Taking the perspective of emergency physicians, this paper provides an overview of the medical support system and examines its activities over the past decade as well as future issues. Fortunately, no major accident has occurred during the past 10 years of NBS. Minor complaints (external otitis, acute otitis media, transient dizziness, conjunctival inflammation, upper respiratory inflammation, dermatitis, abraded wounds, etc.) among the support divers have been addressed onsite by attending emergency physicians. Operations related to the medical support system at the WETS have proceeded smoothly for the former NASDA and continue to proceed without event for JAXA, providing safe, high-quality emergency medical services. If an accident occurs at the WETS, transporting the patient by helicopter following initial treatment by emergency physicians can actually exacerbate symptoms, since the procedure exposes a patient who was recently within a hyperbaric environment to the low-pressure environment involved in air transportation. If a helicopter is used, the flight altitude should be kept as low as possible by taking routes over the river.

The effect of paramedic training on pre-hospital trauma care (EPPTC-study): a study protocol for a prospective semi-qualitative observational trial

PubMed Central

2014-01-01

Background Accidents are the leading cause of death in adults prior to middle age. The care of severely injured patients is an interdisciplinary challenge. Limited evidence is available concerning pre-hospital trauma care training programs and the advantage of such programs for trauma patients. The effect on trauma care procedures or on the safety of emergency crews on the scene is limited; however, there is a high level of experience and expert opinion. Methods I – Video-recorded case studies are the basis of an assessment tool and checklist being developed to verify the results of programs to train participants in the care of seriously injured patients, also known as “objective structured clinical examination” (OSCE). The timing, completeness and quality of the individual measures are assessed using appropriate scales. The evaluation of team communication and interaction will be analyzed with qualitative methods and quantified and verified by existing instruments (e.g. the Clinical Team Scale). The developed assessment tool is validated by several experts in the fields of trauma care, trauma research and medical education. II a) In a German emergency medical service, the subjective assessment of paramedics of their pre-hospital care of trauma patients is evaluated at three time points, namely before, immediately after and one year after training. b) The effect of a standardized course concept on the quality of documentation in actual field operations is determined based on three items relevant to patient safety before and after the course. c) The assessment tool will be used to assess the effect of a standardized course concept on procedures and team communication in pre-hospital trauma care using scenario-based case studies. Discussion This study explores the effect of training on paramedics. After successful study completion, further multicenter studies are conceivable, which would evaluate emergency-physician staffed teams. The influence on the patients and prehospital measures should be assessed based on a retrospective analysis of the emergency room data. Trials registration German Clinical Trials Register, ID DRKS00004713. PMID:24528532

Human Factors and ISS Medical Systems: Highlights of Procedures and Equipment Findings

NASA Technical Reports Server (NTRS)

Byrne, V. E.; Hudy, C.; Smith, D.; Whitmore, M.

2005-01-01

As part of the Space Human Factors Engineering Critical Questions Roadmap, a three year Technology Development Project (TDP) was funded by NASA Headquarters to examine emergency medical procedures on ISS. The overall aim of the emergency medical procedures project was to determine the human factors issues in the procedures, training, communications and equipment, and to recommend solutions that will improve the survival rate of crewmembers in the event of a medical emergency. Currently, each ISS crew remains on orbit for six month intervals. As there is not standing requirement for a physician crewmember, during such time, the maintenance of crew health is dependant on individual crewmembers. Further, in the event of an emergency, crew will need to provide prolonged maintenance care, as well as emergency treatment, to an injured crewmember while awaiting transport to Earth. In addition to the isolation of the crew, medical procedures must be carried out within the further limitations imposed by the physical environment of the space station. For example, in order to administer care on ISS without the benefit of gravity, the Crew Medical Officers (CMOs) must restrain the equipment required to perform the task, restrain the injured crewmember, and finally, restrain themselves. Both the physical environment and the physical space available further limit the technology that can be used onboard. Equipment must be compact, yet able to withstand high levels of radiation and function without gravity. The focus here is to highlight the human factors impacts from our three year project involving the procedures and equipment areas that have been investigated and provided valuable to ISS and provide groundwork for human factors requirements for medical applications for exploration missions.

Competence in pediatric urology upon graduation from residency: perceptions of residents, program directors and pediatric urologists.

PubMed

Mickelson, Jennifer J; Macneily, Andrew E; Samarasekera, Dinesh; Beiko, Darren; Afshar, Kourosh

2008-06-01

We aimed to clarify the scope of pediatric urological procedures that Canadian urology residents are perceived to be competent to perform upon graduation. We conducted a survey from April 2005 to June 2006 of urology residency program directors (UPDs), senior urology residents (SURs) and Pediatric Urologists of Canada (PUC) members from all 12 Canadian training programs. Questions focused on which of 23 pediatric urological procedures the 3 study groups perceived urology residents would be competent to perform upon completion of residency without further fellowship training. Procedures were based on the "A," "B" and "C" lists of procedures (least complex to most complex) as outlined in the Royal College of Physicians and Surgeons of Canada Objectives of Training in Urology. Response rates were 12/12 (100%), 41/53 (77%) and 17/23 (74%) for UPDs, SURs and PUC members, respectively. Average exposure to pediatric urology during residency was 5.4 (range 3-9) months and considered sufficient by 75% of UPDs and 69% of SURs, but only 41% of PUC members (p = 0.05). Overall, the 3 groups disagreed on the level of competence for performing level "A" and "B" procedures, with significant disagreement between PUC members and UPDs as well as SURs (p < 0.005). PUC members perceive Canadian urology residents' exposure to pediatric urology as insufficient and their competence for procedures of low to moderate complexity as inadequate. Further investigation regarding exposure to and competence in other emerging subspecialty spheres of urology may be warranted. Ongoing assessment of the objectives for training in pediatric urology is required.

The development and implementation of cockpit resource management in UAL recurrent training

NASA Technical Reports Server (NTRS)

Shroyer, David H.

1987-01-01

Line Oriented Flight Training (LOFT) for United Airlines started in 1976. At that time it was basically no more than a line-simulated training function conducted in a full-mission simulator with no attention or stress on its human factor content. Very soon after the implementation of the LOFT program concerns were voiced about certain crew behavioral situations they were observing in the flight crew's execution of cockpit duties. These duties involved emergency procedures as well as irregular and normal procedures and situations. It was evident that new information was surfacing concerning crew interaction, or its lack thereof, in the cockpit and its effect on satisfactory performance. These observations naturally raised the question of how this information translated into the safety of aircraft operations. A training system had to be repetitive, the crew interactive, and the training had to be conducted under the crew concept. The foundation had to have two other factors: (1) it was necessary to have adequate human factor content, and (2) an advanced state-of-the-art simulator and appropriate electronic devices were required. These concepts are further discussed.

Higher surgical training opportunities in the general hospital setting; getting the balance right.

PubMed

Robertson, I; Traynor, O; Khan, W; Waldron, R; Barry, K

2013-12-01

The general hospital can play an important role in training of higher surgical trainees (HSTs) in Ireland and abroad. Training opportunities in such a setting have not been closely analysed to date. The aim of this study was to quantify operative exposure for HSTs over a 5-year period in a single institution. Analysis of electronic training logbooks (over a 5-year period, 2007-2012) was performed for general surgery trainees on the higher surgical training programme in Ireland. The most commonly performed adult and paediatric procedures per trainee, per year were analysed. Standard general surgery operations such as herniae (average 58, range 32-86) and cholecystectomy (average 60, range 49-72) ranked highly in each logbook. The most frequently performed emergency operations were appendicectomy (average 45, range 33-53) and laparotomy for acute abdomen (average 48, range 10-79). Paediatric surgical experience included appendicectomy, circumcision, orchidopexy and hernia/hydrocoele repair. Overall, the procedure most commonly performed in the adult setting was endoscopy, with each trainee recording an average of 116 (range 98-132) oesophagogastroduodenoscopies and 284 (range 227-354) colonoscopies. General hospitals continue to play a major role in the training of higher surgical trainees. Analysis of the electronic logbooks over a 5-year period reveals the high volume of procedures available to trainees in a non-specialist centre. Such training opportunities are invaluable in the context of changing work practices and limited resources.

STS-60 Cosmonauts in Weightless Environment Training Facility (WETF) training

NASA Image and Video Library

1993-01-07

S93-26022 (Feb 1993) --- Russian cosmonaut Sergei Krikalev maneuvers a small life raft during bailout training at the Johnson Space Center's (JSC) Weightless Environment Training Facility (WET-F). Shuttle crew members frequently utilize the 25-ft. deep pool to learn proper procedures to follow in the event of emergency egress from their Space Shuttle via the escape pole system. Krikalev is one of two cosmonauts in training for the STS-60 mission. One of the two will serve as primary payload specialist with the other filling an alternate's role. This pool and the facility in which it is housed are titled the WET-F because they are also used by astronauts rehearsing both mission-specific and contingency extravehicular activities (EVA).

KSC-2009-3386

NASA Image and Video Library

2009-06-02

CAPE CANAVERAL, Fla. – STS-127 Pilot Doug Hurley drives the M-113 armored personnel carrier, which is part of the training on emergency egress procedures. The crew members of space shuttle Endeavour's STS-127 mission are taking turns driving the M-113, which will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is at NASA's Kennedy Space Center for a launch dress rehearsal called the terminal countdown demonstration test, or TCDT, which includes the emergency egress training and equipment familiarization. The STS-127 mission is the final of three flights dedicated to the assembly of the Japanese Kibo laboratory complex. Endeavour's launch is targeted for June 13. Photo credit: NASA/Kim Shiflett

KSC-2009-3384

NASA Image and Video Library

2009-06-02

CAPE CANAVERAL, Fla. – STS-127 Commander Mark Polansky takes his turn driving the M-113 armored personnel carrier, which is part of the training on emergency egress procedures. The crew members of space shuttle Endeavour's STS-127 mission are taking turns driving the M-113. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is at NASA's Kennedy Space Center for a launch dress rehearsal called the terminal countdown demonstration test, or TCDT, which includes the emergency egress training and equipment familiarization. The STS-127 mission is the final of three flights dedicated to the assembly of the Japanese Kibo laboratory complex. Endeavour's launch is targeted for June 13. Photo credit: NASA/Kim Shiflett

KSC-2009-3380

NASA Image and Video Library

2009-06-02

CAPE CANAVERAL, Fla. – STS-127 Mission Specialist Tim Kopra practices driving the M-113 armored personnel carrier, which is part of the training on emergency egress procedures. Other crew members are seated behind him and will take their turns at driving the M-113. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is at NASA's Kennedy Space Center for a launch dress rehearsal called the terminal countdown demonstration test, or TCDT, which includes the emergency egress training and equipment familiarization. The STS-127 mission is the final of three flights dedicated to the assembly of the Japanese Kibo laboratory complex. Endeavour's launch is targeted for June 13. Photo credit: NASA/Kim Shiflett

The business of emergency medicine: a nonclinical curriculum proposal for emergency medicine residency programs.

PubMed

Falvo, Thomas; McKniff, Sueanne; Smolin, Gregory; Vega, David; Amsterdam, James T

2009-09-01

Over the course of their postgraduate medical education, physicians are expected not only to acquire an extensive knowledge of clinical medicine and sound procedural skills, but also to develop competence in their other professional roles as communicator, collaborator, mediator, manager, teacher, and patient advocate. Although the need for physicians to develop stronger service delivery skills is well recognized, residency programs may underemphasize formal training in nonclinical proficiencies. As a result, graduates can begin their professional careers with an incomplete understanding of the operation of health care systems and how to utilize system resources in the manner best suited to their patients' needs. This article proposes the content, educational strategy, and needs assessment for an academic program entitled The Business of Emergency Medicine (BOEM). Developed as an adjunct to the (predominantly) clinical content of traditional emergency medicine (EM) training programs, BOEM is designed to enhance the existing academic curricula with additional learning opportunities by which EM residents can acquire a fundamental understanding of the nonclinical skills of their specialty. (c) 2009 by the Society for Academic Emergency Medicine.

The 2015 Academic College of Emergency Experts in India's INDO-US Joint Working Group White Paper on Establishing an Academic Department and Training Pediatric Emergency Medicine Specialists in India

PubMed Central

Mahajan, Prashant; Batra, Prerna; Shah, Binita R; Saha, Abhijeet; Galwankar, Sagar; Aggrawal, Praveen; Hassoun, Ameer; Batra, Bipin; Bhoi, Sanjeev; Kalra, Om Prakash; Shah, Dheeraj

2015-01-01

The concept of pediatric emergency medicine (PEM) is virtually nonexistent in India. Suboptimally, organized prehospital services substantially hinder the evaluation, management, and subsequent transport of the acutely ill and/or injured child to an appropriate facility. Furthermore, the management of the ill child at the hospital level is often provided by overburdened providers who, by virtue of their training, lack experience in the skills required to effectively manage pediatric emergencies. Finally, the care of the traumatized child often requires the involvement of providers trained in different specialities, which further impedes timely access to appropriate care. The recent recognition of Doctor of Medicine (MD) in Emergency Medicine (EM) as an approved discipline of study as per the Indian Medical Council Act provides an unprecedented opportunity to introduce PEM as a formal academic program in India. PEM has to be developed as a 3-year superspeciality course (in PEM) after completion of MD/Diplomate of National Board (DNB) Pediatrics or MD/DNB in EM. The National Board of Examinations (NBE) that accredits and administers postgraduate and postdoctoral programs in India also needs to develop an academic program – DNB in PEM. The goals of such a program would be to impart theoretical knowledge, training in the appropriate skills and procedures, development of communication and counseling techniques, and research. In this paper, the Joint Working Group of the Academic College of Emergency Experts in India (JWG-ACEE-India) gives its recommendations for starting 3-year DM/DNB in PEM, including the curriculum, infrastructure, staffing, and training in India. This is an attempt to provide an uniform framework and a set of guiding principles to start PEM as a structured superspeciality to enhance emergency care for Indian children. PMID:26807394

STS-60 Cosmonauts in Weightless Environment Training Facility (WETF) training

NASA Image and Video Library

1993-01-07

S93-26021 (Feb 1993) --- Russian cosmonaut Sergei Krikalev maneuvers a small life raft during bailout training at the Johnson Space Center's (JSC) Weightless Environment Training Facility (WET-F). Two SCUBA-equipped divers assisted Krikalev in the STS-60 training exercise. Shuttle crew members frequently utilize the 25-ft. deep pool to learn proper procedures to follow in the event of emergency egress from their Space Shuttle via the escape pole system. Krikalev is one of two cosmonauts in training for the STS-60 mission. One of the two will serve as primary payload specialist with the other filling an alternate's role. This pool and the facility in which it is housed are titled the WET-F, because they are also used by astronauts rehearsing both mission-specific and contingency extravehicular activities (EVA).

[Management of ophthalmologic emergencies in general emergency departments: A retrospective multicenter study].

PubMed

Jeannin, A; Mouriaux, F; Mortemousque, B

2016-09-01

The growing shortage of working ophthalmologists makes it more difficult for the patient to access ophthalmological care, especially in an emergent context. These patients are thus taken to general emergency departments for ophthalmologic problems. To observe the epidemiological characteristics of ophthalmic patients in general emergency centers and question the emergency physicians on their practice of ophthalmology. A retrospective epidemiological study was conducted in the emergency departments of Rennes, Lorient and Saint-Brieuc over a period of three months. The demographic characteristics, diagnoses, examinations and procedures performed, opinions obtained from ophthalmologists and patient outcomes were studied. A qualitative study by online questionnaire was sent to the emergency physicians. Seven hundred and eighty-one patients were included, mainly men (68%) under 35 years (45%). The most frequent diagnosis was extra-ocular foreign body (32%). An ophthalmologist opinion was requested in 79% within 24hours. The online questionnaire was sent to 74 emergency physicians: 92% of them were willing to participate in additional training, 90% had sufficient means to practice ophthalmology in the emergency room. Emergency physicians could handle the most frequent ophthalmological emergencies, extra-ocular foreign bodies and minor trauma, with adapted material resources, autonomy for these conditions, and willingness for ophthalmologic training. Protocols could be proposed in order to optimize the care of these patients. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Evaluation of App-Based Serious Gaming as a Training Method in Teaching Chest Tube Insertion to Medical Students: Randomized Controlled Trial

PubMed Central

Ober, Julian; Walker, Tilman; Bergdolt, Christian; Friedrich, Mirco; Müller-Stich, Beat Peter; Forchheim, Franziska; Fischer, Christian; Schmidmaier, Gerhard; Tanner, Michael C

2018-01-01

Background The insertion of a chest tube should be as quick and accurate as possible to maximize the benefit and minimize possible complications for the patient. Therefore, comprehensive training and assessment before an emergency situation are essential for proficiency in chest tube insertion. Serious games have become more prevalent in surgical training because they enable students to study and train a procedure independently, and errors made have no effect on patients. However, up-to-date evidence regarding the effect of serious games on performance in procedures in emergency medicine remains scarce. Objective The aim of this study was to investigate the serious gaming approach in teaching medical students an emergency procedure (chest tube insertion) using the app Touch Surgery and a modified objective structural assessment of technical skills (OSATS). Methods In a prospective, rater-blinded, randomized controlled trial, medical students were randomized into two groups: intervention group or control group. Touch Surgery has been established as an innovative and cost-free app for mobile devices. The fully automatic software enables users to train medical procedures and afterwards self-assess their training effort. The module chest tube insertion teaches each key step in the insertion of a chest tube and enables users the meticulous application of a chest tube. In contrast, the module “Thoracocentesis” discusses a basic thoracocentesis. All students attended a lecture regarding chest tube insertion (regular curriculum) and afterwards received a Touch Surgery training lesson: intervention group used the module chest tube insertion and the control group used Thoracocentesis as control training. Participants’ performance in chest tube insertion on a porcine model was rated on-site via blinded face-to-face rating and via video recordings using a modified OSATS tool. Afterwards, every participant received an individual questionnaire for self-evaluation. Here, trainees gave information about their individual training level, as well as previous experiences, gender, and hobbies. Primary end point was operative performance during chest tube insertion by direct observance. Results A total of 183 students enrolled, 116 students participated (63.4%), and 21 were excluded because of previous experiences in chest tube insertion. Students were randomized to the intervention group (49/95, 52%) and control group (46/95, 48%). The intervention group performed significantly better than the control group (Intervention group: 38.0 [I50=7.0] points; control group: 30.5 [I50=8.0] points; P<.001). The intervention group showed significantly improved economy of time and motion (P=.004), needed significantly less help (P<.001), and was more confident in handling of instruments (P<.001) than the control group. Conclusions The results from this study show that serious games are a valid and effective tool in education of operative performance in chest tube insertion. We believe that serious games should be implemented in the surgical curriculum, as well as residency programs, in addition to traditional learning methods. Trial Registration German Clinical Trials Register (DRKS) DRKS00009994; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00009994 (Archived by Webcite at http://www.webcitation.org/6ytWF1CWg) PMID:29784634

Leading the rebirth of the rural obstetrician.

PubMed

Campbell, Alison M; Brown, James; Simon, David R; Young, Sari; Kinsman, Leigh

2014-12-11

To understand the factors influencing the decisions of rural general practitioners and GP registrars to practise obstetrics, and to understand the impact on these decisions of an innovative obstetric training and support program in the Gippsland region of Victoria. Qualitative approach using semistructured interviews conducted in July and August 2013 and inductive content analysis. Participants were identified from training records over the previous 5 years for the Gippsland GP obstetric training and support program. Two questions were posed during interviews: What challenges face rural GPs in practising obstetrics? What impact has the Gippsland GP obstetric program had on GP obstetric career decisions? Of 60 people invited to participate, 22 agreed. Interviews ranged in duration from 40 to 90 minutes. The major themes that emerged on the challenges facing rural GPs in practising obstetrics were isolation, work-life balance and safety. The major themes that emerged on the impact of the Gippsland GP obstetric program were professional support, structured training and effective leadership. Rural GP obstetricians are challenged by isolation, the impact of their job on work-life balance, and safety. The support, training and leadership offered by the Gippsland expanded obstetric training program helped doctors to deal with these challenges. The Gippsland model of training offers a template for GP obstetric procedural training programs for other rural settings.

Intelligent Pilot Aids for Flight Re-Planning in Emergencies

NASA Technical Reports Server (NTRS)

Pritchett, Amy R.

2002-01-01

Experimental studies were conducted with pilots to investigate the attributes of automation that would be appropriate for aiding pilots in emergencies. The specific focus of this year was on methods of mitigating automation brittleness. Brittleness occurs when the automatic system is used in circumstances it was not designed for, causing it to choose an incorrect action or make an inaccurate decision for the situation. Brittleness is impossible to avoid since it is impossible to predict every potential situation the automatic system will be exposed to over its life. However, operators are always ultimately responsible for the actions and decisions of the automation they are monitoring or using, which means they must evaluate the automation's decisions and actions for accuracy. As has been pointed out, this is a difficult thing for human operators to do. There have been various suggestions as to how to aid operators with this evaluation. In the study described in this report we studied how presentation of contextual information about an automatic system's decision might impact the ability of the human operators to evaluate that decision. This study focused on the planning of emergency descents. Fortunately, emergencies (e.g., mechanical or electrical malfunction, on-board fire, and medical emergency) happen quite rarely. However, they can be catastrophic when they do. For all predictable or conceivable emergencies, pilots have emergency procedures that they are trained on, but those procedures often end with 'determine suitable airport and land as quickly as possible.' Planning an emergency descent to an unplanned airport is a difficult task, particularly under the time pressures of an emergency. Automatic decision aids could be very efficient at the task of determining an appropriate airport and calculating an optimal trajectory to that airport. This information could be conveyed to the pilot through an emergency descent procedure listing all of the actions necessary to safely land the plane. However, there is still the potential problem of brittleness. This study examined the impact of contextual information in presentations of emergency descent procedures to see if they might impact the pilot's evaluation of the feasibility of the presented procedure. The study and its results are described in detail.

Virtual reality training for health-care professionals.

PubMed

Mantovani, Fabrizia; Castelnuovo, Gianluca; Gaggioli, Andrea; Riva, Giuseppe

2003-08-01

Emerging changes in health-care delivery are having a significant impact on the structure of health-care professionals' education. Today it is recognized that medical knowledge doubles every 6-8 years, with new medical procedures emerging everyday. While the half-life of medical information is so short, the average physician practices 30 years and the average nurse 40 years. Continuing education thus represents an important challenge to face. Recent advances in educational technology are offering an increasing number of innovative learning tools. Among these, Virtual Reality represents a promising area with high potential of enhancing the training of health-care professionals. Virtual Reality Training can provide a rich, interactive, engaging educational context, thus supporting experiential learning-by-doing; it can, in fact, contribute to raise interest and motivation in trainees and to effectively support skills acquisition and transfer, since the learning process can be settled within an experiential framework. Current virtual training applications for health-care differ a lot as to both their technological/multimedia sophistication and to the types of skills trained, varying for example from telesurgical applications to interactive simulations of human body and brain, to virtual worlds for emergency training. Other interesting applications include the development of immersive 3D environments for training psychiatrists and psychologists in the treatment of mental disorders. This paper has the main aim of discussing the rationale and main benefits for the use of virtual reality in health-care education and training. Significant research and projects carried out in this field will also be presented, followed by discussion on key issues concerning current limitations and future development directions.

Confidence level in performing clinical procedures among medical officers in nonspecialist government hospitals in Penang, Malaysia.

PubMed

Othman, Mohamad Sabri; Merican, Hassan; Lee, Yew Fong; Ch'ng, Kean Siang; Thurairatnam, Dharminy

2015-03-01

A prospective cross-sectional study was conducted at 3 government hospitals over 6 months to evaluate the confidence level of medical officers (MOs) to perform clinical procedure in nonspecialist government hospitals in Penang. An anonymous self-administered questionnaire in English was designed based on the elective and emergency procedures stated in the houseman training logbook. The questionnaire was distributed to the MOs from Penang State Health Department through the respective hospital directors and returned to Penang State Health Department on completion. The results showed that there was statistically significant difference between those who had undergone 12 months and 24 months as houseman in performing both elective and emergency procedures. MOs who had spent 24 months as housemen expressed higher confidence level than those who had only 12 months of experience. We also found that the confidence level was statistically and significantly influenced by visiting specialist and working together with cooperative experienced paramedics. © 2013 APJPH.

The effects of Above Real-Time Training (ARTT) in an F-16 simulator

NASA Technical Reports Server (NTRS)

Guckenberger, Dutch; Stanney, Kay; Lane, Norman E.

1994-01-01

In this application of above real-time training (ARTT), 24 mission-capable F-16 pilots performed three tasks on a part-task F-16A flight simulator under varying levels of time compression (i.e., 1.0x, 1.5x, 2.0x, and random). All subjects were then tested in a real-time (1.0x) environment. The three tasks under study were an emergency procedure (EP) task, a one versus two air combat maneuvering (ACM) task, and a stern conversion or air intercept task. All ARTT pilots performed the EP task with 28 percent greater accuracy and were better at dealing with a simultaneous MIG threat, reflected by a six-fold increase in the number of MIG kills compared to a real-time control group. In the stern conversion task, there were no statistical differences between groups. In the ACM task, those pilots trained in the mixed time accelerations were faster to acquire lock and were faster to kill both MIG threats than the other groups. These findings are generally consistent with previous findings that show positive effects of task variations (including time variations) during training. Also discussed are related research findings that support the benefits of ARTT and ARTT's impact on emergency procedure training. Further, a synthesis of multidiscipline research outlining the underlying theoretical basis for ARTT is presented. A proposed model of ARTT based on an analogy to Einstein's theory of special relativity is suggested. Conclusions and an outline of future research directions are presented. Successful current commercialization efforts are related as well as future efforts.

Emergency physician perspectives on central venous catheterization in the emergency department: a survey-based study.

PubMed

Ballard, Dustin W; Reed, Mary E; Rauchwerger, Adina S; Chettipally, Uli K; Offerman, Steven R; Mark, Dustin G; Vinson, David R

2014-06-01

The objective was to assess clinician experience, training, and attitudes toward central venous catheterization (CVC) in adult emergency department (ED) patients in a health system promoting increased utilization of CVC for severely septic ED patients. The authors surveyed all emergency physicians (EPs) within a 21-hospital integrated health care delivery system that had recently instituted a modified Rivers protocol for providing early goal-directed therapy (EGDT) to patients with severe sepsis or septic shock, including CVC if indicated. This initiative was accompanied by a structured, but optional, systemwide hands-on training for EPs in real-time ultrasound-guided CVC (US CVC). EPs' responses to questions regarding self-reported experience with CVC in the ED are reported. Data included frequency of CVC (by type) and US CVC training opportunities: both during and after residency and informal ("on-the-job training involving actual ED patients under the oversight of someone more experienced than yourself") and formal ("off-the-job training not involving actual ED patients"). The survey also asked respondents to report their comfort levels with different types of CVC as well as their agreement with possible barriers (philosophical, time-related, equipment-related, and complication-related) to CVC in the ED. Multivariable ordinal logistic regression was used to identify provider characteristics and responses associated with higher yearly CVC volumes. The survey response rate among eligible participants was 365 of 465 (78%). Overall, 154 of 365 (42%) respondents reported performing 11 or more CVCs a year, while 46 of 365 (13%) reported doing two or fewer. Concerning CVC techniques, 271 of 358 (76%) of respondents reported being comfortable with the internal jugular approach with US guidance, compared to 200 of 345 (58%) with the subclavian approach without US. Training rates were reported as 1) in residency, formal 167 of 358 (47%) and informal 189 of 364 (52%); and 2) postresidency, formal 236 of 359 (66%) and informal 260 of 365 (71%). The most commonly self-reported barriers to CVC were procedural time (56%) and complication risk (61%). After multivariate adjustment, the following were significantly associated with greater self-reported CVC use (p < 0.01): 1) informal bedside CVC training after residency, 2) male sex, 3) disagreement with complication-related barrier questions, and 4) self-reported comfort with placing US-guided internal jugular catheters. In this cross-sectional survey-based study, EPs reported varying experience with CVC in the ED and reported high comfort with the US CVC technique. Postresidency informal training experience, male sex, negative responses to complication-related barrier questions, and comfort with placing US-guided internal jugular catheters were associated with yearly CVC volume. These results suggest that higher rates of CVC in eligible patients might be achieved by informal training programs in US and/or by disseminating existing evidence about the low risk of complications associated with the procedure. © 2014 by the Society for Academic Emergency Medicine.

Point-of-care ultrasonography by pediatric emergency medicine physicians.

PubMed

Marin, Jennifer R; Lewiss, Resa E

2015-04-01

Emergency physicians have used point-of-care ultrasonography since the 1990 s. Pediatric emergency medicine physicians have more recently adopted this technology. Point-of-care ultrasonography is used for various scenarios, particularly the evaluation of soft tissue infections or blunt abdominal trauma and procedural guidance. To date, there are no published statements from national organizations specifically for pediatric emergency physicians describing the incorporation of point-of-care ultrasonography into their practice. This document outlines how pediatric emergency departments may establish a formal point-of-care ultrasonography program. This task includes appointing leaders with expertise in point-of-care ultrasonography, effectively training and credentialing physicians in the department, and providing ongoing quality assurance reviews. Copyright © 2015 by the American Academy of Pediatrics.

20 CFR 632.23 - Termination and corrective action of a CAP and/or Master Plan.

Code of Federal Regulations, 2012 CFR

2012-04-01

... and/or Master Plan. 632.23 Section 632.23 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION... and Modification Procedures § 632.23 Termination and corrective action of a CAP and/or Master Plan. (a) Emergency Termination. The Department may terminate or suspend a CAP designation or Master Plan under...

20 CFR 632.23 - Termination and corrective action of a CAP and/or Master Plan.

Code of Federal Regulations, 2011 CFR

2011-04-01

... and/or Master Plan. 632.23 Section 632.23 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION... and Modification Procedures § 632.23 Termination and corrective action of a CAP and/or Master Plan. (a) Emergency Termination. The Department may terminate or suspend a CAP designation or Master Plan under...

Emergency Response Capability Baseline Needs Assessment Compliance Assessment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sharry, John A.

2013-09-16

This document is the second of a two-part analysis of Emergency Response Capabilities of Lawrence Livermore National Laboratory. The first part, 2013 Baseline Needs Assessment Requirements Document established the minimum performance criteria necessary to meet mandatory requirements. This second part analyses the performance of Lawrence Livermore Laboratory Emergency Management Department to the contents of the Requirements Document. The document was prepared based on an extensive review of information contained in the 2009 BNA, the 2012 BNA document, a review of Emergency Planning Hazards Assessments, a review of building construction, occupancy, fire protection features, dispatch records, LLNL alarm system records, firemore » department training records, and fire department policies and procedures.« less

Fire Safety for the Oral and Maxillofacial Surgeon and Surgical Staff.

PubMed

Di Pasquale, LisaMarie; Ferneini, Elie M

2017-05-01

Fire in the operating room is a life-threatening emergency that demands quick, efficient intervention. Because the circumstances surrounding fires are generally well-understood, virtually every operating room fire is preventable. Before every operating room case, thorough preprocedure "time outs" should address each team members' awareness of specific fire risks and agreement regarding fire concerns and emergency actions. Fire prevention centers on 3 constituent parts of the fire triad necessary for fire formation. Regular fire drills should guide policies and procedures to prevent surgical fires. Delivering optimal patient care in emergent situations requires surgical team training, practicing emergency roles, and specific actions. Copyright © 2016 Elsevier Inc. All rights reserved.

See one, do one, teach one: advanced technology in medical education.

PubMed

Vozenilek, John; Huff, J Stephen; Reznek, Martin; Gordon, James A

2004-11-01

The concept of "learning by doing" has become less acceptable, particularly when invasive procedures and high-risk care are required. Restrictions on medical educators have prompted them to seek alternative methods to teach medical knowledge and gain procedural experience. Fortunately, the last decade has seen an explosion of the number of tools available to enhance medical education: web-based education, virtual reality, and high fidelity patient simulation. This paper presents some of the consensus statements in regard to these tools agreed upon by members of the Educational Technology Section of the 2004 AEM Consensus Conference for Informatics and Technology in Emergency Department Health Care, held in Orlando, Florida. Web-based teaching: 1) Every ED should have access to medical educational materials via the Internet, computer-based training, and other effective education methods for point-of-service information, continuing medical education, and training. 2) Real-time automated tools should be integrated into Emergency Department Information Systems [EDIS] for contemporaneous education. Virtual reality [VR]: 1) Emergency physicians and emergency medicine societies should become more involved in VR development and assessment. 2) Nationally accepted protocols for the proper assessment of VR applications should be adopted and large multi-center groups should be formed to perform these studies. High-fidelity simulation: Emergency medicine residency programs should consider the use of high-fidelity patient simulators to enhance the teaching and evaluation of core competencies among trainees. Across specialties, patient simulation, virtual reality, and the Web will soon enable medical students and residents to... see one, simulate many, do one competently, and teach everyone.

Epidemiology of Pediatric Prehospital Basic Life Support Care in the United States.

PubMed

Diggs, Leigh Ann; Sheth-Chandra, Manasi; De Leo, Gianluca

2016-01-01

Children have unique medical needs compared to adults. Emergency medical services personnel need proper equipment and training to care for children. The purpose of this study is to characterize emergency medical services pediatric basic life support to help better understand the needs of children transported by ambulance. Pediatric basic life support patients were identified in this retrospective descriptive study. Descriptive statistics were used to examine incident location, possible injury, cardiac arrest, resuscitation attempted, chief complaint, primary symptom, provider's primary impression, cause of injury, and procedures performed during pediatric basic life support calls using the largest aggregate of emergency medical services data available, the 2013 National Emergency Medical Services Information System (NEMSIS) Public Release Research Data Set. Pediatric calls represented 7.4% of emergency medical services activations. Most pediatric patients were male (49.8%), White (40.0%), and of non-Hispanic origin (56.5%). Most incidents occurred in the home. Injury, cardiac arrest, and resuscitation attempts were highest in the 15 to 19 year old age group. Global complaints (37.1%) predominated by anatomic location and musculoskeletal complaints (26.9%) by organ system. The most common primary symptom was pain (30.3%) followed by mental/psychiatric (13.4%). Provider's top primary impression was traumatic injury (35.7%). The most common cause of injury was motor vehicle accident (32.3%). The most common procedure performed was patient assessment (27.4%). Median EMS system response time was 7 minutes (IQR: 5-12). Median EMS scene time was 12 minutes (IQR: 8-19). Median transport time was 14 minutes (IQR: 8-24). Median EMS total call time was 51 minutes (IQR: 33-77). The epidemiology of pediatric basic life support can help to guide efforts in both emergency medical services operations and training.

Identifying gaps in the surgical training curriculum in Rwanda through evaluation of operative activity at a teaching hospital.

PubMed

Rickard, Jennifer L; Ntakiyiruta, Georges; Chu, Kathryn M

2015-01-01

To define the operations performed by surgical residents at a tertiary referral hospital in Rwanda to help guide development of the residency program. Cross-sectional study of all patients operated by surgical residents from October 2012 to September 2013. University Teaching Hospital of Kigali (Centre Hospitalier Universitaire de Kigali [CHUK]), a public, tertiary referral hospital in Kigali, Rwanda. All patient data were entered into the operative database by surgical residents at CHUK. A total of 2833 cases were entered into the surgical database. Of them, 53 cases were excluded from further analysis because no surgical resident was listed as the primary or assistant surgeon, leaving 2780 cases for analysis. There were 2780 operations involving surgical residents. Of them, 51% of procedures were classified under general surgery, 38% orthopedics, 7% neurosurgery, and 4% urology. Emergency operations accounted for 64% of the procedures, with 56% of those being general surgery and 35% orthopedic. Further, 50% of all operations were trauma, with 71% of those orthopedic and 21% general surgery. Surgical faculty were involved in 45% of operations as either the primary or the assistant surgeons, while the remainder of operations did not involve surgical faculty. Residents were primary surgeons in 68% of procedures and assistant surgeons in 84% of procedures. The operative experience of surgery residents at CHUK primarily involves emergency and trauma procedures. Although this likely reflects the demographics of surgical care within Rwanda, more focus should be placed on elective procedures to ensure that surgical residents are broadly trained. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Emergency preparedness and intervention: social work education needs in Israel.

PubMed

Findley, Patricia A; Isralowitz, Richard; Reznik, Alexander

2014-01-01

Emergency preparedness and response is gaining increasing global attention; numerous conditions contribute to disaster situations including acts of terror and war, earthquakes, hurricanes, floods, and tornadoes. Internationally, social workers are among the first responders addressing needs of children, families, and others affected by traumatic events. Assess the level of emergency preparedness and experience of intervening of social workers in Negev, Israel. Social workers (n = 183) employed by public and nonprofit nongovernment organizations throughout the Negev, Israel, including population centers of Beer Sheva, Ashkelon, Ashdod, and Sderot were queried for this study regarding their experience and training in emergency preparedness and interventions. Seventy-six percent of study participants had 10 years or less experience; and, the majority (56.1 percent) reported they treat trauma and/or post-traumatic stress disorder. Overall, the types of populations with whom the participants worked with were children and adolescents (65.5 percent), adults (59.6 percent), individuals with drug or alcohol dependence (30.1 percent), people with serious mental illness (27.9 percent), reporting sexual abuse (25.7 percent), those with physical disabilities (20.8 percent), and elderly (18.6 percent). Screening and referral were the most common services provided, especially by older, more experienced social workers who were more likely to have received training to provide disaster mental health intervention. Respondents reported disaster intervention training related to work with children and families to be most important. Further research should consider more targeted studies of on emergency preparedness policies for vulnerable populations, evaluation of implementation procedures, and training on both the professional and community levels among other issues.

Definition of Specific Functions and Procedural Skills Required by Cuban Specialists in Intensive Care and Emergency Medicine.

PubMed

Véliz, Pedro L; Berra, Esperanza M; Jorna, Ana R

2015-07-01

INTRODUCTION Medical specialties' core curricula should take into account functions to be carried out, positions to be filled and populations to be served. The functions in the professional profile for specialty training of Cuban intensive care and emergency medicine specialists do not include all the activities that they actually perform in professional practice. OBJECTIVE Define the specific functions and procedural skills required of Cuban specialists in intensive care and emergency medicine. METHODS The study was conducted from April 2011 to September 2013. A three-stage methodological strategy was designed using qualitative techniques. By purposive maximum variation sampling, 82 professionals were selected. Documentary analysis and key informant criteria were used in the first stage. Two expert groups were formed in the second stage: one used various group techniques (focus group, oral and written brainstorming) and the second used a three-round Delphi method. In the final stage, a third group of experts was questioned in semistructured in-depth interviews, and a two-round Delphi method was employed to assess priorities. RESULTS Ultimately, 78 specific functions were defined: 47 (60.3%) patient care, 16 (20.5%) managerial, 6 (7.7%) teaching, and 9 (11.5%) research. Thirty-one procedural skills were identified. The specific functions and procedural skills defined relate to the profession's requirements in clinical care of the critically ill, management of patient services, teaching and research at the specialist's different occupational levels. CONCLUSIONS The specific functions and procedural skills required of intensive care and emergency medicine specialists were precisely identified by a scientific method. This product is key to improving the quality of teaching, research, administration and patient care in this specialty in Cuba. The specific functions and procedural skills identified are theoretical, practical, methodological and social contributions to inform future curricular reform and to help intensive care specialists enhance their performance in comprehensive patient care. KEYWORDS Intensive care, urgent care, emergency medicine, continuing medical education, curriculum, diagnostic techniques and procedures, medical residency, Cuba.

Incidental orthographic learning during a color detection task.

PubMed

Protopapas, Athanassios; Mitsi, Anna; Koustoumbardis, Miltiadis; Tsitsopoulou, Sofia M; Leventi, Marianna; Seitz, Aaron R

2017-09-01

Orthographic learning refers to the acquisition of knowledge about specific spelling patterns forming words and about general biases and constraints on letter sequences. It is thought to occur by strengthening simultaneously activated visual and phonological representations during reading. Here we demonstrate that a visual perceptual learning procedure that leaves no time for articulation can result in orthographic learning evidenced in improved reading and spelling performance. We employed task-irrelevant perceptual learning (TIPL), in which the stimuli to be learned are paired with an easy task target. Assorted line drawings and difficult-to-spell words were presented in red color among sequences of other black-colored words and images presented in rapid succession, constituting a fast-TIPL procedure with color detection being the explicit task. In five experiments, Greek children in Grades 4-5 showed increased recognition of words and images that had appeared in red, both during and after the training procedure, regardless of within-training testing, and also when targets appeared in blue instead of red. Significant transfer to reading and spelling emerged only after increased training intensity. In a sixth experiment, children in Grades 2-3 showed generalization to words not presented during training that carried the same derivational affixes as in the training set. We suggest that reinforcement signals related to detection of the target stimuli contribute to the strengthening of orthography-phonology connections beyond earlier levels of visually-based orthographic representation learning. These results highlight the potential of perceptual learning procedures for the reinforcement of higher-level orthographic representations. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Training healthcare personnel for mass-casualty incidents in a virtual emergency department: VED II.

PubMed

Heinrichs, Wm Leroy; Youngblood, Patricia; Harter, Phillip; Kusumoto, Laura; Dev, Parvati

2010-01-01

Training emergency personnel on the clinical management of a mass-casualty incident (MCI) with prior chemical, biological, radioactive, nuclear, or explosives (CBRNE) -exposed patients is a component of hospital preparedness procedures. The objective of this research was to determine whether a Virtual Emergency Department (VED), designed after the Stanford University Medical Center's Emergency Department (ED) and populated with 10 virtual patient victims who suffered from a dirty bomb blast (radiological) and 10 who suffered from exposure to a nerve toxin (chemical), is an effective clinical environment for training ED physicians and nurses for such MCIs. Ten physicians with an average of four years of post-training experience, and 12 nurses with an average of 9.5 years of post-graduate experience at Stanford University Medical Center and San Mateo County Medical Center participated in this IRB-approved study. All individuals were provided electronic information about the clinical features of patients exposed to a nerve toxin or radioactive blast before the study date and an orientation to the "game" interface, including an opportunity to practice using it immediately prior to the study. An exit questionnaire was conducted using a Likert Scale test instrument. Among these 22 trainees, two-thirds of whom had prior Code Triage (multiple casualty incident) training, and one-half had prior CBRNE training, about two-thirds felt immersed in the virtual world much or all of the time. Prior to the training, only four trainees (18%) were confident about managing CBRNE MCIs. After the training, 19 (86%) felt either "confident" or "very confident", with 13 (59%) attributing this change to practicing in the virtual ED. Twenty-one (95%) of the trainees reported that the scenarios were useful for improving healthcare team skills training, the primary objective for creating them. Eighteen trainees (82%) believed that the cases also were instructive in learning about clinical skills management of such incidents. These data suggest that training healthcare teams in online, virtual environments with dynamic virtual patients is an effective method of training for management of MCIs, particularly for uncommonly occurring incidents.

KSC-2009-3385

NASA Image and Video Library

2009-06-02

CAPE CANAVERAL, Fla. – STS-127 Pilot Doug Hurley smiles after practicing driving the M-113 armored personnel carrier. The crew members of space shuttle Endeavour's STS-127 mission will each practice driving the M-113 in turn as part of their training on emergency egress procedures. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is at NASA's Kennedy Space Center for a launch dress rehearsal called the terminal countdown demonstration test, or TCDT, which includes the emergency egress training and equipment familiarization. The STS-127 mission is the final of three flights dedicated to the assembly of the Japanese Kibo laboratory complex. Endeavour's launch is targeted for June 13. Photo credit: NASA/Kim Shiflett

KSC-2009-3373

NASA Image and Video Library

2009-06-02

CAPE CANAVERAL, Fla. – STS-127 Mission Specialist Dave Wolf takes the wheel of the M-113 armored personnel carrier. Driving the M-113 is part of the training on emergency egress procedures. The crew members of space shuttle Endeavour's STS-127 mission are taking turns driving the M-113. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is at NASA's Kennedy Space Center for a launch dress rehearsal called the terminal countdown demonstration test, or TCDT, which includes the emergency egress training and equipment familiarization. The STS-127 mission is the final of three flights dedicated to the assembly of the Japanese Kibo laboratory complex. Endeavour's launch is targeted for June 13. Photo credit: NASA/Kim Shiflett

KSC-2009-3375

NASA Image and Video Library

2009-06-02

CAPE CANAVERAL, Fla. – STS-127 Mission Specialist Christopher Cassidy is ready to take the wheel to practice driving the M-113 armored personnel carrier, which is part of the training on emergency egress procedures. The crew members of space shuttle Endeavour's STS-127 mission are taking turns driving the M-113. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is at NASA's Kennedy Space Center for a launch dress rehearsal called the terminal countdown demonstration test, or TCDT, which includes the emergency egress training and equipment familiarization. The STS-127 mission is the final of three flights dedicated to the assembly of the Japanese Kibo laboratory complex. Endeavour's launch is targeted for June 13. Photo credit: NASA/Kim Shiflett

KSC-2009-3374

NASA Image and Video Library

2009-06-02

CAPE CANAVERAL, Fla. – STS-127 Mission Specialist Dave Wolf poses for a photograph after driving the M-113 armored personnel carrier, which is part of the training on emergency egress procedures. The crew members of space shuttle Endeavour's STS-127 mission are taking turns driving the M-113. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is at NASA's Kennedy Space Center for a launch dress rehearsal called the terminal countdown demonstration test, or TCDT, which includes the emergency egress training and equipment familiarization. The STS-127 mission is the final of three flights dedicated to the assembly of the Japanese Kibo laboratory complex. Endeavour's launch is targeted for June 13. Photo credit: NASA/Kim Shiflett

KSC-2009-3382

NASA Image and Video Library

2009-06-02

CAPE CANAVERAL, Fla. – STS-127 Mission Specialist Tom Marshburn takes his turn driving the M-113 armored personnel carrier, which is part of the training on emergency egress procedures. The crew members of space shuttle Endeavour's STS-127 mission are taking turns driving the M-113. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is at NASA's Kennedy Space Center for a launch dress rehearsal called the terminal countdown demonstration test, or TCDT, which includes the emergency egress training and equipment familiarization. The STS-127 mission is the final of three flights dedicated to the assembly of the Japanese Kibo laboratory complex. Endeavour's launch is targeted for June 13. Photo credit: NASA/Kim Shiflett

KSC-2009-3379

NASA Image and Video Library

2009-06-02

CAPE CANAVERAL, Fla. – STS-127 Mission Specialist Tim Kopra is happy to have successfully driven the M-113 armored personnel carrier, which is part of the training on emergency egress procedures. The crew members of space shuttle Endeavour's STS-127 mission are taking turns driving the M-113. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is at NASA's Kennedy Space Center for a launch dress rehearsal called the terminal countdown demonstration test, or TCDT, which includes the emergency egress training and equipment familiarization. The STS-127 mission is the final of three flights dedicated to the assembly of the Japanese Kibo laboratory complex. Endeavour's launch is targeted for June 13. Photo credit: NASA/Kim Shiflett

KSC-2009-3383

NASA Image and Video Library

2009-06-02

CAPE CANAVERAL, Fla. – STS-127 Commander Mark Polansky smiles after practicing driving the M-113 armored personnel carrier. The crew members of space shuttle Endeavour's STS-127 mission will each practice driving the M-113 in turn as part of their training on emergency egress procedures. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is at NASA's Kennedy Space Center for a launch dress rehearsal called the terminal countdown demonstration test, or TCDT, which includes the emergency egress training and equipment familiarization. The STS-127 mission is the final of three flights dedicated to the assembly of the Japanese Kibo laboratory complex. Endeavour's launch is targeted for June 13. Photo credit: NASA/Kim Shiflett

KSC-2009-3381

NASA Image and Video Library

2009-06-02

CAPE CANAVERAL, Fla. – STS-127 Mission Specialist Tom Marshburn smiles after successfully driving the M-113 armored personnel carrier, which is part of the training on emergency egress procedures. The crew members of space shuttle Endeavour's STS-127 mission are taking turns driving the M-113. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is at NASA's Kennedy Space Center for a launch dress rehearsal called the terminal countdown demonstration test, or TCDT, which includes the emergency egress training and equipment familiarization. The STS-127 mission is the final of three flights dedicated to the assembly of the Japanese Kibo laboratory complex. Endeavour's launch is targeted for June 13. Photo credit: NASA/Kim Shiflett

Bite or brain: Implication of sensorimotor regulation and neuroplasticity in oral rehabilitation procedures.

PubMed

Kumar, A; Kothari, M; Grigoriadis, A; Trulsson, M; Svensson, P

2018-04-01

Tooth loss, decreased mass and strength of the masticatory muscles leading to difficulty in chewing have been suggested as important determinants of eating and nutrition in the elderly. To compensate for the loss of teeth, in particular, a majority of the elderly rely on dental prosthesis for chewing. Chewing function is indeed an important aspect of oral health, and therefore, oral rehabilitation procedures should aim to restore or maintain adequate function. However, even if the possibilities to anatomically restore lost teeth and occlusion have never been better; conventional rehabilitation procedures may still fail to optimally restore oral functions. Perhaps this is due to the lack of focus on the importance of the brain in the rehabilitation procedures. Therefore, the aim of this narrative review was to discuss the importance of maintaining or restoring optimum chewing function in the superageing population and to summarise the emerging studies on oral motor task performance and measures of cortical neuroplasticity induced by systematic training paradigms in healthy participants. Further, brain imaging studies in patients undergoing or undergone oral rehabilitation procedures will be discussed. Overall, this information is believed to enhance the understanding and develop better rehabilitative strategies to exploit training-induced cortical neuroplasticity in individuals affected by impaired oral motor coordination and function. Training or relearning of oral motor tasks could be important to optimise masticatory performance in dental prosthesis users and may represent a much-needed paradigm shift in the approach to oral rehabilitation procedures. © 2018 John Wiley & Sons Ltd.

The organizational commitment of emergency physicians in Spanish public hospitals

PubMed

Noval de la Torre, A; Bulchand Gidumal, J; Melián González, S

2016-12-30

Background. There are not too many studies that deal with the organizational commitment of emergency physicians. This commitment has been shown to impact organizational performance. The aim of this paper is to analyse the degree of commitment of the emergency physicians in Spanish public hospitals and the factors that may influence it. Method. Online survey using SurveyMonkey to emergency physicians in Spanish public hospitals. Results. Two hundred and five questionnaires were received, 162 from physicians and 43 from heads of the emergency service. Results show an intermediate level of commitment, with affective commitment showing the lowest level and continuance commitment showing the highest level. The capabilities of the physician have an influence on their affective commitment; specific training in emergency procedures and seniority has an influence on their continuance commitment; and the opinion they hold about the organization of their service influences affective commitment. Conclusions. Emergency physicians show an average involvement in the hospital in which they work (average 3.8 on a range of 1 to 5), feel an average affection for it (3.4), and have a high intention to keep working there (4.0). The resources the hospital has due to its level do not have an influence on this commitment, while the training and perceptions of the service do have an influence.

Relations among Acute and Chronic Nicotine Administration, Short-Term Memory, and Tactics of Data Analysis

ERIC Educational Resources Information Center

Kangas, Brian D.; Branch, Marc N.

2012-01-01

Emerging evidence suggests that nicotine may enhance short-term memory. Some of this evidence comes from nonhuman primate research using a procedure called delayed matching-to-sample, wherein the monkey is trained to select a comparison stimulus that matches some physical property of a previously presented sample stimulus. Delays between sample…

Astronaut C. Michael Foale is briefed on use of Sky Genie

NASA Technical Reports Server (NTRS)

1994-01-01

Astronaut C. Michael Foale, STS-63 mission specialist, is briefed on the use of Sky Genie device by Karin L. Porter. The device would aid in emergency egress operations aboard a troubled Space Shuttle. Porter, an employee of Rockwell International, helps train astronauts in egress procedures at JSC's Shuttle mockup and integration laboratory.

STS-35 MS Hoffman is suspended above pool during JSC water egress exercises

NASA Technical Reports Server (NTRS)

1990-01-01

STS-35 Mission Specialist (MS) Jeffrey A. Hoffman is suspended above pool during launch emergency egress procedures conducted in JSC's Weightless Environmental Training Facility Bldg 29. Hoffman, wearing a launch and entry suit (LES) and launch and entry helmet (LEH), adjusts flotation device (life jacket) as he is raised above the pool.

Computer Forensics: Is It the Next Hot IT Subject?

ERIC Educational Resources Information Center

Williams, Victor G.; Revels, Ken

2006-01-01

Digital Forensics is not just the recovery of data or information from computer systems and their networks. It is not a procedure that can be accomplished by software alone, and most important, it is not something that can be accomplished by other than a trained IT forensic professional. Digital Forensics is an emerging science and was developed…

Group 13, 1990 ASCAN Charles J. Precourt at Vance Air Force Base, Oklahoma

NASA Technical Reports Server (NTRS)

1990-01-01

Group 13, 1990 Astronaut Candidate (ASCAN) Charles J. Precourt, suspended in a parachute harness, has just completed a practice parachute jump from a parasail tower during a survival training course exercise at Vance Air Force Base (AFB) in Enid, Oklahoma. The course is designed to familiarize the trainees with procedures to follow in the event of an emergency ejection from a jet aircraft. Precourt, along with 22 other ASCANs, began a year's training and evaluation in July. This session was conducted from 07-29-90 through 07-31-90.

Simulation trainer for practicing emergent open thoracotomy procedures.

PubMed

Hamilton, Allan J; Prescher, Hannes; Biffar, David E; Poston, Robert S

2015-07-01

An emergent open thoracotomy (OT) is a high-risk, low-frequency procedure uniquely suited for simulation training. We developed a cost-effective Cardiothoracic (CT) Surgery trainer and assessed its potential for improving technical and interprofessional skills during an emergent simulated OT. We modified a commercially available mannequin torso with artificial tissue models to create a custom CT Surgery trainer. The trainer's feasibility for simulating emergent OT was tested using a multidisciplinary CT team in three consecutive in situ simulations. Five discretely observable milestones were identified as requisite steps in carrying out an emergent OT; namely (1) diagnosis and declaration of a code situation, (2) arrival of the code cart, (3) arrival of the thoracotomy tray, (4) initiation of the thoracotomy incision, and (5) defibrillation of a simulated heart. The time required for a team to achieve each discrete step was measured by an independent observer over the course of each OT simulation trial and compared. Over the course of the three OT simulation trials conducted in the coronary care unit, there was an average reduction of 29.5% (P < 0.05) in the times required to achieve the five critical milestones. The time required to complete the whole OT procedure improved by 7 min and 31 s from the initial to the final trial-an overall improvement of 40%. In our preliminary evaluation, the CT Surgery trainer appears to be useful for improving team performance during a simulated emergent bedside OT in the coronary care unit. Copyright © 2015 Elsevier Inc. All rights reserved.

Are oral and maxillofacial surgery residents being adequately trained to care for pediatric patients?

PubMed

Abramowicz, Shelly; Kaban, Leonard B; Wurtzel, Andrew S; Roser, Steven M

2017-09-01

To evaluate whether current oral and maxillofacial surgery (OMS) residents are receiving adequate training and experience to perform specific surgical procedures and anesthesia for pediatric patients. A 17-question survey was sent electronically to fellows of the American Academy of Craniomaxillofacial Surgeons. Descriptive data for individual surgeons, their associated residency programs, and the quantity of specific pediatric procedures they performed were collected. Resident case load for inpatient and outpatient procedures and overall experience in medical, surgical, and anesthetic management of pediatric OMS patients were explored. Surveys were sent to 110 active fellows; 64 completed the questionnaire (58%). There were 59 male fellows and 5 female fellows, with a mean age of 50.4 years. Of those, 68.8% practice in an academic setting. Specifically, 93.8% take after-hours emergency calls covering adult and pediatric patients and 98.4% have admitting privileges at a children's hospital or a pediatric unit in an adult hospital. Their affiliated residency programs include required rotations in pediatrics or pediatric subspecialties. In their opinion, >90% of graduating OMS residents have the appropriate skill set to perform dentoalveolar procedures, outpatient anesthesia, orthognathic procedures, and alveolar bone grafts. However, residents have limited ability to reconstruct pediatric ramus-condyle unit with a costochondral graft. Results of this study indicate that, in the opinion of the respondents, graduates of OMS residency programs have adequate training to perform dentoalveolar procedures, outpatient anesthesia, orthognathic surgery, and alveolar bone grafts in pediatric procedures, but have limited experience with reconstruction of pediatric ramus-condyle unit via costochondral graft. Copyright © 2017 Elsevier Inc. All rights reserved.

Emergency management and infection control in a radiology department during an outbreak of severe acute respiratory syndrome.

PubMed

Lin, Y C; Dong, S L; Yeh, Y H; Wu, Y S; Lan, G Y; Liu, C M; Chu, T C

2005-07-01

The World Health Organization classified Taiwan as a serious epidemic-stricken area when the extent of severe acute respiratory syndrome (SARS) in Taiwan became clear. As of 11 July 2003, 671 probable SARS cases had been identified in Taiwan and 7 healthcare workers had died from the disease. Radiographers were easily infected by SARS because they had close contact with suspected or probable cases while conducting chest X-ray examinations. Three radiographers had been infected by the end of May 2003. Because of the impact of SARS on the Radiology Department, the department established a SARS emergency infection control team and re-designed the department's infection-control and emergency-management procedures based on the concept of risk-grade protection. This effort included installing a radiographic room at the fever-screening station, re-allocating human resources in the Radiology Department, training the department staff in infection control, and drafting new operational procedures for radiographers conducting X-ray examinations on SARS patients. The goal of this program was to reduce the infection rate and distribute materials efficiently in the department. This article introduces the emergency-management procedure of the Radiology Department during the SARS outbreak and the infection-protection experience of the department staff.

Evaluation of App-Based Serious Gaming as a Training Method in Teaching Chest Tube Insertion to Medical Students: Randomized Controlled Trial.

PubMed

Haubruck, Patrick; Nickel, Felix; Ober, Julian; Walker, Tilman; Bergdolt, Christian; Friedrich, Mirco; Müller-Stich, Beat Peter; Forchheim, Franziska; Fischer, Christian; Schmidmaier, Gerhard; Tanner, Michael C

2018-05-21

The insertion of a chest tube should be as quick and accurate as possible to maximize the benefit and minimize possible complications for the patient. Therefore, comprehensive training and assessment before an emergency situation are essential for proficiency in chest tube insertion. Serious games have become more prevalent in surgical training because they enable students to study and train a procedure independently, and errors made have no effect on patients. However, up-to-date evidence regarding the effect of serious games on performance in procedures in emergency medicine remains scarce. The aim of this study was to investigate the serious gaming approach in teaching medical students an emergency procedure (chest tube insertion) using the app Touch Surgery and a modified objective structural assessment of technical skills (OSATS). In a prospective, rater-blinded, randomized controlled trial, medical students were randomized into two groups: intervention group or control group. Touch Surgery has been established as an innovative and cost-free app for mobile devices. The fully automatic software enables users to train medical procedures and afterwards self-assess their training effort. The module chest tube insertion teaches each key step in the insertion of a chest tube and enables users the meticulous application of a chest tube. In contrast, the module "Thoracocentesis" discusses a basic thoracocentesis. All students attended a lecture regarding chest tube insertion (regular curriculum) and afterwards received a Touch Surgery training lesson: intervention group used the module chest tube insertion and the control group used Thoracocentesis as control training. Participants' performance in chest tube insertion on a porcine model was rated on-site via blinded face-to-face rating and via video recordings using a modified OSATS tool. Afterwards, every participant received an individual questionnaire for self-evaluation. Here, trainees gave information about their individual training level, as well as previous experiences, gender, and hobbies. Primary end point was operative performance during chest tube insertion by direct observance. A total of 183 students enrolled, 116 students participated (63.4%), and 21 were excluded because of previous experiences in chest tube insertion. Students were randomized to the intervention group (49/95, 52%) and control group (46/95, 48%). The intervention group performed significantly better than the control group (Intervention group: 38.0 [I 50 =7.0] points; control group: 30.5 [I 50 =8.0] points; P<.001). The intervention group showed significantly improved economy of time and motion (P=.004), needed significantly less help (P<.001), and was more confident in handling of instruments (P<.001) than the control group. The results from this study show that serious games are a valid and effective tool in education of operative performance in chest tube insertion. We believe that serious games should be implemented in the surgical curriculum, as well as residency programs, in addition to traditional learning methods. German Clinical Trials Register (DRKS) DRKS00009994; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00009994 (Archived by Webcite at http://www.webcitation.org/6ytWF1CWg). ©Patrick Haubruck, Felix Nickel, Julian Ober, Tilman Walker, Christian Bergdolt, Mirco Friedrich, Beat Peter Müller-Stich, Franziska Forchheim, Christian Fischer, Gerhard Schmidmaier, Michael C Tanner. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 21.05.2018.

The Aircraft Simulation Role in Improving Flight Safety Through Control Room Training

NASA Technical Reports Server (NTRS)

Shy, Karla S.; Hageman, Jacob J.; Le, Jeanette H.; Sitz, Joel (Technical Monitor)

2002-01-01

NASA Dryden Flight Research Center uses its six-degrees-of-freedom (6-DOF) fixed-base simulations for mission control room training to improve flight safety and operations. This concept is applied to numerous flight projects such as the F-18 High Alpha Research Vehicle (HARV), the F-15 Intelligent Flight Control System (IFCS), the X-38 Actuator Control Test (XACT), and X-43A (Hyper-X). The Dryden 6-DOF simulations are typically used through various stages of a project, from design to ground tests. The roles of these simulations have expanded to support control room training, reinforcing flight safety by building control room staff proficiency. Real-time telemetry, radar, and video data are generated from flight vehicle simulation models. These data are used to drive the control room displays. Nominal static values are used to complete information where appropriate. Audio communication is also an integral part of training sessions. This simulation capability is used to train control room personnel and flight crew for nominal missions and emergency situations. Such training sessions are also opportunities to refine flight cards and control room display pages, exercise emergency procedures, and practice control room setup for the day of flight. This paper describes this technology as it is used in the X-43A and F-15 IFCS and XACT projects.

STS-55 Payload Specialist Schlegel with technicians during JSC WETF bailout

NASA Technical Reports Server (NTRS)

1992-01-01

STS-55 Columbia, Orbiter Vehicle (OV) 102, Payload Specialist 2 Hans Schlegel, wearing launch and entry suit (LES), launch and entry helmet (LEH), and parachute, discusses procedures with technicians Karen Porter and Todd Bailey prior to launch emergency egress (bailout) exercises. The session, held in JSC's Weightless Environment Training Facility (WETF) Bldg 29, used the facility's 25-foot deep pool to simulate the ocean as Schlegel and other crewmembers practiced water bailout procedures. Schlegel represents the DLR for the upcoming Spacelab Deutsche 2 (SL-D2) mission.

Just-in-time training of dental responders in a simulated pandemic immunization response exercise.

PubMed

Colvard, Michael D; Hirst, Jeremy L; Vesper, Benjamin J; DeTella, George E; Tsagalis, Mila P; Roberg, Mary J; Peters, David E; Wallace, Jimmy D; James, James J

2014-06-01

The reauthorization of the Pandemic and All-Hazards Preparedness Act in 2013 incorporated the dental profession and dental professionals into the federal legislation governing public health response to pandemics and all-hazard situations. Work is now necessary to expand the processes needed to incorporate and train oral health care professionals into pandemic and all-hazard response events. A just-in-time (JIT) training exercise and immunization drill using an ex vivo porcine model system was conducted to demonstrate the rapidity to which dental professionals can respond to a pandemic influenza scenario. Medical history documentation, vaccination procedures, and patient throughput and error rates of 15 dental responders were evaluated by trained nursing staff and emergency response personnel. The average throughput (22.33/hr) and medical error rates (7 of 335; 2.08%) of the dental responders were similar to those found in analogous influenza mass vaccination clinics previously conducted using certified public health nurses. The dental responder immunization drill validated the capacity and capability of dental professionals to function as a valuable immunization resource. The ex vivo porcine model system used for JIT training can serve as a simple and inexpensive training tool to update pandemic responders' immunization techniques and procedures supporting inoculation protocols.

How is animal welfare addressed in Canada's emergency response plans?

PubMed

Wittnich, Carin; Belanger, Michael

2008-01-01

In 2005, Hurricanes Katrina and Rita clearly revealed that even in the United States the welfare of companion animals and nonhuman animals in the wild, zoo, or aquarium was not considered within the evacuation plans for their human caretakers (owners). The lack of proper planning and trained individuals resulted in a huge loss of animal life as well as suffering and trauma to both animals and their owners. The present Canadian Federal Emergency Response Plan does not have adequate procedures for the evacuation of animals together with their owners, nor do Canada or the provinces and territories have a plan in place that consists of properly trained and equipped individuals to respond to this aspect of disaster management. The Canadian Veterinary Reserve (CVR) was thus organized at a national level to respond properly to disasters or emergencies of all types and thereby reduce animal suffering and loss of life. This article describes the formation of the CVR and its anticipated national role in addressing animal welfare during times of catastrophic need.

A Cognitive Task Analysis for an Emergency Management Serious Game.

PubMed

Dass, Susan; Barnieu, Joanne; Cummings, Paul; Cid, Victor

2016-01-01

The Bethesda Hospitals' Emergency Preparedness Partnership identified a need to design training systems for hospital emergency management scenarios that included incident command situations. As part of this partnership, the National Library of Medicine (NLM) was challenged to develop an engaging, learner-centered simulation to specifically address hospital procedures for highly infectious diseases (HIDs) for multiple hospital roles. A serious game approach was selected for the simulation because collaborative (multiplayer) immersive, game-based simulations have been proven to generate realistic and engaging learning experiences and, when properly designed, can enhance training while minimizing cost compared to full-scale disaster exercises (Spain et al., 2013). Although substantial research effort has been put into design and evaluation of serious games, less time has been spent on developing sound instructional design methodologies to support serious game development. So how does one collect the appropriate, relevant, contextualized content and then align with serious game design elements? This paper describes how a cognitive task approach supported by a live demonstration with a think-aloud protocol was used to collect the rich psychomotor, procedural, and cognitive data necessary for the design of a serious game for handling HIDs. Furthermore, the paper presents a process to translate the collected data into meaningful content to support rapid prototyping. Recommendations for data collection and translation for a serious game close the paper.

A Cognitive Task Analysis for an Emergency Management Serious Game

PubMed Central

Dass, Susan; Barnieu, Joanne; Cummings, Paul; Cid, Victor

2017-01-01

The Bethesda Hospitals' Emergency Preparedness Partnership identified a need to design training systems for hospital emergency management scenarios that included incident command situations. As part of this partnership, the National Library of Medicine (NLM) was challenged to develop an engaging, learner-centered simulation to specifically address hospital procedures for highly infectious diseases (HIDs) for multiple hospital roles. A serious game approach was selected for the simulation because collaborative (multiplayer) immersive, game-based simulations have been proven to generate realistic and engaging learning experiences and, when properly designed, can enhance training while minimizing cost compared to full-scale disaster exercises (Spain et al., 2013). Although substantial research effort has been put into design and evaluation of serious games, less time has been spent on developing sound instructional design methodologies to support serious game development. So how does one collect the appropriate, relevant, contextualized content and then align with serious game design elements? This paper describes how a cognitive task approach supported by a live demonstration with a think-aloud protocol was used to collect the rich psychomotor, procedural, and cognitive data necessary for the design of a serious game for handling HIDs. Furthermore, the paper presents a process to translate the collected data into meaningful content to support rapid prototyping. Recommendations for data collection and translation for a serious game close the paper. PMID:29629430

Human Factors Assessment and Redesign of the ISS Respiratory Support Pack (RSP) Cue Card

NASA Technical Reports Server (NTRS)

Byrne, Vicky; Hudy, Cynthia; Whitmore, Mihriban; Smith, Danielle

2007-01-01

The Respiratory Support Pack (RSP) is a medical pack onboard the International Space Station (ISS) that contains much of the necessary equipment for providing aid to a conscious or unconscious crewmember in respiratory distress. Inside the RSP lid pocket is a 5.5 by 11 inch paper procedural cue card, which is used by a Crew Medical Officer (CMO) to set up the equipment and deliver oxygen to a crewmember. In training, crewmembers expressed concerns about the readability and usability of the cue card; consequently, updating the cue card was prioritized as an activity to be completed. The Usability Testing and Analysis Facility at the Johnson Space Center (JSC) evaluated the original layout of the cue card, and proposed several new cue card designs based on human factors principles. The approach taken for the assessment was an iterative process. First, in order to completely understand the issues with the RSP cue card, crewmember post training comments regarding the RSP cue card were taken into consideration. Over the course of the iterative process, the procedural information was reorganized into a linear flow after the removal of irrelevant (non-emergency) content. Pictures, color coding, and borders were added to highlight key components in the RSP to aid in quickly identifying those components. There were minimal changes to the actual text content. Three studies were conducted using non-medically trained JSC personnel (total of 34 participants). Non-medically trained personnel participated in order to approximate a scenario of limited CMO exposure to the RSP equipment and training (which can occur six months prior to the mission). In each study, participants were asked to perform two respiratory distress scenarios using one of the cue card designs to simulate resuscitation (using a mannequin along with the hardware). Procedure completion time, errors, and subjective ratings were recorded. The last iteration of the cue card featured a schematic of the RSP, colors, borders, and simplification of the flow of information. The time to complete the RSP procedure was reduced by approximately three minutes with the new design. In an emergency situation, three minutes significantly increases the probability of saving a life. In addition, participants showed the highest preference for this design. The results of the studies and the new design were presented to a focus group of astronauts, flight surgeons, medical trainers, and procedures personnel. The final cue card was presented to a medical control board and approved for flight. The revised RSP cue card is currently onboard ISS.

A Secure and High-Fidelity Live Animal Model for Off-Pump Coronary Bypass Surgery Training.

PubMed

Liu, Xiaopeng; Yang, Yan; Meng, Qiang; Sun, Jiakang; Luo, Fuliang; Cui, Yongchun; Zhang, Hong; Zhang, Dong; Tang, Yue

2016-01-01

Existing simulators for off-pump coronary artery (CA) bypass grafting training are unable to provide cardiac surgery residents all necessary skills they need entering the operation room. In this study, we introduced a secure and high-fidelity live animal model to supplement the in vitro simulators for off-pump CA bypass grafting training. The left internal thoracic artery (ITA) of 3 Chinese miniature pigs was grafted to the left anterior descending CA using an end-to-side anastomosis. The free segment of the ITA was fixed on the ventricle surface, making it a simulative CA beating in synchrony with the heart. A total of 6 to 8 training anastomoses were made on each ITA. Animal Experiment Center in Fuwai Hospital. In total, 19 resident surgeons with at least 3 years of cardiac surgery work experience were trained using the new model. Their performances were recorded and reviewed. Simulative coronary arteries were successfully constructed in all 3 animals with no adverse event observed. A total of 19 anastomoses were then completed, 1 pig of 7 anastomoses and the other 2 animals of 6 anastomoses. Time consumption for the anastomosis was 782 ± 107 seconds. Anastomotic leakage was observed in 10/19 procedures. The most frequency site (7/10) was at the toe of the anastomosis. Further, the most common cause was uneven spacing or small margin of the stitches or both. Emergencies occurred during the training process included hypotension (7 procedures), tachyarrhythmia (4 procedures), and low blood oxygen saturation (1 procedure). This study demonstrated the safety and feasibility of our new live pig model in training resident surgeons. The simulative arteries can be easily accomplished and were long enough to place at least 6 anastomoses. Both on lumen diameter and motion status, they were proven to be a good substitution of the CA. Copyright © 2016. Published by Elsevier Inc.

Workplace Violence Training Programs for Health Care Workers: An Analysis of Program Elements.

PubMed

Arbury, Sheila; Hodgson, Michael; Zankowski, Donna; Lipscomb, Jane

2017-06-01

Commercial workplace violence (WPV) prevention training programs differ in their approach to violence prevention and the content they present. This study reviews 12 such programs using criteria developed from training topics in the Occupational Safety and Health Administration's (OSHA) Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers and a review of the WPV literature. None of the training programs addressed all the review criteria. The most significant gap in content was the lack of attention to facility-specific risk assessment and policies. To fill this gap, health care facilities should supplement purchased training programs with specific training in organizational policies and procedures, emergency action plans, communication, facility risk assessment, and employee post-incident debriefing and monitoring. Critical to success is a dedicated program manager who understands risk assessment, facility clinical operations, and program management and evaluation.

A comparison of methods for teaching receptive labeling to children with autism spectrum disorders.

PubMed

Grow, Laura L; Carr, James E; Kodak, Tiffany M; Jostad, Candice M; Kisamore, April N

2011-01-01

Many early intervention curricular manuals recommend teaching auditory-visual conditional discriminations (i.e., receptive labeling) using the simple-conditional method in which component simple discriminations are taught in isolation and in the presence of a distracter stimulus before the learner is required to respond conditionally. Some have argued that this procedure might be susceptible to faulty stimulus control such as stimulus overselectivity (Green, 2001). Consequently, there has been a call for the use of alternative teaching procedures such as the conditional-only method, which involves conditional discrimination training from the onset of intervention. The purpose of the present study was to compare the simple-conditional and conditional-only methods for teaching receptive labeling to 3 young children diagnosed with autism spectrum disorders. The data indicated that the conditional-only method was a more reliable and efficient teaching procedure. In addition, several error patterns emerged during training using the simple-conditional method. The implications of the results with respect to current teaching practices in early intervention programs are discussed.

Design and Implementation of a postgraduate curriculum to support Ethiopia's first emergency medicine residency training program: the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM).

PubMed

Meshkat, Nazanin; Teklu, Sisay; Hunchak, Cheryl

2018-04-06

To design and implement an emergency medicine (EM) postgraduate training curriculum to support the establishment of the first EM residency program at Addis Ababa University (AAU). In response to the Ethiopian Federal Ministry of Health mandate to develop EM services in Ethiopia, University of Toronto EM faculty were invited to develop and deliver EM content and expertise for the first EM postgraduate residency training program at AAU. The Toronto Addis Ababa Academic Collaboration-EM (TAAAC-EM) used five steps of a six-step approach to guide curriculum development and implementation: 1. Problem identification and general needs assessment, 2. Targeted needs assessment using indirect methods (interviews and site visits of the learners and learning environment), 3. Defining goals and objectives, 4. Choosing educational strategies and curriculum map development and 5. The needs assessment identified a learning environment with appropriate, though limited, resources for the implementation of an EM residency program. A lack of educational activities geared towards EM practice was identified, specifically of active learning techniques (ALTs) such as bedside teaching, simulation and procedural teaching. A curriculum map was devised to supplement the AAU EM residency program curriculum. The TAAAC-EM curriculum was divided into three distinct streams: clinical, clinical epidemiology and EM administration. The clinical sessions were divided into didactic and ALTs including practical/procedural and simulation sessions, and bedside teaching was given a strong emphasis. Implementation is currently in its seventh year, with continuous monitoring and revisions of the curriculum to meet evolving needs. We have outlined the design and implementation of the TAAAC-EM curriculum; an evaluation of this curriculum is currently underway. As EM spreads as a specialty throughout Africa and other resource-limited regions, this model can serve as a working guide for similar bi-institutional educational partnerships seeking to develop novel EM postgraduate training programs.

United Airlines LOFT training

NASA Technical Reports Server (NTRS)

Cavanagh, D.; Traub, B.

1981-01-01

Line oriented training is used in a broader, more generic sense that as a specific program under FAR 12.1409 and AC 120-35. A company policy was adopted more than twenty years ago requiring that all pilot checks and recurrent training be conducted with a full crew occupying the seats they occupy on the line. Permission was obtained to reschedule the hours for recurrent proficiency training to include one and one-half hours of LOFT flight. The number of emergencies and abnormal procedures which could be undertaken were considered and the introduction of an a occasional incapacitation revealed which person is the most difficult to replace on the widebodies. By using the LOFT concept, every training period can be structured like a typical line flight. The use of LOFT in simulator syllabus development and problems that need to be refined are discussed.

[Out-of-hospital pediatric emergencies. Perception and assessment by emergency physicians].

PubMed

Eich, C; Roessler, M; Timmermann, A; Heuer, J F; Gentkow, U; Albrecht, B; Russo, S G

2009-09-01

Out-of-hospital (OOH) pediatric emergencies have a relatively low prevalence. In Germany the vast majority of cases are attended by non-specialized emergency physicians (EPs) for whom these are not routine procedures. This may lead to insecurity and fear. However, it is unknown how EPs perceive and assess pediatric emergencies and how they could be better prepared for them. All active EPs (n=50) of the Department of Anaesthesiology, Emergency and Intensive Care Medicine at the University Medical Centre of Göttingen were presented with a structured questionnaire in order to evaluate their perception and assessment of OOH pediatric emergencies. The 43 participating EPs made highly detailed statements on the expected characteristics of OOH pediatric emergencies. Their confidence level grew with the children's age (p<0.03) and with their own experience (p<0.01). The EPs felt particular deficits in the fields of cardiopulmonary resuscitation (n=18) and trauma management (n=8). The preferred educational strategies included simulator-based training (n=24) as well as more exposure to pediatric intensive care and pediatric anesthesia (n=12). Despite their own limited experience EPs can realistically assess the incidence and severity of pediatric emergencies. They felt the greatest deficits were in the care of infrequent but life-threatening emergencies. Three educational groups can be differentiated: knowledge and skills to be gained with children in hospital, clinical experience from adult care also applicable in children and rare diagnoses and interventions to be trained with manikins or simulators.

Interventional psychiatry: how should psychiatric educators incorporate neuromodulation into training?

PubMed

Williams, Nolan R; Taylor, Joseph J; Snipes, Jonathan M; Short, E Baron; Kantor, Edward M; George, Mark S

2014-04-01

Interventional psychiatry is an emerging subspecialty that uses a variety of procedural neuromodulation techniques in the context of an electrocircuit-based view of mental dysfunction as proximal causes for psychiatric diseases. The authors propose the development of an interventional psychiatry-training paradigm analogous to those found in cardiology and neurology. The proposed comprehensive training in interventional psychiatry would include didactics in the theory, proposed mechanisms, and delivery of invasive and noninvasive brain stimulation. The development and refinement of this subspecialty would facilitate safe, effective growth in the field of brain stimulation by certified and credentialed practitioners within the field of psychiatry while also potentially improving the efficacy of current treatments.

KSC-2009-3378

NASA Image and Video Library

2009-06-02

CAPE CANAVERAL, Fla. – STS-127 Mission Specialist Julie Payette smiles after her success in driving the M-113 armored personnel carrier, which is part of the training on emergency egress procedures. Payette represents the Canadian Space Agency. The crew members of space shuttle Endeavour's STS-127 mission are taking turns driving the M-113. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is at NASA's Kennedy Space Center for a launch dress rehearsal called the terminal countdown demonstration test, or TCDT, which includes the emergency egress training and equipment familiarization. The STS-127 mission is the final of three flights dedicated to the assembly of the Japanese Kibo laboratory complex. Endeavour's launch is targeted for June 13. Photo credit: NASA/Kim Shiflett

KSC-2009-3376

NASA Image and Video Library

2009-06-02

CAPE CANAVERAL, Fla. – STS-127 Mission Specialist Christopher Cassidy practices driving the M-113 armored personnel carrier, which is part of the training on emergency egress procedures. Other crew members seated behind him are Mission Specialist Julie Payette, Dave Wolf, Tom Marshburn and Pilot Doug Hurley, who will take their turns at driving the M-113. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is at NASA's Kennedy Space Center for a launch dress rehearsal called the terminal countdown demonstration test, or TCDT, which includes the emergency egress training and equipment familiarization. The STS-127 mission is the final of three flights dedicated to the assembly of the Japanese Kibo laboratory complex. Endeavour's launch is targeted for June 13. Photo credit: NASA/Kim Shiflett

KSC-2009-3377

NASA Image and Video Library

2009-06-02

CAPE CANAVERAL, Fla. – STS-127 Mission Specialist Julie Payette takes her turn practice driving the M-113 armored personnel carrier, which is part of the training on emergency egress procedures. Payette represents the Canadian Space Agency. Behind her is Pilot Doug Hurley. The crew members of space shuttle Endeavour's STS-127 mission are taking turns driving the M-113. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is at NASA's Kennedy Space Center for a launch dress rehearsal called the terminal countdown demonstration test, or TCDT, which includes the emergency egress training and equipment familiarization. The STS-127 mission is the final of three flights dedicated to the assembly of the Japanese Kibo laboratory complex. Endeavour's launch is targeted for June 13. Photo credit: NASA/Kim Shiflett

Message Received How to Bridge the Communication Gap and Save Lives

DTIC Science & Technology

2004-03-01

safety during an emergency depend on the ability of first responders to talk via radio, directly, without dispatch and in real time. Many technologies are...Words interoperability Coast Guard first responders procedures interagency communications policies 18...communication interoperability for public safety first responders entails far more than finding and emplacing a technology and training the operators. The

RCRA Refresher Self-Study, Course 28582

DOE Office of Scientific and Technical Information (OSTI.GOV)

Simpson, Lewis Edward

Federal and state regulations require hazardous and mixed waste facility workers at treatment and storage facilities (TSFs) and <90-day accumulation areas to be trained in hazardous and mixed waste management. This course will refamiliarize and update <90-day accumulation area workers, TSF workers, and supervisors of TSF workers regarding waste identification, pollution prevention, storage area requirements, emergency response procedures, and record-keeping requirements.

Re-Emergence of Under-Selected Stimuli, after the Extinction of Over-Selected Stimuli in an Automated Match to Samples Procedure

ERIC Educational Resources Information Center

Broomfield, Laura; McHugh, Louise; Reed, Phil

2008-01-01

Stimulus over-selectivity occurs when one of potentially many aspects of the environment comes to control behaviour. In two experiments, adults with no developmental disabilities, were trained and tested in an automated match to samples (MTS) paradigm. In Experiment 1, participants completed two conditions, in one of which the over-selected…

The impact of body-part-naming training on the accuracy of imitative performances in 2- to 3-year-old children.

PubMed

Camões-Costa, Vera; Erjavec, Mihela; Horne, Pauline J

2011-11-01

A series of three experiments explored the relationship between 3-year-old children's ability to name target body parts and their untrained matching of target hand-to-body touches. Nine participants, 3 per experiment, were presented with repeated generalized imitation tests in a multiple-baseline procedure, interspersed with step-by-step training that enabled them to (i) tact the target locations on their own and the experimenter's bodies or (ii) respond accurately as listeners to the experimenter's tacts of the target locations. Prompts for on-task naming of target body parts were also provided later in the procedure. In Experiment 1, only tact training followed by listener probes were conducted; in Experiment 2, tacting was trained first and listener behavior second, whereas in Experiment 3 listener training preceded tact training. Both tact and listener training resulted in emergence of naming together with significant and large improvements in the children's matching performances; this was true for each child and across most target gestures. The present series of experiments provides evidence that naming--the most basic form of self-instructional behavior--may be one means of establishing untrained matching as measured in generalized imitation tests. This demonstration has a bearing on our interpretation of imitation reported in the behavior analytic, cognitive developmental, and comparative literature.

The Impact of Body-Part-Naming Training on the Accuracy of Imitative Performances in 2- to 3-Year-Old Children

PubMed Central

Camões-Costa, Vera; Erjavec, Mihela; Horne, Pauline J

2011-01-01

A series of three experiments explored the relationship between 3-year-old children's ability to name target body parts and their untrained matching of target hand-to-body touches. Nine participants, 3 per experiment, were presented with repeated generalized imitation tests in a multiple-baseline procedure, interspersed with step-by-step training that enabled them to (i) tact the target locations on their own and the experimenter's bodies or (ii) respond accurately as listeners to the experimenter's tacts of the target locations. Prompts for on-task naming of target body parts were also provided later in the procedure. In Experiment 1, only tact training followed by listener probes were conducted; in Experiment 2, tacting was trained first and listener behavior second, whereas in Experiment 3 listener training preceded tact training. Both tact and listener training resulted in emergence of naming together with significant and large improvements in the children's matching performances; this was true for each child and across most target gestures. The present series of experiments provides evidence that naming —the most basic form of self-instructional behavior—may be one means of establishing untrained matching as measured in generalized imitation tests. This demonstration has a bearing on our interpretation of imitation reported in the behavior analytic, cognitive developmental, and comparative literature. PMID:22084492

The surgical ensemble: choreography as a simulation and training tool.

PubMed

Satava, Richard M; Hunter, Anne Marie

2011-09-01

Team training and interprofessional training have recently emerged as critical new simulations that enhance performance by coordinating communication, leadership, professional, and, to a certain extent, technical skills. In describing these new training tools, the term choreography has been loosely used, but no critical appraisal of the role of the science of choreography has been applied to a surgical procedure. By analogy, the surgical team, including anesthetists, surgeons, nurses, and technicians, constitutes a complete ensemble, whose physical actions and interactions constitute the "performance of surgery." There are very specific "elements" (tools) that are basic to choreography, such as space, timing, rhythm, energy, cues, transitions, and especially rehearsal. This review explores whether such a metaphor is appropriate and the possibility of applying the science of choreography to the surgical team in the operating theater.

Improving education: just-in-time splinting video.

PubMed

Wang, Vincent; Cheng, Yu-Tsun; Liu, Deborah

2016-06-01

Just-in-time training (JITT) is an emerging concept in medical procedural education, but with few studies to support its routine use. Providing a brief educational intervention in the form of a digital video immediately prior to patient care may be an effective method to reteach knowledge for procedural techniques learned previously. Paediatric resident physicians were taught to perform a volar splint in a small workshop setting. Subsequently, they were asked to demonstrate their splinting proficiency by performing a splint on another doctor. Proficiency was scored on a five-point assessment tool. After 2-12 months, participants were asked to demonstrate their splinting proficiency on one of the investigators, and were divided into the control group (no further instruction) and the intervention group, which viewed a 3-minute JITT digital video demonstrating the splinting technique prior to performing the procedure. Thirty subjects were enrolled between August 2012 and July 2013, and 29 of 30 completed the study. The retest splinting time was not significantly different, but if the JITT group included watching the video, the total time difference was statistically significant: 3.86 minutes (control) versus 7.07 minutes (JITT) (95% confidence interval: 2.20-3.90 minutes). The average assessment score difference was 1.87 points higher for the JITT group, which was a statistically significant difference (95% confidence interval: 1.00-3.00). Just-in-time training is an emerging concept in medical procedural education JITT seems to be an effective tool in medical education for reinforcing previously learned skills. JITT may offer other possibilities for enhancing medical education. © 2015 John Wiley & Sons Ltd.

Astronaut Joseph Tanner checks gloves during during launch/entry training

NASA Image and Video Library

1994-06-23

S94-40082 (23 June 1994) --- Astronaut Joseph R. Tanner, mission specialist, checks his glove during a rehearsal for launch and entry phases of the scheduled November flight of STS-66. This rehearsal, held in the Crew Compartment Trainer (CCT) of the Johnson Space Center's (JSC) Shuttle Mockup and Integration Laboratory, was followed by a training session on emergency egress procedures. In November, Tanner will join four other NASA astronauts and a European mission specialist for a week and a half aboard the Space Shuttle Atlantis in Earth-orbit in support of the Atmospheric Laboratory for Applications and Science (ATLAS-3).

STS-42 Payload Specialist Bondar in single person life raft at JSC's WETF

NASA Technical Reports Server (NTRS)

1991-01-01

STS-42 Discovery, Orbiter Vehicle (OV) 103, Payload Specialist Roberta L. Bondar, wearing launch and entry suit (LES) and launch and entry helmet (LEH), floats in single person life raft during launch emergency egress exercises held in the Weightless Environment Training Facility (WETF) Bldg 29 pool. Bondar holds the Space Shuttle Search and Rescue Satellite Aided Tracking (SARSAT) portable locating beacon (PLB). The STS-42 crewmembers rehearsed procedures for launch emergency egress and a water landing. Bondar is representing Canada during the International Microgravity Laboratory 1 (IML-1) mission aboard OV-103.

Management of potentially life-threatening emergencies at 74 primary level hospitals in Mongolia: results of a prospective, observational multicenter study.

PubMed

Mendsaikhan, Naranpurev; Gombo, Davaa; Lundeg, Ganbold; Schmittinger, Christian; Dünser, Martin W

2017-05-08

While the capacities to care for and epidemiology of emergency and critically ill patients have been reported for secondary and tertiary level hospitals in Mongolia, no data exist for Mongolian primary level hospitals. In this prospective, observational multicenter study, 74 primary level hospitals of Mongolia were included. We determined the capacities of these hospitals to manage medical emergencies. Furthermore, characteristics of patients presenting with potentially life-threatening emergencies to these hospitals were evaluated during a 6 month period. An emergency/resuscitation room was available in 62.2% of hospitals. One third of the study hospitals had an operation theatre (32.4%). No hospital ran an intensive care unit or had trained emergency/critical care physicians or nurses available. Diagnostic resources were inconsistently available (sonography, 59.5%; echocardiography, 0%). Basic emergency procedures (wound care, 97.3%; foreign body removal, 86.5%; oxygen application, 85.2%) were commonly but advanced procedures (advanced cardiac life support, 10.8%; airway management, 13.5%; mechanical ventilation, 0%; renal replacement therapy, 0%) rarely available. During 6 months, 14,545 patients were hospitalized in the 74 study hospitals, of which 8.7% [n = 1267; median age, 34 (IQR 18-53) years; male gender, 54.4%] were included in the study. Trauma (excl. brain trauma) (20.4%), acute abdomen (16.9%) and heart failure (9.6%) were the most common conditions. Five-hundred-thirty patients (41.8%) were transferred to a secondary level hospital. The hospital mortality of patients not transferred was 3.2%. Capacities of Mongolian primary level hospitals to manage life-threatening emergencies are highly limited. Trauma, surgical and medical conditions make up the most common emergencies. In view of the fact that almost half of the patients with a potentially life-threatening emergency were transferred to secondary level hospitals and the mortality of those hospitalized in primary level hospitals was 3.2%, room for improvement is clearly evident. Based on our findings, improvements could be obtained by strengthening inter-hospital transfer systems, training staff in emergency/critical care skills and by making mechanical ventilation and advanced life support techniques available at the emergency rooms of primary level hospitals.

The influence of staff training on challenging behaviour in individuals with intellectual disability: a review.

PubMed

Cox, Alison D; Dube, Charmayne; Temple, Beverley

2015-03-01

Many individuals with intellectual disability engage in challenging behaviour. This can significantly limit quality of life and also negatively impact caregivers (e.g., direct care staff, family caregivers and teachers). Fortunately, efficacious staff training may alleviate some negative side effects of client challenging behaviour. Currently, a systematic review of studies evaluating whether staff training influences client challenging behaviour has not been conducted. The purpose of this article was to identify emerging patterns, knowledge gaps and make recommendations for future research on this topic. The literature search resulted in a total of 19 studies that met our inclusion criteria. Articles were separated into four staff training categories. Studies varied across sample size, support staff involved in training, study design, training duration and data collection strategy. A small sample size (n = 19) and few replication studies, alongside several other procedural limitations prohibited the identification of a best practice training approach. © The Author(s) 2014.

Interventional radiology virtual simulator for liver biopsy.

PubMed

Villard, P F; Vidal, F P; ap Cenydd, L; Holbrey, R; Pisharody, S; Johnson, S; Bulpitt, A; John, N W; Bello, F; Gould, D

2014-03-01

Training in Interventional Radiology currently uses the apprenticeship model, where clinical and technical skills of invasive procedures are learnt during practice in patients. This apprenticeship training method is increasingly limited by regulatory restrictions on working hours, concerns over patient risk through trainees' inexperience and the variable exposure to case mix and emergencies during training. To address this, we have developed a computer-based simulation of visceral needle puncture procedures. A real-time framework has been built that includes: segmentation, physically based modelling, haptics rendering, pseudo-ultrasound generation and the concept of a physical mannequin. It is the result of a close collaboration between different universities, involving computer scientists, clinicians, clinical engineers and occupational psychologists. The technical implementation of the framework is a robust and real-time simulation environment combining a physical platform and an immersive computerized virtual environment. The face, content and construct validation have been previously assessed, showing the reliability and effectiveness of this framework, as well as its potential for teaching visceral needle puncture. A simulator for ultrasound-guided liver biopsy has been developed. It includes functionalities and metrics extracted from cognitive task analysis. This framework can be useful during training, particularly given the known difficulties in gaining significant practice of core skills in patients.

Cadaveric surgery in core gynaecology training: a feasibility study.

PubMed

Lim, Chou Phay; Roberts, Mark; Chalhoub, Tony; Waugh, Jason; Delegate, Laura

2018-01-01

Fresh frozen cadaver training has been proposed as a better model than virtual reality simulators in laparoscopy training. We aimed to explore the relationship between cadaveric surgical training and increased surgical confidence.To determine feasibility, we devised two 1-day cadaveric surgical training days targeted at trainees in obstetrics and gynaecology. Seven defined surgical skills were covered during the course of the day. The relationship between surgical training and surgical confidence was explored using both quantitative (confidence scores) and qualitative tools (questionnaires). Participants rated a consistent improvement in their level of confidence after the training. They universally found the experience positive and three overarching themes emerged from the qualitative analysis including self-concept, social persuasion and stability of task. It is pragmatically feasible to provide procedure-specific cadaveric surgical training alongside supervised clinical training. This small, non-generalisable study suggests that cadaveric training may contribute to an increase in surgical self-confidence and efficacy. This will form the basis of a larger study and needs to be explored in more depth with a larger population.

Have “new” methods in medical education reached German-speaking Central Europe: a survey

PubMed Central

2014-01-01

Background Simulation-based-training (SBT) in the education of health professionals is discussed as an effective alternative for knowledge and skills enhancement as well as for the establishment of a secure learning environment, for learners and patients. In the Anglo-American region, SBT and simulation and training centers (STC) are numbered as standard for medical training. In German-speaking Central Europe, priority is still given to the establishment of SBT and STC. The purpose of this study was (i) to survey the status quo relating to the existence and facilities of simulation and training centers at medical universities in German-speaking Central Europe and (ii) the evaluation of training methods, especially in the area of emergency medicine skills. Methods All public and private medical universities or medical faculties in Germany (36), Austria (4) and German-speaking Switzerland (3) were interviewed. In the survey, information regarding the existence and facilities of STCs and information with regards to the use of SBT in the area of emergency medicine was requested. The questions were partly posed in a closed-ended-, in an open-ended- and in a multiple choice format (with the possibility of selecting more than one answer). Results Of a total of 43 contacted medical universities/medical faculties, 40 ultimately participated in the survey. As decisive for the establishment of a STC the potential to improve the clinical-practical training and the demand by students were listed. Obligatory training in a STC during the first and sixth academic year was confirmed only by 12 institutions, before the first invasive procedure on patients by 17 institutions. 13 institutions confirmed the use of the STC for the further training of physicians and care-staff. Training for the acute care and emergency medicine skills in the field of pediatrics, for the most part, occurs decentralized. Conclusions New methods in medical training have reached German-speaking Central Europe, but the simulation and training centers vary in size, equipment or regarding their integration into the obligatory curriculum as much as the number and variety of the offering to be trained voluntarily or on an obligatory basis. PMID:25129398

Have "new" methods in medical education reached German-speaking Central Europe: a survey.

PubMed

Fandler, Martin; Habersack, Marion; Dimai, Hans P

2014-08-16

Simulation-based-training (SBT) in the education of health professionals is discussed as an effective alternative for knowledge and skills enhancement as well as for the establishment of a secure learning environment, for learners and patients. In the Anglo-American region, SBT and simulation and training centers (STC) are numbered as standard for medical training. In German-speaking Central Europe, priority is still given to the establishment of SBT and STC. The purpose of this study was (i) to survey the status quo relating to the existence and facilities of simulation and training centers at medical universities in German-speaking Central Europe and (ii) the evaluation of training methods, especially in the area of emergency medicine skills. All public and private medical universities or medical faculties in Germany (36), Austria (4) and German-speaking Switzerland (3) were interviewed. In the survey, information regarding the existence and facilities of STCs and information with regards to the use of SBT in the area of emergency medicine was requested. The questions were partly posed in a closed-ended-, in an open-ended- and in a multiple choice format (with the possibility of selecting more than one answer). Of a total of 43 contacted medical universities/medical faculties, 40 ultimately participated in the survey. As decisive for the establishment of a STC the potential to improve the clinical-practical training and the demand by students were listed. Obligatory training in a STC during the first and sixth academic year was confirmed only by 12 institutions, before the first invasive procedure on patients by 17 institutions. 13 institutions confirmed the use of the STC for the further training of physicians and care-staff. Training for the acute care and emergency medicine skills in the field of pediatrics, for the most part, occurs decentralized. New methods in medical training have reached German-speaking Central Europe, but the simulation and training centers vary in size, equipment or regarding their integration into the obligatory curriculum as much as the number and variety of the offering to be trained voluntarily or on an obligatory basis.

How do clinicians with different training backgrounds manage walk-in patients in the ED setting?

PubMed

Harris, Tim; McDonald, Keith

2014-12-01

To compare the initial assessment and management of walk-in emergency department (ED) patients between different types of healthcare providers. A large teaching hospital with an annual ED census of 140 000 adult patients. A random sample of 384 patients who self-presented to the ED was obtained. A detailed analysis of each patient record was performed by two clinicians. Data were obtained on the presenting condition, and disposition of each patient, either into the ED for further assessment, or discharge. GPs were significantly more likely to discharge patients home as compared to emergency nurses. ED senior nurses were more likely than GPs to stream patients into the ED for further assessment. Of the patients referred into the ED for further assessment by senior ED nurses, the majority were discharged home. There were insufficient numbers of emergency physician assessments for meaningful statistical analysis. The clinician groups studied here demonstrated different patterns of discharge and referral, reflecting their training and experience. When planning operational procedures, the training and background of the staff allocated to each area should be considered. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Clinical skills temporal degradation assessment in undergraduate medical education.

PubMed

Fisher, Joseph; Viscusi, Rebecca; Ratesic, Adam; Johnstone, Cameron; Kelley, Ross; Tegethoff, Angela M; Bates, Jessica; Situ-Lacasse, Elaine H; Adamas-Rappaport, William J; Amini, Richard

2018-01-01

Medical students' ability to learn clinical procedures and competently apply these skills is an essential component of medical education. Complex skills with limited opportunity for practice have been shown to degrade without continued refresher training. To our knowledge there is no evidence that objectively evaluates temporal degradation of clinical skills in undergraduate medical education. The purpose of this study was to evaluate temporal retention of clinical skills among third year medical students. This was a cross-sectional study conducted at four separate time intervals in the cadaver laboratory at a public medical school. Forty-five novice third year medical students were evaluated for retention of skills in the following three procedures: pigtail thoracostomy, femoral line placement, and endotracheal intubation. Prior to the start of third-year medical clerkships, medical students participated in a two-hour didactic session designed to teach clinically relevant materials including the procedures. Prior to the start of their respective surgery clerkships, students were asked to perform the same three procedures and were evaluated by trained emergency medicine and surgery faculty for retention rates, using three validated checklists. Students were then reassessed at six week intervals in four separate groups based on the start date of their respective surgical clerkships. We compared the evaluation results between students tested one week after training and those tested at three later dates for statistically significant differences in score distribution using a one-tailed Wilcoxon Mann-Whitney U-test for non-parametric rank-sum analysis. Retention rates were shown to have a statistically significant decline between six and 12 weeks for all three procedural skills. In the instruction of medical students, skill degradation should be considered when teaching complex technical skills. Based on the statistically significant decline in procedural skills noted in our investigation, instructors should consider administering a refresher course between six and twelve weeks from initial training.

Novel ex vivo model for hands-on teaching of and training in EUS-guided biliary drainage: creation of "Mumbai EUS" stereolithography/3D printing bile duct prototype (with videos).

PubMed

Dhir, Vinay; Itoi, Takao; Fockens, Paul; Perez-Miranda, Manuel; Khashab, Mouen A; Seo, Dong Wan; Yang, Ai Ming; Lawrence, Khek Yu; Maydeo, Amit

2015-02-01

EUS-guided biliary drainage (EUS-BD) has emerged as an alternative rescue method in patients with failed ERCP. Opportunities for teaching and training are limited because of a low case volume at most centers. To evaluate a stereolithography/3-dimensional (3D) printing bile duct prototype for teaching and training in EUS-BD. Prospective observational feasibility study. Tertiary referral center. Twenty endosonographers attending an interventional EUS workshop. A prototype of a dilated biliary system was prepared by computer-aided design and 3D printing. The study participants performed guidewire manipulation and EUS-BD procedures (antegrade procedure and/or choledochoduodenostomy) on the prototype. Participants were scored with the device on a scale of 1 to 5 via a questionnaire. Participants' success rate for various steps of the EUS-BD procedure was noted. Subjective and objective evaluation of the prototype regarding its overall applicability, quality of radiographic and EUS images, and 4 steps of EUS-BD procedure (needle puncture, guidewire manipulation, tract dilation, stent placement). Fifteen participants returned the questionnaire, and 10 completed all 4 steps of EUS-BD. The median score for overall utility was 4, whereas that for EUS and US views was 5. Participants with experience in performing more than 20 EUS-BD procedures scored the prototype significantly lower for stent placement (P = .013) and equivalent for needle puncture, tract dilation, and wire manipulation. The success rate of various steps was 100% for needle puncture and tract dilation, 82.35% for wire manipulation, and 80% for stent placement. The mean overall procedure time was 18 minutes. Small number of participants. The 3D printing bile duct prototype appears suitable for teaching of and training in the various steps of EUS-BD. Further studies are required to elucidate its role. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

KSC-07pd3344

NASA Image and Video Library

2007-11-18

KENNEDY SPACE CENTER, FLA. -- STS-122 Mission Specialist Rex Walheim, at right, practices driving an M-113 armored personnel carrier as the instructor beside him monitors his performance. The practice near Launch Pad 39B is part of training on emergency egress procedures. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is participating in Terminal Countdown Demonstration Test activities, a standard part of launch preparations. The TCDT provides astronauts and ground crews with equipment familiarization, emergency egress training and a simulated launch countdown. On mission STS-122, Atlantis will deliver the European Space Agency's Columbus module to the International Space Station. Columbus is a multifunctional, pressurized laboratory that will be permanently attached to U.S. Node 2, called Harmony, and will expand the research facilities aboard the station. Launch is targeted for Dec. 6. Photo credit: NASA/Kim Shiflett

KSC-07pd3336

NASA Image and Video Library

2007-11-18

KENNEDY SPACE CENTER, FLA. -- STS-122 Commander Stephen Frick takes time out from driving practice of the M-113 armored personnel carrier to pose for a photo. The practice near Launch Pad 39B is part of training on emergency egress procedures. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is participating in Terminal Countdown Demonstration Test activities, a standard part of launch preparations. The TCDT provides astronauts and ground crews with equipment familiarization, emergency egress training and a simulated launch countdown. On mission STS-122, Atlantis will deliver the European Space Agency's Columbus module to the International Space Station. Columbus is a multifunctional, pressurized laboratory that will be permanently attached to U.S. Node 2, called Harmony, and will expand the research facilities aboard the station. Launch is targeted for Dec. 6. Photo credit: NASA/Kim Shiflett

KSC-07pd3338

NASA Image and Video Library

2007-11-18

KENNEDY SPACE CENTER, FLA. -- STS-122 Pilot Alan Poindexter takes time out from driving practice of the M-113 armored personnel carrier to pose for a photo. The practice near Launch Pad 39B is part of training on emergency egress procedures. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is participating in Terminal Countdown Demonstration Test activities, a standard part of launch preparations. The TCDT provides astronauts and ground crews with equipment familiarization, emergency egress training and a simulated launch countdown. On mission STS-122, Atlantis will deliver the European Space Agency's Columbus module to the International Space Station. Columbus is a multifunctional, pressurized laboratory that will be permanently attached to U.S. Node 2, called Harmony, and will expand the research facilities aboard the station. Launch is targeted for Dec. 6. Photo credit: NASA/Kim Shiflett

KSC-07pd3340

NASA Image and Video Library

2007-11-18

KENNEDY SPACE CENTER, FLA. -- STS-122 Mission Specialist Leland Melvin takes time out from driving practice of the M-113 armored personnel carrier to pose for a photo. The practice near Launch Pad 39B is part of training on emergency egress procedures. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is participating in Terminal Countdown Demonstration Test activities, a standard part of launch preparations. The TCDT provides astronauts and ground crews with equipment familiarization, emergency egress training and a simulated launch countdown. On mission STS-122, Atlantis will deliver the European Space Agency's Columbus module to the International Space Station. Columbus is a multifunctional, pressurized laboratory that will be permanently attached to U.S. Node 2, called Harmony, and will expand the research facilities aboard the station. Launch is targeted for Dec. 6. Photo credit: NASA/Kim Shiflett

KSC-07pd3345

NASA Image and Video Library

2007-11-18

KENNEDY SPACE CENTER, FLA. -- STS-122 Mission Specialist Hans Schlegel, of the European Space Agency, takes time out from driving practice of the M-113 armored personnel carrier to pose for a photo. The practice near Launch Pad 39B is part of training on emergency egress procedures. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is participating in Terminal Countdown Demonstration Test activities, a standard part of launch preparations. The TCDT provides astronauts and ground crews with equipment familiarization, emergency egress training and a simulated launch countdown. On mission STS-122, Atlantis will deliver the European Space Agency's Columbus module to the International Space Station. Columbus is a multifunctional, pressurized laboratory that will be permanently attached to U.S. Node 2, called Harmony, and will expand the research facilities aboard the station. Launch is targeted for Dec. 6. Photo credit: NASA/Kim Shiflett

The surgical experience of general surgery residents: an analysis of the applicability of the specialty program in General and Digestive Surgery.

PubMed

Targarona Soler, Eduardo Ma; Jover Navalon, Jose Ma; Gutierrez Saiz, Javier; Turrado Rodríguez, Víctor; Parrilla Paricio, Pascual

2015-03-01

Residents in our country have achieved a homogenous surgical training by following a structured residency program. This is due to the existence of specific training programs for each specialty. The current program, approved in 2007, has a detailed list of procedures that a surgeon should have performed in order to complete training. The aim of this study is to analyze the applicability of the program with regard to the number of procedures performed during the residency period. A data collection form was designed that included the list of procedures from the program of the specialty; it was sent in April 2014 to all hospitals with accredited residency programs. In September 2014 the forms were analysed, and a general descriptive study was performed; a subanalysis according to the resident's sex and Autonomous region was also performed. The number of procedures performed according to the number of residents in the different centers was also analyzed. The survey was sent to 117 hospitals with accredited programs, which included 190 resident places. A total of 91 hospitals responded (53%). The training offered adapts in general to the specialty program. The total number of procedures performed in the different sub-areas, in laparoscopic and emergency surgery is correct or above the number recommended by the program, with the exception of esophageal-gastric and hepatobiliary surgery. The sub-analysis according to Autonomous region did not show any significant differences in the total number of procedures, however, there were significant differences in endocrine surgery (P=.001) and breast surgery (P=.042). A total of 55% of residents are female, with no significant differences in distribution in Autonomous regions. However, female surgeons operate more than their male counterparts during the residency period (512±226 vs. 625±244; P<.01). The number of residents in the hospital correlates with the number of procedures performed; the residents with more procedures trained in hospitals where there were less residents (669±237 vs. 527±209; P=.004). The surgical activity performed by spanish surgeons is adequate to the specialty program, except in hepatobiliary and esophageal-gastric surgery. The distribution is homogeneous in the different autonomous regions, although there are differences that depend on the number and sex the of residents in each hospital. This information is essential to evaluate the quality of the specialty program and to design new training programs. Copyright © 2015 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

The Role of Multiple-Exemplar Training and Naming in Establishing Derived Equivalence in an Infant

PubMed Central

Luciano, Carmen; Becerra, Inmaculada Gómez; Valverde, Miguel Rodríguez

2007-01-01

The conditions under which symmetry and equivalence relations develop are still controversial. This paper reports three experiments that attempt to analyze the impact of multiple-exemplar training (MET) in receptive symmetry on the emergence of visual–visual equivalence relations with a very young child, Gloria. At the age of 15 months 24 days (15m24d), Gloria was tested for receptive symmetry and naming and showed no evidence of either repertoire. In the first experiment, MET in immediate and delayed receptive symmetrical responding or listener behavior (from object–sound to immediate and delayed sound–object selection) proceeded for one month with 10 different objects. This was followed, at 16m25d, by a second test conducted with six new objects. Gloria showed generalized receptive symmetry with a 3-hr delay; however no evidence of naming with new objects was found. Experiment 2 began at 17m with the aim of establishing derived visual–visual equivalence relations using a matching-to-sample format with two comparisons. Visual–visual equivalence responding emerged at 19m, although Gloria still had not shown evidence of naming. Experiment 3 (22m to 23m25d) used a three-comparison matching-to-sample procedure to establish visual–visual equivalence. Equivalence responding emerged as in Experiment 2, and naming emerged by the end of Experiment 3. Results are discussed in terms of the history of training in bidirectional relations responsible for the emergence of visual–visual equivalence relations and of their implications for current theories of stimulus equivalence. PMID:17575901

[Nurses and social care workers in emergency teams in Norway].

PubMed

Hilpüsch, Frank; Parschat, Petra; Fenes, Sissel; Aaraas, Ivar J; Gilbert, Mads

2011-01-07

The Norwegian counties Troms and Finnmark are dominated by large areas with widespread habitation and rather long response times for ambulances and doctors. We wished to investigate the extent to which the municipal preparedness in these counties use employees from the municipal nursing and social care services and if these are part of local emergency teams. In the autumn of 2008, we sent a questionnaire to the district medical officers and the leaders for municipal nursing and social care services in all 44 municipalities in Troms and Finnmark. The answers were analyzed manually. 41 municipalities responded. In 34 of these the municipal nurses and social care workers practice emergency medicine procedures. The content in these training sessions is much more comprehensive than that in a typical first aid course. In three of four municipalities ambulance personnel do not participate in this training. In 31 municipalities the inhabitants contact nurses and social care workers directly if they are acutely ill. In only 10 of the municipalities the nurses and social care workers are organized in local teams including a doctor and an ambulance. In the districts, nursing and social care services are a resource in an emergency medicine context. The potential within these professions can be exploited better and be an important supplement in emergencies. In emergencies, cooperation across disciplines requires a clear organizational and economical structure, local basis and leadership.

Emergency Response Capability Baseline Needs Assessment - Compliance Assessment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sharry, John A.

This document was prepared by John A. Sharry, LLNL Fire Marshal and Division Leader for Fire Protection and was reviewed by LLNL Emergency Management Department Head, James Colson. This document is the second of a two-part analysis on Emergency Response Capabilities of Lawrence Livermore National Laboratory. The first part, 2016 Baseline Needs Assessment Requirements Document established the minimum performance criteria necessary to meet mandatory requirements. This second part analyses the performance of Lawrence Livermore Laboratory Emergency Management Department to the contents of the Requirements Document. The document was prepared based on an extensive review of information contained in the 2016more » BNA, a review of Emergency Planning Hazards Assessments, a review of building construction, occupancy, fire protection features, dispatch records, LLNL alarm system records, fire department training records, and fire department policies and procedures. The 2013 BNA was approved by NNSA’s Livermore Field Office on January 22, 2014.« less

Intelligent Medical Systems for Aerospace Emergency Medical Services

NASA Technical Reports Server (NTRS)

Epler, John; Zimmer, Gary

2004-01-01

The purpose of this project is to develop a portable, hands free device for emergency medical decision support to be used in remote or confined settings by non-physician providers. Phase I of the project will entail the development of a voice-activated device that will utilize an intelligent algorithm to provide guidance in establishing an airway in an emergency situation. The interactive, hands free software will process requests for assistance based on verbal prompts and algorithmic decision-making. The device will allow the CMO to attend to the patient while receiving verbal instruction. The software will also feature graphic representations where it is felt helpful in aiding in procedures. We will also develop a training program to orient users to the algorithmic approach, the use of the hardware and specific procedural considerations. We will validate the efficacy of this mode of technology application by testing in the Johns Hopkins Department of Emergency Medicine. Phase I of the project will focus on the validation of the proposed algorithm, testing and validation of the decision making tool and modifications of medical equipment. In Phase 11, we will produce the first generation software for hands-free, interactive medical decision making for use in acute care environments.

Characteristics of emergency pages using a computer-based anesthesiology paging system in children and adults undergoing procedures at a tertiary care medical center.

PubMed

Weingarten, Toby N; Abenstein, John P; Dutton, Claire H; Kohn, Melinda A; Lee, Elizabeth A; Mullenbach, Tami E; Narr, Bradly J; Schroeder, Darrell R; Sprung, Juraj

2013-04-01

In our large academic supervisory practice, attending anesthesiologists concomitantly care for multiple patients. To manage communications within the procedural environment, we use a proprietary electronic computer-based anesthesiology visual paging system. This system can send an emergency page that instantly alerts the attending anesthesiologist and other available personnel that immediate help is needed. We analyzed the characteristics of intraoperative emergency pages in children and adults. We identified all emergency page activations between January 1, 2005 and July 31, 2010 in our main operating rooms. Electronic medical records were reviewed for rates and characteristics of pages such as primary etiology, performed interventions, and outcomes. During the study period, 258,135 anesthetics were performed (n = 32,103 children, younger than 18 years) and 370 emergency pages (n = 309 adults, n = 61 children) were recorded (1.4 per 1000 cases; 95% confidence interval, 1.3-1.6). Infants had the highest rates (9.4 per 1000; 95% confidence interval, 5.7-14.4) of emergency page activations (P < 0.001 compared with each other age group). In adults, the most frequent causes were hemodynamic (55%), and in children respiratory and airway (60.7%) events. Emergency pages were rare in patients older than 2 years. Infants were more likely than children 1 to 2 years of age to have emergency page activation, despite both groups being cared for by pediatric fellowship trained anesthesiologists.

Should nurses be trained to use ultrasound for intravenous access to patients with difficult veins?

PubMed

Smith, Claire

2018-06-14

Peripheral venous access is the most common invasive procedure performed on patients in the UK and is traditionally the responsibility of nursing staff. In an emergency, intravenous therapy can be lifesaving. Approximately 11% of adults have difficult venous access and are often subjected to repeated failed attempts, resulting in delayed diagnosis and treatment. Eventually, rescue methods are used by a doctor, but this increases demand on their time and the workflow of emergency departments. This article explores whether training nurses to obtain venous access using ultrasound would have a positive effect on doctors' workload and benefit adult patients with difficult veins. Research indicates that nurses can successfully use ultrasound to reduce the number of attempts, time to access and patient discomfort, and can prevent the insertion of unnecessary central lines. Ultrasound training programmes for nurses demonstrate benefits for patients and clinicians. © 2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Preliminary study of the pilot's workload during emergency procedures in helicopters air operations.

PubMed

Bezerra, Flávio G V; Ribeiro, Selma L O

2012-01-01

Military air operations and law enforcement operations in helicopters are examples of activities that require high performance of the operator. This article aimed at presenting a preliminary analysis of data obtained in the initial study in order to validate the instruments and the research protocol that focuses on the analysis of the workload imposed on helicopter pilots in emergency situations. The research was conducted in an environment of real flight training and used the NASA-TLX Scale to assess the workload and an interview guide to obtain reports on the main tasks performed. Preliminary data obtained is related to the participation of 10 (ten) volunteer pilots with experience in different types of helicopters. Four scenarios involving helicopter emergency procedures of HB-350 "Squirrel" were outlined. For this article, the analysis used only the data regarding the Physical and Mental Demands of the NASA-TLX Scale. Preliminarily, the results indicate that the "time pressure" as a factor contributing to increase mental requirement in emergency situations in flight, and that this increase was reflected in the request of mental processes such as: identification of the breakdown, attention and monitoring parameters. Future steps include extending the sample and adding physiological tools to better understand the effects of these types of emergencies on pilot performance and flight safety.

Care Situation for Female Victims of Sexual Violence in Metropolitan Emergency Departments with Charité/Berlin as an Example

PubMed Central

Hoffmann-Walbeck, H.; Möckel, M.; Etzold, S.; David, M.

2016-01-01

of the perpetrators were friends or relations; 17 % were (ex-)partners. The waiting time in the Charité emergency departments amounted to 58 minutes on average, the medical treatment time 55 minutes. About 80 % of the personnel evaluated the “stuprum kit” as being altogether good or very good. More than ⅓ considered the time and room conditions as being unsuitable or rather unsuitable for the situation. Two thirds expressed the desire for further training and supervision. Conclusion: The structured procedure by means of the “stuprum kit” has proved its value. A need for optimisation was seen especially for the examination facilities in the emergency departments. PMID:27904168

Surgical motion characterization in simulated needle insertion procedures

NASA Astrophysics Data System (ADS)

Holden, Matthew S.; Ungi, Tamas; Sargent, Derek; McGraw, Robert C.; Fichtinger, Gabor

2012-02-01

PURPOSE: Evaluation of surgical performance in image-guided needle insertions is of emerging interest, to both promote patient safety and improve the efficiency and effectiveness of training. The purpose of this study was to determine if a Markov model-based algorithm can more accurately segment a needle-based surgical procedure into its five constituent tasks than a simple threshold-based algorithm. METHODS: Simulated needle trajectories were generated with known ground truth segmentation by a synthetic procedural data generator, with random noise added to each degree of freedom of motion. The respective learning algorithms were trained, and then tested on different procedures to determine task segmentation accuracy. In the threshold-based algorithm, a change in tasks was detected when the needle crossed a position/velocity threshold. In the Markov model-based algorithm, task segmentation was performed by identifying the sequence of Markov models most likely to have produced the series of observations. RESULTS: For amplitudes of translational noise greater than 0.01mm, the Markov model-based algorithm was significantly more accurate in task segmentation than the threshold-based algorithm (82.3% vs. 49.9%, p<0.001 for amplitude 10.0mm). For amplitudes less than 0.01mm, the two algorithms produced insignificantly different results. CONCLUSION: Task segmentation of simulated needle insertion procedures was improved by using a Markov model-based algorithm as opposed to a threshold-based algorithm for procedures involving translational noise.

Predicting emergency coronary artery bypass graft following PCI: application of a computational model to refer patients to hospitals with and without onsite surgical backup

PubMed Central

Syed, Zeeshan; Moscucci, Mauro; Share, David; Gurm, Hitinder S

2015-01-01

Background Clinical tools to stratify patients for emergency coronary artery bypass graft (ECABG) after percutaneous coronary intervention (PCI) create the opportunity to selectively assign patients undergoing procedures to hospitals with and without onsite surgical facilities for dealing with potential complications while balancing load across providers. The goal of our study was to investigate the feasibility of a computational model directly optimised for cohort-level performance to predict ECABG in PCI patients for this application. Methods Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry data with 69 pre-procedural and angiographic risk variables from 68 022 PCI procedures in 2004–2007 were used to develop a support vector machine (SVM) model for ECABG. The SVM model was optimised for the area under the receiver operating characteristic curve (AUROC) at the level of the training cohort and validated on 42 310 PCI procedures performed in 2008–2009. Results There were 87 cases of ECABG (0.21%) in the validation cohort. The SVM model achieved an AUROC of 0.81 (95% CI 0.76 to 0.86). Patients in the predicted top decile were at a significantly increased risk relative to the remaining patients (OR 9.74, 95% CI 6.39 to 14.85, p<0.001) for ECABG. The SVM model optimised for the AUROC on the training cohort significantly improved discrimination, net reclassification and calibration over logistic regression and traditional SVM classification optimised for univariate performance. Conclusions Computational risk stratification directly optimising cohort-level performance holds the potential of high levels of discrimination for ECABG following PCI. This approach has value in selectively referring PCI patients to hospitals with and without onsite surgery. PMID:26688738

Emergency in the clinic: a simulation curriculum to improve outpatient safety.

PubMed

Espey, Eve; Baty, Gillian; Rask, John; Chungtuyco, Michelle; Pereda, Brenda; Leeman, Lawrence

2017-12-01

Emergency response skills are essential when events such as seizure, anaphylaxis, or hemorrhage occur in the outpatient setting. As services and procedures increasingly move outside the hospital, training to manage complications may improve outcomes. The objective of this study was to evaluate a simulation-based curriculum in outpatient emergency management skills with the outcome measures of graded objective performance and learner self-efficacy. This pre- and postcurriculum study enrolled residents and fellows in Obstetrics and Gynecology and Family Medicine in a simulation-based, outpatient emergency management curriculum. Learners completed self-efficacy questionnaires and were videotaped managing 3 medical emergency scenarios (seizure, over-sedation/cardiopulmonary arrest, and hemorrhage) in the simulation laboratory both before and after completion of the curriculum. Evaluators who were blinded to training level scored the simulation performance videotapes using a graded rubric with critical action checklists. Scenario scores were assigned in 5 domains and globally. Paired t-tests were used to determine differences pre- and postcurriculum. Thirty residents completed the curriculum and pre- and postcurriculum testing. Subjects' objective performance scores improved in all 5 domains (P<.05) in all scenarios. When scores were stratified by level of training, all participants demonstrated global improvement. When scores were stratified by previous outpatient simulation experience, subjects with previous experience improved in all but management of excess sedation. Pre- and postcurriculum self-efficacy evaluations demonstrated improvement in all 7 measured areas: confidence, use of appropriate resources, communication skills, complex airway management, bag mask ventilation, resuscitation, and hemorrhage management. Self-efficacy assessment showed improvement in confidence managing outpatient emergencies (P=.001) and ability to communicate well in emergency situations (P<.001). A simulation-based curriculum improved both self-efficacy and objectively rated performance scores in management of outpatient medical emergencies. Simulation-based curricula should be incorporated into residency education. Copyright © 2017 Elsevier Inc. All rights reserved.

Pediatric emergency and essential surgical care in Zambian hospitals: a nationwide study.

PubMed

Bowman, Kendra G; Jovic, Goran; Rangel, Shawn; Berry, William R; Gawande, Atul A

2013-06-01

Pediatric surgical care in developing countries is not well studied. We sought to identify the range of pediatric surgery available, the barriers to provision, and level of safety of surgery performed for the entire pediatric population in Zambia. In cooperation with the Ministry of Health, we validated and adapted a World Health Organization instrument. During onsite visits, the availability of 32 emergency and essential surgical procedures relevant to children was surveyed. The availability of basic World Health Organization surgical safety criteria was determined. A single interviewer visited 103 (95%) of 108 surgical hospitals in Zambia and carried out 495 interviews. An average of 68% of the 32 emergency and essential surgical procedures was available (range 32%-100%). Lack of surgical skill was the primary reason for referral in 72% of procedure types, compared with 24%, 2% and 3% due to lack of equipment, supplies and anesthesia skills, respectively (p<0.001). Minimum pediatric surgical safety criteria were met by 14% of hospitals. The primary limitation to providing pediatric surgical care in Zambia is lack of surgical skills. Minimum safety standards were met by 14% of hospitals. Efforts to improve pediatric surgery should prioritize teaching surgical skills to expand access and providing safety training, equipment and supplies to increase safety. Copyright © 2013 Elsevier Inc. All rights reserved.

A COMPARISON OF METHODS FOR TEACHING RECEPTIVE LABELING TO CHILDREN WITH AUTISM SPECTRUM DISORDERS

PubMed Central

Grow, Laura L; Carr, James E; Kodak, Tiffany M; Jostad, Candice M; Kisamore, April N

2011-01-01

Many early intervention curricular manuals recommend teaching auditory-visual conditional discriminations (i.e., receptive labeling) using the simple-conditional method in which component simple discriminations are taught in isolation and in the presence of a distracter stimulus before the learner is required to respond conditionally. Some have argued that this procedure might be susceptible to faulty stimulus control such as stimulus overselectivity (Green, 2001). Consequently, there has been a call for the use of alternative teaching procedures such as the conditional-only method, which involves conditional discrimination training from the onset of intervention. The purpose of the present study was to compare the simple-conditional and conditional-only methods for teaching receptive labeling to 3 young children diagnosed with autism spectrum disorders. The data indicated that the conditional-only method was a more reliable and efficient teaching procedure. In addition, several error patterns emerged during training using the simple-conditional method. The implications of the results with respect to current teaching practices in early intervention programs are discussed. PMID:21941380

Pediatric surgical capacity building - a pathway to improving access to pediatric surgical care in Haiti.

PubMed

Kaseje, Neema; Jenny, Hillary; Jeudy, Andre Patrick; MacLee, Jean Louis; Meara, John G; Ford, Henri R

2018-02-01

Lack of human resources is a major barrier to accessing pediatric surgical care globally. Our aim was to establish a model for pediatric surgical training of general surgery residents in a resource constrained region. A pediatric surgical program with a pediatric surgical rotation for general surgery residents in a tertiary hospital in Haiti in 2015 was established. We conducted twice daily patient rounds, ran an outpatient clinic, and provided emergent and elective pediatric surgical care, with tasks progressively given to residents until they could run clinic and perform the most common elective and emergent procedures. We conducted baseline and post-intervention knowledge exams and dedicated 1 day a week to teaching and research activities. We measured the following outcomes: number of residents that completed the rotation, mean pre and post intervention test scores, patient volume in clinic and operating room, postoperative outcomes, resident ability to perform most common elective and emergent procedures, and resident participation in research. Nine out of 9 residents completed the rotation; 987 patients were seen in outpatient clinic, and 564 procedures were performed in children <15years old. There was a 50% increase in volume of pediatric cases and a 100% increase in procedures performed in children <4years old. Postoperative outcomes were: 0% mortality for elective cases and 18% mortality for emergent cases, 3% complication rate for elective cases and 6% complication rate for emergent cases. Outcomes did not change with increased responsibility given to residents. All senior residents (n=4) could perform the most common elective and emergent procedures without changes in mortality and complication rates. Increases in mean pre and post intervention test scores were 12% (PGY1), 24% (PGY2), and 10% (PGY3). 75% of senior residents participated in research activities as first or second authors. Establishing a program in pediatric surgery with capacity building of general surgery residents for pediatric surgical care provision is feasible in a resource constrained setting without negative effects on patient outcomes. This model can be applied in other resource constrained settings to increase human resources for global pediatric surgical care provision. III. Copyright © 2017 Elsevier Inc. All rights reserved.

Complaints from emergency department patients largely result from treatment and communication problems.

PubMed

Taylor, David McD; Wolfe, Rory; Cameron, Peter A

2002-03-01

Emergency department patient complaints are often justified and may lead to apology, remedial action or compensation. The aim of the present study was to analyse emergency department patient complaints in order to identify procedures or practices that require change and to make recommendations for intervention strategies aimed at decreasing complaint rates. We undertook a retrospective analysis of patient complaints from 36 Victorian emergency departments during a 61 month period. Data were obtained from the Health Complaint Information Program (Health Services Commissioner). In all, 2,419 emergency department patients complained about a total of 3,418 separate issues (15.4% of all issues from all hospital departments). Of these, 1,157 complaints (47.80%) were received by telephone and 829 (34.3%) were received by letter; 1,526 (63.1 %) complaints were made by a person other than the patient. Highest complaint rates were received from patients who were female, born in non-English-speaking countries and very young or very old. One thousand one hundred and forty-one issues (33.4%) related to patient treatment, including inadequate treatment (329 issues) and inadequate diagnosis (249 issues); 1079 (31.6%) issues related to communication, including poor staff attitude, discourtesy and rudeness (444 issues); 407 (11.9%) issues related to delay in treatment. Overall, 2516 issues (73.6%) were resolved satisfactorily, usually by explanation or apology. Only 59 issues (1.7%) resulted in a procedure or policy change. Remedial action was taken in 109 issues (3.2%) and compensation was paid to eight patients. Communication remains a significant factor in emergency department patient dissatisfaction. While patient complaints have resulted in major changes to policy and procedure, research and intervention strategies into communication problems are indicated. In the short term, focused staff training is recommended.

Do procedural skills workshops during family practice residency work?

PubMed

MacKenzie, Mark S; Berkowitz, Jonathan

2010-08-01

To determine if participation in a procedural skills workshop during family practice residency affects future use of these skills in postgraduate clinical practice. Survey involving self-assessment of procedural skills experience and competence. British Columbia. Former University of British Columbia family practice residents who trained in Vancouver, BC, including residents who participated in a procedural skills workshop in 2001 or 2003 and residents graduating in 2000 and 2002 who did not participate in the procedural skills workshop. Self-assessed experience and competence in the 6 office-based procedural skills that were taught during the procedural skills workshops in 2001 and 2003. Participation in a procedural skills workshop had no positive effect on future use of these skills in clinical practice. Participation in the workshop was associated with less reported experience (P = .091) in injection of lateral epicondylitis. As with previous Canadian studies, more women than men reported experience and competence in gynecologic procedures. More women than men reported experience (P = .001) and competence (P = .004) in intrauterine device insertion and experience (P = .091) in endometrial aspiration biopsy. More men than women reported competence (P = .052) in injection of trochanteric bursae. A third year of emergency training was correlated with an increase in reported experience (P = .021) in shoulder injection. Participation in a procedural skills workshop during family practice residency did not produce a significant increase in the performance of these skills on the part of participants once they were in clinical practice. The benefit of a skills workshop might be lost when there is no opportunity to practise and perfect these skills. Sex bias in the case of some procedures might represent a needs-based acquisition of skills on the part of practising physicians. Short procedural skills workshops might be better suited to graduated physicians with more clinical experience.

Role of cytopathology in cancer control in low-resource settings: sub-Saharan Africa's perspective.

PubMed

Thomas, Jaiyeola

2011-03-01

Cancer is an emerging public health problem in Africa especially with increasing exposure to risky life styles, environmental carcinogens and emergence of AIDS-associated cancers. Of the WHO estimated 7.9 million cancer-related deaths in 2007 more than 72% occurred in the low- and middle-income countries and 80% presented in the late stages. To implement the WHO resolution on cancer control programs in these settings, feasible evidence-based interventions for prevention, early diagnosis and detection need to be widely introduced. Fundamental to appropriate cancer treatment and statistics is accurate diagnosis. In low-resource settings, the diagnostic techniques and procedures should be reliable, cost-effective, simple and acceptable to patients. In addition, the required equipment should be affordable, requiring minimal maintenance and with readily available consumables. Cytology, as a simple standardized low-technology procedure, fulfills these criteria and is most effective in addressing the major components of cancer control programs in these areas. The major obstacles to its widespread establishment are lack of awareness and inadequate numbers of trained personnel compounded by sociopolitical factors, poor national planning and implementation. Rather than investing in new technology or alternative screening methods, efforts should focus on the education and training of local personnel, as feasible options, to improve the chances of implementing meaningful cancer control programs.

Virtual reality in surgical education.

PubMed

Ota, D; Loftin, B; Saito, T; Lea, R; Keller, J

1995-03-01

Virtual reality (VR) is an emerging technology that can teach surgeons new procedures and can determine their level of competence before they operate on patients. Also VR allows the trainee to return to the same procedure or task several times later as a refresher course. Laparoscopic surgery is a new operative technique which requires the surgeon to observe the operation on a video-monitor and requires the acquisition of new skills. VR simulation could duplicate the operative field and thereby enhance training and reduce the need for expensive animal training models. Our preliminary experience has shown that we have the technology to model tissues and laparoscopic instruments and to develop in real time a VR learning environment for surgeons. Another basic need is to measure competence. Surgical training is an apprenticeship requiring close supervision and 5-7 years of training. Technical competence is judged by the mentor and has always been subjective. If VR surgical simulators are to play an important role in the future, quantitative measurement of competence would have to be part of the system. Because surgical competence is "vague" and is characterized by such terms as "too long, too short" or "too close, too far," it is possible that the principles of fuzzy logic could be used to measure competence in a VR surgical simulator. Because a surgical procedure consists of a series of tasks and each task is a series of steps, we will plan to create two important tasks in a VR simulator and validate their use. These tasks consist of laparoscopic knot tying and laparoscopic suturing. Our hypothesis is that VR in combination with fuzzy logic can educate surgeons and determine when they are competent to perform these procedures on patients.

Teaching Splinting Techniques Using a Just-in-Time Training Instructional Video.

PubMed

Cheng, Yu-Tsun; Liu, Deborah R; Wang, Vincent J

2017-03-01

Splinting is a multistep procedure that is seldom performed by primary care physicians. Just-in-time training (JITT) is an emerging teaching modality and can be an invaluable asset for infrequently performed procedures or in locations where teaching resources and trained professionals are limited. Our objective was to determine the utility of JITT for teaching medical students the short-arm (SA) volar splinting technique. This was a prospective randomized controlled pilot study. An instructional video on SA volar splinting was produced. Students viewed the video or had access to standard medical textbooks (control group) immediately before applying an SA volar splint. The students were assessed for the quality of the splint via a standard 6-point skills checklist. The times required for presplinting preparation and for completion of the splint were also measured. Just-in-time training group students scored higher on the splint checklist (mean [SD], 5.45 [1.06]; 95% confidence interval [CI], 4.99-5.92 vs mean [SD], 1.58 [1.12]; 95% CI, 1.04-2.12; P < 0.0001), had higher pass rates (73%; 95% CI, 53%-93% vs 0%; P < 0.0001), and required less time (minutes) for presplinting preparation (mean [SD], 7.86 [2.45]; 95% CI, 6.78-8.94 vs mean [SD], 9.89 [0.46]; 95% CI, 9.67-10.12; P < 0.0001) compared with the control group. No difference was seen in the time required to complete a splint, successful or not. In comparison with reading standard textbooks, watching a brief JITT instructional video before splinting yielded faster learning times combined with more successful procedural skills. The use of a JITT instructional video may have potential applications, including globally, as an alternative resource for teaching and disseminating procedural skills, such as SA volar splinting.

Visually guided male urinary catheterization: a feasibility study.

PubMed

Willette, Paul A; Banks, Kevin; Shaffer, Lynn

2013-01-01

Ten percent to 15% of urinary catheterizations involve complications. New techniques to reduce risks and pain are indicated. This study examines the feasibility and safety of male urinary catheterization by nursing personnel using a visually guided device in a clinical setting. The device, a 0.6-mm fiber-optic bundle inside a 14F triple-lumen flexible urinary catheter with a lubricious coating, irrigation port, and angled tip, connects to a camera, allowing real-time viewing of progress on a color monitor. Two emergency nurses were trained to use the device. Male patients 18 years or older presenting to the emergency department with an indication for urinary catheterization using a standard Foley or Coudé catheter were eligible to participate in the study. Exclusion criteria were a current suprapubic tube or gross hematuria prior to the procedure. Twenty-five patients were enrolled. Data collected included success of placement, total procedure time, pre-procedure pain and maximum pain during the procedure, gross hematuria, abnormalities or injuries identified if catheterization failed, occurrence of and reason for equipment failures, and number of passes required for placement. All catheters were successfully placed. The median number of passes required was 1. For all but one patient, procedure time was ≤ 17 minutes. A median increase in pain scores of 1 point from baseline to the maximum was reported. Gross hematuria was observed in 2 patients. The success rate for placement of a Foley catheter with the visually guided device was 100%, indicating its safety, accuracy, and feasibility in a clinical setting. Minimal pain was associated with the procedure. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

[Emergency Doctor Training for Psychiatric Emergencies: Evaluation of an Interactive Training Program].

PubMed

Flüchter, Peter; Müller, Vincent; Bischof, Felix; Pajonk, Frank-Gerald Bernhard

2017-03-01

Aim Emergency physicians are often confronted with psychiatric emergencies, but are not well trained for it and often feel unable to cope sufficiently with them. The aim of this investigation was to examine whether multisensoric training may improve learning effects in the training of emergency physicians with regard to psychiatric emergencies. Method Participation in a multi-modal, multi-media training program with video case histories and subsequent evaluation by questionnaire. Results 66 emergency physicians assessed their learning effects. 75 % or 73 % rated it as "rather high" or "very high". In particular, in comparison with classical training/self-study 89 % assessed the effects in learning as "rather high" or "very high" . Conclusion This training receives a high level of acceptance. Using videos, learning content may be provided more practice-related. Thus, emergency physicians are able to develop a greater understanding of psychiatric emergencies. © Georg Thieme Verlag KG Stuttgart · New York.

Risk factors for the severity of injury incurred in crashes involving on-duty police cars.

PubMed

Chu, Hsing-Chung

2016-07-03

This article explores the risk factors associated with police cars on routine patrol and/or on an emergency run and their effects on the severity of injuries in crashes. The binary probit model is used to examine the effects of important factors on the risk of injuries sustained in crashes involving on-duty police cars. Several factors significantly increase the probability of crashes that cause severe injuries. Among those causes are police officers who drive at excessive speeds, traffic violations during emergency responses or pursuits, and driving during the evening (6 to 12 p.m.) or in rainy weather. Findings also indicate some potential issues associated with an increase in the probability of crashes that cause injuries. Younger police drivers were found to be more likely to be involved in crashes causing injuries than middle-aged drivers were. Distracted driving by on-duty police officers as well as civilian drivers who did not pull over to let a police car pass in emergency situations also caused serious crashes. Police cars are exempted from certain traffic laws under emergency circumstances. However, to reduce the probability of being involved in a crash resulting in severe injuries, officers are still obligated to drive safely and follow safety procedures when responding to emergencies or pursuing a car. Enhancement of training techniques for emergency situations or driving in pursuit of an offender and following the safety procedures are essential for safety in driving during an emergency run by police.

Tumescent liposuction: standard guidelines of care.

PubMed

Mysore, Venkataram

2008-01-01

Tumescent liposuction is a technique for the removal of subcutaneous fat under a special form of local anesthesia called tumescent anesthesia. PHYSICIAN'S QUALIFICATIONS: The physician performing liposuction should have completed postgraduate training in dermatology or a surgical specialty and should have had adequate training in dermatosurgery at a center that provides training in cutaneous surgery. In addition, the physician should obtain specific liposuction training or experience at the surgical table ("hands on") under the supervision of an appropriately trained and experienced liposuction surgeon. In addition to the surgical technique, training should include instruction in fluid and electrolyte balance, potential complications of liposuction, tumescent and other forms of anesthesia as well as emergency resuscitation and care. Liposuction can be performed safely in an outpatient day care surgical facility, or a hospital operating room. The day care theater should be equipped with facilities for monitoring and handling emergencies. A plan for handling emergencies should be in place with which all nursing staff should be familiar. A physician trained in emergency medical care and acute cardiac emergencies should be available in the premises. It is recommended but not mandatory, that an anesthetist be asked to stand by. Liposuction is recommended for all localized deposits of fat. Novices should restrict themselves to the abdomen, thighs, buttocks and male breasts. Arms, the medial side of the thigh and the female breast need more experience and are recommended for experienced surgeons. Liposuction may be performed for non-cosmetic indications such as hyperhidrosis of axillae after adequate experience has been acquired, but is not recommended for the treatment of obesity. Detailed history is to be taken with respect to any previous disease, drug intake and prior surgical procedures. Liposuction is contraindicated in patients with severe cardiovascular disease, severe coagulation disorders including thrombophilia, and during pregnancy. Physical evaluation should be detailed and should include assessment of general physical health to determine the fitness of the patient for surgery, as well as the examination of specific sites that need liposuction to check for potential problems. The patient should sign a detailed consent form listing details about the procedure and possible complications. The consent form should specifically state the limitations of the procedure and should mention whether more procedures are needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures, computer presentations, and personal discussions. Preoperative laboratory studies to be performed include Hb%, blood counts including platelet counts, bleeding and clotting time (or prothrombin and activated partial thromboplastin time) and blood chemistry profile; ECG is advisable. Liver function tests, and pregnancy test for women of childbearing age are performed as mandated by the individual patient's requirements. Ultrasound examination is recommended in cases of gynecomastia. Preoperative antibiotics and non-sedative analgesics such as paracetamol are recommended. The choice of antibiotic and analgesic agents depends on the individual physician's preference and the prevailing local conditions. Lidocaine is the preferred local anesthetic; its recommended dose is 35-45 mg/kg and doses should not exceed 55 mg/kg wt. The recommended concentration of epinephrine in tumescent solutions is 0.25-1.5 mg/L. The total dosage of epinephrine should be minimized and should not exceed 50 microg/kg. t is always advisable not to combine liposuction with other procedures to avoid exceeding the recommended dosage of lignocaine. However, such combinations may be attempted if the total required dose of lignocaine does not exceed the maximum dose indicated above. The recommended cannula size for liposuction is not to be larger than 3.5 mm in diameter. The recommended volume of fat removed is in proportion to the fat content and/or size and/or weight of the patient being treated. It is recommended that the volume of fat removed not exceed 5000 mL in a single operative session. arge volume liposuctions or mega-liposuctions are not recommended. Baseline vital signs including blood pressure and heart rate, are recorded pre- and postoperatively. Pulse oximeter monitoring is essential in all cases. Postoperative antibiotics should be selected by the physician and taken for five days. Postoperative antiinflammatory drugs such as Cox 2 Inhibiters may be given for 5-7 days; specialized compression garments, binders, and tape help to reduce bruising, hematomas, seromas, and pain. Generally, compression is recommended for two weeks although this is variable according to the needs of the individual patient.

KSC-07pd0490

NASA Image and Video Library

2007-02-22

KENNEDY SPACE CENTER, FLA. -- At the 195-foot level of the fixed service structure on Launch Pad 39A, STS-117 crew members receive instruction on emergency egress during Terminal Countdown Demonstration Test activities. Pilot Lee Archambault reviews emergency egress procedures using the slidewire basket system to get off the pad. The TCDT also includes M-113 armored personnel carrier training, and a simulated launch countdown. The mission payload aboard Space Shuttle Atlantis is the S3/S4 integrated truss structure, along with a third set of solar arrays and batteries. The crew of six astronauts will install the truss to continue assembly of the International Space Station. Photo credit: NASA/Kim Shiflett

Simulation Training for the Office-Based Anesthesia Team.

PubMed

Ritt, Richard M; Bennett, Jeffrey D; Todd, David W

2017-05-01

An OMS office is a complex environment. Within such an environment, a diverse scope of complex surgical procedures is performed with different levels of anesthesia, ranging from local anesthesia to general anesthesia, on patients with varying comorbidities. Optimal patient outcomes require a functional surgical and anesthetic team, who are familiar with both standard operational principles and emergency recognition and management. Offices with high volume and time pressure add further stress and potential risk to the office environment. Creating and maintaining a functional surgical and anesthetic team that is competent with a culture of patient safety and risk reduction is a significant challenge that requires time, commitment, planning, and dedication. This article focuses on the role of simulation training in office training and preparation. Copyright © 2017 Elsevier Inc. All rights reserved.

Integrating musculoskeletal sonography into rehabilitation: Therapists’ experiences with training and implementation

PubMed Central

Gray, Julie McLaughlin; Frank, Gelya; Roll, Shawn C.

2018-01-01

Musculoskeletal sonography is rapidly extending beyond radiology; however, best practices for successful integration into new practice contexts are unknown. This study explored non-physician experiences with the processes of training and integration of musculoskeletal sonography into rehabilitation. Qualitative data were captured through multiple sources and iterative thematic analysis was used to describe two occupational therapists’ experiences. The dominant emerging theme was competency, in three domains: technical, procedural and analytical. Additionally, three practice considerations were illuminated: (1) understanding imaging within the dynamics of rehabilitation, (2) navigating nuances of interprofessional care, and (3) implications for post-professional training. Findings indicate that sonography training for rehabilitation providers requires multi-level competency development and consideration of practice complexities. These data lay a foundation on which to explore and develop best practices for incorporating sonographic imaging into the clinic as a means for engaging clients as active participants in the rehabilitation process to improve health and rehabilitation outcomes. PMID:28830315

Are All Competencies Equal in the Eyes of Residents? A Multicenter Study of Emergency Medicine Residents' Interest in Feedback.

PubMed

Bentley, Suzanne; Hu, Kevin; Messman, Anne; Moadel, Tiffany; Khandelwal, Sorabh; Streich, Heather; Noelker, Joan

2017-01-01

Feedback, particularly real-time feedback, is critical to resident education. The emergency medicine (EM) milestones were developed in 2012 to enhance resident assessment, and many programs use them to provide focused resident feedback. The purpose of this study was to evaluate EM residents' level of interest in receiving real-time feedback on each of the 23 competencies/sub-competencies. This was a multicenter cross-sectional study of EM residents. We surveyed participants on their level of interest in receiving real-time on-shift feedback on each of the 23 competencies/sub-competencies. Anonymous paper or computerized surveys were distributed to residents at three four-year training programs and three three-year training programs with a total of 223 resident respondents. Residents rated their level of interest in each milestone on a six-point Likert-type response scale. We calculated average level of interest for each of the 23 sub-competencies, for all 223 respondents and separately by postgraduate year (PGY) levels of training. One-way analyses of variance were performed to determine if there were differences in ratings by level of training. The overall survey response rate across all institutions was 82%. Emergency stabilization had the highest mean rating (5.47/6), while technology had the lowest rating (3.24/6). However, we observed no differences between levels of training on any of the 23 competencies/sub-competencies. Residents seem to ascribe much more value in receiving feedback on domains involving high-risk, challenging procedural skills as compared to low-risk technical and communication skills. Further studies are necessary to determine whether residents' perceived importance of competencies/sub-competencies needs to be considered when developing an assessment or feedback program based on these 23 EM competencies/sub-competencies.

Intensive skills week for military medical students increases technical proficiency, confidence, and skills to minimize negative stress.

PubMed

Mueller, Genevieve; Hunt, Bonnie; Wall, Van; Rush, Robert; Molof, Alan; Schoeff, Jonathan; Wedmore, Ian; Schmid, James; Laporta, Anthony

2012-01-01

The effects of stress induced cortisol on learning and memory is well documented in the literature.1-3 Memory and learning are enhanced at low levels while high levels are detrimental. Repetitive training in stressful situations enables management of the stress response4 as demonstrated by the high intensity training military members undergo to prepare for tactical situations. Appropriate management of one?s stress response is critical in the medical field, as the negative effects of stress can potentially hinder life-saving procedures and treatments. This also applies to physicians-in-training as they learn and practice triage, emergency medicine, and surgical skills prior to graduation. Rocky Vista University?s Military Medicine Honor?s Track (MMHT) held a week long high-intensity emergency medicine and surgical Intensive Skills Week (ISW), facilitated by military and university physicians, to advance students? skills and maximize training using the Human Worn Partial Surgical Task Simulator (Cut Suit). The short-term goal of the ISW was to overcome negative stress responses to increase confidence, technical and non-technical knowledge, and skill in surgery and emergency medicine in an effort to improve performance as third-year medical students. The long-term goal was to enhance performance and proficiency in residency and future medical practice. The metrics for the short-term goals were the focus of this pilot study. Results show an increase in confidence and decrease in perceived stress as well as statistically significant improvements in technical and non-technical skills and surgical instrumentation knowledge throughout the week. There is a correlative benefit to physician and non-physician military personnel, especially Special Operations Forces (SOF) medical personnel, from developing and implementing similar training programs when live tissue or cadaver models are unavailable or unfeasible. 2012.

Assessment of provider attitudes toward #naloxone on Twitter.

PubMed

Haug, Nancy A; Bielenberg, Jennifer; Linder, Steven H; Lembke, Anna

2016-01-01

As opioid overdose rates continue to pose a major public health crisis, the need for naloxone treatment by emergency first responders is critical. Little is known about the views of those who administer naloxone. The current study examines attitudes of health professionals on the social media platform Twitter to better understand their perceptions of opioid users, the role of naloxone, and potential training needs. Public comments on Twitter regarding naloxone were collected for a period of 3 consecutive months. The occupations of individuals who posted tweets were identified through Twitter profiles or hashtags. Categories of emergency service first responders and medical personnel were created. Qualitative analysis using a grounded theory approach was used to produce thematic content. The relationships between occupation and each theme were analyzed using Pearson chi-square statistics and post hoc analyses. A total of 368 individuals posted 467 naloxone-related tweets. Occupations consisted of professional first responders such as emergency medical technicians (EMTs), firefighters, and paramedics (n = 122); law enforcement officers (n = 70); nurses (n = 62); physicians (n = 48); other health professionals including pharmacists, pharmacy technicians, counselors, and social workers (n = 31); naloxone-trained individuals (n = 12); and students (n = 23). Primary themes included burnout, education and training, information seeking, news updates, optimism, policy and economics, stigma, and treatment. The highest levels of burnout, fatigue, and stigma regarding naloxone and opioid overdose were among nurses, EMTs, other health care providers, and physicians. In contrast, individuals who self-identified as "naloxone-trained" had the highest optimism and the lowest amount of burnout and stigma. Provider training and refinement of naloxone administration procedures are needed to improve treatment outcomes and reduce provider stigma. Social networking sites such as Twitter may have potential for offering psychoeducation to health care providers.

Optimal training for emergency needle thoracostomy placement by prehospital personnel: didactic teaching versus a cadaver-based training program.

PubMed

Grabo, Daniel; Inaba, Kenji; Hammer, Peter; Karamanos, Efstathios; Skiada, Dimitra; Martin, Matthew; Sullivan, Maura; Demetriades, Demetrios

2014-09-01

Tension pneumothorax can rapidly progress to cardiac arrest and death if not promptly recognized and appropriately treated. We sought to evaluate the effectiveness of traditional didactic slide-based lectures (SBLs) as compared with fresh tissue cadaver-based training (CBT) for placement of needle thoracostomy (NT). Forty randomly selected US Navy corpsmen were recruited to participate from incoming classes of the Navy Trauma Training Center at the LAC + USC Medical Center and were then randomized to one of two NT teaching methods. The following outcomes were compared between the two study arms: (1) time required to perform the procedure, (2) correct placement of the needle, and (3) magnitude of deviation from the correct position. During the study period, a total of 40 corpsmen were enrolled, 20 randomized to SBL and 20 to CBT arms. When outcomes were analyzed, time required to NT placement was not different between the two arms. Examination of the location of needle placement revealed marked differences between the two study groups. Only a minority of the SBL group (35%) placed the NT correctly in the second intercostal space. In comparison, the majority of corpsmen assigned to the CBT group demonstrated accurate placement in the second intercostal space (75%). In a CBT module, US Navy corpsmen were better trained to place NT accurately than their traditional didactic SBL counterparts. Further studies are indicated to identify the optimal components of effective simulation training for NT and other emergent interventions.

Emergency management training program: Guide to good practice

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1991-07-01

The Emergency Management Training Program Guide to Good Practice is a project of the Training Resources and Data Exchange (TRADE) Emergency Management Issues Special Interest Group (EMI SIG). EMI SIG members expressed interest in a resource to assist in development of a comprehensive emergency management training program. This publication provides guidelines, methods, and materials for EMI SIG members to use, assisting in complete and effective emergency management programs. The purposes of the Emergency Management Training Program Guide to Good Practice are: Provide guidance in the development and management of Emergency Management (EM) training programs; Assist EM trainers to incorporate componentsmore » of the DOE Emergency Management System philosophy of planning, preparedness, readiness assurance, and response into EM training programs; Help EM training managers meet EM training requirements and conditions established by current regulations and policies; Supplement other TRADE EMI SIG documents and complement individual facility training documents. This program is designed for emergency management personnel who are responsible for providing or overseeing EM training but who do not necessarily possess expertise in developing training. It provides good practices from the manager's point of view on how to produce, administer, and document facility EM training programs in the spirit of the DOE EM system philosophy. Basic guidance is also included for personnel who design, develop, deliver, and/or evaluate EM training programs or parts. This guidance includes key points of EM training programs and identifies other documents that contain useful and/or more detailed training information.« less

Emergency management training program: Guide to good practice

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1991-07-01

The Emergency Management Training Program Guide to Good Practice is a project of the Training Resources and Data Exchange (TRADE) Emergency Management Issues Special Interest Group (EMI SIG). EMI SIG members expressed interest in a resource to assist in development of a comprehensive emergency management training program. This publication provides guidelines, methods, and materials for EMI SIG members to use, assisting in complete and effective emergency management programs. The purposes of the Emergency Management Training Program Guide to Good Practice are: Provide guidance in the development and management of Emergency Management (EM) training programs; Assist EM trainers to incorporate componentsmore » of the DOE Emergency Management System philosophy of planning, preparedness, readiness assurance, and response into EM training programs; Help EM training managers meet EM training requirements and conditions established by current regulations and policies; Supplement other TRADE EMI SIG documents and complement individual facility training documents. This program is designed for emergency management personnel who are responsible for providing or overseeing EM training but who do not necessarily possess expertise in developing training. It provides good practices from the manager`s point of view on how to produce, administer, and document facility EM training programs in the spirit of the DOE EM system philosophy. Basic guidance is also included for personnel who design, develop, deliver, and/or evaluate EM training programs or parts. This guidance includes key points of EM training programs and identifies other documents that contain useful and/or more detailed training information.« less

Preparing emergency personnel in dialysis: a just-in-time training program for additional staffing during disasters.

PubMed

Stoler, Genevieve B; Johnston, James R; Stevenson, Judy A; Suyama, Joe

2013-06-01

There are 341 000 patients in the United States who are dependent on routine dialysis for survival. Recent large-scale disasters have emphasized the importance of disaster preparedness, including supporting dialysis units, for people with chronic disease. Contingency plans for staffing are important for providing continuity of care for a technically challenging procedure such as dialysis. PReparing Emergency Personnel in Dialysis (PREP-D) is a just-in-time training program designed to train individuals having minimum familiarity with the basic steps of dialysis to support routine dialysis staff during a disaster. A 5-module educational program was developed through a collaborative, multidisciplinary effort. A pilot study testing the program was performed using 20 nontechnician dialysis facility employees and 20 clinical-year medical students as subjects. When comparing pretest and posttest scores, the entire study population showed a mean improvement of 28.9%, with dialysis facility employees and medical students showing improvements of 21.8% and 36.4%, respectively (P < .05 for all comparisons). PREP-D participants were able to demonstrate improved tests scores when taught in a just-in-time training format. The knowledge gained by using the PREP-D program during a staffing shortage may allow for continuity of care for critical services such as dialysis during a disaster.

[Pre-hospital management of adults with life-threatening emergencies].

PubMed

Wattel, Francis; Dubois, François

2012-01-01

In France, acute life-threatening situations are handled by the French Secours a Personne (assistance to persons) and emergency medical facilities. An unequivocal success, this early management of life-threatening emergency situations relies upon centralized call reception, medical dispatching, and immediate on-site emergency medical care. We describe the different emergency care providers and steps involved in the response to emergency situations. Each call centre (Samu, phone number 15; Sapeurs-Pompiers, 18) provides a response tailored to the nature of incoming calls for assistance. A check-list of grounds for an "automatic response" by the SDIS (Service Départemental d'Incendie et de Secours--the French fire brigade) is in use, ensuring that firefighters are often the first on the spot, while the knowledge and skills of the dispatching physician are essential to ascertain the patient's needs, to preserve life and vital functions, and to ensure the patient is sent to the appropriate emergency healthcare facility. In life-threatening emergency situations, patients must be brought straight to the appropriate reference emergency healthcare facility, as quickly as possible, without prior admittance to an emergency department. This is the procedure for extremely acute emergency situations in the following areas: trauma (multiple trauma and/or uncontrolled bleeding, spinal cord trauma), delivery bleeding, other life-threatening situations such as ischemic heart disease, cardiac arrest (sudden death), cerebrovascular stroke and ensuing brain damage, some acute respiratory situations such as anaphylactic shock, foreign-body inhalation, electrocution, drowning, drug overdose, certain forms of poisoning, and conditions requiring initial hyperbaric oxygen (diving accidents, acute carbon monoxide and smoke poisoning). The reasons for suboptimal emergency care in life-threatening situations are currently a major issue, with medical facilities being reduced in some areas, fewer voluntary firemen, hospital reorganization, tight funding, difficulties of medical dispatching, and the varying skills of "first-on-the-scene "emergency workers. Grievances include late emergency responses, inappropriate medical care, and dispatching to the wrong facility. This raises the question of equal opportunity for all in a country with widely varying geographic features and population density. Improvement in the system's efficiency will require a series of objectives to be met in varied and complementary--Enhanced functional coordination, by speeding up the deployment of the ANTARES digital radio-frequency transmission network (Adaptation Nationale des Transmissions Aux Risques Et aux Secours).--Implementation of a network of emergency services with varying degrees of emergency healthcare management related to the technical nature of the facilities. Three levels of emergency healthcare must be made available: level 1 is provided by local hospitals, level 2 includes support facilities available in general hospitals (not necessarily the nearest hospital), and level 3 provides specialized healthcare in large and/or training hospitals with specialized departments. Life-threatening emergency situations are to be handled by level 2 or 3 facilities. Specific facilities must be selected as reference centers. In France, the ARS (Agences Régionales de Santé) is in charge of this procedure, as it provide funding for healthcare continuity--Reducing inequalities in access to emergency care. This will involve improving the network of SDIS brigades, making local medical facilities more responsive, delegating more medical procedures, on-site telemedicine, providing more helicopters equipped with healthcare facilities, more automated external defibrillators, and more dedicated neuro-vascular units.--First aid training must be made widely available. The French National Academy of Medicine has approved ten recommendations regarding organization and facilities.

Chapter 9. Educational process. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

PubMed

Richards, Guy A; Sprung, Charles L

2010-04-01

To provide recommendations and standard operating procedures (SOPs) for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with focus on education of all stakeholders, specifically the emergency executive control groups, ICU staff and staff co-opted to assist with patient management. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics, including staff education. Key recommendations include: (1) define functional roles and responsibilities of the internal personnel and interface agencies or sectors; (2) determine logistic support and requirements necessary for the effective implementation of the SOPs; (3) determine what is required to maintain the SOPs; (4) recommended training and activities include: (a) personal protection techniques; (b) environmental contamination; (c) medical management; (d) laboratory specimens; (e) alert lists; (f) training of recruited staff; (g) ethical issues; (h) psychosocial issues; (i) dealing with the deceased; (j) policies for restricting visitors; (k) mechanisms for enforcing policies; (5) Training should begin as soon as possible with daily demonstrations followed by supervised practice; (6) identify the staff to participate in training programs, verify that they have participated and evaluate their knowledge subsequently. Judicious planning and adoption of protocols for staff education are necessary to optimize outcomes during a pandemic.

Biological Risks and Laboratory-Acquired Infections: A Reality That Cannot be Ignored in Health Biotechnology

PubMed Central

Coelho, Ana Cláudia; García Díez, Juan

2015-01-01

Advances and research in biotechnology have applications over a wide range of areas, such as microbiology, medicine, the food industry, agriculture, genetically modified organisms, and nanotechnology, among others. However, research with pathogenic agents, such as virus, parasites, fungi, rickettsia, bacterial microorganisms, or genetic modified organisms, has generated concern because of their potential biological risk – not only for people, but also for the environment due to their unpredictable behavior. In addition, concern for biosafety is associated with the emergence of new diseases or re-emergence of diseases that were already under control. Biotechnology laboratories require biosafety measures designed to protect their staff, the population, and the environment, which may be exposed to hazardous organisms and materials. Laboratory staff training and education is essential, not only to acquire a good understanding about the direct handling of hazardous biological agents but also knowledge of the epidemiology, pathogenicity, and human susceptibility to the biological materials used in research. Biological risk can be reduced and controlled by the correct application of internationally recognized procedures such as proper microbiological techniques, proper containment apparatus, adequate facilities, protective barriers, and special training and education of laboratory workers. To avoid occupational infections, knowledge about standardized microbiological procedures and techniques and the use of containment devices, facilities, and protective barriers is necessary. Training and education about the epidemiology, pathogenicity, and biohazards of the microorganisms involved may prevent or decrease the risk. In this way, the scientific community may benefit from the lessons learned in the past to anticipate future problems. PMID:25973418

Don't fix it if it isn't broken: a survey of preparedness for practice among graduates of Fellowship Council-accredited fellowships.

PubMed

Watanabe, Yusuke; Madani, Amin; Bilgic, Elif; McKendy, Katherine M; Enani, Gada; Ghaderi, Iman; Fried, Gerald M; Feldman, Liane S; Vassiliou, Melina C

2017-05-01

General surgery residency may not adequately prepare residents for independent practice. It is unclear; however, if non-ACGME-accredited fellowships are better meeting training needs. The purpose of this mixed-method study was to determine perceived preparedness for practice and to identify gaps in fellowship training. A survey was developed using an iterative qualitative methodology based on interviews and focus groups of graduated fellows and program directors. Five central themes emerged and were used as a framework: professional development, job marketability, autonomy, networking, and practice management. The survey was then circulated by email to fellows who graduated from Fellowship Council (FC)-accredited programs within the past 3 years. Of 201 respondents (response rate = 41 %), 95 and 97 % were highly satisfied with their operative and non-operative experiences; 83 % acquired jobs aligned with their skills and expectations, while 17 % sought additional training after fellowship. Respondents who intended to learn a given procedure felt competent after fellowship to perform 51(85 %) of the 60 procedures listed. They would have liked more experience in advanced therapeutic endoscopy, complex and revisional bariatric surgery, and uncommon laparoscopic procedures such as esophagectomy, adrenalectomy, and common bile duct exploration. Thirty-one percent expressed the desire for more autonomy in the management of complications. Educational gaps existed mostly in areas of coding and billing (42 %), hiring administrative staff (42 %), and managing insurance issues (34 %). FC-accredited fellowships seem to adequately prepare surgeons for independent practice and bridge training gaps after residency. Graduates are highly satisfied with the individualized training experience and acquire desired jobs aligned with their career goals.

Comprehensive national analysis of emergency and essential surgical capacity in Rwanda.

PubMed

Petroze, R T; Nzayisenga, A; Rusanganwa, V; Ntakiyiruta, G; Calland, J F

2012-03-01

Disparities in the global availability of operating theatres, essential surgical equipment and surgically trained providers are profound. Although efforts are ongoing to increase surgical care and training, little is known about the surgical capacity in developing countries. The aim of this study was to create a baseline for surgical development planning at a national level. A locally adapted World Health Organization survey was conducted in November 2010 to assess emergency and essential surgical capacity and volumes, with on-site interviews at 44 district and referral hospitals in Rwanda. Results were compiled for education and capacity development discussions with the Rwandan Ministry of Health and the Rwanda Surgical Society. Among 10·1 million people, there were 44 hospitals and 124 operating rooms (1·2 operating rooms per 100,000 persons). There was a total of 50 surgeons practising full- or part-time in Rwanda (0·49 total surgeons per 100,000 persons). The majority of consultant surgeons worked in the capital (covering 10 per cent of the population). Anaesthesia was performed primarily by anaesthesia technicians, and six of 44 hospitals had no trained anaesthesia provider. Continuous availability of electricity, running water and generators was lacking in eight hospitals, and 19 reported an absence or shortage in the availability of pulse oximetry. Equipment for life-saving surgical airway procedures, particularly in children, was lacking. A dedicated emergency area was available in only 19 hospitals. In 2009 and 2010 over 80,000 surgical procedures (major and minor) were recorded annually in Rwanda. A comprehensive countrywide assessment of surgical capacity in resource-limited settings found severe shortages in available resources. Immediate local feedback is a useful tool for creating a baseline of surgical capacity to inform country-specific surgical development. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Barriers in detecting elder abuse among emergency medical technicians.

PubMed

Reingle Gonzalez, Jennifer M; Cannell, M Brad; Jetelina, Katelyn K; Radpour, Sepeadeh

2016-09-02

Elder abuse and neglect are highly under-reported in the United States. This may be partially attributed to low incidence of reporting among emergency medical technicians' (EMTs), despite state-mandated reporting of suspected elder abuse. Innovative solutions are needed to address under-reporting. The objective was to describe EMTs' experience detecting and reporting elder abuse. Qualitative data were collected from 11 EMTs and 12 Adult Protective Services (APS) caseworkers that participated in one of five semi-structured focus groups. Focus group data were iteratively coded by two coders. Findings suggest a number of barriers prevent EMTs from reporting elder abuse to APS. Participants suggested that limited training on elder abuse detection or reporting has been provided to them. EMTs suggested that training, creation of an automated reporting system or brief screening tool could be used to enhance EMT's ability to detect and communicate suspected cases of elder abuse to APS. Results from the present study suggest that EMTs may be uniquely situated to serve as elder abuse and neglect surveillance personnel. EMTs are eager to work with APS to address the under-reporting of elder abuse and neglect, but training is minimal and current reporting procedures are time-prohibitive given their primary role as emergency healthcare providers. Future studies should seek to translate these findings into practice by identifying specific indicators predictive of elder abuse and neglect for inclusion on an automated reporting instrument for EMTs.

A Safer Future. Reducing the Impacts of Natural Disasters

DTIC Science & Technology

1991-01-01

press think-tanks such as initiatives should-be directed to teachers at day-care the Gannett -Center for Media Studies and the centers and preschools as...ty of science and technology with the Academy’s purposes of fir- competencies and with regard for appropriate balance. thering knowledge and advising...nity emergency procedures, warning signals, disaster the 12th grade. Teachers should be given training on resources, and relief facilities and

Space station pressurized laboratory safety guidelines

NASA Technical Reports Server (NTRS)

Mcgonigal, Les

1990-01-01

Before technical safety guidelines and requirements are established, a common understanding of their origin and importance must be shared between Space Station Program Management, the User Community, and the Safety organizations involved. Safety guidelines and requirements are driven by the nature of the experiments, and the degree of crew interaction. Hazard identification; development of technical safety requirements; operating procedures and constraints; provision of training and education; conduct of reviews and evaluations; and emergency preplanning are briefly discussed.

STS-50 Payload Specialist Trinh during JSC WETF Bailout Exercises in Bldg 29

NASA Technical Reports Server (NTRS)

1992-01-01

STS-50 Columbia, Orbiter Vehicle (OV) 102, United States Microgravity Laboratory 1 (USML-1) Payload Specialist Eugene H. Trinh, wearing launch and entry suit (LES), listens to instructions prior to participating in launch emergency egress (bailout) exercises in JSC's Weightless Environment Training Facility (WETF) Bldg 29. The WETF's 25-foot deep pool will simulate the ocean as crewmembers familiarize themselves with procedures associated with a bailout and subsequent water landing.

Economic evaluation of emergency obstetric care training: a systematic review.

PubMed

Banke-Thomas, Aduragbemi; Wilson-Jones, Megan; Madaj, Barbara; van den Broek, Nynke

2017-12-04

Training healthcare providers in Emergency Obstetric Care (EmOC) has been shown to be effective in improving their capacity to provide this critical care package for mothers and babies. However, little is known about the costs and cost-effectiveness of such training. Understanding costs and cost-effectiveness is essential in guaranteeing value-for-money in healthcare spending. This study systematically reviewed the available literature on cost and cost-effectiveness of EmOC trainings. Peer-reviewed and grey literature was searched for relevant papers published after 1990. Studies were included if they described an economic evaluation of EmOC training and the training cost data were available. Two reviewers independently searched, screened, and selected studies that met the inclusion criteria, with disagreements resolved by a third reviewer. Quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards statement. For comparability, all costs in local currency were converted to International dollar (I$) equivalents using purchasing power parity conversion factors. The cost per training per participant was calculated. Narrative synthesis was used to summarise the available evidence on cost effectiveness. Fourteen studies (five full and nine partial economic evaluations) met the inclusion criteria. All five and two of the nine partial economic evaluations were of high quality. The majority of studies (13/14) were from low- and middle-income countries. Training equipment, per diems and resource person allowance were the most expensive components. Cost of training per person per day ranged from I$33 to I$90 when accommodation was required and from I$5 to I$21 when training was facility-based. Cost-effectiveness of training was assessed in 5 studies with differing measures of effectiveness (knowledge, skills, procedure cost and lives saved) making comparison difficult. Economic evaluations of EmOC training are limited. There is a need to scale-up and standardise processes that capture both cost and effectiveness of training and to agree on suitable economic evaluation models that allow for comparability across settings. PROSPERO_CRD42016041911 .

A preliminary report on resident emergency psychiatry training from a survey of psychiatry chief residents.

PubMed

Bennett, Jeffrey I; Dzara, Kristina; Mazhar, Mir Nadeem; Behere, Aniruddh

2011-03-01

The Accreditation Council for Graduate Medical Education (ACGME) requirements stipulate that psychiatry residents need to be educated in the area of emergency psychiatry. Existing research investigating the current state of this training is limited, and no research to date has assessed whether the ACGME Residency Review Committee requirements for psychiatry residency training are followed by psychiatry residency training programs. We administered, to chief resident attendees of a national leadership conference, a 24-item paper survey on the types and amount of emergency psychiatry training provided by their psychiatric residency training programs. Descriptive statistics were used in the analysis. Of 154 surveys distributed, 111 were returned (72% response rate). Nearly one-third of chief resident respondents indicated that more than 50% of their program's emergency psychiatry training was provided during on-call periods. A minority indicated that they were aware of the ACGME program requirements for emergency psychiatry training. While training in emergency psychiatry occurred in many programs through rotations-different from the on-call period-direct supervision was available during on-call training only about one-third of the time. The findings suggest that about one-third of psychiatry residency training programs do not adhere to the ACGME standards for emergency psychiatry training. Enhanced knowledge of the ACGME requirements may enhance psychiatry residents' understanding on how their programs are fulfilling the need for more emergency psychiatry training. Alternative settings to the on-call period for emergency psychiatry training are more likely to provide for direct supervision.

Practice style and patient health outcomes: The case of heart attacks

PubMed Central

Currie, Janet; MacLeod, W. Bentley; Van Parys, Jessica

2016-01-01

When a patient arrives at the Emergency Room with acute myocardial infarction (AMI), the provider on duty must quickly decide how aggressively the patient should be treated. Using Florida data on all such patients from 1992 to 2014, we decompose practice style into two components: The provider's probability of conducting invasive procedures on the average patient (which we characterize as aggressiveness), and the responsiveness of the choice of procedure to the patient's characteristics. We show that within hospitals and years, patients with more aggressive providers have consistently higher costs and better outcomes. Since all patients benefit from higher utilization of invasive procedures, targeting procedure use to the most appropriate patients benefits these patients at the expense of the less appropriate patients. We also find that the most aggressive and responsive physicians are young, male, and trained in top 20 schools. PMID:26938940

49 CFR 239.103 - Passenger train emergency simulations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Passenger train emergency simulations. 239.103....103 Passenger train emergency simulations. (a) General. Each railroad operating passenger train service shall conduct full-scale emergency simulations, in order to determine its capability to execute...

49 CFR 239.103 - Passenger train emergency simulations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Passenger train emergency simulations. 239.103....103 Passenger train emergency simulations. (a) General. Each railroad operating passenger train service shall conduct full-scale emergency simulations, in order to determine its capability to execute...

49 CFR 239.103 - Passenger train emergency simulations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 4 2012-10-01 2012-10-01 false Passenger train emergency simulations. 239.103....103 Passenger train emergency simulations. (a) General. Each railroad operating passenger train service shall conduct full-scale emergency simulations, in order to determine its capability to execute...

49 CFR 239.103 - Passenger train emergency simulations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 4 2013-10-01 2013-10-01 false Passenger train emergency simulations. 239.103....103 Passenger train emergency simulations. (a) General. Each railroad operating passenger train service shall conduct full-scale emergency simulations, in order to determine its capability to execute...

Open cholecystectomy in the laparoscopic era.

PubMed

Jenkins, P J; Paterson, H M; Parks, R W; Garden, O J

2007-11-01

As techniques in laparoscopic cholecystectomy have improved, surgeon experience of open cholecystectomy may be limited. This study examined the current indications for and techniques used in primary open cholecystectomy. Some 3100 consecutive patients undergoing elective or emergency cholecystectomy over a 5-year interval were identified from a prospective surgical audit database. Demographic, diagnostic and procedural data were examined. There were 123 (4.0 per cent) primary and 219 (7.4 per cent) converted open cholecystectomies. Some 48.0 and 45.6 per cent of patients in the primary open cholecystectomy and converted groups respectively were men, compared with 24.0 per cent of 2758 who had a successful laparoscopic procedure. Primary open cholecystectomy was employed principally for previous upper abdominal open surgery (22.7 per cent) and emergency operation for general peritonitis (19.5 per cent). The fundus-first approach was employed in 53.7 per cent of primary open procedures and 53.0 per cent of conversions, with subtotal excision in 4.9 and 13.2 per cent respectively. Primary open cholecystectomy remains a common procedure in the treatment of gallbladder disease despite the success of laparoscopic cholecystectomy. Successful outcome in difficult cases requires familiarity with specific techniques, exposure to which may be limited in current training programmes. Copyright (c) 2007 British Journal of Surgery Society Ltd.

Naval Training Equipment Center Index of Technical Reports,

DTIC Science & Technology

1982-09-01

741 RECOMMENDED PROCEDURES AND TRAINING NAVAL TRAINING AIDS. tAMPHIBIOUS OPERATIONS PROCEDURES AND RESEARCH PLANNING AD- 642 590 TRAINING DEVICES FOR...PROCEDURES AND RESEARCH PLANNING OBSERVATION AND FIRE CONTROL WITH FOR ANTI-AIR WARFARE TRAINING SPECIFIC REFERENCE TO THE TRAINING *AMPUTEES PROGRAM...619 AD- 707 757 NAVAL PERSONNEL *COMMUNICATION SATELLITES PROCEDURES AND RESEARCH PLANNING *COMBUSTION PRODUCTS Computer Managed Instruction by FOR

Introducing a Fresh Cadaver Model for Ultrasound-guided Central Venous Access Training in Undergraduate Medical Education

PubMed Central

Miller, Ryan; Ho, Hang; Ng, Vivienne; Tran, Melissa; Rappaport, Douglas; Rappaport, William J.A.; Dandorf, Stewart J.; Dunleavy, James; Viscusi, Rebecca; Amini, Richard

2016-01-01

Introduction Over the past decade, medical students have witnessed a decline in the opportunities to perform technical skills during their clinical years. Ultrasound-guided central venous access (USG-CVA) is a critical procedure commonly performed by emergency medicine, anesthesia, and general surgery residents, often during their first month of residency. However, the acquisition of skills required to safely perform this procedure is often deficient upon graduation from medical school. To ameliorate this lack of technical proficiency, ultrasound simulation models have been introduced into undergraduate medical education to train venous access skills. Criticisms of simulation models are the innate lack of realistic tactile qualities, as well as the lack of anatomical variances when compared to living patients. The purpose of our investigation was to design and evaluate a life-like and reproducible training model for USG-CVA using a fresh cadaver. Methods This was a cross-sectional study at an urban academic medical center. An 18-point procedural knowledge tool and an 18-point procedural skill evaluation tool were administered during a cadaver lab at the beginning and end of the surgical clerkship. During the fresh cadaver lab, procedure naïve third-year medical students were trained on how to perform ultrasound-guided central venous access of the femoral and internal jugular vessels. Preparation of the fresh cadaver model involved placement of a thin-walled latex tubing in the anatomic location of the femoral and internal jugular vein respectively. Results Fifty-six third-year medical students participated in this study during their surgical clerkship. The fresh cadaver model provided high quality and lifelike ultrasound images despite numerous cannulation attempts. Technical skill scores improved from an average score of 3 to 12 (p<0.001) and procedural knowledge scores improved from an average score of 4 to 8 (p<0.001). Conclusion The use of this novel cadaver model prevented extravasation of fluid, maintained ultrasound-imaging quality, and proved to be an effective educational model allowing third-year medical students to improve and maintain their technical skills. PMID:27330672

Introducing a Fresh Cadaver Model for Ultrasound-guided Central Venous Access Training in Undergraduate Medical Education.

PubMed

Miller, Ryan; Ho, Hang; Ng, Vivienne; Tran, Melissa; Rappaport, Douglas; Rappaport, William J A; Dandorf, Stewart J; Dunleavy, James; Viscusi, Rebecca; Amini, Richard

2016-05-01

Over the past decade, medical students have witnessed a decline in the opportunities to perform technical skills during their clinical years. Ultrasound-guided central venous access (USG-CVA) is a critical procedure commonly performed by emergency medicine, anesthesia, and general surgery residents, often during their first month of residency. However, the acquisition of skills required to safely perform this procedure is often deficient upon graduation from medical school. To ameliorate this lack of technical proficiency, ultrasound simulation models have been introduced into undergraduate medical education to train venous access skills. Criticisms of simulation models are the innate lack of realistic tactile qualities, as well as the lack of anatomical variances when compared to living patients. The purpose of our investigation was to design and evaluate a life-like and reproducible training model for USG-CVA using a fresh cadaver. This was a cross-sectional study at an urban academic medical center. An 18-point procedural knowledge tool and an 18-point procedural skill evaluation tool were administered during a cadaver lab at the beginning and end of the surgical clerkship. During the fresh cadaver lab, procedure naïve third-year medical students were trained on how to perform ultrasound-guided central venous access of the femoral and internal jugular vessels. Preparation of the fresh cadaver model involved placement of a thin-walled latex tubing in the anatomic location of the femoral and internal jugular vein respectively. Fifty-six third-year medical students participated in this study during their surgical clerkship. The fresh cadaver model provided high quality and lifelike ultrasound images despite numerous cannulation attempts. Technical skill scores improved from an average score of 3 to 12 (p<0.001) and procedural knowledge scores improved from an average score of 4 to 8 (p<0.001). The use of this novel cadaver model prevented extravasation of fluid, maintained ultrasound-imaging quality, and proved to be an effective educational model allowing third-year medical students to improve and maintain their technical skills.

STS-26 MS Hilmers during egress training at JSC's MAIL full fuselage trainer

NASA Technical Reports Server (NTRS)

1988-01-01

STS-26 Discovery, Orbiter Vehicle (OV) 103, Mission Specialist (MS) David C. Hilmers, wearing a launch and entry suit (LES) and launch and entry helmet (LEH), tries out the new crew escape system (CES) inflated slide during an emergency egress training exercise in JSC's Shuttle Mockup and Integration Laboratory (MAIL) Bldg 9A. Technicians stand on either side of the slide ready to help Hilmers to his feet once he reaches the bottom. Watching from floor level at the far left is astronaut Steven R. Nagel. A second crewmember stands in the open side hatch of the Full Fuselage Trainer (FFT) awaiting his turn to slide to 'safety'. During Crew Station Review (CSR) #3, the crew donned the new (navy blue) partial pressure suits (LESs) and checked out CES slide and other CES configurations to evaluate crew equipment and procedures related to emergency egress methods and proposed crew escape options. The CES pole extends out the side hatch just above Hilmers' head.

KSC-2009-3372

NASA Image and Video Library

2009-06-02

CAPE CANAVERAL, Fla. – The STS-127 crew members sit in the M-113 armored personnel carrier for instructions on driving the M-113 as part of their training on emergency egress procedures. On the left are Commander Mark Polansky and Mission Specialists Tom Marshburn, Julie Payette and Dave Wolf (behind Payette). On the right are Mission Specialist Christopher Cassidy, Pilot Doug Hurley and Mission Specialist Tim Kopra. The crew members of space shuttle Endeavour's STS-127 mission will each practice driving the M-113. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is at NASA's Kennedy Space Center for a launch dress rehearsal called the terminal countdown demonstration test, or TCDT, which includes the emergency egress training and equipment familiarization. The STS-127 mission is the final of three flights dedicated to the assembly of the Japanese Kibo laboratory complex. Endeavour's launch is targeted for June 13. Photo credit: NASA/Kim Shiflett

KSC-07pd3348

NASA Image and Video Library

2007-11-18

KENNEDY SPACE CENTER, FLA. -- STS-122 Mission Specialist Stanley Love, at right, practices driving an M-113 armored personnel carrier as the instructor behind him monitors his performance. Former astronaut Jerry Ross, chief of the Vehicle Integration Test Office at NASA Johnson Space Center, enjoys the ride in back. The practice near Launch Pad 39B is part of training on emergency egress procedures. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The crew is participating in Terminal Countdown Demonstration Test activities, a standard part of launch preparations. The TCDT provides astronauts and ground crews with equipment familiarization, emergency egress training and a simulated launch countdown. On mission STS-122, Atlantis will deliver the European Space Agency's Columbus module to the International Space Station. Columbus is a multifunctional, pressurized laboratory that will be permanently attached to U.S. Node 2, called Harmony, and will expand the research facilities aboard the station. Launch is targeted for Dec. 6. Photo credit: NASA/Kim Shiflett

Is the Australian hospital system adequately prepared for terrorism?

PubMed

Rosenfeld, Jeffrey V; Fitzgerald, Mark; Kossmann, Thomas; Pearce, Andrew; Joseph, Anthony; Joseph, Andrew; Tan, Gim; Gardner, Michele; Shapira, Shmuel

Australian hospitals need to be prepared to deal with mass casualties from terrorist strikes, including bomb blasts and chemical, biological and radiation injury. Injuries from bomb explosions are more severe than those commonly seen in Australian hospitals. In disasters involving mass casualties in urban areas, many of the injured make their own way to hospital, often arriving before the more seriously injured casualties. Major hospitals in Australia should plan for large numbers of undifferentiated and potentially contaminated casualties arriving with minimal warning. It is critical that experienced and trained senior medical officers perform the triage of casualties in emergency departments, with frequent reassessment to detect missed injuries (especially pulmonary blast injury). Hospitals require well developed standard operating procedures for mass casualty events, reinforced by regular drills. Preparing for a major event includes training staff in major incident management, setting up an operational/control unit, nominating key personnel, ensuring there is an efficient intra-hospital communication system, and enhancing links with other emergency services and hospitals.

None of Us Will Get Out of Here Alive: The Intersection of Perceived Risk for HIV, Risk Behaviors and Survival Expectations among African American Emerging Adults.

PubMed

Edwards, Lorece V; Lindong, Ian; Brown, Lawrence; Hawkins, Anita S; Dennis, Sabriya; Fajobi, Olaoluwa; Rowel, Randolph; Braithwaite, Ronald; Sydnor, Kim D

2017-01-01

The Human Immunodeficiency Virus (HIV) significantly affects minority emerging adults, among whom the rate of new diagnoses is high and health disparities are more pronounced. Importantly, emerging adults today have limited knowledge of the earlier toll of the virus when it was identified as a killer. Among this population, perceptions of risk for HIV are low and sexual risk taking behaviors are high. The Get SMART Project is a behavioral intervention aimed to provide re-purposed HIV, alcohol, and substance abuse prevention education and HIV testing to African American emerging adults ages 18-24. The project was guided by the Health Belief Model, Community Promise, and Training for Institutional Procedures. Findings revealed that HIV testing is low. Marijuana and alcohol are drugs of choice. Emerging adults do not see themselves at risk for HIV, although they engaged in high-risk behaviors. Additionally, survival expectations influence behavior risk.

Optimized operation of dielectric laser accelerators: Multibunch

NASA Astrophysics Data System (ADS)

Hanuka, Adi; Schächter, Levi

2018-06-01

We present a self-consistent analysis to determine the optimal charge, gradient, and efficiency for laser driven accelerators operating with a train of microbunches. Specifically, we account for the beam loading reduction on the material occurring at the dielectric-vacuum interface. In the case of a train of microbunches, such beam loading effect could be detrimental due to energy spread, however this may be compensated by a tapered laser pulse. We ultimately propose an optimization procedure with an analytical solution for group velocity which equals to half the speed of light. This optimization results in a maximum efficiency 20% lower than the single bunch case, and a total accelerated charge of 1 06 electrons in the train. The approach holds promise for improving operations of dielectric laser accelerators and may have an impact on emerging laser accelerators driven by high-power optical lasers.

Automatic Training of Rat Cyborgs for Navigation.

PubMed

Yu, Yipeng; Wu, Zhaohui; Xu, Kedi; Gong, Yongyue; Zheng, Nenggan; Zheng, Xiaoxiang; Pan, Gang

2016-01-01

A rat cyborg system refers to a biological rat implanted with microelectrodes in its brain, via which the outer electrical stimuli can be delivered into the brain in vivo to control its behaviors. Rat cyborgs have various applications in emergency, such as search and rescue in disasters. Prior to a rat cyborg becoming controllable, a lot of effort is required to train it to adapt to the electrical stimuli. In this paper, we build a vision-based automatic training system for rat cyborgs to replace the time-consuming manual training procedure. A hierarchical framework is proposed to facilitate the colearning between rats and machines. In the framework, the behavioral states of a rat cyborg are visually sensed by a camera, a parameterized state machine is employed to model the training action transitions triggered by rat's behavioral states, and an adaptive adjustment policy is developed to adaptively adjust the stimulation intensity. The experimental results of three rat cyborgs prove the effectiveness of our system. To the best of our knowledge, this study is the first to tackle automatic training of animal cyborgs.

Automatic Training of Rat Cyborgs for Navigation

PubMed Central

Yu, Yipeng; Wu, Zhaohui; Xu, Kedi; Gong, Yongyue; Zheng, Nenggan; Zheng, Xiaoxiang; Pan, Gang

2016-01-01

A rat cyborg system refers to a biological rat implanted with microelectrodes in its brain, via which the outer electrical stimuli can be delivered into the brain in vivo to control its behaviors. Rat cyborgs have various applications in emergency, such as search and rescue in disasters. Prior to a rat cyborg becoming controllable, a lot of effort is required to train it to adapt to the electrical stimuli. In this paper, we build a vision-based automatic training system for rat cyborgs to replace the time-consuming manual training procedure. A hierarchical framework is proposed to facilitate the colearning between rats and machines. In the framework, the behavioral states of a rat cyborg are visually sensed by a camera, a parameterized state machine is employed to model the training action transitions triggered by rat's behavioral states, and an adaptive adjustment policy is developed to adaptively adjust the stimulation intensity. The experimental results of three rat cyborgs prove the effectiveness of our system. To the best of our knowledge, this study is the first to tackle automatic training of animal cyborgs. PMID:27436999

Simulation training in video-assisted urologic surgery.

PubMed

Hoznek, András; Salomon, Laurent; de la Taille, Alexandre; Yiou, René; Vordos, Dimitrios; Larre, Stéphane; Abbou, Clément-Claude

2006-03-01

The current system of surgical education is facing many challenges in terms of time efficiency, costs, and patient safety. Training using simulation is an emerging area, mostly based on the experience of other high-risk professions like aviation. The goal of simulation-based training in surgery is to develop not only technical but team skills. This learning environment is stress-free and safe, allows standardization and tailoring of training, and also objectively evaluate performances. The development of simulation training is straightforward in endourology, since these procedures are video-assisted and the low degree of freedom of the instruments is easily replicated. On the other hand, these interventions necessitate a long learning curve, training in the operative room is especially costly and risky. Many models are already in use or under development in all fields of video-assisted urologic surgery: ureteroscopy, percutaneous surgery, transurethral resection of the prostate, and laparoscopy. Although bench models are essential, simulation increasingly benefits from the achievements and development of computer technology. Still in its infancy, virtual reality simulation will certainly belong to tomorrow's teaching tools.

Patient and family attitudes regarding the practice of procedures on the newly deceased.

PubMed

Manifold, C A; Storrow, A; Rodgers, K

1999-02-01

Performance of emergency lifesaving procedures is an integral part of emergency medicine resident training. To assess attitudes of ED patients regarding the practice of procedures on the newly deceased. A descriptive survey was administered to a convenience sample of ED patients and their families at two urban military Level-1 trauma centers. Subjects were asked about their overall opinions regarding the practice of nontherapeutic procedural skills on themselves or relatives immediately after death in the ED. Subgroup analysis included the issue of advanced permission and opinions regarding procedures defined by the investigators as noninvasive (e.g., laryngeal mask airway) or invasive (e.g., cricothyrotomy). Data were analyzed descriptively and with chi-square as appropriate. For comparison of proportions, a sample size of at least 140 was chosen for an alpha of 0.05 and a beta of 0.10 to detect an effect size of 0.3. Alpha was corrected for multiple comparisons prior to the study. Three hundred seventeen surveys were collected and 88% (n = 280) were complete. Seventy-five percent (n = 290) and 70% (n = 273) of the respondents agreed to after-death procedures on themselves or their relatives, respectively. However, only 40% (n = 106) and 50% (n = 131) would allow such procedures without prior permission. Seventy-one percent (n = 189) were willing to give permission in a living will, while 85% (n = 238) indicated support of a wallet card format. There was no significant difference in permission rates when contrasting individual noninvasive and invasive procedures. Most patients are willing to have procedures performed on themselves or relatives shortly after death, yet the majority request that permission be obtained in advance. A living will or carried card would be acceptable for such permission.

Development and evaluation of a leadership training program for public health emergency response: results from a Chinese study.

PubMed

Wang, Chongjian; Wei, Sheng; Xiang, Hao; Wu, Jing; Xu, Yihua; Liu, Li; Nie, Shaofa

2008-10-30

Since the 9/11 attack and severe acute respiratory syndrome (SARS), the development of qualified and able public health leaders has become a new urgency in building the infrastructure needed to address public health emergencies. Although previous studies have reported that the training of individual leaders is an important approach, the systemic and scientific training model need further improvement and development. The purpose of this study was to develop, deliver, and evaluate a participatory leadership training program for emergency response. Forty-one public health leaders (N = 41) from five provinces completed the entire emergency preparedness training program in China. The program was evaluated by anonymous questionnaires and semi-structured interviews held prior to training, immediately post-training and 12-month after training (Follow-up). The emergency preparedness training resulted in positive shifts in knowledge, self-assessment of skills for public health leaders. More than ninety-five percent of participants reported that the training model was scientific and feasible. Moreover, the response of participants in the program to the avian influenza outbreak, as well as the planned evaluations for this leadership training program, further demonstrated both the successful approaches and methods and the positive impact of this integrated leadership training initiative. The emergency preparedness training program met its aims and objectives satisfactorily, and improved the emergency capability of public health leaders. This suggests that the leadership training model was effective and feasible in improving the emergency preparedness capability.

STS-56 Commander Cameron & Pilot Oswald at CCT hatch during JSC training

NASA Image and Video Library

1992-12-01

STS-56 Discovery, Orbiter Vehicle (OV) 103, Commander Kenneth Cameron (right) and Pilot Stephen S. Oswald, wearing launch and entry suits (LESs), stand at the side hatch of the crew compartment trainer (CCT), a shuttle mockup, prior to entering the mockup. Once inside the CCT, they will don their launch and entry helmets (LEHs) and participate in emergency egress (bailout) procedures. The CCT is located in JSC's Mockup and Integration Laboratory (MAIL) Bldg 9NE.

STS-55 MS3 Harris listens to technician during JSC WETF egress exercises

NASA Technical Reports Server (NTRS)

1992-01-01

STS-55 Columbia, Orbiter Vehicle (OV) 102, Mission Specialist 3 (MS3) Bernard A. Harris, Jr, wearing launch and entry suit (LES), launch and entry helmet (LEH), and parachute, listens to technician Karen Porter's instructions prior to launch emergency egress (bailout) exercises. The session, held in JSC's Weightless Environment Training Facility (WETF) Bldg 29, used the facility's 25-foot deep pool to simulate the ocean as Harris and other crewmembers practiced water bailout procedures.

Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for procedural skill training in medicine.

PubMed

Sawyer, Taylor; White, Marjorie; Zaveri, Pavan; Chang, Todd; Ades, Anne; French, Heather; Anderson, JoDee; Auerbach, Marc; Johnston, Lindsay; Kessler, David

2015-08-01

Acquisition of competency in procedural skills is a fundamental goal of medical training. In this Perspective, the authors propose an evidence-based pedagogical framework for procedural skill training. The framework was developed based on a review of the literature using a critical synthesis approach and builds on earlier models of procedural skill training in medicine. The authors begin by describing the fundamentals of procedural skill development. Then, a six-step pedagogical framework for procedural skills training is presented: Learn, See, Practice, Prove, Do, and Maintain. In this framework, procedural skill training begins with the learner acquiring requisite cognitive knowledge through didactic education (Learn) and observation of the procedure (See). The learner then progresses to the stage of psychomotor skill acquisition and is allowed to deliberately practice the procedure on a simulator (Practice). Simulation-based mastery learning is employed to allow the trainee to prove competency prior to performing the procedure on a patient (Prove). Once competency is demonstrated on a simulator, the trainee is allowed to perform the procedure on patients with direct supervision, until he or she can be entrusted to perform the procedure independently (Do). Maintenance of the skill is ensured through continued clinical practice, supplemented by simulation-based training as needed (Maintain). Evidence in support of each component of the framework is presented. Implementation of the proposed framework presents a paradigm shift in procedural skill training. However, the authors believe that adoption of the framework will improve procedural skill training and patient safety.

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Enhancing creative cognition with a rapid right-parietal neurofeedback procedure.

PubMed

Agnoli, Sergio; Zanon, Marco; Mastria, Serena; Avenanti, Alessio; Corazza, Giovanni Emanuele

2018-02-14

The present article describes an innovative neurofeedback training (NFT) procedure aimed at increasing creative cognition through the enhancement of specific brain activities previously associated with divergent thinking. We designed and tested two NFT protocols based on training alpha and beta EEG oscillations selectively measured over the right parietal region. A total of 80 participants were involved, 40 in the alpha NFT protocol and 40 in the beta NFT protocol. The NFT loop was closed on a video stream that would advance only when oscillation power exceeded a normalized threshold. The total duration of the protocol was two hours in a single day, hence its classification as rapid. Changes in ideational fluency and originality, measured with a divergent thinking task, were compared between participants receiving real video feedback and participants receiving sham feedback. We controlled for individual differences in creative achievement level. Results showed that the protocols were effective at enhancing alpha and beta activities in the targeted area. Differences between the two protocols emerged in their effectiveness at promoting divergent thinking. While no significant changes in originality resulted from the rapid alpha NFT, increases in both originality and fluency emerged as a consequence of the rapid beta NFT. These results were particularly evident in participants starting with a low creative achievement level. Possible interpretations and future directions are proposed and discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.

Local-regional anesthesia in the management of stingray stings: Experience of the Bouffard medical-surgical hospital in Djibouti.

PubMed

Vanoye, C; Lacroix, G; Le Gonidec, E; Couret, A; Benois, A; Peigne, V

2017-02-01

Stingray injuries are very painful. Systemic analgesics are ineffective, and the use of local-regional anesthesia has been reported. This retrospective descriptive study reviewed all cases of stingray injuries seen at the emergency department of the Bouffard Hospital (Djbouti, Africa) between 2011 and 2014. The study included 35 patients. Most of the injuries (n= 31, 89%) concerned the lower limbs. Median pain intensity was 6 [5-8] on a visual analog scale of 0 (no pain) to 10. The following systemic medications were administered: acetaminophen to 13 (27%) patients, morphine to 8 (23%), and tramadol to 6 (17%). In all, 25 (71%) patients received local-regional anesthesia, 15 (60%) by injections at the ankle. All procedures were successful, and no adverse event was reported. This study reports clinical data about stingray injuries in the Red Sea area and highlights the interest of local-regional anesthesia in their management. Most of the procedures were distal and could be performed by trained emergency physicians.

DEVELOPMENT OF AN EMERGENCY NURSING TRAINING CURRICULUM IN GHANA

PubMed Central

Bell, Sue Anne; Oteng, Rockefeller; Redman, Richard; Lapham, Jeremy; Bam, Victoria; Dzomecku, Veronica; Yakubu, Jamila; Tagoe, Nadia; Donkor, Peter

2014-01-01

The formal provision of emergency health care is a developing specialty in many sub-Saharan African countries, including Ghana. While emergency medicine training programs for physicians are on the rise, there are few established training programs for emergency nurses. The results of a unique collaboration are described between a university in the United States, a Ghanaian university and a Ghanaian teaching hospital that has developed an emergency nursing diploma program. The expected outcomes of this training program include: a) an innovative, interdisciplinary, team-based clinical training model b) a unique and low-resource emergency nursing curriculum and c) a comprehensive and sustainable training program to increase in-country retention of nurses. PMID:24631161

Primary care emergency team training in situ means learning in real context

PubMed Central

Brandstorp, Helen; Halvorsen, Peder A.; Sterud, Birgitte; Haugland, Bjørgun; Kirkengen, Anna Luise

2016-01-01

Objective The purpose of our study was to explore the local learning processes and to improve in situ team training in the primary care emergency teams with a focus on interaction. Design, setting and subjects As participating observers, we investigated locally organised trainings of teams constituted ad hoc, involving nurses, paramedics and general practitioners, in rural Norway. Subsequently, we facilitated focus discussions with local participants. We investigated what kinds of issues the participants chose to elaborate in these learning situations, why they did so, and whether and how local conditions improved during the course of three and a half years. In addition, we applied learning theories to explore and challenge our own and the local participants’ understanding of team training. Results In situ team training was experienced as challenging, engaging, and enabling. In the training sessions and later focus groups, the participants discussed a wide range of topics constitutive for learning in a sociocultural perspective, and topics constitutive for patient safety culture. The participants expanded the types of training sites, themes and the structures for participation, improved their understanding of communication and developed local procedures. The flexible structure of the model mirrors the complexity of medicine and provides space for the participants’ own sense of responsibility. Conclusion Challenging, monthly in situ team trainings organised by local health personnel facilitate many types of learning. The flexible training model provides space for the participants’ own sense of responsibility and priorities. Outcomes involve social and structural improvements, including a sustainable culture of patient safety. Key Points Challenging, monthly in situ team trainings, organised by local health personnel, facilitate many types of learning.The flexible structure of the training model mirrors the complexity of medicine and the realism of the simulation sessions.Providing room for the participants’ own priorities and sense of responsibility allows for improvement on several levels.The participants demonstrated a consistent, long-term motivation to strengthen safety, both for their patients and for themselves. PMID:27442268

Primary care emergency team training in situ means learning in real context.

PubMed

Brandstorp, Helen; Halvorsen, Peder A; Sterud, Birgitte; Haugland, Bjørgun; Kirkengen, Anna Luise

2016-09-01

The purpose of our study was to explore the local learning processes and to improve in situ team training in the primary care emergency teams with a focus on interaction. As participating observers, we investigated locally organised trainings of teams constituted ad hoc, involving nurses, paramedics and general practitioners, in rural Norway. Subsequently, we facilitated focus discussions with local participants. We investigated what kinds of issues the participants chose to elaborate in these learning situations, why they did so, and whether and how local conditions improved during the course of three and a half years. In addition, we applied learning theories to explore and challenge our own and the local participants' understanding of team training. In situ team training was experienced as challenging, engaging, and enabling. In the training sessions and later focus groups, the participants discussed a wide range of topics constitutive for learning in a sociocultural perspective, and topics constitutive for patient safety culture. The participants expanded the types of training sites, themes and the structures for participation, improved their understanding of communication and developed local procedures. The flexible structure of the model mirrors the complexity of medicine and provides space for the participants' own sense of responsibility. Challenging, monthly in situ team trainings organised by local health personnel facilitate many types of learning. The flexible training model provides space for the participants' own sense of responsibility and priorities. Outcomes involve social and structural improvements, including a sustainable culture of patient safety. KEY POINTS Challenging, monthly in situ team trainings, organised by local health personnel, facilitate many types of learning. The flexible structure of the training model mirrors the complexity of medicine and the realism of the simulation sessions. Providing room for the participants' own priorities and sense of responsibility allows for improvement on several levels. The participants demonstrated a consistent, long-term motivation to strengthen safety, both for their patients and for themselves.

The roles and training of primary care doctors: China, India, Brazil and South Africa.

PubMed

Mash, Robert; Almeida, Magda; Wong, William C W; Kumar, Raman; von Pressentin, Klaus B

2015-12-04

China, India, Brazil and South Africa contain 40% of the global population and are key emerging economies. All these countries have a policy commitment to universal health coverage with an emphasis on primary health care. The primary care doctor is a key part of the health workforce, and this article, which is based on two workshops at the 2014 Towards Unity For Health Conference in Fortaleza, Brazil, compares and reflects on the roles and training of primary care doctors in these four countries. Key themes to emerge were the need for the primary care doctor to function in support of a primary care team that provides community-orientated and first-contact care. This necessitates task-shifting and an openness to adapt one's role in line with the needs of the team and community. Beyond clinical competence, the primary care doctor may need to be a change agent, critical thinker, capability builder, collaborator and community advocate. Postgraduate training is important as well as up-skilling the existing workforce. There is a tension between training doctors to be community-orientated versus filling the procedural skills gaps at the facility level. In training, there is a need to plan postgraduate education at scale and reform the system to provide suitable incentives for doctors to choose this as a career path. Exposure should start at the undergraduate level. Learning outcomes should be socially accountable to the needs of the country and local communities, and graduates should be person-centred comprehensive generalists.

Training in the management of critical problems: teacher's view.

PubMed

van Geijn, H P; Vothknecht, S

1996-03-01

Teaching in critical obstetric problems should have special interest during residency and thereafter. Obstetric emergencies are relatively rare but may occur at any time. The obstetrician at that moment enters a special area requiring a multidisciplinary approach. From experiences in recent years and study of the literature the following recommendations can be summarized; (1) the need to understand (patho)physiologic changes in pregnancy, (2) cultivation of an anticipative attitude towards conditions with elevated risks, (3) adequate knowledge of diagnostic procedures, (4) the discipline to make a differential diagnosis, (5) experience with monitoring of (fetal and) maternal condition, (6) availability of management protocols for emergencies such as shock, eclampsia, uterine rupture, amniotic fluid embolism, thrombo-embolism, sepsis and diabetic ketoacidosis, (7) awareness of pitfalls with inspection of lesions and assessment of blood loss, (8) awareness that caesarean section without prior stabilization can be a life threatening procedure, (9) practice in life-saving measures such as uterine compression, packing, ligation of vessels, postpartum hysterectomy, (10) teaching of postoperative care, (11) insight into the cascade of events finally leading to multi-organ failure. Obstetric emergencies require a disciplined approach, in which teamwork is the cornerstone.

46 CFR 35.10-1 - Emergency training, musters, and drills-T/ALL.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Emergency training, musters, and drills-T/ALL. 35.10-1... Emergency Requirements § 35.10-1 Emergency training, musters, and drills—T/ALL. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and Arrangements) of this...

46 CFR 35.10-1 - Emergency training, musters, and drills-T/ALL.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 1 2013-10-01 2013-10-01 false Emergency training, musters, and drills-T/ALL. 35.10-1... Emergency Requirements § 35.10-1 Emergency training, musters, and drills—T/ALL. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and Arrangements) of this...

46 CFR 35.10-1 - Emergency training, musters, and drills-T/ALL.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 1 2014-10-01 2014-10-01 false Emergency training, musters, and drills-T/ALL. 35.10-1... Emergency Requirements § 35.10-1 Emergency training, musters, and drills—T/ALL. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and Arrangements) of this...

46 CFR 35.10-1 - Emergency training, musters, and drills-T/ALL.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 1 2012-10-01 2012-10-01 false Emergency training, musters, and drills-T/ALL. 35.10-1... Emergency Requirements § 35.10-1 Emergency training, musters, and drills—T/ALL. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and Arrangements) of this...

46 CFR 35.10-1 - Emergency training, musters, and drills-T/ALL.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 1 2011-10-01 2011-10-01 false Emergency training, musters, and drills-T/ALL. 35.10-1... Emergency Requirements § 35.10-1 Emergency training, musters, and drills—T/ALL. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and Arrangements) of this...

Performance Support Tools for Space Medical Operations

NASA Technical Reports Server (NTRS)

Byrne, Vicky E.; Schmidt, Josef; Barshi, Immanuel

2009-01-01

The early Constellation space missions are expected to have medical capabilities very similar to those currently on the Space Shuttle and International Space Station (ISS). For Crew Exploration Vehicle (CEV) missions to ISS, medical equipment will be located on ISS, and carried into CEV in the event of an emergency. Flight Surgeons (FS) on the ground in Mission Control will be expected to direct the Crew Medical Officer (CMO) during medical situations. If there is a loss of signal and the crew is unable to communicate with the ground, a CMO would be expected to carry out medical procedures without the aid of a FS. In these situations, performance support tools can be used to reduce errors and time to perform emergency medical tasks. Human factors personnel at Johnson Space Center have recently investigated medical performance support tools for CMOs on-orbit, and FSs on the ground. This area of research involved the feasibility of Just-in-time (JIT) training techniques and concepts for real-time medical procedures. In Phase 1, preliminary feasibility data was gathered for two types of prototype display technologies: a hand-held PDA, and a Head Mounted Display (HMD). The PDA and HMD were compared while performing a simulated medical procedure using ISS flight-like medical equipment. Based on the outcome of Phase 1, including data on user preferences, further testing was completed using the PDA only. Phase 2 explored a wrist-mounted PDA, and compared it to a paper cue card. For each phase, time to complete procedures, errors, and user satisfaction were captured. Information needed by the FS during ISS mission support, especially for an emergency situation (e.g. fire onboard ISS), may be located in many different places around the FS s console. A performance support tool prototype is being developed to address this issue by bringing all of the relevant information together in one place. The tool is designed to include procedures and other information needed by a FS during an emergency, as well as procedures and information to be used after the emergency is resolved. Several walkthroughs of the prototype with FSs have been completed within a mockup of an ISS FS console. Feedback on the current tool design as well as recommendations for existing ISS FS displays were captured.

Simulated emergencies test preparedness

DOE Office of Scientific and Technical Information (OSTI.GOV)

Atkinson, J.D.

This paper reports that Canadian western Natural Gas has developed emergency plans to enable the company to respond effectively to natural gas incidents. Emergency procedures and training manuals have been developed over many years, stressing prevention first and foremost, and then effective response in the event of an actual occurrence. Canadian western is a natural gas utility serving the southern half of the province of Alberta. It is owned and operated by Canadian Utilities Ltd., which also owns and operates Northwestern Utilities Ltd. in central and northern Alberta. The company has production, storage, transmission and distribution facilities throughout an extensivemore » franchise area. It operates more than 11,000 miles of transmission and distribution pipeline to serve more than 315,000 customers in 115 communities. Canadian Western provides gas service to two major urban centers, the cities of Calgary and Lethbridge.« less

Perceived Safety at Work in the Wake of Terror: The Importance of Security Measures and Emergency Preparedness.

PubMed

Nissen, Alexander; Heir, Trond

2016-12-01

We aimed to explore how perceived safety after terrorism is connected to views on security measures and emergency preparedness in a workplace setting. Using a questionnaire-based, cross-sectional study of ministerial employees in Norway who were targeted in a terrorist attack in 2011 (n=3344), we investigated how employees' perceived safety at work 9 to 10 months after the attack was associated with their perceptions of whether security measures were sufficiently prioritized at work, whether there had been sufficient escape and evacuation training, and whether they were confident with evacuation procedures. We found strong evidence of increasing perceived safety at work the more employees believed security measures were sufficiently prioritized at work (partially confounded by post-traumatic stress disorder), and the better their knowledge of evacuation procedures (modified by gender and education). The present study suggests that employers may enhance perceived safety at work for terror-exposed employees by showing a commitment to security measures and by ensuring employees know evacuation procedures well. More research is needed to investigate causality patterns behind the associations found in this cross-sectional study. (Disaster Med Public Health Preparedness. 2016;10:805-811).

A clinical procedures curriculum for undergraduate medical students: the eight-year history of a third-year immersive experience.

PubMed

Thompson, Laura; Exline, Matthew; Leung, Cynthia G; Way, David P; Clinchot, Daniel; Bahner, David P; Khandelwal, Sorabh

2016-01-01

Background Procedural skills training is a critical component of medical education, but is often lacking in standard clinical curricula. We describe a unique immersive procedural skills curriculum for medical students, designed and taught primarily by emergency medicine faculty at The Ohio State University College of Medicine. Objectives The primary educational objective of this program was to formally introduce medical students to clinical procedures thought to be important for success in residency. The immersion strategy (teaching numerous procedures over a 7-day period) was intended to complement the student's education on third-year core clinical clerkships. Program design The course introduced 27 skills over 7 days. Teaching and learning methods included lecture, prereading, videos, task trainers, peer teaching, and procedures practice on cadavers. In year 4 of the program, a peer-team teaching model was adopted. We analyzed program evaluation data over time. Impact Students valued the selection of procedures covered by the course and felt that it helped prepare them for residency (97%). The highest rated activities were the cadaver lab and the advanced cardiac life support (97 and 93% positive endorsement, respectively). Lectures were less well received (73% positive endorsement), but improved over time. The transition to peer-team teaching resulted in improved student ratings of course activities (p<0.001). Conclusion A dedicated procedural skills curriculum successfully supplemented the training medical students received in the clinical setting. Students appreciated hands-on activities and practice. The peer-teaching model improved course evaluations by students, which implies that this was an effective teaching method for adult learners. This course was recently expanded and restructured to place the learning closer to the clinical settings in which skills are applied.

A clinical procedures curriculum for undergraduate medical students: the eight-year history of a third-year immersive experience.

PubMed

Thompson, Laura; Exline, Matthew; Leung, Cynthia G; Way, David P; Clinchot, Daniel; Bahner, David P; Khandelwal, Sorabh

2016-01-01

Procedural skills training is a critical component of medical education, but is often lacking in standard clinical curricula. We describe a unique immersive procedural skills curriculum for medical students, designed and taught primarily by emergency medicine faculty at The Ohio State University College of Medicine. The primary educational objective of this program was to formally introduce medical students to clinical procedures thought to be important for success in residency. The immersion strategy (teaching numerous procedures over a 7-day period) was intended to complement the student's education on third-year core clinical clerkships. The course introduced 27 skills over 7 days. Teaching and learning methods included lecture, prereading, videos, task trainers, peer teaching, and procedures practice on cadavers. In year 4 of the program, a peer-team teaching model was adopted. We analyzed program evaluation data over time. Students valued the selection of procedures covered by the course and felt that it helped prepare them for residency (97%). The highest rated activities were the cadaver lab and the advanced cardiac life support (97 and 93% positive endorsement, respectively). Lectures were less well received (73% positive endorsement), but improved over time. The transition to peer-team teaching resulted in improved student ratings of course activities (p<0.001). A dedicated procedural skills curriculum successfully supplemented the training medical students received in the clinical setting. Students appreciated hands-on activities and practice. The peer-teaching model improved course evaluations by students, which implies that this was an effective teaching method for adult learners. This course was recently expanded and restructured to place the learning closer to the clinical settings in which skills are applied.

Building an evidence-base for the training of evidence-based treatments in community settings: Use of an expert-informed approach.

PubMed

Scudder, Ashley; Herschell, Amy D

2015-08-01

In order to make EBTs available to a large number of children and families, developers and expert therapists have used their experience and expertise to train community-based therapists in EBTs. Understanding current training practices of treatment experts may be one method for establishing best practices for training community-based therapists prior to comprehensive empirical examinations of training practices. A qualitative study was conducted using surveys and phone interviews to identify the specific procedures used by treatment experts to train and implement an evidence-based treatment in community settings. Twenty-three doctoral-level, clinical psychologists were identified to participate because of their expertise in conducting and training Parent-Child Interaction Therapy. Semi-structured qualitative interviews were completed by phone, later transcribed verbatim, and analyzed using thematic coding. The de-identified data were coded by two independent qualitative data researchers and then compared for consistency of interpretation. The themes that emerged following the final coding were used to construct a training protocol to be empirically tested. The goal of this paper is to not only understand the current state of training practices for training therapists in a particular EBT, Parent-Child Interaction Therapy, but to illustrate the use of expert opinion as the best available evidence in preparation for empirical evaluation.

The effect of a standardised source of divided attention in airway management: A randomised, crossover, interventional manikin study.

PubMed

Prottengeier, Johannes; Petzoldt, Marlen; Jess, Nikola; Moritz, Andreas; Gall, Christine; Schmidt, Joachim; Breuer, Georg

2016-03-01

Dual-tasking, the need to divide attention between concurrent tasks, causes a severe increase in workload in emergency situations and yet there is no standardised training simulation scenario for this key difficulty. We introduced and validated a quantifiable source of divided attention and investigated its effects on performance and workload in airway management. A randomised, crossover, interventional simulation study. Center for Training and Simulation, Department of Anaesthesiology, Erlangen University Hospital, Germany. One hundred and fifty volunteer medical students, paramedics and anaesthesiologists of all levels of training. Participants secured the airway of a manikin using a supraglottic airway, conventional endotracheal intubation and video-assisted endotracheal intubation with and without the Paced Auditory Serial Addition Test (PASAT), which served as a quantifiable source of divided attention. Primary endpoint was the time for the completion of each airway task. Secondary endpoints were the number of procedural mistakes made and the perceived workload as measured by the National Aeronautics and Space Administration's task load index (NASA-TLX). This is a six-dimensional questionnaire, which assesses the perception of demands, performance and frustration with respect to a task on a scale of 0 to 100. All 150 participants completed the tests. Volunteers perceived our test to be challenging (99%) and the experience of stress and distraction true to an emergency situation (80%), but still fair (98%) and entertaining (95%). The negative effects of divided attention were reproducible in participants of all levels of expertise. Time consumption and perceived workload increased and almost half the participants make procedural mistakes under divided attention. The supraglottic airway technique was least affected by divided attention. The scenario was effective for simulation training involving divided attention in acute care medicine. The significant effects on performance and perceived workload demonstrate the validity of the model, which was also characterised by high acceptability, technical simplicity and a novel degree of standardisation.

NASA Virtual Glovebox (VBX): Emerging Simulation Technology for Space Station Experiment Design, Development, Training and Troubleshooting

NASA Technical Reports Server (NTRS)

Smith, Jeffrey D.; Twombly, I. Alexander; Maese, A. Christopher; Cagle, Yvonne; Boyle, Richard

2003-01-01

The International Space Station demonstrates the greatest capabilities of human ingenuity, international cooperation and technology development. The complexity of this space structure is unprecedented; and training astronaut crews to maintain all its systems, as well as perform a multitude of research experiments, requires the most advanced training tools and techniques. Computer simulation and virtual environments are currently used by astronauts to train for robotic arm manipulations and extravehicular activities; but now, with the latest computer technologies and recent successes in areas of medical simulation, the capability exists to train astronauts for more hands-on research tasks using immersive virtual environments. We have developed a new technology, the Virtual Glovebox (VGX), for simulation of experimental tasks that astronauts will perform aboard the Space Station. The VGX may also be used by crew support teams for design of experiments, testing equipment integration capability and optimizing the procedures astronauts will use. This is done through the 3D, desk-top sized, reach-in virtual environment that can simulate the microgravity environment in space. Additional features of the VGX allow for networking multiple users over the internet and operation of tele-robotic devices through an intuitive user interface. Although the system was developed for astronaut training and assisting support crews, Earth-bound applications, many emphasizing homeland security, have also been identified. Examples include training experts to handle hazardous biological and/or chemical agents in a safe simulation, operation of tele-robotic systems for assessing and diffusing threats such as bombs, and providing remote medical assistance to field personnel through a collaborative virtual environment. Thus, the emerging VGX simulation technology, while developed for space- based applications, can serve a dual use facilitating homeland security here on Earth.

78 FR 65676 - Agency Information Collection Activities: Proposed Collection; Comment Request; Approval and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-01

... and/or housing for emergency preparedness training conducted at the Federal Emergency Management... the purpose of emergency preparedness. In response, FEMA established the National Emergency Training... those participating in emergency preparedness training and a request for use of these areas must be made...

[Advanced Trauma Life Support (ATLS) in the emergency room. Is it suitable as an SOP?].

PubMed

Shafizadeh, S; Tjardes, T; Steinhausen, E; Balke, M; Paffrath, T; Bouillon, B; Bäthis, H

2010-08-01

There is clinical evidence that a standardized management of trauma patients in the emergency room improves outcome. ATLS is a training course that teaches a systematic approach to the trauma patient in the emergency room. The aims are a rapid and accurate assessment of the patient's physiologic status, treatment according to priorities, and making decisions on whether the local resources are sufficient for adequate definitive treatment of the patient or if transfer to a trauma center is necessary. Above all it is important to prevent secondary injury, to realize timing as a relevant factor in the initial treatment, and to assure a high standard of care. A standard operating procedure (SOP) exactly regulates the approach to trauma patients and determines the responsibilities of the involved faculties. An SOP moreover incorporates the organizational structure in the treatment of trauma patients as well as the necessary technical equipment and staff requirements. To optimize process and result quality, priorities are in the fields of medical fundamentals of trauma care, education, and fault management. SOPs and training courses increase the process and result quality in the treatment of the trauma patient in the emergency room. These programs should be based on the special demands of the physiology of the trauma as well as the structural specifics of the hospital. ATLS does not equal an SOP but it qualifies as a standardized concept for management of trauma patients in the emergency room.

Development of an emergency nursing training curriculum in Ghana.

PubMed

Bell, Sue Anne; Oteng, Rockefeller; Redman, Richard; Lapham, Jeremy; Bam, Victoria; Dzomecku, Veronica; Yakubu, Jamila; Tagoe, Nadia; Donkor, Peter

2014-10-01

The formal provision of emergency health care is a developing specialty in many sub-Saharan African countries, including Ghana. While emergency medicine training programs for physicians are on the rise, there are few established training programs for emergency nurses. The results of a unique collaboration are described between a university in the United States, a Ghanaian university and a Ghanaian teaching hospital that has developed an emergency nursing diploma program. The expected outcomes of this training program include: (a) an innovative, interdisciplinary, team-based clinical training model, (b) a unique and low-resource emergency nursing curriculum and (c) a comprehensive and sustainable training program to increase in-country retention of nurses. Copyright © 2014 Elsevier Ltd. All rights reserved.

Do procedural skills workshops during family practice residency work?

PubMed Central

MacKenzie, Mark S.; Berkowitz, Jonathan

2010-01-01

ABSTRACT OBJECTIVE To determine if participation in a procedural skills workshop during family practice residency affects future use of these skills in postgraduate clinical practice. DESIGN Survey involving self-assessment of procedural skills experience and competence. SETTING British Columbia. PARTICIPANTS Former University of British Columbia family practice residents who trained in Vancouver, BC, including residents who participated in a procedural skills workshop in 2001 or 2003 and residents graduating in 2000 and 2002 who did not participate in the procedural skills workshop. MAIN OUTCOME MEASURES Self-assessed experience and competence in the 6 office-based procedural skills that were taught during the procedural skills workshops in 2001 and 2003. RESULTS Participation in a procedural skills workshop had no positive effect on future use of these skills in clinical practice. Participation in the workshop was associated with less reported experience (P = .091) in injection of lateral epicondylitis. As with previous Canadian studies, more women than men reported experience and competence in gynecologic procedures. More women than men reported experience (P = .001) and competence (P = .004) in intrauterine device insertion and experience (P = .091) in endometrial aspiration biopsy. More men than women reported competence (P = .052) in injection of trochanteric bursae. A third year of emergency training was correlated with an increase in reported experience (P = .021) in shoulder injection. CONCLUSION Participation in a procedural skills workshop during family practice residency did not produce a significant increase in the performance of these skills on the part of participants once they were in clinical practice. The benefit of a skills workshop might be lost when there is no opportunity to practise and perfect these skills. Sex bias in the case of some procedures might represent a needs-based acquisition of skills on the part of practising physicians. Short procedural skills workshops might be better suited to graduated physicians with more clinical experience. PMID:20705868

A national survey of terrorism preparedness training among pediatric, family practice, and emergency medicine programs.

PubMed

Martin, Shelly D; Bush, Anneke C; Lynch, Julia A

2006-09-01

Domestic terrorism is a real threat focusing on a need to engage in effective emergency preparedness planning and training. Front-line physicians are an important component of any emergency preparedness plan. Potential victims of an attack include children who have unique physiologic and psychological vulnerabilities in disasters. Front-line providers need to have adequate training to effectively participate in local planning initiatives and to recognize and treat casualties including children. The goal of the survey was to assess the current state of terrorism preparedness training, including child victims, by emergency medicine, family practice, and pediatric residency programs in the United States and to assess methods of training and barriers to establishing effective training. A survey was e-mailed to a comprehensive list of all US pediatric, family practice, and emergency medicine residency programs 3 times between September 2003 and January 2004. The survey measured the perceived risk of terrorist attack, level of training by type of attack, level of training regarding children, method of training, and barriers to training. Overall, 21% of programs responded (46 of 182 pediatric, 75 of 400 family practice, and 29 of 125 emergency medicine programs). Across all of the event types, emergency medicine programs were more likely to report adequate/comprehensive training. However, < 50% of emergency medicine programs report adequate training for children. Didactic classroom-based lectures were the most commonly used method of training. Emergency medicine programs were more likely to use scenario-based exercises. Among programs that use scenario exercises, 93% report that they never (40%) or only sometimes (53%) incorporate child victims into the scenarios. Time, funding, access to subject matter experts, and availability of training material are the most important barriers to effective training. Children are a precious national resource and a vulnerable population in disasters. Despite the availability of terrorism preparedness funding, these data suggest that we are failing to provide adequate training to front-line providers who may care for children in a catastrophic domestic terrorist event.

Medical Operations Console Procedure Evaluation: BME Response to Crew Call Down for an Emergency

NASA Technical Reports Server (NTRS)

Johnson-Troop; Pettys, Marianne; Hurst, Victor, IV; Smaka, Todd; Paul, Bonnie; Rosenquist, Kevin; Gast, Karin; Gillis, David; McCulley, Phyllis

2006-01-01

International Space Station (ISS) Mission Operations are managed by multiple flight control disciplines located at the lead Mission Control Center (MCC) at NASA-Johnson Space Center (JSC). ISS Medical Operations are supported by the complementary roles of Flight Surgeons (Surgeon) and Biomedical Engineer (BME) flight controllers. The Surgeon, a board certified physician, oversees all medical concerns of the crew and the BME provides operational and engineering support for Medical Operations Crew Health Care System. ISS Medical Operations is currently addressing the coordinated response to a crew call down for an emergent medical event, in particular when the BME is the only Medical Operations representative in MCC. In this case, the console procedure BME Response to Crew Call Down for an Emergency will be used. The procedure instructs the BME to contact a Surgeon as soon as possible, coordinate with other flight disciplines to establish a Private Medical Conference (PMC) for the crew and Surgeon, gather information from the crew if time permits, and provide Surgeon with pertinent console resources. It is paramount that this procedure is clearly written and easily navigated to assist the BME to respond consistently and efficiently. A total of five BME flight controllers participated in the study. Each BME participant sat in a simulated MCC environment at a console configured with resources specific to the BME MCC console and was presented with two scripted emergency call downs from an ISS crew member. Each participant used the procedure while interacting with analog MCC disciplines to respond to the crew call down. Audio and video recordings of the simulations were analyzed and each BME participant's actions were compared to the procedure. Structured debriefs were conducted at the conclusion of both simulations. The procedure was evaluated for its ability to elicit consistent responses from each BME participant. Trials were examined for deviations in procedure task completion and/or navigation, in particular the execution of the Surgeon call sequence. Debrief comments were used to analyze unclear procedural steps and to discern any discrepancies between the procedure and generally accepted BME actions. The sequence followed by BME participants differed considerably from the sequence intended by the procedure. Common deviations included the call sequence used to contact Surgeon, the content of BME and crew interaction and the gathering of pertinent console resources. Differing perceptions of task priority and imprecise language seem to have caused multiple deviations from the procedure s intended sequence. The study generated 40 recommendations for the procedure, of which 34 are being implemented. These recommendations address improving the clarity of the instructions, identifying training considerations, expediting Surgeon contact, improving cues for anticipated flight control team communication and identifying missing console tools.

Value of artisanal simulators to train veterinary students in performing invasive ultrasound-guided procedures.

PubMed

Hage, Maria Cristina F N S; Massaferro, Ana Beatriz; Lopes, Érika Rondon; Beraldo, Carolina Mariano; Daniel, Jéssika

2016-03-01

Pericardial effusion can lead to cardiac tamponade, which endangers an animal's life. Ultrasound-guided pericardiocentesis is used to remove abnormal liquid; however, it requires technical expertise. In veterinary medical education, the opportunity to teach this procedure to save lives during emergencies is rare; therefore, simulators are recommended for this practice. The present study aimed to create a model that can be made "at home" at low cost for ultrasound-guided pericardiocentesis training and to gather feedback about this model through questionnaires given to the participants. Eighteen professionals and thirty-six students were introduced to the simulator in pairs. After the simulation training session, participants filled out the questionnaire. Participants considered the model strong in the following areas: visualization of the pericardium, the heart, fluid in the pericardium, and fluid decrease during fictitious pericardiocentesis and its realism. They considered the model weak or moderate in the following areas: visualization of the surrounding tissues, difficulty of pericardial puncture, and visualization of the catheter. The professionals classified the realism of the experimental heart as moderate, whereas the undergraduate students classified it as strong. All participants believed that the experimental model could be useful in preparing for a future real situation. This model fulfills the need for a practical, realistic, and cost-effective model for ultrasound-guided pericardiocentesis training. Copyright © 2016 The American Physiological Society.

Emergency Medical Care Training and Adolescents.

ERIC Educational Resources Information Center

Topham, Charles S.

1982-01-01

Describes an 11-week emergency medical care training program for adolescents focusing on: pretest results; factual emergency instruction and first aid; practical experience training; and assessment. (RC)

The Core Competencies for General Orthopaedic Surgeons.

PubMed

Kellam, James F; Archibald, Douglas; Barber, James W; Christian, Eugene P; D'Ascoli, Richard J; Haynes, Richard J; Hecht, Suzanne S; Hurwitz, Shepard R; Kellam, James F; McLaren, Alexander C; Peabody, Terrance D; Southworth, Stephen R; Strauss, Robert W; Wadey, Veronica M R

2017-01-18

With the changing delivery of orthopaedic surgical care, there is a need to define the knowledge and competencies that are expected of an orthopaedist providing general and/or acute orthopaedic care. This article provides a proposal for the knowledge and competencies needed for an orthopaedist to practice general and/or acute care orthopaedic surgery. Using the modified Delphi method, the General Orthopaedic Competency Task Force consisting of stakeholders associated with general orthopaedic practice has proposed the core knowledge and competencies that should be maintained by orthopaedists who practice emergency and general orthopaedic surgery. For relevancy to clinical practice, 2 basic sets of competencies were established. The assessment competencies pertain to the general knowledge needed to evaluate, investigate, and determine an overall management plan. The management competencies are generally procedural in nature and are divided into 2 groups. For the Management 1 group, the orthopaedist should be competent to provide definitive care including assessment, investigation, initial or emergency care, operative or nonoperative care, and follow-up. For the Management 2 group, the orthopaedist should be competent to assess, investigate, and commence timely non-emergency or emergency care and then either transfer the patient to the appropriate subspecialist's care or provide definitive care based on the urgency of care, exceptional practice circumstance, or individual's higher training. This may include some higher-level procedures usually performed by a subspecialist, but are consistent with one's practice based on experience, practice environment, and/or specialty interest. These competencies are the first step in defining the practice of general orthopaedic surgery including acute orthopaedic care. Further validation and discussion among educators, general orthopaedic surgeons, and subspecialists will ensure that these are relevant to clinical practice. These competencies provide many stakeholders, including orthopaedic educators and orthopaedists, with what may be the minimum knowledge and competencies necessary to deliver acute and general orthopaedic care. This document is the first step in defining a practice-based standard for training programs and certification groups.

Emergency nurses' perceptions of emergency department preparedness for an ebola outbreak: A qualitative descriptive study.

PubMed

Pincha Baduge, Mihirika Sds; Moss, Cheryle; Morphet, Julia

2017-05-01

Ebola Virus Disease is highly contagious and has high mortality. In 2014, when the outbreak in West Africa was declared a public health emergency, emergency departments in Australia commenced preparation and vigilance for people presenting with ebola like symptoms, to limit spread of the disease. To examine Australian emergency nurses' perceptions regarding their own and their emergency departments' preparedness to manage an ebola outbreak. A qualitative descriptive design was used to collect and analyse data in one metropolitan emergency department in Victoria, Australia. Four focus groups were conducted with 13 emergency nurses. Data were thematically analysed. Major themes emerged from the data: organisational, personal and future preparedness. Participants' believed that both the organisation and themselves had achieved desirable and appropriate preparedness for ebola in their emergency setting. Participants trusted their organisation to prepare and protect them for ebola. Appropriate policies, procedures, and equipment infrastructure were reportedly in place. Nurses' decisions to care for a patient with ebola were informed by professional commitment, and personal responsibilities. Participants were concerned about transmitting ebola to their families, and suggested that more regular training in personal protective equipment would increase confidence and skill in self-protection. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

Analysis of the pre-incident education and subsequent performance of emergency medical responders to the Volendam café fire.

PubMed

Welling, Lieke; Perez, Roberto S G M; van Harten, Sabine M; Patka, Peter; Mackie, Dave P; Kreis, Robert W; Bierens, Joost J L M

2005-12-01

At this moment, in the Netherlands, rescue workers are not given any specific standardized training in disaster response or disaster management. After the café fire in Volendam, the Netherlands, on New Year's Eve 2000, around 200 rescue workers were deployed on-site. The aim of this study is to investigate the rescue workers' experiences with regard to their level of preparation for the emergency response. In 2002, 30 members of the medical and paramedical personnel were requested to participate in a structured interview, focused on education, task perception, triage and registration. Twenty-seven participated. Twenty-two rescue workers received previous training in emergency medicine. During the alarm phase, 11 rescue workers had a clear perception of their tasks. Twenty-four were involved in triage and injury assessment. Three rescue workers used a protocol for triage and 15 for injury assessment. Twenty-five rescue workers gave on-scene treatment and 15 used a protocol. Eight registered their findings. Preparation for the emergency response lacked standardized procedures. The use of triage protocols was extremely poor, as was documentation of actions. Slightly more than half of the personnel followed treatment protocols. It is advisable that all rescue workers become familiar with the basic uniform principles and protocols regarding disaster management. A dedicated and standardized national disaster management course is needed for all rescue workers.

Don't mess with H/sub 2/S

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1987-09-01

The American Petroleum Institute issued a report on ''Recommended Practices for Safe Drilling of Wells Containing Hydrogen Sulfide.'' The study (RP49) updates a first edition published in September 1974. It provides a solid overview of preventive steps that should be taken to safeguard crew and equipment when drilling through H/sub 2/S zones. Discussions cover personnel training, protective equipment, wellsite layout, rig and well equipment, general rig operations and contingency planning and emergency procedures. This article summarizes the report.

STS-47 Commander Gibson and Pilot Brown at CCT side hatch during JSC training

NASA Technical Reports Server (NTRS)

1992-01-01

STS-47 Endeavour, Orbiter Vehicle (OV) 105, Spacelab Japan (SLJ) Commander Robert L. Gibson (right) and Pilot Curtis L. Brown, Jr, wearing launch and entry suits (LESs), pose in front of the Crew Compartment Trainer (CCT) mockup side hatch during post landing emergency egress procedures held at JSC's Mockup and Integration Laboratory (MAIL) Bldg 9NE. Note that the crew escape system (CES) pole is in position at side hatch but is not extended.

STS-56 Commander Cameron and Pilot Oswald at CCT hatch during JSC training

NASA Technical Reports Server (NTRS)

1993-01-01

STS-56 Discovery, Orbiter Vehicle (OV) 103, Commander Kenneth Cameron (right) and Pilot Stephen S. Oswald, wearing launch and entry suits (LESs), stand at the side hatch of the crew compartment trainer (CCT), a shuttle mockup, prior to entering the mockup. Once inside the CCT, they will don their launch and entry helmets (LEHs) and participate in emergency egress (bailout) procedures. The CCT is located in JSC's Mockup and Integration Laboratory (MAIL) Bldg 9NE.

Newly emerging resource efficiency manager programs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wolf, S.; Howell, C.

1997-12-31

Many facilities in the northwest such as K--12 schools, community colleges, and military installations are implementing resource-efficiency awareness programs. These programs are generally referred to as resource efficiency manager (REM) or resource conservation manager (RCM) programs. Resource efficiency management is a systems approach to managing a facility`s energy, water, and solid waste. Its aim is to reduce utility budgets by focusing on behavioral changes, maintenance and operation procedures, resource accounting, education and training, and a comprehensive awareness campaign that involves everyone in the organization.

Inflight Emergencies During Eurasian Flights.

PubMed

Kesapli, Mustafa; Akyol, Can; Gungor, Faruk; Akyol, Angelika Janitzky; Guven, Dilek Soydam; Kaya, Gokhan

2015-01-01

This study evaluated the incidence and status of urgent medical conditions, the attitudes of health professionals who encounter such conditions, the adequacy of medical kits and training of cabin crew in data-received-company aircrafts suggested by Aerospace Medical Association, and the demographic data of patients. Data were collected from medical records of a major flight company from 2011 through 2013. All patients with complete records were included in the study. Numerical variables were defined as median and interquartiles (IQR) for median, while categorical variables were defined as numbers and percentage. During the study period, 10,100,000 passengers were carried by the company flights, with 1,312 (0.013%) demands for urgent medical support (UMS). The median age of the passengers who requested UMS was 45 years (IQR: 29-62). Females constituted 698 (53.2%) among the patients, and 721 (55%) patients were evaluated by medical professionals found among passengers. The most common nontraumatic complaints resulting in requests for UMS were flight anxiety (311 patients, 23.7%) and dyspnea (145 patients, 11%). The most common traumatic complaint was burns (221 patients, 16.8%) resulting from trauma during flight. A total of 22 (1.67%) emergency landings occurred for which the most frequent reasons were epilepsy (22.7%) and death (18.2%). Deaths during flights were recorded in 13 patients, whose median age was 77 years (IQR: 69-82), which was significantly higher compared to the age of patients requiring UMS (p < 0.0001). A total of 592 (45%) patients did not require any treatment for UMS. Medical kits and training were found to be sufficient according to the symptomatic treatments. Most of the urgent cases encountered during flights can be facilitated with basic medical support. "Traumatic emergency procedures inflight medical care" would be useful for additional training. Medical professionals as passengers are significantly involved in encountered emergency situations. Adding automated external defibrillator and pulse oximetry to recommended kits and training can help facilitate staff decisions such as emergency landings and tele-assistance. © 2015 International Society of Travel Medicine.

Evaluation of retention of knowledge and skills imparted to first-year medical students through basic life support training.

PubMed

Pande, Sushma; Pande, Santosh; Parate, Vrushali; Pande, Sanket; Sukhsohale, Neelam

2014-03-01

Poor awareness among medical graduates about basic life support (BLS) is a matter of great concern. The presence of a trained rescuer is the key determinant of ultimate survival from life-threatening emergencies. To achieve this goal, early exposure to such life-saving skills is the right decision to foster these skills for medical students, which can be reenforced in succeeding years. Forty-two first-year medical students participated in this study. The entire procedure consisted of faculty training, assessment of knowledge of students by a pretest questionnaire, a lecture, a demonstration, and hands-on training using a mannequin (with special emphasis on the site, depth, rate, and sustainment of uninterrupted chest compressions). Posttest 1 was conducted to assess the knowledge gained. The retention of knowledge and skills in the second year was evaluated by posttest 2 and directly observed procedural skills, respectively. Student feedback was collected on five-point Likert scale. Analysis using a Freidman test indicated the mean rank for posttest 1 (2.81) to be significantly higher than the pretest (1.26), indicating a gain in knowledge. The mean rank for posttest 2 (1.93) was lower than for posttest 1 (2.81) but was significantly higher compared with the pretest (1.26), indicating a significant retention of knowledge during the second year. Directly observed procedural skill evaluation showed that 7% students could perform all the seven steps correctly and that 74% students could perform three or more steps correctly, signifying a good retention of skill. Two students taught BLS skills to their family members as well. The results of this study suggest that the program provides students with sound basic knowledge and adequate practical skills in BLS.

Percutaneous tracheostomy--special considerations.

PubMed

Ernst, Armin; Critchlow, Jonathan

2003-09-01

Percutaneous tracheostomy is safe and highly effective in well-trained hands in establishing a long-term artificial airway. Most alleged contraindications and some suggestions on how the procedures should be performed likely stem from early trials when only "perfect candidates" were chosen. Most of those contraindications should not be viewed as prohibitions, but as suggestions related to the skill level and training of the operator. We have used this technique in many situations where the small incision and tamponading effect of the tracheostomy tube has been quite beneficial, in selected patients with coagulapathies and severe venous congestion from superior cava syndromes as well as thyroid cancers, and in whom operative approaches would have been difficult. Knowing one's level of expertise and comfort in choosing and rejecting patients and procedures accordingly is the key to keeping PT a procedure with an excellent safety record. As the experience with PT grows, more and more perceived contraindications will disappear. Studies will address the role of PT in children and as a means of establishing emergent airway access. Also, the exact coagulation limits will need to be established. Few contraindications will most likely remain absolute, such as active infections over the proposed entry site, uncontrollable bleeding disorders and excessive ventilatory and oxygenation requirements. In our institution, taking into account these absolute contraindications, fewer than 5% of patients in need of a tracheostomy in the intensive care unit will undergo a primary open procedure.

Autogenic Feedback Training Applications for Man in Space

NASA Technical Reports Server (NTRS)

Cowings, Patricia S.; Wade, Charles E. (Technical Monitor)

1994-01-01

Finding an effective treatment for the motion sickness-like symptoms that occur in space has become a high priority for NASA. This paper reviews the back-round research and procedures of an experiment designed to prevent space motion sickness in shuttle crewmembers. The preventive method used, Autogenic - Feedback Training (AFT) involves training subjects to control voluntarily several of their own physiological responses to environmental stressors. AFT has been used reliably to increase tolerance to motion sickness during around based tests in over 300 men and women under a variety of conditions that induce motion sickness, and preliminary evidence from space suggests that AFT may be an effective treatment for space motion sickness as well. Other applications of AFT described include; (1) a potential treatment for post flight orthostatic intolerance, a serious biomedical problem resulting from long duration exposure to micro-g and (2) improving pilot performance during emergency flying conditions.

STS-65 Mission Specialist Chiao floats in a single person raft in JSC's WETF

NASA Technical Reports Server (NTRS)

1994-01-01

Having just deployed a small, single-person life raft, astronaut and STS-65 Mission Specialist Leroy Chiao, outfitted in a launch and entry suit (LES) and launch and entry helmet (LEH), floats in a 25-feet deep pool at the Johnson Space Center (JSC). The astronaut was in the Weightless Environment Training Facility (WETF) Bldg 29 pool for a training exercise, designed to familiarize crewmembers with procedures to call on in the event of an emergency egress situation with the Space Shuttle. Chiao will join five other NASA astronauts and a Japanese payload specialist for the second International Microgravity Laboratory 2 (IML-2) mission aboard the Space Shuttle Columbia, Orbiter Vehicle (OV) 102, later this year.

Training for long duration space missions

NASA Technical Reports Server (NTRS)

Goldberg, Joseph H.

1987-01-01

The successful completion of an extended duration manned mission to Mars will require renewed research effort in the areas of crew training and skill retention techniques. The current estimate of inflight transit time is about nine months each way, with a six month surface visit, an order of magnitude beyond previous U.S. space missions. Concerns arise when considering the level of skill retention required for highly critical, one time operations such as an emergency procedure or a Mars orbit injection. The factors responsible for the level of complex skill retention are reviewed, optimal ways of refreshing degraded skills are suggested, and a conceptual crew training design for a Mars mission is outlined. Currently proposed crew activities during a Mars mission were reviewed to identify the spectrum of skills which must be retained over a long time period. Skill retention literature was reviewed to identify those factors which must be considered in deciding when and which tasks need retraining. Task, training, and retention interval factors were identified. These factors were then interpreted in light of the current state of spaceflight and adaptive training systems.

Determining procedures for simulation-based training in radiology: a nationwide needs assessment.

PubMed

Nayahangan, Leizl Joy; Nielsen, Kristina Rue; Albrecht-Beste, Elisabeth; Bachmann Nielsen, Michael; Paltved, Charlotte; Lindorff-Larsen, Karen Gilboe; Nielsen, Bjørn Ulrik; Konge, Lars

2018-06-01

New training modalities such as simulation are widely accepted in radiology; however, development of effective simulation-based training programs is challenging. They are often unstructured and based on convenience or coincidence. The study objective was to perform a nationwide needs assessment to identify and prioritize technical procedures that should be included in a simulation-based curriculum. A needs assessment using the Delphi method was completed among 91 key leaders in radiology. Round 1 identified technical procedures that radiologists should learn. Round 2 explored frequency of procedure, number of radiologists performing the procedure, risk and/or discomfort for patients, and feasibility for simulation. Round 3 was elimination and prioritization of procedures. Response rates were 67 %, 70 % and 66 %, respectively. In Round 1, 22 technical procedures were included. Round 2 resulted in pre-prioritization of procedures. In round 3, 13 procedures were included in the final prioritized list. The three highly prioritized procedures were ultrasound-guided (US) histological biopsy and fine-needle aspiration, US-guided needle puncture and catheter drainage, and basic abdominal ultrasound. A needs assessment identified and prioritized 13 technical procedures to include in a simulation-based curriculum. The list may be used as guide for development of training programs. • Simulation-based training can supplement training on patients in radiology. • Development of simulation-based training should follow a structured approach. • The CAMES Needs Assessment Formula explores needs for simulation training. • A national Delphi study identified and prioritized procedures suitable for simulation training. • The prioritized list serves as guide for development of courses in radiology.

Interactions Between Children and Pediatric Nurses at the Emergency Department: A Swedish Interview Study.

PubMed

Grahn, Malin; Olsson, Emmy; Mansson, Marie Edwinson

2016-01-01

Admission to an emergency department can be considered a stressful event for both the child and the family. Due to the nature of traumas, illnesses and fatalities it is a chaotic forum in which good communication between child and staff can be difficult to establish. The purpose of the study was to describe nurses' methods when interacting with children aged three to six at a pediatric emergency department and to identify aspects in need of further investigation. The study included seven nurses who work with children. The data were collected through semi-structured interviews and analyzed using qualitative content analysis. The analysis resulted in three main themes; fundamentals for being able to create a good encounter, nurse's adaptations when encountering children and limitations associated with providing child and family-centered care in the pediatric emergency department. Healthcare organizations must create time to allow important communication to take place between staff and pediatric patients so that children and families feel safe when being treated. The implementation of effective measures to train staff in communication with pediatric patients is important. The child should participate in his/her care and in procedures as much as possible. By listening to children and their parents proposals, especially before invasive procedures, effective ways to handle pain and discomfort may be developed. Copyright © 2016 Elsevier Inc. All rights reserved.

[Anesthesia practice in Catalan hospitals and other health care facilities].

PubMed

Villalonga, Antonio; Sabaté, Sergi; Campos, Juan Manuel; Fornaguera, Joan; Hernández, Carmen; Sistac, José María

2006-05-24

The aim of this arm of the ANESCAT study was to characterize anesthesia practice in the various types of health care facilities of Catalonia, Spain, in 2003. We analyzed data from the survey according to a) source of a facility's funding: public hospitals financed by the Catalan Public Health Authority (ICS), the network of subsidized hospitals for public use (XHUP), or private hospitals; b) size: facilities without hospital beds, hospitals with fewer than 250 beds, those with 251 to 500, and those with over 500; and c) training accreditation status: whether or not a facility gave medical resident training. A total of 131 facilities participated (11 under the ICS, 47 from the XHUP, and 73 private hospitals). Twenty-six clinics had no hospital beds, 78 facilities had fewer than 250, 21 had 251 to 500, and 6 had more than 500. Seventeen hospitals trained medical residents. XHUP hospitals performed 44.3% of all anesthetic procedures, private hospitals 36.7%, and ICS facilities 18.5%. Five percent of procedures were performed in clinics without beds, 42.9% in facilities with fewer than 250 beds, 35% in hospitals with 251 to 500, and 17.1% in hospitals with over 500. Anesthetists in teaching hospitals performed 35.5% of all procedures. The mean age of patients was lower in private hospitals, facilities with fewer than 250 beds, and hospitals that did not train medical residents. The physical status of patients was worse in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. It was noteworthy that 25% of anesthetic procedures were performed on an emergency basis in XHUP and ICS hospitals, in facilities with more than 250 beds, and in teaching hospitals. Anesthesia for outpatient procedures accounted for 40% of the total in private hospitals and 31% of the practice in ICS and XHUP hospitals. The duration of anesthesia and postanesthetic recovery was longer in ICS hospitals, in facilities with over 500 beds, and in those with medical resident training programs. The numbers of postoperative admissions to critical care units and of specialized analgesic techniques performed were higher in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. The complexity of both anesthesia and surgical practice and the severity of patient condition increased with hospital size and public funding status.

46 CFR 109.213 - Emergency training and drills.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 4 2013-10-01 2013-10-01 false Emergency training and drills. 109.213 Section 109.213 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS OPERATIONS Tests, Drills, and Inspections § 109.213 Emergency training and drills. (a) Training materials...

46 CFR 109.213 - Emergency training and drills.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 4 2012-10-01 2012-10-01 false Emergency training and drills. 109.213 Section 109.213 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS OPERATIONS Tests, Drills, and Inspections § 109.213 Emergency training and drills. (a) Training materials...

46 CFR 109.213 - Emergency training and drills.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 4 2014-10-01 2014-10-01 false Emergency training and drills. 109.213 Section 109.213 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS OPERATIONS Tests, Drills, and Inspections § 109.213 Emergency training and drills. (a) Training materials...

46 CFR 109.213 - Emergency training and drills.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Emergency training and drills. 109.213 Section 109.213 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS OPERATIONS Tests, Drills, and Inspections § 109.213 Emergency training and drills. (a) Training materials...

46 CFR 109.213 - Emergency training and drills.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Emergency training and drills. 109.213 Section 109.213 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS OPERATIONS Tests, Drills, and Inspections § 109.213 Emergency training and drills. (a) Training materials...

[Simulation as possible training for palliative emergencies: prospective initial data analysis of participants from two simulation training sessions].

PubMed

Wiese, C H R; Bosse, G; Schröder, T; Lassen, C L; Bundscherer, A C; Graf, B M; Zausig, Y A

2015-01-01

Palliative emergencies describe an acute situation in patients with a life-limiting illness. At present defined curricula for prehospital emergency physician training for palliative emergencies are limited. Simulation-based training (SBT) for such palliative emergency situations is an exception both nationally and internationally. This article presents the preparation of recommendations in the training and development of palliative care emergency situations. A selected literature search was performed using PubMed, EMBASE, Medline and the Cochrane database (1990-2013). Reference lists of included articles were checked by two reviewers. Data of the included articles were extracted, evaluated und summarized. In the second phase the participants of two simulated scenarios of palliative emergencies were asked to complete an anonymous 15-item questionnaire. The results of the literature search and the questionnaire-based investigation were compared and recommendations were formulated based on the results. Altogether 30 eligible national and international articles were included. Overall, training curricula in palliative emergencies are currently being developed nationally and internationally but are not yet widely integrated into emergency medical training and education. In the second part of the investigation, 25 participants (9 male, 16 female, 20 physicians and 5 nurses) were included in 4 multiprofessional emergency medical simulation training sessions. The most important interests of the participants were the problems for training and further education concerning palliative emergencies described in the national and international literature. The literature review and the expectations of the participants underlined that the development and characteristics of palliative emergencies will become increasingly more important in outpatient emergency medicine. All participants considered palliative care to be very important concerning the competency for end-of-life decisions in palliative patients. For this reason, special curricula and simulation for dealing with palliative care patients and special treatment decisions in emergency situations seem to be necessary.

[Improvement of emergency physician education through simulator training. Consideration on the basis of the model project "NASimSaar25"].

PubMed

Armbruster, W; Kubulus, D; Schlechtriemen, T; Adler, J; Höhn, M; Schmidt, D; Duchêne, S; Steiner, P; Volk, T; Wrobel, M

2014-09-01

Prehospital emergency medicine is a challenge for trainee emergency physicians. Rare injuries and diseases as well as patients in extreme age groups can unexpectedly face emergency physicians. In the regulations on medical education the German Medical Association requires participation in 50 emergency missions under the supervision of an experienced emergency physician. This needs to be improved because on-the-job training does not generally represent the whole spectrum of emergency medicine and a good and structured training under on call conditions is nearly impossible. The subject of the model project described was whether practical training for emergency physicians can be achieved by participation in simulation training instead of real emergency situations. After modification of the Saarland regulations on medical education it was possible to replace up to 25 participations in emergency missions by simulation training. The concept of the course NASimSaar25 requires participants to complete 25 simulator cases in 3 days in small training groups. Emergency situations from all medical disciplines need to be treated. A special focus is on the treatment of life-threatening and rare diseases and injuries. Modern simulators and actors are used. The debriefings are conducted by experienced tutors based on approved principles. Medical contents, learning targets from the field of crew resource management (CRM) and soft skills are discussed in these debriefings. Education in the field of emergency medicine can be improved by simulator-based learning and training. However, practical work under a tutor in real and clinical experience cannot be completely replaced by simulation. Simulator training can only be successful if theoretical knowledge has already been acquired. A simulator-based course concept can result in an improvement of emergency medical education. The model project NASimSaar25 was well received by the target audience and mostly very well evaluated in terms of learning and reality. If this project becomes established the demand on simulation-based training will increase. The training should achieve a consistent standard of quality.

More Learners, Finite Resources, and the Changing Landscape of Procedural Training at the Bedside.

PubMed

Gisondi, Michael A; Regan, Linda; Branzetti, Jeremy; Hopson, Laura R

2018-05-01

There is growing competition for nonoperative, procedural training in teaching hospitals, due to an increased number of individuals seeking to learn procedures from a finite number of appropriate teaching cases. Procedural training is required by students, postgraduate learners, and practicing providers who must maintain their skills. These learner groups are growing in size as the number of medical schools increases and advance practice providers expand their skills to include complex procedures. These various learner needs occur against a background of advancing therapeutic techniques that improve patient care but also act to reduce the overall numbers of procedures available to learners. This article is a brief review of these and other challenges that are arising for program directors, medical school leaders, and hospital administrators who must act to ensure that all of their providers acquire and maintain competency in a wide array of procedural skills. The authors conclude their review with several recommendations to better address procedural training in this new era of learner competition. These include a call for innovative clinical rotations deliberately designed to improve procedural training, access to training opportunities at new clinical sites acquired in health system expansions, targeted faculty development for those who teach procedures, reporting of competition for bedside procedures by trainees, more frequent review of resident procedure and case logs, and the creation of an institutional oversight committee for procedural training.

Use and implementation of standard operating procedures and checklists in prehospital emergency medicine: a literature review.

PubMed

Chen, Chulin; Kan, Ting; Li, Shuang; Qiu, Chen; Gui, Li

2016-12-01

This review aimed to analyze published literature to introduce the use and implementation of standard operating procedures (SOPs) and checklists in prehospital emergency medicine and their impact on guideline adherence and patient outcome. An English literature search was carried out using the Cochrane Library, MEDLINE, EMBASE, Springer, Elsevier, and ProQuest databases. Original articles describing the use and implementation of SOPs or checklists in prehospital emergency medicine were included. Editorials, comments, letters, bulletins, news articles, conference abstracts, and notes were excluded from the analysis. Relevant information was extracted relating to application areas, development of SOPs/checklists, educational preparation and training regarding SOPs/checklists implementation, staff attitudes and the effects of SOPs/checklists use on guideline adherence and patient outcomes. The literature search found 2187 potentially relevant articles, which were narrowed down following an abstract review and a full text review. A final total of 13 studies were identified that described the use and implementation of SOPs (9 studies) and checklists (4 studies) in different areas of prehospital emergency medicine including prehospital management of patients with acute exacerbated chronic obstructive pulmonary disease and acute coronary syndrome, prehospital airway management, medical documentation, Emergency Medical Services triage, and transportation of patients. The use and implementation of SOPs and checklists in prehospital emergency medicine have shown some benefits of improving guidelines adherence and patient outcomes in airway management, patient records, identification and triage, and other prehospital interventions. More research in this area is necessary to optimize the future use and implementation of SOPs and checklists to improve emergency personnel performance and patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

The emergence of autoclitic frames in atypically and typically developing children as a function of multiple exemplar instruction.

PubMed

Luke, Nicole; Greer, R Douglas; Singer-Dudek, Jessica; Keohane, Dolleen-Day

2011-01-01

In two experiments, we tested the effect of multiple exemplar instruction (MEI) for training sets on the emergence of autoclitic frames for spatial relations for novel tacts and mands. In Experiment 1, we used a replicated pre- and post-intervention probe design with four students with significant learning disabilities to test for acquisition of four autoclitic frames with novel tacts and mands before and after MEI. The untaught topographies emerged for all participants. In Experiment 2, we used a multiple probe design to test the effects of the MEI procedures on the same responses in four typically developing, bilingual students. The novel usage emerged for all participants. In the latter experiment, the children demonstrated untaught usage of mand or tact frames regardless of whether they were taught to respond in either listener or speaker functions alone or across listener and speaker functions. The findings are discussed in terms of the role of MEI in the formation of abstractions.

Device-Task Fidelity and Transfer of Training: Aircraft Cockpit Procedures Training.

ERIC Educational Resources Information Center

Prophet, Wallace W.; Boyd, H. Alton

An evaluation was made of the training effectiveness of two cockpit procedures training devices, differing greatly in physical fidelity and cost, for use on the ground for a twin-engine, turboprop, fixed-wing aircraft. One group of students received training in cockpit procedures in a relatively expensive, sophisticated, computerized trainer,…

KSC-08pd1168

NASA Image and Video Library

2008-05-07

CAPE CANAVERAL, Fla. -- STS-124 crew members get instructions inside an M113 armored personnel carrier about emergency procedures. Clockwise from left are Mission Specialists Greg Chamitoff and Akihiko Hoshide, Commander Mark Kelly, Mission Specialist Ron Garan, instructor Battalion Chief George Hoggard, Pilot Ken Ham and Mission Specialists Karen Nyberg and Mike Fossum. They are at NASA's Kennedy Space Center for a dress launch rehearsal called the terminal countdown demonstration test. TCDT provides astronauts and ground crews with an opportunity to participate in various simulated countdown activities, including equipment familiarization and emergency training. On the STS-124 mission, the crew will deliver and install the Japanese Experiment Module – Pressurized Module and Japanese Remote Manipulator System. Discovery's launch is targeted for May 31. Photo credit: NASA/Kim Shiflett

Nontrauma emergency surgery: optimal case mix for general surgery and acute care surgery training.

PubMed

Cherry-Bukowiec, Jill R; Miller, Barbra S; Doherty, Gerard M; Brunsvold, Melissa E; Hemmila, Mark R; Park, Pauline K; Raghavendran, Krishnan; Sihler, Kristen C; Wahl, Wendy L; Wang, Stewart C; Napolitano, Lena M

2011-11-01

To examine the case mix and patient characteristics and outcomes of the nontrauma emergency (NTE) service in an academic Division of Acute Care Surgery. An NTE service (attending, chief resident, postgraduate year-3 and postgraduate year-2 residents, and two physician assistants) was created in July 2005 for all urgent and emergent inpatient and emergency department general surgery patient consults and admissions. An NTE database was created with prospective data collection of all NTE admissions initiated from November 1, 2007. Prospective data were collected by a dedicated trauma registrar and Acute Physiology and Chronic Health Evaluation-intensive care unit (ICU) coordinator daily. NTE case mix and ICU characteristics were reviewed for the 2-year time period January 1, 2008, through December 31, 2009. During the same time period, trauma operative cases and procedures were examined and compared with the NTE case mix. Thousand seven hundred eight patients were admitted to the NTE service during this time period (789 in 2008 and 910 in 2009). Surgical intervention was required in 70% of patients admitted to the NTE service. Exploratory laparotomy or laparoscopy was performed in 449 NTE patients, comprising 37% of all surgical procedures. In comparison, only 118 trauma patients (5.9% of admissions) required a major laparotomy or thoracotomy during the same time period. Acuity of illness of NTE patients was high, with a significant portion (13%) of NTE patients requiring ICU admission. NTE patients had higher admission Acute Physiology and Chronic Health Evaluation III scores [61.2 vs. 58.8 (2008); 58.2 vs. 55.8 (2009)], increased mortality [(9.71% vs. 4.89% (2008); 6.78% vs. 5.16% (2009)], and increased readmission rates (15.5% vs. 7.4%) compared with the total surgical ICU (SICU) admissions. In an era of declining operative caseload in trauma, the NTE service provides ample opportunity for complex general surgery decision making and operative procedures for surgical residency education, including advanced surgical critical care management. In addition, creation of an NTE service provides an optimal general surgery case mix, including major abdominal operations, that can augment declining trauma surgery caseloads, maintain acute care faculty surgical skills, and support general and acute care surgery residency training.

Are All Competencies Equal in the Eyes of Residents? A Multicenter Study of Emergency Medicine Residents’ Interest in Feedback

PubMed Central

Bentley, Suzanne; Hu, Kevin; Messman, Anne; Moadel, Tiffany; Khandelwal, Sorabh; Streich, Heather; Noelker, Joan

2017-01-01

Introduction Feedback, particularly real-time feedback, is critical to resident education. The emergency medicine (EM) milestones were developed in 2012 to enhance resident assessment, and many programs use them to provide focused resident feedback. The purpose of this study was to evaluate EM residents’ level of interest in receiving real-time feedback on each of the 23 competencies/sub-competencies. Methods This was a multicenter cross-sectional study of EM residents. We surveyed participants on their level of interest in receiving real-time on-shift feedback on each of the 23 competencies/sub-competencies. Anonymous paper or computerized surveys were distributed to residents at three four-year training programs and three three-year training programs with a total of 223 resident respondents. Residents rated their level of interest in each milestone on a six-point Likert-type response scale. We calculated average level of interest for each of the 23 sub-competencies, for all 223 respondents and separately by postgraduate year (PGY) levels of training. One-way analyses of variance were performed to determine if there were differences in ratings by level of training. Results The overall survey response rate across all institutions was 82%. Emergency stabilization had the highest mean rating (5.47/6), while technology had the lowest rating (3.24/6). However, we observed no differences between levels of training on any of the 23 competencies/sub-competencies. Conclusion Residents seem to ascribe much more value in receiving feedback on domains involving high-risk, challenging procedural skills as compared to low-risk technical and communication skills. Further studies are necessary to determine whether residents’ perceived importance of competencies/sub-competencies needs to be considered when developing an assessment or feedback program based on these 23 EM competencies/sub-competencies. PMID:28116012

Surgical specialty procedures in rural surgery practices: implications for rural surgery training.

PubMed

Sticca, Robert P; Mullin, Brady C; Harris, Joel D; Hosford, Clint C

2012-12-01

Specialty procedures constitute one eighth of rural surgery practice. Currently, general surgeons intending to practice in rural hospitals may not get adequate training for specialty procedures, which they will be expected to perform. Better definition of these procedures will help guide rural surgery training. Current Procedural Terminology codes for all surgical procedures for 81% of North Dakota and South Dakota rural surgeons were entered into the Dakota Database for Rural Surgery. Specialty procedures were analyzed and compared with the Surgical Council on Resident Education curriculum to determine whether general surgery training is adequate preparation for rural surgery practice. The Dakota Database for Rural Surgery included 46,052 procedures, of which 5,666 (12.3%) were specialty procedures. Highest volume specialty categories included vascular, obstetrics and gynecology, orthopedics, cardiothoracic, urology, and otolaryngology. Common procedures in cardiothoracic and vascular surgery are taught in general surgical residency, while common procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology are usually not taught in general surgery training. Optimal training for rural surgery practice should include experience in specialty procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology. Copyright © 2012 Elsevier Inc. All rights reserved.

Written versus verbal consent: a qualitative study of stakeholder views of consent procedures used at the time of recruitment into a peripartum trial conducted in an emergency setting.

PubMed

Lawton, J; Hallowell, N; Snowdon, C; Norman, J E; Carruthers, K; Denison, F C

2017-05-24

Obtaining prospective written consent from women to participate in trials when they are experiencing an obstetric emergency is challenging. Alternative consent pathways, such as gaining verbal consent at enrolment followed, later, by obtaining written consent, have been advocated by some clinicians and bioethicists but have received little empirical attention. We explored women's and staff views about the consent procedures used during the internal pilot of a trial (GOT-IT), where the protocol permitted staff to gain verbal consent at recruitment. Interviews with staff (n = 27) and participating women (n = 22). Data were analysed thematically and interviews were cross-compared to identify differences and similarities in participants' views about the consent procedures used. Women and some staff highlighted benefits to obtaining verbal consent at trial enrolment, including expediting recruitment and reducing the burden on those left exhausted by their births. However, most staff with direct responsibility for taking consent expressed extreme reluctance to proceed with enrolment until they had obtained written consent, despite being comfortable using verbal procedures in their clinical practice. To account for this resistance, staff drew a strong distinction between research and clinical care and suggested that a higher level of consent was needed when recruiting into trials. In doing so, staff emphasised the need to engage women in reflexive decision-making and highlighted the role that completing the consent form could play in enabling and evidencing this process. While most staff cited their ethical responsibilities to women, they also voiced concerns that the absence of a signed consent form at recruitment could expose them to greater risk of litigation were an individual to experience a complication during the trial. Inexperience of recruiting into peripartum trials and limited availability of staff trained to take consent also reinforced preferences for obtaining written consent at recruitment. While alternative consent pathways have an important role to play in advancing emergency medicine research, and may be appreciated by potential recruits, they may give rise to unintended ethical and logistical challenges for staff. Staff would benefit from training and support to increase their confidence and willingness to recruit into trials using alternative consent pathways. This qualitative research was undertaken as part of the GOT-IT Trial (trial registration number: ISCRTN 88609453 ). Date of registration 26/03/2014.

The Challenge of Aviation Emergency and Abnormal Situations

NASA Technical Reports Server (NTRS)

Burian, Barbara K.; Barshi, Immanuel; Dismukes, Key

2005-01-01

Emergency and abnormal situations occur on flights everyday around the world. They range from minor situations readily managed to extremely serious and highly time-critical situations that deeply challenge the skills of even the most effective crews. How well crews respond to these situations is a function of several interacting sets of issues: (1) the design of non-normal procedures and checklists, (2) design of aircraft systems and automation, (3) specific aspects of the non-normal situation, such as time criticality and complexity of the situation, (4) human performance capabilities and cognitive limitations under high workload and stress, (5) design of training for non-normal situations, (6) philosophies, policies and practices within the industry, and (7) economic and regulatory constraints. Researchers and pilots working on NASA's Emergency and Abnormal Situations project are addressing these issues in a long-range study. In this paper we discuss these issues and illustrate them with examples from recent incidents and accidents.

Development of an accommodative smartphone app for medical guidelines in pediatric emergencies.

PubMed

Schmucker, Michael; Heid, Jörn; Haag, Martin

2014-01-01

One of the outcomes of a training concept for physicians and nurses concerning pediatric emergencies at the Heidelberg University Hospital was that the work and procedures in childhood emergencies could be simplified by replacing the existing paper-based guidelines with a smartphone app. Since the project funds for this were already used up, a group of students from the master program "Medical Informatics" of Heidelberg and Heilbronn Universities took over the development of the app. Particular attention was given to the need for compatibility with the variety of devices (device size and screen resolution) and platform independence. The guidelines themselves were scripted in HTML5, JavaScript and CSS (responsive web design); managed by a container programmed in Sencha Touch. Even though the app is not yet available in the App-Store due to the limited timeframe, the students gained a great deal of valuable experience in developing platform independent software for mobile devices.

Impact of operator experience and training strategy on procedural outcomes with leadless pacing: Insights from the Micra Transcatheter Pacing Study.

PubMed

El-Chami, Mikhael; Kowal, Robert C; Soejima, Kyoko; Ritter, Philippe; Duray, Gabor Z; Neuzil, Petr; Mont, Lluis; Kypta, Alexander; Sagi, Venkata; Hudnall, John Harrison; Stromberg, Kurt; Reynolds, Dwight

2017-07-01

Leadless pacemaker systems have been designed to avoid the need for a pocket and transvenous lead. However, delivery of this therapy requires a new catheter-based procedure. This study evaluates the role of operator experience and different training strategies on procedural outcomes. A total of 726 patients underwent implant attempt with the Micra transcatheter pacing system (TPS; Medtronic, Minneapolis, MN, USA) by 94 operators trained in a teaching laboratory using a simulator, cadaver, and large animal models (lab training) or locally at the hospital with simulator/demo model and proctorship (hospital training). Procedure success, procedure duration, fluoroscopy time, and safety outcomes were compared between training methods and experience (implant case number). The Micra TPS procedure was successful in 99.2% of attempts and did not differ between the 55 operators trained in the lab setting and the 39 operators trained locally at the hospital (P = 0.189). Implant case number was also not a determinant of procedural success (P = 0.456). Each operator performed between one and 55 procedures. Procedure time and fluoroscopy duration decreased by 2.0% (P = 0.002) and 3.2% (P < 0.001) compared to the previous case. Major complication rate and pericardial effusion rate were not associated with case number (P = 0.755 and P = 0.620, respectively). There were no differences in the safety outcomes by training method. Among a large group of operators, implantation success was high regardless of experience. While procedure duration and fluoroscopy times decreased with implant number, complications were low and not associated with case number. Procedure and safety outcomes were similar between distinct training methodologies. © 2017 Wiley Periodicals, Inc.

46 CFR 167.65-1 - Emergency training, musters, and drills.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Emergency training, musters, and drills. 167.65-1... NAUTICAL SCHOOL SHIPS Special Operating Requirements § 167.65-1 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 97.15-35 - Emergency training, musters, and drills.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Emergency training, musters, and drills. 97.15-35... VESSELS OPERATIONS Tests, Drills, and Inspections § 97.15-35 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 196.15-35 - Emergency training, musters, and drills.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Emergency training, musters, and drills. 196.15-35... VESSELS OPERATIONS Test, Drills, and Inspections § 196.15-35 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 78.17-50 - Emergency training, musters, and drills.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 3 2010-10-01 2010-10-01 false Emergency training, musters, and drills. 78.17-50... OPERATIONS Tests, Drills, and Inspections § 78.17-50 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 167.65-1 - Emergency training, musters, and drills.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 7 2011-10-01 2011-10-01 false Emergency training, musters, and drills. 167.65-1... NAUTICAL SCHOOL SHIPS Special Operating Requirements § 167.65-1 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 167.65-1 - Emergency training, musters, and drills.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 7 2012-10-01 2012-10-01 false Emergency training, musters, and drills. 167.65-1... NAUTICAL SCHOOL SHIPS Special Operating Requirements § 167.65-1 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 196.15-35 - Emergency training, musters, and drills.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 7 2013-10-01 2013-10-01 false Emergency training, musters, and drills. 196.15-35... VESSELS OPERATIONS Test, Drills, and Inspections § 196.15-35 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 167.65-1 - Emergency training, musters, and drills.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 7 2014-10-01 2014-10-01 false Emergency training, musters, and drills. 167.65-1... NAUTICAL SCHOOL SHIPS Special Operating Requirements § 167.65-1 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 97.15-35 - Emergency training, musters, and drills.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 4 2014-10-01 2014-10-01 false Emergency training, musters, and drills. 97.15-35... VESSELS OPERATIONS Tests, Drills, and Inspections § 97.15-35 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 196.15-35 - Emergency training, musters, and drills.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 7 2012-10-01 2012-10-01 false Emergency training, musters, and drills. 196.15-35... VESSELS OPERATIONS Test, Drills, and Inspections § 196.15-35 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 196.15-35 - Emergency training, musters, and drills.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 7 2014-10-01 2014-10-01 false Emergency training, musters, and drills. 196.15-35... VESSELS OPERATIONS Test, Drills, and Inspections § 196.15-35 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 97.15-35 - Emergency training, musters, and drills.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 4 2012-10-01 2012-10-01 false Emergency training, musters, and drills. 97.15-35... VESSELS OPERATIONS Tests, Drills, and Inspections § 97.15-35 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 97.15-35 - Emergency training, musters, and drills.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Emergency training, musters, and drills. 97.15-35... VESSELS OPERATIONS Tests, Drills, and Inspections § 97.15-35 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 167.65-1 - Emergency training, musters, and drills.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 7 2013-10-01 2013-10-01 false Emergency training, musters, and drills. 167.65-1... NAUTICAL SCHOOL SHIPS Special Operating Requirements § 167.65-1 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 78.17-50 - Emergency training, musters, and drills.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 3 2013-10-01 2013-10-01 false Emergency training, musters, and drills. 78.17-50... OPERATIONS Tests, Drills, and Inspections § 78.17-50 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 196.15-35 - Emergency training, musters, and drills.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 7 2011-10-01 2011-10-01 false Emergency training, musters, and drills. 196.15-35... VESSELS OPERATIONS Test, Drills, and Inspections § 196.15-35 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 97.15-35 - Emergency training, musters, and drills.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 4 2013-10-01 2013-10-01 false Emergency training, musters, and drills. 97.15-35... VESSELS OPERATIONS Tests, Drills, and Inspections § 97.15-35 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 78.17-50 - Emergency training, musters, and drills.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 3 2014-10-01 2014-10-01 false Emergency training, musters, and drills. 78.17-50... OPERATIONS Tests, Drills, and Inspections § 78.17-50 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 78.17-50 - Emergency training, musters, and drills.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 3 2012-10-01 2012-10-01 false Emergency training, musters, and drills. 78.17-50... OPERATIONS Tests, Drills, and Inspections § 78.17-50 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

46 CFR 78.17-50 - Emergency training, musters, and drills.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 3 2011-10-01 2011-10-01 false Emergency training, musters, and drills. 78.17-50... OPERATIONS Tests, Drills, and Inspections § 78.17-50 Emergency training, musters, and drills. Onboard training, musters, and drills must be in accordance with subchapter W (Lifesaving Appliances and...

Recollection Training and Transfer Effects in Alzheimer's Disease: Effectiveness of the Repetition-Lag Procedure

ERIC Educational Resources Information Center

Boller, Benjamin; Jennings, Janine M.; Dieudonne, Benedicte; Verny, Marc; Ergis, Anne-Marie

2012-01-01

Objective: This study was designed to extend the use of a memory training technique, known as the repetition-lag procedure, to Alzheimer patients. The specificity of this procedure is to target the process of recollection for improvement. Method: A group of 12 patients were trained individually for 6 h. The training procedure consisted of a series…

Functions of standard CPR training on performance qualities of medical volunteers for Mt. Taishan International Mounting Festival.

PubMed

Fanshan, Meng; Lin, Zhao; Wenqing, Liu; Chunlei, Lu; Yongqiang, Liu; Naiyi, Li

2013-01-01

Cardiopulmonary resuscitation (CPR) is a sudden emergency procedure that requires a rapid and efficient response, and personnel training in lifesaving procedures. Regular practice and training are necessary to improve resuscitation skills and reduce anxiety among the staff. As one of the most important skills mastered by medical volunteers serving for Mt. Taishan International Mounting Festival, we randomly selected some of them to evaluate the quality of CPR operation and compared the result with that of the untrained doctors and nurses. In order to evaluate the functions of repeating standard CPR training on performance qualities of medical volunteers for Mt. Taishan International Mounting Festival, their performance qualities of CPR were compared with those of the untrained medical workers working in emergency departments of hospitals in Taian. The CPR performance qualities of 52 medical volunteers (Standard Training Group), who had continually taken part in standard CPR technical training for six months, were tested at random and were compared with those of 68 medical workers (Compared Group) working in emergency departments of hospitals in Taian who hadn't attended CPR training within a year. The QCPR 3535 monitor (provided by Philips Company) was used to measure the standard degree of single simulated CPR performance, including the chest compression depth, frequency, released pressure between compressions and performance time of compression and ventilation, the results of which were recorded in the table and the number of practical compression per minute was calculated. The data were analyzed by x2 Test and t Test. The factors which would influence CPR performance, including gender, age, placement, hand skill, posture of compression and frequency of training, were classified and given parameters, and were put to Logistic repression analysis. The CPR performance qualities of volunteers were much higher than those of the compared group. The overall pass rates were respectively 86.4% and 31.9%; the pass rates of medical volunteers in terms of the chest compression depth, frequency, released pressure between compressions were higher than those of the compared group, which were 89.6%, 94.2%, 95.8% vs 50.3%, 53.0%, 83.1%, P<0.01; there were few differences in overall performance time, which were (118.4 ± 13.5s) vs (116.0 ± 10.4s), P>0.05; the duration time of ventilation in each performance section was much shorter than that in the compared group, which were (6.38 ± 1.2) vs (7.47 ± 1.7), P<0.01; there were few differences in the number of practical compression per minute, which were (78.2 ± 3.5) vs (78.8 ± 12.2), P>0.05); the time proportion of compression and ventilation was 2.6:1 vs 2.1:1. The Logistic repression analysis showed that CPR performance qualities were clearly related to hand skill, posture of compression and repeating standard training, which were respectively OR 13.12 and 95%CI (2.35~73.2); OR 30.89, 95%CI (3.62~263.5); OR 4.07,95%CI (1.16~14.2). The CPR performance qualities of volunteers who had had repeating standard training were much higher than those of untrained medical workers, which proved that standard training helped improve CPR performance qualities.

KSC-08pd0467

NASA Image and Video Library

2008-02-23

KENNEDY SPACE CENTER, FLA. -- At NASA Kennedy Space Center's Launch Complex 39, STS-123 Mission Specialist Takao Doi of the Japan Aerospace Exploration Agency takes time out from driving practice of the M-113 armored personnel carrier to pose for a photo. The crew members of space shuttle Endeavour's STS-123 mission will each practice driving the M-113 in turn as part of his training on emergency egress procedures. An M-113 will be available to transport the crew to safety in the event of a contingency on the pad before their launch. The STS-123 crew is at Kennedy for a full launch dress rehearsal, known as the terminal countdown demonstration test or TCDT. Endeavour's seven astronauts arrived at Kennedy's Shuttle Landing Facility in their T-38 training aircraft between 10:45 and 10:58 a.m. EST. The terminal countdown demonstration test provides astronauts and ground crews with an opportunity to participate in various simulated countdown activities, including equipment familiarization and emergency training. Endeavour is targeted to launch March 11 at 2:28 a.m. EDT on a 16-day mission to the International Space Station. On the mission, Endeavour and its crew will deliver the first section of the Japan Aerospace Exploration Agency's Kibo laboratory and the Canadian Space Agency's two-armed robotic system, Dextre. Photo credit: NASA/Kim Shiflett

The development of sustainable emergency care in ghana: physician, nursing and prehospital care training initiatives.

PubMed

Martel, John; Oteng, Rockefeller; Mould-Millman, Nee-Kofi; Bell, Sue Anne; Zakariah, Ahmed; Oduro, George; Kowalenko, Terry; Donkor, Peter

2014-10-01

Ghana's first Emergency Medicine residency and nursing training programs were initiated in 2009 and 2010, respectively, at Komfo Anokye Teaching Hospital in the city of Kumasi in association with Kwame Nkrumah University of Science and Technology and the Universities of Michigan and Utah. In addition, the National Ambulance Service was commissioned initially in 2004 and has developed to include both prehospital transport services in all regions of the country and Emergency Medical Technician training. Over a decade of domestic and international partnership has focused on making improvements in emergency care at a variety of institutional levels, culminating in the establishment of comprehensive emergency care training programs. We describe the history and status of novel postgraduate emergency physician, nurse, and prehospital provider training programs as well as the prospect of creating a board certification process and formal continuing education program for practicing emergency physicians. Significant strides have been made in the development of emergency care and training in Ghana over the last decade, resulting in the first group of Specialist-level emergency physicians as of late 2012, as well as development of accredited emergency nursing curricula and continued expansion of a national Emergency Medical Service. This work represents a significant move toward in-country development of sustainable, interdisciplinary, team-based emergency provider training programs designed to retain skilled health care workers in Ghana and may serve as a model for similar developing nations. Copyright © 2014 Elsevier Inc. All rights reserved.

Verifying the buildingEXODUS through an emergency response procedure (ERP) exercise at an underground intervention shaft

NASA Astrophysics Data System (ADS)

Tajedi, Noor Aqilah A.; Sukor, Nur Sabahiah A.; Ismail, Mohd Ashraf M.; Shamsudin, Shahrul A.

2017-10-01

An Emergency Response Plan (ERP) is an essential safety procedure that needs to be taken into account for railway operations, especially for underground railway networks. Several parameters need to be taken into consideration in planning an ERP such as the design of tunnels and intervention shafts, and operation procedures for underground transportation systems. Therefore, the purpose of this paper is to observe and analyse the Emergency Response Procedure (ERP) exercise for the underground train network at the LRT Kelana Jaya Line. The exercise was conducted at one of the underground intervention shaft exits, where the height of the staircase from the bottom floor to the upper floor was 24.59 metres. Four cameras were located at selected levels of the shaft, and 71 participants were assigned for the evacuation exercise. The participants were tagged with a number at the front and back of their safety vests. Ten respondents were randomly selected to give details of their height and weight and, at the same time, they had to self-record the time taken for them to evacuate from the bottom to the top of the shaft. The video footages that were taken during the ERP were analysed, and the data were used for the verification process on the buildingEXODUS simulation software. It was found that the results of the ERP experiment were significantly similar to the simulation results, thereby successfully verifying the simulation. This verification process was important to ensure that the results of the simulation were in accordance with the real situation. Therefore, a further evacuation analysis made use of the results from this verification.

How to train surgical residents to perform laparoscopic Roux-en-Y gastric bypass safely.

PubMed

Iordens, Gijs I T; Klaassen, René A; van Lieshout, Esther M M; Cleffken, Berry I; van der Harst, Erwin

2012-09-01

As a result of increasing numbers of patients with morbid obesity there is a worldwide demand for bariatric surgeons. The Roux-en-Y gastric bypass, nowadays performed mostly laparoscopically (LRYGB), has been proven to be a highly effective surgical treatment for morbid obesity. This procedure is technically demanding and requires a long learning curve. Little is known about implementing these demanding techniques in the training of the surgical resident. The aim of this study was to evaluate the safety and feasibility of the introduction of LRYGB into the training of surgical residents. All patients who underwent LRYGB between March 2006 and July 2010 were retrospectively analyzed. The procedure was performed by a surgical resident under strict supervision of a bariatric surgeon (group I) or by a bariatric surgeon (group II). The primary end point was the occurrence of complications. Secondary end points included operative time, days of hospitalization, rate of readmission, and reappearance in the emergency department (ED) within 30 days. A total of 409 patients were found eligible for inclusion in the study: 83 patients in group I and 326 in group II. There was a significant difference in operating time (129 min in group I vs. 116 min in group II; p < 0.001) and days of hospitalization. Postoperative complication rate, reappearance in the ED, and rate of readmission did not differ between the two groups. Our data suggest that under stringent supervision and with sufficient laparoscopic practice, implementation of LRYGB as part of surgical training is safe and results in only a slightly longer operating time. Complication rates, days of hospitalization, and the rates of readmission and reappearance in the ED within 30 days were similar between the both groups. These results should be interpreted by remembering that all procedures in group I were performed in a training environment so occasional intervention by a bariatric surgeon, when necessary, was inevitable.

Findings of Phlebotomy Practices in Kenya in 2010: Need for Action

PubMed Central

Kimani, Daniel; Kamau, Rachel; Gadde, Renuka; Selenic, Dejana; Maina, Stephen; Marum, Lawrence; Hongjiang, Gao; Mwalili, Samuel; Marfin, Anthony; Mwangi, Jane

2016-01-01

Background. Phlebotomy, a commonly performed medical procedure in healthcare, is essential for disease diagnosis and patient management. However, poorly performed phlebotomy can compromise patient safety, healthcare worker (HCW) safety, and specimen quality. We carried out a study between June and July 2010 to assess knowledge, quality and safety of phlebotomy before implementation of a public-private partnership between Becton, Dickinson and Company and the US President's Emergency Plan for AIDS Relief. Methods. This was a cross-sectional observational study in 8 healthcare facilities within 4 regions of Kenya. HCWs were observed conducting venous and capillary blood collections, and pre- and posttests were offered during HCW training. Results. Of 283 blood samples obtained, 194 were venous draws conducted by 72 HCWs and 89 were capillary draws performed by 33 HCWs. Based on 12 preset quality-associated criteria, none of the 194 observed phlebotomies met the standard. In total, 91 HCWs were trained in phlebotomy. The mean knowledge increase between pre- and posttraining test was 41%, ranging from 39% to 45% (95% confidence interval, 29.3%–53.5%; P < .001). Conclusions. Inadequate knowledge and imperfect phlebotomy procedures were noted. This formed the basis for the safe phlebotomy partnership to address these deficiencies. To ensure sustainability, safe phlebotomy practices were integrated into preservice training. PMID:27025699

[Emergency response management near the tracks of the public railway network: special aspects of missions connected with the German national railway system].

PubMed

Krämer, P; Aul, A; Vock, B; Frank, C

2010-11-01

Emergency response management and rescue operations concerning the railway network in Germany need special attention and implementation in several ways. The emergency response concerning the German national railway network managed by Deutsche Bahn AG is subject to various rules and regulations which have to be followed precisely. Only by following these rules and procedures is the safety of all emergency staff at the scene ensured. The German national railway network (Deutsche Bahn AG) provides its own emergency response control center, which specializes in managing its response to emergencies and dispatches an emergency response manager to the scene. This person serves as the primary Deutsche Bahn AG representative at the scene and is the only person who is allowed to earth the railway electrical power lines. This article will discuss different emergency situations concerning railway accidents and the emergency medical response to them based on a near collision with a high speed train during a rescue mission close to the railway track. Injury to personnel could only be avoided by chance and luck. The dangers and risks for rescue staff are specified. Furthermore, the article details practical guidelines for rescue operations around the German national railway track system.

Responding to the deaf in disasters: establishing the need for systematic training for state-level emergency management agencies and community organizations.

PubMed

Engelman, Alina; Ivey, Susan L; Tseng, Winston; Dahrouge, Donna; Brune, Jim; Neuhauser, Linda

2013-03-07

Deaf and hard-of-hearing (Deaf/HH) individuals have been underserved before and during emergencies. This paper will assess Deaf/HH related emergency preparedness training needs for state emergency management agencies and deaf-serving community-based organizations (CBOs). Four approaches were used: 1) a literature review; 2) results from 50 key informant (KI) interviews from state and territorial-level emergency management and public health agencies; 3) results from 14 KI interviews with deaf-serving CBOs in the San Francisco Bay Area; and 4) a pilot program evaluation of an emergency responder training serving the Deaf/HH in one urban community. Results from literature review and state and territorial level KIs indicate that there is a substantive gap in emergency preparedness training on serving Deaf/HH provided by state agencies. In addition, local KI interviews with 14 deaf-serving CBOs found gaps in training within deaf-serving CBOs. These gaps have implications for preparing for and responding to all-hazards emergencies including weather-related or earthquake-related natural disasters, terrorist attacks, and nuclear-chemical disasters. Emergency preparedness trainings specific to responding to or promoting preparedness of the Deaf/HH is rare, even for state agency personnel, and frequently lack standardization, evaluation, or institutionalization in emergency management infrastructure. This has significant policy and research implications. Similarly, CBOs are not adequately trained to serve the needs of their constituents.

Aircraft Emergency Decisions: Cognitive and Situational Variables

DTIC Science & Technology

1979-07-01

Training 2-U 2.5.1 Current Programs 2-14 2.5.2 Recommendations 2-18 2.6 Stress 2-21 2.7 Siwmary 2-27 3. AIRCREW EMERGENCY DECISION TRAINING...training, and the effects of stress . Chapter 3 1-7 briefly reviews the events and resulting recommendations of the Aircrew Emergency Decision...training, and performance under stress , yhile the literature on each of these separate topics Is large, and in some cases voluminous, aircrew emergency

High-Fidelity Simulation: Preparing Dental Hygiene Students for Managing Medical Emergencies.

PubMed

Bilich, Lisa A; Jackson, Sarah C; Bray, Brenda S; Willson, Megan N

2015-09-01

Medical emergencies can occur at any time in the dental office, so being prepared to properly manage the situation can be the difference between life and death. The entire dental team must be properly trained regarding all aspects of emergency management in the dental clinic. The aim of this study was to evaluate a new educational approach using a high-fidelity simulator to prepare dental hygiene students for medical emergencies. This study utilized high-fidelity simulation (HFS) to evaluate the abilities of junior dental hygiene students at Eastern Washington University to handle a medical emergency in the dental hygiene clinic. Students were given a medical emergency scenario requiring them to assess the emergency and implement life-saving protocols in a simulated "real-life" situation using a high-fidelity manikin. Retrospective data were collected for four years from the classes of 2010 through 2013 (N=114). The results indicated that learning with simulation was effective in helping the students identify the medical emergency in a timely manner, implement emergency procedures correctly, locate and correctly utilize contents of the emergency kit, administer appropriate intervention/treatment for a specific patient, and provide the patient with appropriate follow-up instructions. For dental hygiene programs seeking to enhance their curricula in the area of medical emergencies, this study suggests that HFS is an effective tool to prepare students to appropriately handle medical emergencies. Faculty calibration is essential to standardize simulation.

An audit of bronchoscopy practice in the United Kingdom: a survey of adherence to national guidelines

PubMed Central

Honeybourne, D.; Neumann, C. S.

1997-01-01

BACKGROUND: Both patient and staff safety are of major importance during the procedure of fibreoptic bronchoscopy. Patient safety depends partly on adequate disinfection of instruments and accessories used as well as careful monitoring during the procedure. Adequate facilities, manpower and training are also essential. Staff safety depends partly on adequate procedures to minimise any risks of sensitisation to agents such as glutaraldehyde. An audit was carried out of bronchoscopy procedures in hospitals in the UK and the findings were compared with published guidelines on good practice and clinical consensus. METHODS: A postal questionnaire was sent to 218 bronchoscopy units in the UK. Findings were then compared with published evidence of good practice in the areas of disinfection, including the use of glutaraldehyde, patient monitoring, manpower, facilities, and training. RESULTS: A 73% response rate was obtained. Recommended minimum disinfection times before and after routine bronchoscopies were not achieved by 35% of units. No disinfection was carried out in 34% of units before emergency bronchoscopies and in 19% of units after suspected cases of tuberculosis. Adequate rinsing of the bronchoscope with sterile or filtered water was not carried out by 43% of units. Contrary to recommendations, 31% of departments were still using glutaraldehyde in the patient examination room and inadequate room ventilation was common. Protective clothing was often not worn by staff during bronchoscopy. Inadequate intravenous access and use of supplementary oxygen were found in many units. Practice standards were higher in departments where dedicated bronchoscopy/endoscopy units of the hospital were used, and also where staff had been on external training courses. CONCLUSIONS: This audit has shown that many units do not adhere to guidelines on disinfection procedures and patient monitoring. Unnecessary potential risks due to staff exposure to glutaraldehyde were apparent. National guidelines on good practice are not being followed in areas which may potentially affect patient and staff safety. 


 PMID:9337830

American Board of Emergency Medicine Report on Residency and Fellowship Training Information (2017-2018).

PubMed

Nelson, Lewis S; Keim, Samuel M; Baren, Jill M; Beeson, Michael S; Carius, Michael L; Chudnofsky, Carl R; Gausche-Hill, Marianne; Goyal, Deepi G; Kowalenko, Terry; Marco, Catherine A; Muelleman, Robert L; Johnston, Mary M; Joldersma, Kevin B

2018-05-01

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine-sponsored residency and fellowship programs, as well as the residents and fellows training in those programs. We present the 2018 annual report on the status of US emergency medicine training programs. Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

32 CFR 310.38 - Training methodology and procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... procedures. (a) Each DoD Component is responsible for the development of training procedures and methodology... widest possible audience. Web-based training and video conferencing have been effective means to provide...

Introduction of basic obstetrical ultrasound screening in undergraduate medical education.

PubMed

Hamza, A; Solomayer, E-F; Takacs, Z; Juhasz-Boes, I; Joukhadar, R; Radosa, J C; Mavrova, R; Marc, W; Volk, T; Meyberg-Solomayer, G

2016-09-01

Teaching ultrasound procedures to undergraduates has recently been proposed to improve the quality of medical education. We address the impact of applying standardized ultrasound teaching to our undergraduates. Medical students received an additional theoretical and practical course involving hands-on ultrasound screening during their mandatory practical training week in obstetrics and gynecology. The students' theoretical knowledge and fetal image recognition skills were tested before and after the course. After the course, the students were asked to answer a course evaluation questionnaire. To standardize the teaching procedure, we used Peyton's 4-Step Approach to teach the skills needed for a German Society of Ultrasound in Medicine Level 1 ultrasound examiner. The multiple-choice question scores after the course showed statistically significant improvement (50 vs. 80 %; P < 0.001). The questionnaire revealed that students were satisfied with the course, felt that it increased their ultrasound knowledge, and indicated that they wanted more sonographic hands-on training in both obstetrics and gynecology and other medical fields. Using practical, hands-on medical teaching is an emerging method for undergraduate education that should be further evaluated, standardized, and developed.

Use of bispectral index system (BIS) to Monitor Enteral Conscious (moderate) sedation during general dental procedures.

PubMed

Donaldson, Mark; Goodchild, Jason H

2009-12-01

Although dental board regulations for the provision of in-office enteral conscious (oral) sedation vary widely with respect to training and pharmacologic strategies, they agree on the use of drugs that are inherently safe, the use of pulse oximetry and the availability of emergency equipment, including pharmacologic antagonists. Patient safety is of greatest concern and is best addressed by appropriate selection of patients, adequate training of personnel and appropriate monitoring of patients. Readings from bispectral index system (BIS) monitors, which use electroencephalographic signals, correlate accurately with depth of sedation during nondissociative general anesthesia of adults and children in the operating room setting. The usefulness of such monitoring as an adjunct to other forms of monitoring of in-office enteral sedation in the dental setting may represent the next important application of this tool, adding a further level of safety for the patient and another level of predictability for the practitioner. This paper reviews the current evidence supporting this new technique, presenting data from 20 procedures in which BIS monitoring during in-office enteral sedation was employed in a community dental practice.

Volcanic risk and tourism in southern Iceland: Implications for hazard, risk and emergency response education and training

NASA Astrophysics Data System (ADS)

Bird, Deanne K.; Gisladottir, Gudrun; Dominey-Howes, Dale

2010-01-01

This paper examines the relationship between volcanic risk and the tourism sector in southern Iceland and the complex challenge emergency management officials face in developing effective volcanic risk mitigation strategies. An early warning system and emergency response procedures were developed for communities surrounding Katla, the volcano underlying the Mýrdalsjökull ice cap. However, prior to and during the 2007 tourist season these mitigation efforts were not effectively communicated to stakeholders located in the tourist destination of Þórsmörk despite its location within the hazard zone of Katla. The hazard zone represents the potential extent of a catastrophic jökulhlaup (glacial outburst flood). Furthermore, volcanic risk mitigation efforts in Þórsmörk were based solely on information derived from physical investigations of volcanic hazards. They did not consider the human dimension of risk. In order to address this gap and provide support to current risk mitigation efforts, questionnaire surveys were used to investigate tourists' and tourism employees' hazard knowledge, risk perception, adoption of personal preparedness measures, predicted behaviour if faced with a Katla eruption and views on education. Results indicate that tourists lack hazard knowledge and they do not adopt preparedness measures to deal with the consequences of an eruption. Despite a high level of risk perception, tourism employees lack knowledge about the early warning system and emergency response procedures. Results show that tourists are positive about receiving information concerning Katla and its hazards and therefore, the reticence of tourism employees with respect to disseminating hazard information is unjustified. In order to improve the tourism sector's collective capacity to positively respond during a future eruption, recommendations are made to ensure adequate dissemination of hazard, risk and emergency response information. Most importantly education campaigns should focus on: (a) increasing tourists' knowledge of Katla, jökulhlaup and other volcanic hazards and (b) increasing tourist and employee awareness of the early warning and information system and appropriate behavioural response if a warning is issued. Further, tourism employees should be required to participate in emergency training and evacuation exercises annually. These efforts are timely given that Katla is expected to erupt in the near future and international tourism is an expanding industry in Þórsmörk.

NHEXAS PHASE I REGION 5 STUDY--STANDARD OPERATING PROCEDURE FOR TRAINING FILE INSPECTIONS (NHX/SOP-815-004)

EPA Science Inventory

This procedure details the procedure for inspecting training files. Training file inspections are performed primarily to ensure that the program requirements are being met and that a current summary of training and experience is being maintained for each individual engaged in the...

Propofol for procedural sedation and analgesia reduced dedicated emergency nursing time while maintaining safety in a community emergency department.

PubMed

Reynolds, Joshua C; Abraham, Michael K; Barrueto, Fermin F; Lemkin, Daniel L; Hirshon, Jon M

2013-09-01

Procedural sedation and analgesia is a core competency in emergency medicine. Propofol is replacing midazolam in many emergency departments. Barriers to performing procedural sedation include resource utilization. We hypothesized that emergency nursing time is shorter with propofol than midazolam, without increasing complications. Retrospective analysis of a procedural sedation registry for two community emergency departments with combined census of 100,000 patients/year. Demographics, procedure, and ASA physical classification status of adult patients receiving procedural sedation between 2007-2010 with midazolam or propofol were analyzed. Primary outcome was dedicated emergency nursing time. Secondary outcomes were procedural success, ED length of stay, and complication rate. Comparative statistics were performed with Mann-Whitney, Kruskal-Wallis, chi-square, or Fisher's exact test. Linear regression was performed with log-transformed procedural sedation time to define predictors. Of 328 procedural sedation and analgesia, 316 met inclusion criteria, of which 60 received midazolam and 256 propofol. Sex distribution varied between groups (midazolam 3% male; propofol 55% male; P = 0.04). Age, procedure, and ASA status were not significantly different. Propofol had shorter procedural sedation time (propofol 32.5 ± 24.2 minutes; midazolam 78.7 ± 51.5 minutes; P < 0.001) and higher rates of procedural success (propofol 98%; midazolam 92%; P = 0.02). There were no significant differences between complication rates (propofol 14%; midazolam 13%; P = 0.88) or emergency department length of stay (propofol 262.5 ± 132.8 minutes; midazolam 288.6 ± 130.6 minutes; P = 0.09). Use of propofol resulted in shorter emergency nursing time and higher procedural success rate than midazolam with a comparable safety profile. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

Autoshaping, random control, and omission training in the rat1

PubMed Central

Locurto, Charles; Terrace, H. S.; Gibbon, John

1976-01-01

The role of the stimulus-reinforcer contingency in the development and maintenance of lever contact responding was studied in hooded rats. In Experiment I, three groups of experimentally naive rats were trained either on autoshaping, omission training, or a random-control procedure. Subjects trained by the autoshaping procedure responded more consistently than did either random-control or omission-trained subjects. The probability of at least one lever contact per trial was slightly higher in subjects trained by the omission procedure than by the random-control procedure. However, these differences were not maintained during extended training, nor were they evident in total lever-contact frequencies. When omission and random-control subjects were switched to the autoshaping condition, lever contacts increased in all animals, but a pronounced retardation was observed in omission subjects relative to the random-control subjects. In addition, subjects originally exposed to the random-control procedure, and later switched to autoshaping, acquired more rapidly than naive subjects that were exposed only on the autoshaping procedure. In Experiment II, subjects originally trained by an autoshaping procedure were exposed either to an omission, a random-control, or an extinction procedure. No differences were observed among the groups either in the rate at which lever contacts decreased or in the frequency of lever contacts at the end of training. These data implicate prior experience in the interpretation of omission-training effects and suggest limitations in the influence of stimulus-reinforcer relations in autoshaping. PMID:16811960

Autoshaping, random control, and omission training in the rat.

PubMed

Locurto, C; Terrace, H S; Gibbon, J

1976-11-01

The role of the stimulus-reinforcer contingency in the development and maintenance of lever contact responding was studied in hooded rats. In Experiment I, three groups of experimentally naive rats were trained either on autoshaping, omission training, or a random-control procedure. Subjects trained by the autoshaping procedure responded more consistently than did either random-control or omission-trained subjects. The probability of at least one lever contact per trial was slightly higher in subjects trained by the omission procedure than by the random-control procedure. However, these differences were not maintained during extended training, nor were they evident in total lever-contact frequencies. When omission and random-control subjects were switched to the autoshaping condition, lever contacts increased in all animals, but a pronounced retardation was observed in omission subjects relative to the random-control subjects. In addition, subjects originally exposed to the random-control procedure, and later switched to autoshaping, acquired more rapidly than naive subjects that were exposed only on the autoshaping procedure. In Experiment II, subjects originally trained by an autoshaping procedure were exposed either to an omission, a random-control, or an extinction procedure. No differences were observed among the groups either in the rate at which lever contacts decreased or in the frequency of lever contacts at the end of training. These data implicate prior experience in the interpretation of omission-training effects and suggest limitations in the influence of stimulus-reinforcer relations in autoshaping.

Emerging technologies in education and training: applications for the laboratory animal science community.

PubMed

Ketelhut, Diane Jass; Niemi, Steven M

2007-01-01

This article examines several new and exciting communication technologies. Many of the technologies were developed by the entertainment industry; however, other industries are adopting and modifying them for their own needs. These new technologies allow people to collaborate across distance and time and to learn in simulated work contexts. The article explores the potential utility of these technologies for advancing laboratory animal care and use through better education and training. Descriptions include emerging technologies such as augmented reality and multi-user virtual environments, which offer new approaches with different capabilities. Augmented reality interfaces, characterized by the use of handheld computers to infuse the virtual world into the real one, result in deeply immersive simulations. In these simulations, users can access virtual resources and communicate with real and virtual participants. Multi-user virtual environments enable multiple participants to simultaneously access computer-based three-dimensional virtual spaces, called "worlds," and to interact with digital tools. They allow for authentic experiences that promote collaboration, mentoring, and communication. Because individuals may learn or train differently, it is advantageous to combine the capabilities of these technologies and applications with more traditional methods to increase the number of students who are served by using current methods alone. The use of these technologies in animal care and use programs can create detailed training and education environments that allow students to learn the procedures more effectively, teachers to assess their progress more objectively, and researchers to gain insights into animal care.

Role of in-situ simulation for training in healthcare: opportunities and challenges.

PubMed

Kurup, Viji; Matei, Veronica; Ray, Jessica

2017-12-01

Simulation has now been acknowledged as an important part of training in healthcare, and most academic hospitals have a dedicated simulation center. In-situ simulation occurs in patient care units with scenarios involving healthcare professionals in their actual working environment. The purpose of this review is to describe the process of putting together the components of in-situ simulation for training programs and to review outcomes studied, and challenges with this approach. In-situ simulation has been used to 'test-drive' new centers, train personnel in new procedures in existing centers, for recertification training and to uncover latent threats in clinical care areas. It has also emerged as an attractive alternative to traditional simulations for institutions that do not have their own simulation center. In-situ simulation can be used to improve reliability and safety especially in areas of high risk, and in high-stress environments. It is also a reasonable and attractive alternative for programs that want to conduct interdisciplinary simulations for their trainees and faculty, and for those who do not have access to a fully functional simulation center. Further research needs to be done in assessing effectiveness of training using this method and the effect of such training on clinical outcomes.

Simulation center training as a means to improve resident performance in percutaneous noncontinuous CT-guided fluoroscopic procedures with dose reduction.

PubMed

Mendiratta-Lala, Mishal; Williams, Todd R; Mendiratta, Vivek; Ahmed, Hafeez; Bonnett, John W

2015-04-01

The purpose of this study was to evaluate the effectiveness of a multifaceted simulation-based resident training for CT-guided fluoroscopic procedures by measuring procedural and technical skills, radiation dose, and procedure times before and after simulation training. A prospective analysis included 40 radiology residents and eight staff radiologists. Residents took an online pretest to assess baseline procedural knowledge. Second-through fourth-year residents' baseline technical skills with a procedural phantom were evaluated. First-through third-year residents then underwent formal didactic and simulation-based procedural and technical training with one of two interventional radiologists and followed the training with 1 month of supervised phantom-based practice. Thereafter, residents underwent final written and practical examinations. The practical examination included essential items from a 20-point checklist, including site and side marking, consent, time-out, and sterile technique along with a technical skills portion assessing pedal steps, radiation dose, needle redirects, and procedure time. The results indicated statistically significant improvement in procedural and technical skills after simulation training. For residents, the median number of pedal steps decreased by three (p=0.001), median dose decreased by 15.4 mGy (p<0.001), median procedure time decreased by 4.0 minutes (p<0.001), median number of needle redirects decreased by 1.0 (p=0.005), and median number of 20-point checklist items successfully completed increased by three (p<0.001). The results suggest that procedural skills can be acquired and improved by simulation-based training of residents, regardless of experience. CT simulation training decreases procedural time, decreases radiation dose, and improves resident efficiency and confidence, which may transfer to clinical practice with improved patient care and safety.

Procedural volume and structure of interventional pulmonary fellowships: a survey of fellows and fellowship program directors.

PubMed

Yarmus, Lonny; Feller-Kopman, David; Imad, Melhem; Kim, Stephanie; Lee, Hans J

2013-09-01

Current interventional pulmonary (IP) procedural guidelines for competency are based on expert opinion. There are few objective data to support competency metrics for IP procedures. This survey reports procedural volume during IP fellowships to help define new standards in training and curriculum development. A web-based survey was developed to evaluate IP training procedural volume. The survey was administered to all US and Canadian IP fellowship directors and graduates in training from 2006 to 2011. The survey inquired about all diagnostic and therapeutic procedures performed during the specialized year of IP training. Questions regarding the training program structure were collected and analyzed. There was a 92.5% fellow response rate (37 of 40) and 77% fellowship director response rate (10 of 13) from programs in existence at the time of the survey. Procedural volume was consistent between fellowship directors and graduates (P = .64). Although there was a wide range of procedural volume and types of procedures between different programs, the procedural mean volumes were all significantly higher than the American College of Chest Physicians (ACCP) and American Thoracic Society/European Respiratory Society (ATS/ERS) guideline recommendations (P < .005). US and Canadian IP fellowships produce fellows with variable procedural volumes; however, these are significantly higher than ACCP and ATS/ERS guidelines for most programs and procedures. With a uniform training curriculum being adopted by the majority of IP fellowship programs in the United States and Canada, as well as data showing improved core knowledge in IP fellows undergoing a dedicated year of additional training, further metrics examining the impact of advanced IP training on patient outcomes are needed.