Trauma teams and time to early management during in situ trauma team training.

PubMed

Härgestam, Maria; Lindkvist, Marie; Jacobsson, Maritha; Brulin, Christine; Hultin, Magnus

2016-01-29

To investigate the association between the time taken to make a decision to go to surgery and gender, ethnicity, years in profession, experience of trauma team training, experience of structured trauma courses and trauma in the trauma team, as well as use of closed-loop communication and leadership styles during trauma team training. In situ trauma team training. The patient simulator was preprogrammed to represent a severely injured patient (injury severity score: 25) suffering from hypovolemia due to external trauma. An emergency room in an urban Scandinavian level one trauma centre. A total of 96 participants were divided into 16 trauma teams. Each team consisted of six team members: one surgeon/emergency physician (designated team leader), one anaesthesiologist, one registered nurse anaesthetist, one registered nurse from the emergency department, one enrolled nurse from the emergency department and one enrolled nurse from the operating theatre. HRs with CIs (95% CI) for the time taken to make a decision to go to surgery was computed from a Cox proportional hazards model. Three variables remained significant in the final model. Closed-loop communication initiated by the team leader increased the chance of a decision to go to surgery (HR: 3.88; CI 1.02 to 14.69). Only 8 of the 16 teams made the decision to go to surgery within the timeframe of the trauma team training. Conversely, call-outs and closed-loop communication initiated by the team members significantly decreased the chance of a decision to go to surgery, (HR: 0.82; CI 0.71 to 0.96, and HR: 0.23; CI 0.08 to 0.71, respectively). Closed-loop communication initiated by the leader appears to be beneficial for teamwork. In contrast, a high number of call-outs and closed-loop communication initiated by team members might lead to a communication overload. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Why saying what you mean matters: An analysis of trauma team communication.

PubMed

Jung, Hee Soo; Warner-Hillard, Charles; Thompson, Ryan; Haines, Krista; Moungey, Brooke; LeGare, Anne; Shaffer, David Williamson; Pugh, Carla; Agarwal, Suresh; Sullivan, Sarah

2018-02-01

We hypothesized that team communication with unmatched grammatical form and communicative intent (mixed mode communication) would correlate with worse trauma teamwork. Interdisciplinary trauma simulations were conducted. Team performance was rated using the TEAM tool. Team communication was coded for grammatical form and communicative intent. The rate of mixed mode communication (MMC) was calculated. MMC rates were compared to overall TEAM scores. Statements with advisement intent (attempts to guide behavior) and edification intent (objective information) were specifically examined. The rates of MMC with advisement intent (aMMC) and edification intent (eMMC) were also compared to TEAM scores. TEAM scores did not correlate with MMC or eMMC. However, aMMC rates negatively correlated with total TEAM scores (r = -0.556, p = 0.025) and with the TEAM task management component scores (r = -0.513, p = 0.042). Trauma teams with lower rates of mixed mode communication with advisement intent had better non-technical skills as measured by TEAM. Copyright © 2017 Elsevier Inc. All rights reserved.

Decision making in trauma settings: simulation to improve diagnostic skills.

PubMed

Murray, David J; Freeman, Brad D; Boulet, John R; Woodhouse, Julie; Fehr, James J; Klingensmith, Mary E

2015-06-01

In the setting of acute injury, a wrong, missed, or delayed diagnosis can impact survival. Clinicians rely on pattern recognition and heuristics to rapidly assess injuries, but an overreliance on these approaches can result in a diagnostic error. Simulation has been advocated as a method for practitioners to learn how to recognize the limitations of heuristics and develop better diagnostic skills. The objective of this study was to determine whether simulation could be used to provide teams the experiences in managing scenarios that require the use of heuristic as well as analytic diagnostic skills to effectively recognize and treat potentially life-threatening injuries. Ten scenarios were developed to assess the ability of trauma teams to provide initial care to a severely injured patient. Seven standard scenarios simulated severe injuries that once diagnosed could be effectively treated using standard Advanced Trauma Life Support algorithms. Because diagnostic error occurs more commonly in complex clinical settings, 3 complex scenarios required teams to use more advanced diagnostic skills to uncover a coexisting condition and treat the patient. Teams composed of 3 to 5 practitioners were evaluated in the performance of 7 (of 10) randomly selected scenarios (5 standard, 2 complex). Expert rates scored teams using standardized checklists and global scores. Eighty-three surgery, emergency medicine, and anesthesia residents constituted 21 teams. Expert raters were able to reliably score the scenarios. Teams accomplished fewer checklist actions and received lower global scores on the 3 analytic scenarios (73.8% [12.3%] and 5.9 [1.6], respectively) compared with the 7 heuristic scenarios (83.2% [11.7%] and 6.6 [1.3], respectively; P < 0.05 for both). Teams led by more junior residents received higher global scores on the analytic scenarios (6.4 [1.3]) than the more senior team leaders (5.3 [1.7]). This preliminary study indicates that teams led by more senior residents received higher scores when managing heuristic scenarios but were less effective when managing the scenarios that require a more analytic approach. Simulation can be used to provide teams with decision-making experiences in trauma settings and could be used to improve diagnostic skills as well as study the decision-making process.

Development of an Integrated Team Training Design and Assessment Architecture to Support Adaptability in Healthcare Teams

DTIC Science & Technology

2016-10-01

and implementation of embedded, adaptive feedback and performance assessment. The investigators also initiated work designing a Bayesian Belief ...training; Teamwork; Adaptive performance; Leadership; Simulation; Modeling; Bayesian belief networks (BBN) 16. SECURITY CLASSIFICATION OF: 17. LIMITATION...Trauma teams Team training Teamwork Adaptability Adaptive performance Leadership Simulation Modeling Bayesian belief networks (BBN) 6

Implementation and Evaluation of a Team Simulation Training Program.

PubMed

Rice, Yvonne; DeLetter, Mary; Fryman, Lisa; Parrish, Evelyn; Velotta, Cathie; Talley, Cynthia

2016-01-01

Care of the trauma patient requires a well-coordinated intensive effort during the golden hour to optimize survival. We hypothesized that this program would improve knowledge, satisfaction, self-confidence, and simulated team performance. A pre-, post-test design with N = 7 BSN nurses, 21 years of age, less than 2 years of intensive care unit and nursing experience. Trauma intensive care unit, single-center academic Level 1 trauma center. Improvement was shown in perception of team structure (paired t test 13.71-12.57; p = .0001) and communication (paired t test 14.85-12.14; p = .009). Improvement was shown in observed situation monitoring (paired t test 17.42-25.28; p = .000), mutual support (paired t test 12.57-18.57; p = .000), and communication (paired t test 15.42-25.00; p = .001). A decrease was shown in attitudes of mutual support (paired t test 25.85-19.71; p = .04) and communication (paired t test 26.14-23.00; p = .001). Mean satisfaction scores were 21.5 of a possible 25 points. Mean self-confidence scores were 38.83 out of a possible 40 points. Simulation-based team training improved teamwork attitudes, perceptions, and performance. Team communication demonstrated significant improvement in 2 of the 3 instruments. Most participants agreed or strongly agreed that they were satisfied with simulation and had gained self-confidence.

Trauma team leaders' non-verbal communication: video registration during trauma team training.

PubMed

Härgestam, Maria; Hultin, Magnus; Brulin, Christine; Jacobsson, Maritha

2016-03-25

There is widespread consensus on the importance of safe and secure communication in healthcare, especially in trauma care where time is a limiting factor. Although non-verbal communication has an impact on communication between individuals, there is only limited knowledge of how trauma team leaders communicate. The purpose of this study was to investigate how trauma team members are positioned in the emergency room, and how leaders communicate in terms of gaze direction, vocal nuances, and gestures during trauma team training. Eighteen trauma teams were audio and video recorded during trauma team training in the emergency department of a hospital in northern Sweden. Quantitative content analysis was used to categorize the team members' positions and the leaders' non-verbal communication: gaze direction, vocal nuances, and gestures. The quantitative data were interpreted in relation to the specific context. Time sequences of the leaders' gaze direction, speech time, and gestures were identified separately and registered as time (seconds) and proportions (%) of the total training time. The team leaders who gained control over the most important area in the emergency room, the "inner circle", positioned themselves as heads over the team, using gaze direction, gestures, vocal nuances, and verbal commands that solidified their verbal message. Changes in position required both attention and collaboration. Leaders who spoke in a hesitant voice, or were silent, expressed ambiguity in their non-verbal communication: and other team members took over the leader's tasks. In teams where the leader had control over the inner circle, the members seemed to have an awareness of each other's roles and tasks, knowing when in time and where in space these tasks needed to be executed. Deviations in the leaders' communication increased the ambiguity in the communication, which had consequences for the teamwork. Communication cannot be taken for granted; it needs to be practiced regularly just as technical skills need to be trained. Simulation training provides healthcare professionals the opportunity to put both verbal and non-verbal communication in focus, in order to improve patient safety. Non-verbal communication plays a decisive role in the interaction between the trauma team members, and so both verbal and non-verbal communication should be in focus in trauma team training. This is even more important for inexperienced leaders, since vague non-verbal communication reinforces ambiguity and can lead to errors.

Evaluating the long-term impact of the Trauma Team Training course in Guyana: an explanatory mixed-methods approach.

PubMed

Pemberton, Julia; Rambaran, Madan; Cameron, Brian H

2013-02-01

We evaluated the retention of trauma knowledge and skills after an interprofessional Trauma Team Training (TTT) course in Guyana and explored the course impact on participants. A mixed-methods design evaluated knowledge using a multiple-choice quiz test, skills and trauma moulage simulation with checklists, and course impact with qualitative interviews. Participants were evaluated at 3 time points; before, after, and 4 months after TTT. Forty-seven course participants included 20 physicians, 17 nurses, and 10 paramedical providers. All participants had improved multiple-choice quiz test scores after the course and retained knowledge after 4 months, with nonphysicians showing the most improved scores. Trauma skill and moulage scores declined slightly after 4 months, with the greatest decline observed in complex skills. Qualitatively, course participants self-reported impact of the TTT course included improved empowerment, knowledge, teamwork, and patient care. Interprofessional team-based training led to the retention of trauma knowledge and skills as well as the empowerment of nonphysicians. The decline in performance of some trauma skills indicates the need for a regular trauma update course. Copyright © 2013 Elsevier Inc. All rights reserved.

Simulation-based team training for multi-professional obstetric care teams to improve patient outcome: a multicentre, cluster randomised controlled trial.

PubMed

Fransen, A F; van de Ven, J; Schuit, E; van Tetering, Aac; Mol, B W; Oei, S G

2017-03-01

To investigate whether simulation-based obstetric team training in a simulation centre improves patient outcome. Multicentre, open, cluster randomised controlled trial. Obstetric units in the Netherlands. Women with a singleton pregnancy beyond 24 weeks of gestation. Random allocation of obstetric units to a 1-day, multi-professional, simulation-based team training focusing on crew resource management (CRM) in a simulation centre or to no such team training. Intention-to-treat analyses were performed at the cluster level, including a measurement 1 year prior to the intervention. Primary outcome was a composite outcome of obstetric complications during the first year post-intervention, including low Apgar score, severe postpartum haemorrhage, trauma due to shoulder dystocia, eclampsia and hypoxic-ischaemic encephalopathy. Maternal and perinatal mortality were also registered. Each study group included 12 units with a median unit size of 1224 women, combining for a total of 28 657 women. In total, 471 medical professionals received the training course. The composite outcome of obstetric complications did not differ between study groups [odds ratio (OR) 1.0, 95% confidence interval (CI) 0.80-1.3]. Team training reduced trauma due to shoulder dystocia (OR 0.50, 95% CI 0.25-0.99) and increased invasive treatment for severe postpartum haemorrhage (OR 2.2, 95% CI 1.2-3.9) compared with no intervention. Other outcomes did not differ between study groups. A 1-day, off-site, simulation-based team training, focusing on teamwork skills, did not reduce a composite of obstetric complications. 1-day, off-site, simulation-based team training did not reduce a composite of obstetric complications. © 2016 Royal College of Obstetricians and Gynaecologists.

Model for Team Training Using the Advanced Trauma Operative Management Course: Pilot Study Analysis.

PubMed

Perkins, R Serene; Lehner, Kathryn A; Armstrong, Randy; Gardiner, Stuart K; Karmy-Jones, Riyad C; Izenberg, Seth D; Long, William B; Wackym, P Ashley

2015-01-01

Education and training of surgeons has traditionally focused on the development of individual knowledge, technical skills, and decision making. Team training with the surgeon's operating room staff has not been prioritized in existing educational paradigms, particularly in trauma surgery. We aimed to determine whether a pilot curriculum for surgical technicians and nurses, based on the American College of Surgeons' Advanced Trauma Operative Management (ATOM) course, would improve staff knowledge if conducted in a team-training environment. Between December 2012 and December 2014, 22 surgical technicians and nurses participated in a curriculum complementary to the ATOM course, consisting of 8 individual 8-hour training sessions designed by and conducted at our institution. Didactic and practical sessions included educational content, hands-on instruction, and alternating role play during 5 system-specific injury scenarios in a simulated operating room environment. A pre- and postcourse examination was administered to participants to assess for improvements in team members' didactic knowledge. Course participants displayed a significant improvement in didactic knowledge after working in a team setting with trauma surgeons during the ATOM course, with a 9-point improvement on the postcourse examination (83%-92%, p = 0.0008). Most participants (90.5%) completing postcourse surveys reported being "highly satisfied" with course content and quality after working in our simulated team-training setting. Team training is critical to improving the knowledge base of surgical technicians and nurses in the trauma operative setting. Improved communication, efficiency, appropriate equipment use, and staff awareness are the desired outcomes when shifting the paradigm from individual to surgical team training so that improved patient outcomes, decreased risk, and cost savings can be achieved. Determine whether a pilot curriculum for surgical technicians and nurses, based on the American College of Surgeons' ATOM course, improves staff knowledge if conducted in a team-training environment. Surgical technicians and nurses participated in a curriculum complementary to the ATOM course. In all, 8 individual 8-hour training sessions were conducted at our institution and contained both didactic and practical content, as well as alternating role play during 5 system-specific injury scenarios. A pre- and postcourse examination was administered to assess for improvements in didactic knowledge. The course was conducted in a simulated team-training setting at the Legacy Institute for Surgical Education and Innovation (Portland, OR), an American College of Surgeons Accredited Educational Institute. In all, 22 surgical technicians and operating room nurses participated in 8 separate ATOM(s) courses and had at least 1 year of surgical scrubbing experience in general surgery with little or no exposure to Level I trauma surgical care. Of these participants, 16 completed the postcourse examination. Participants displayed a significant improvement in didactic knowledge (83%-92%, p = 0.0008) after the ATOM(s) course. Of the 14 participants who completed postcourse surveys, 90.5% were "highly satisfied" with the course content and quality. Team training is critical to improving the knowledge base of surgical technicians and nurses in the trauma operative setting and may contribute to improved patient outcomes, decreased risk, and hospital cost savings. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Trauma simulation in bilingual Canada: Insurmountable barrier or unexpected strength? Insights from the first bilingual S.T.A.R.T.T. course.

PubMed

Gillman, Lawrence M; Widder, Sandy; Clément, Julien; Engels, Paul T; Paton-Gay, John Damian; Brindley, Peter G

2016-04-01

The Standardized Trauma and Resuscitation Team Training (S.T.A.R.T.T.) course focuses on training multidisciplinary trauma teams: surgeons/physicians, registered nurses (RNs), respiratory therapists (RTs) and, most recently, prehospital personnel. The S.T.A.R.T.T. curriculum highlights crisis management (CRM) skills: communication, teamwork, leadership, situational awareness and resource utilization. This commentary outlines the modifications made to the course curriculum in order to satisfy the learning needs of a bilingual audience. The results suggest that bilingual multidisciplinary CRM courses are feasible, are associated with high participant satisfaction and have no clear detriments.

Association of a Surgical Task During Training With Team Skill Acquisition Among Surgical Residents: The Missing Piece in Multidisciplinary Team Training.

PubMed

Sparks, Jessica L; Crouch, Dustin L; Sobba, Kathryn; Evans, Douglas; Zhang, Jing; Johnson, James E; Saunders, Ian; Thomas, John; Bodin, Sarah; Tonidandel, Ashley; Carter, Jeff; Westcott, Carl; Martin, R Shayn; Hildreth, Amy

2017-09-01

The human patient simulators that are currently used in multidisciplinary operating room team training scenarios cannot simulate surgical tasks because they lack a realistic surgical anatomy. Thus, they eliminate the surgeon's primary task in the operating room. The surgical trainee is presented with a significant barrier when he or she attempts to suspend disbelief and engage in the scenario. To develop and test a simulation-based operating room team training strategy that challenges the communication abilities and teamwork competencies of surgeons while they are engaged in realistic operative maneuvers. This pre-post educational intervention pilot study compared the gains in teamwork skills for midlevel surgical residents at Wake Forest Baptist Medical Center after they participated in a standardized multidisciplinary team training scenario with 3 possible levels of surgical realism: (1) SimMan (Laerdal) (control group, no surgical anatomy); (2) "synthetic anatomy for surgical tasks" mannequin (medium-fidelity anatomy), and (3) a patient simulated by a deceased donor (high-fidelity anatomy). Participation in the simulation scenario and the subsequent debriefing. Teamwork competency was assessed using several instruments with extensive validity evidence, including the Nontechnical Skills assessment, the Trauma Management Skills scoring system, the Crisis Resource Management checklist, and a self-efficacy survey instrument. Participant satisfaction was assessed with a Likert-scale questionnaire. Scenario participants included midlevel surgical residents, anesthesia providers, scrub nurses, and circulating nurses. Statistical models showed that surgical residents exposed to medium-fidelity simulation (synthetic anatomy for surgical tasks) team training scenarios demonstrated greater gains in teamwork skills compared with control groups (SimMan) (Nontechnical Skills video score: 95% CI, 1.06-16.41; Trauma Management Skills video score: 95% CI, 0.61-2.90) and equivalent gains in teamwork skills compared with high-fidelity simulations (deceased donor) (Nontechnical Skills video score: 95% CI, -8.51 to 6.71; Trauma Management Skills video score: 95% CI, -1.70 to 0.49). Including a surgical task in operating room team training significantly enhanced the acquisition of teamwork skills among midlevel surgical residents. Incorporating relatively inexpensive, medium-fidelity synthetic anatomy in human patient simulators was as effective as using high-fidelity anatomies from deceased donors for promoting teamwork skills in this learning group.

Improving teamwork and communication in trauma care through in situ simulations.

PubMed

Miller, Daniel; Crandall, Cameron; Washington, Charles; McLaughlin, Steven

2012-05-01

Teamwork and communication often play a role in adverse clinical events. Due to the multidisciplinary and time-sensitive nature of trauma care, the effects of teamwork and communication can be especially pronounced in the treatment of the acutely injured patient. Our hypothesis was that an in situ trauma simulation (ISTS) program (simulating traumas in the trauma bay with all members of the trauma team) could be implemented in an emergency department (ED) and that this would improve teamwork and communication measured in the clinical setting. This was an observational study of the effect of an ISTS program on teamwork and communication during trauma care. The authors observed a convenience sample of 39 trauma activations. Cases were selected by their presenting to the resuscitation bay of a Level I trauma center between 09:00 and 16:00, Monday through Thursday, during the study period. Teamwork and communication were measured using the previously validated Clinical Teamwork Scale (CTS). The observers were three Trauma Nursing Core Course certified RNs trained on the CTS by observing simulated and actual trauma cases and following each of these cases with a discussion of appropriate CTS scores with two certified Advanced Trauma Life Support instructors/emergency physicians. Cases observed for measurement were scored in four phases: 1) preintervention phase (baseline); 2) didactic-only intervention, the phase following a lecture series on teamwork and communication in trauma care; 3) ISTS phase, real trauma cases scored during period when weekly ISTSs were performed; and 4) potential decay phase, observations following the discontinuation of the ISTSs. Multirater agreement was assessed with Krippendorf's alpha coefficient; agreement was excellent (mean agreement = 0.92). Nonparametric procedures (Kruskal-Wallis) were used to test the hypothesis that the scores observed during the various phases were different and to compare each individual phase to baseline scores. The ISTS program was implemented and achieved regular participation of all components of our trauma team. Data were collected on 39 cases. The scores for 11 of 14 measures improved from the baseline to the didactic phase, and the mean and median scores of all CTS component measures were greatest during the ISTS phase. When each phase was compared to baseline scores, using the baseline as a control, there were no significant differences seen during the didactic or the decay phases, but 12 of the 14 measures showed significant improvements from the baseline to the simulation phase. However, when the Kruskal-Wallis test was used to test for differences across all phases, only overall communication showed a significant difference. During the potential decay phase, the scores for every measure returned to baseline phase values. This study shows that an ISTS program can be implemented with participation from all members of a multidisciplinary trauma team in the ED of a Level I trauma center. While teamwork and communication in the clinical setting were improved during the ISTS program, this effect was not sustained after ISTS were stopped. © 2012 by the Society for Academic Emergency Medicine.

Cost-effectiveness of simulation-based team training in obstetric emergencies (TOSTI study).

PubMed

van de Ven, J; van Baaren, G J; Fransen, A F; van Runnard Heimel, P J; Mol, B W; Oei, S G

2017-09-01

Team training is frequently applied in obstetrics. We aimed to evaluate the cost-effectiveness of obstetric multi-professional team training in a medical simulation centre. We performed a model-based cost-effectiveness analysis to evaluate four strategies for obstetric team training from a hospital perspective (no training, training without on-site repetition and training with 6 month or 3-6-9 month repetition). Data were retrieved from the TOSTI study, a randomised controlled trial evaluating team training in a medical simulation centre. We calculated the incremental cost-effectiveness ratio (ICER), which represent the costs to prevent the adverse outcome, here (1) the composite outcome of obstetric complications and (2) specifically neonatal trauma due to shoulder dystocia. Mean costs of a one-day multi-professional team training in a medical simulation centre were €25,546 to train all personnel of one hospital. A single training in a medical simulation centre was less effective and more costly compared to strategies that included repetition training. Compared to no training, the ICERs to prevent a composite outcome of obstetric complications were €3432 for a single repetition training course on-site six months after the initial training and €5115 for a three monthly repetition training course on-site after the initial training during one year. When we considered neonatal trauma due to shoulder dystocia, a three monthly repetition training course on-site after the initial training had an ICER of €22,878. Multi-professional team training in a medical simulation centre is cost-effective in a scenario where repetition training sessions are performed on-site. Copyright © 2017 Elsevier B.V. All rights reserved.

Does the effect of one-day simulation team training in obstetric emergencies decline within one year? A post-hoc analysis of a multicentre cluster randomised controlled trial.

PubMed

van de Ven, J; Fransen, A F; Schuit, E; van Runnard Heimel, P J; Mol, B W; Oei, S G

2017-09-01

Does the effect of one-day simulation team training in obstetric emergencies decline within one year? A post-hoc analysis of a multicentre cluster randomised controlled trial. J van de Ven, AF Fransen, E Schuit, PJ van Runnard Heimel, BW Mol, SG Oei OBJECTIVE: To investigate whether the effect of a one-day simulation-based obstetric team training on patient outcome changes over time. Post-hoc analysis of a multicentre, open, randomised controlled trial that evaluated team training in obstetrics (TOSTI study).We studied women with a singleton pregnancy beyond 24 weeks of gestation in 24 obstetric units. Included obstetric units were randomised to either a one-day, multi-professional simulation-based team training focusing on crew resource management in a medical simulation centre (12 units) or to no team training (12 units). We assessed whether outcomes differed between both groups in each of the first four quarters following the team training and compared the effect of team training over quarters. Primary outcome was a composite outcome of low Apgar score, severe postpartum haemorrhage, trauma due to shoulder dystocia, eclampsia and hypoxic-ischemic encephalopathy. During a one year period after the team training the rate of obstetric complications, both on the composite level and the individual component level, did not differ between any of the quarters. For trauma due to shoulder dystocia team training led to a significant decrease in the first quarter (0.06% versus 0.26%, OR 0.19, 95% CI 0.03 to 0.98) but in the subsequent quarters no significant reductions were observed. Similar results were found for invasive treatment for severe postpartum haemorrhage where a significant increase was only seen in the first quarter (0.4% versus 0.03%, OR 19, 95% CI 2.5-147), and not thereafter. The beneficial effect of a one-day, simulation-based, multiprofessional, obstetric team training seems to decline after three months. If team training is further evaluated or implemented, repetitive training sessions every three months seem therefore recommended. Copyright © 2017 Elsevier B.V. All rights reserved.

Teamwork education improves trauma team performance in undergraduate health professional students.

PubMed

Baker, Valerie O'Toole; Cuzzola, Ronald; Knox, Carolyn; Liotta, Cynthia; Cornfield, Charles S; Tarkowski, Robert D; Masters, Carolynn; McCarthy, Michael; Sturdivant, Suzanne; Carlson, Jestin N

2015-01-01

Effective trauma resuscitation requires efficient and coordinated care from a team of providers; however, providers are rarely instructed on how to be effective members of trauma teams. Team-based learning using Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) has been shown to improve team dynamics among practicing professionals, including physicians and nurses. The impact of TeamSTEPPS on students being trained in trauma management in an undergraduate health professional program is currently unknown. We sought to determine the impact of TeamSTEPPS on team dynamics among undergraduate students being trained in trauma resuscitation. We enrolled teams of undergraduate health professional students from four programs: nursing, physician assistant, radiologic science, and respiratory care. After completing an online training on trauma resuscitation principles, the participants completed a trauma resuscitation scenario. The participants then received teamwork training using TeamSTEPPS and completed a second trauma resuscitation scenario identical to the first. All resuscitations were recorded and scored offline by two blinded research assistants using both the Team Emergency Assessment Measure (TEAM) and Trauma Team Performance Observation Tool (TPOT) scoring systems. Pre-test and post-test TEAM and TPOT scores were compared. We enrolled a total of 48 students in 12 teams. Team leadership, situational monitoring, and overall communication improved with TeamSTEPPS training (P=0.04, P=0.02, and P=0.03, respectively), as assessed by the TPOT scoring system. TeamSTEPPS also improved the team's ability to prioritize tasks and work together to complete tasks in a rapid manner (P<0.01 and P=0.02, respectively) as measured by TEAM. Incorporating TeamSTEPPS into trauma team education leads to improved TEAM and TPOT scores among undergraduate health professionals.

KSC-2009-5273

NASA Image and Video Library

2009-10-01

CAPE CANAVERAL, Fla. – At NASA's Kennedy Space Center in Florida, volunteers and teams take part in a Mode II-IV exercise that allows teams to practice an emergency response at Launch Pad 39A, including helicopter evacuation to local hospitals. The exercise involves NASA fire rescue personnel, volunteers portraying astronauts with simulated injuries, helicopters and personnel from the Air Force’s 920th Rescue Wing and medical trauma teams at three central Florida hospitals. The Space Shuttle Program and U.S. Air Force are conducting the emergency simulation. Photo credit: NASA/Troy Cryder

KSC-2009-5274

NASA Image and Video Library

2009-10-01

CAPE CANAVERAL, Fla. – At NASA's Kennedy Space Center in Florida, volunteers and teams take part in a Mode II-IV exercise that allows teams to practice an emergency response at Launch Pad 39A, including helicopter evacuation to local hospitals. The exercise involves NASA fire rescue personnel, volunteers portraying astronauts with simulated injuries, helicopters and personnel from the Air Force’s 920th Rescue Wing and medical trauma teams at three central Florida hospitals. The Space Shuttle Program and U.S. Air Force are conducting the emergency simulation. Photo credit: NASA/Troy Cryder

The Role of Communication During Trauma Activations: Investigating the Need for Team and Leader Communication Training.

PubMed

Raley, Jessica; Meenakshi, Rani; Dent, Daniel; Willis, Ross; Lawson, Karla; Duzinski, Sarah

Fatal errors due to miscommunication among members of trauma teams are 2 to 4 times more likely to occur than in other medical teams, yet most trauma team members do not receive communication effectiveness training. A needs assessment was conducted to examine trauma team members' miscommunication experiences and research scientists' evaluations of live trauma activations. The purpose of this study is to demonstrate that communication training is necessary and highlight specific team communication competencies that trauma teams should learn to improve communication during activations. Data were collected in 2 phases. Phase 1 required participants to complete a series of surveys. Phase 2 included live observations and assessments of pediatric trauma activations using the assessment of pediatric resuscitation team assessments (APRC-TA) and assessment of pediatric resuscitation leader assessments (APRC-LA). Data were collected at a southwestern pediatric hospital. Trauma team members and leaders completed surveys at a meeting and were observed while conducting activations in the trauma bay. Trained research scientists and clinical staff used the APRC-TA and APRC-LA to measure trauma teams' medical performance and communication effectiveness. The sample included 29 healthcare providers who regularly participate in trauma activations. Additionally, 12 live trauma activations were assessed monday to friday from 8am to 5pm. Team members indicated that communication training should focus on offering assistance, delegating duties, accepting feedback, and controlling emotional expressions. Communication scores were not significantly different from medical performance scores. None of the teams were coded as effective medical performance and ineffective team communication and only 1 team was labeled as ineffective leader communication and effective medical performance. Communication training may be necessary for trauma teams and offer a deeper understanding of the communication competencies that should be addressed. The APRC-TA and APRC-LA both include team communication competencies that could be used as a guide to design training for trauma team members and leaders. Researchers should also continue to examine recommendations for improved team and leader communication during activations using in-depth interviews and focus groups. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

ROLE CONFUSION AND SELF ASSESSMENT IN INTERPROFESSIONAL TRAUMA TEAMS

PubMed Central

Steinemann, Susan; Kurosawa, Gene; Wei, Alexander; Ho, Nina; Lim, Eunjung; Suares, Gregory; Bhatt, Ajay; Berg, Benjamin

2015-01-01

Background Trauma care requires coordinating an interprofessional team, with formative feedback on teamwork skills. We hypothesized nurses and surgeons have different perceptions regarding roles during resuscitation; that nurses’ teamwork self-assessment differs from experts’, and that video debriefing might improve accuracy of self-assessment. Methods Trauma nurses and surgeons were surveyed regarding resuscitation responsibilities. Subsequently, nurses joined interprofessional teams in simulated trauma resuscitations. Following each resuscitation, nurses and teamwork experts independently scored teamwork (T-NOTECHS). After video debriefing, nurses repeated T-NOTECHS self-assessment. Results Nurses and surgeons assumed significantly more responsibility by their own profession for 71% of resuscitation tasks. Nurses’ overall T-NOTECHS ratings were slightly higher than experts’. This was evident in all T-NOTECHS subdomains except “leadership,” but despite statistical significance the difference was small and clinically irrelevant. Video debriefing did not improve the accuracy of self-assessment. Conclusions Nurses and physicians demonstrated discordant perceptions of responsibilities. Nurses’ self-assessment of teamwork was statistically, but not clinically significantly, higher than experts’ in all domains except physician leadership. PMID:26801092

Filling in the gaps of predeployment fleet surgical team training using a team-centered approach.

PubMed

Hoang, Tuan N; Kang, Jeff; Laporta, Anthony J; Makler, Vyacheslav I; Chalut, Carissa

2013-01-01

Teamwork and successful communication are essential parts of any medical specialty, especially in the trauma setting. U.S. Navy physicians developed a course for deploying fleet surgical teams to reinforce teamwork, communication, and baseline knowledge of trauma management. The course combines 22 hours of classroom didactics along with 28 hours of hands-on simulation and cadaver-based laboratories to reinforce classroom concepts. It culminates in a 6-hour, multiwave exercise of multiple, critically injured victims of a mass casualty and uses the ?Cut Suit? (Human Worn Partial Task Surgical Simulator; Strategic Operations), which enables performance of multiple realistic surgical procedures as encountered on real casualties. Participants are graded on time taken from initial patient encounter to disposition and the number of errors made. Pre- and post-training written examinations are also given. The course is graded based on participants? evaluation of the course. The majority of the participants indicated that the course promoted teamwork, enhanced knowledge, and gave confidence. Only 51.72% of participants felt confident in dealing with trauma patients before the course, while 82.76% felt confident afterward (p = .01). Both the time spent on each patient and the number of errors made also decreased after course completion. The course was successful in improving teamwork, communication and base knowledge of all the team members. 2013.

In situ pediatric trauma simulation: assessing the impact and feasibility of an interdisciplinary pediatric in situ trauma care quality improvement simulation program.

PubMed

Auerbach, Marc; Roney, Linda; Aysseh, April; Gawel, Marcie; Koziel, Jeannette; Barre, Kimberly; Caty, Michael G; Santucci, Karen

2014-12-01

This study aimed to evaluate the feasibility and measure the impact of an in situ interdisciplinary pediatric trauma quality improvement simulation program. Twenty-two monthly simulations were conducted in a tertiary care pediatric emergency department with the aim of improving the quality of pediatric trauma (February 2010 to November 2012). Each session included 20 minutes of simulated patient care, followed by 30 minutes of debriefing that focused on teamwork, communication, and the identification of gaps in care. A single rater scored the performance of the team in real time using a validated assessment instrument for 6 subcomponents of care (teamwork, airway, intubation, breathing, circulation, and disability). Participants completed a survey and written feedback forms. A trend analysis of the 22 simulations found statistically significant positive trends for overall performance, teamwork, and intubation subcomponents; the strength of the upward trend was the strongest for the teamwork (τ = 0.512), followed by overall performance (τ = 0.488) and intubation (τ = 0.433). Two hundred fifty-one of 398 participants completed the participant feedback form (response rate, 63%), reporting that debriefing was the most valuable aspect of the simulation. An in situ interdisciplinary pediatric trauma simulation quality improvement program resulted in improved validated trauma simulation assessment scores for overall performance, teamwork, and intubation. Participants reported high levels of satisfaction with the program, and debriefing was reported as the most valuable component of the program.

Trauma facilities in Denmark - a nationwide cross-sectional benchmark study of facilities and trauma care organisation.

PubMed

Weile, Jesper; Nielsen, Klaus; Primdahl, Stine C; Frederiksen, Christian A; Laursen, Christian B; Sloth, Erik; Mølgaard, Ole; Knudsen, Lars; Kirkegaard, Hans

2018-03-27

Trauma is a leading cause of death among adults aged < 44 years, and optimal care is a challenge. Evidence supports the centralization of trauma facilities and the use multidisciplinary trauma teams. Because knowledge is sparse on the existing distribution of trauma facilities and the organisation of trauma care in Denmark, the aim of this study was to identify all Danish facilities that care for traumatized patients and to investigate the diversity in organization of trauma management. We conducted a systematic observational cross-sectional study. First, all hospitals in Denmark were identified via online services and clarifying phone calls to each facility. Second, all trauma care manuals on all facilities that receive traumatized patients were gathered. Third, anesthesiologists and orthopedic surgeons on call at all trauma facilities were contacted via telephone for structured interviews. A total of 22 facilities in Denmark were found to receive traumatized patients. All facilities used a trauma care manual and all had a multidisciplinary trauma team. The study found three different trauma team activation criteria and nine different compositions of teams who participate in trauma care. Training was heterogeneous and, beyond the major trauma centers, databases were only maintained in a few facilities. The study established an inventory of the existing Danish facilities that receive traumatized patients. The trauma team activation criteria and the trauma teams were heterogeneous in both size and composition. A national database for traumatized patients, research on nationwide trauma team activation criteria, and team composition guidelines are all called for.

Implementation of team training in medical education in Denmark

PubMed Central

Ostergaard, H; Ostergaard, D; Lippert, A

2004-01-01

In the field of medicine, team training aiming at improving team skills such as leadership, communication, co-operation, and followership at the individual and the team level seems to reduce risk of serious events and therefore increase patient safety. The preferred educational method for this type of training is simulation. Team training is not, however, used routinely in the hospital. In this paper, we describe a framework for the development of a team training course based on need assessment, learning objectives, educational methods including full-scale simulation and evaluations strategies. The use of this framework is illustrated by the present multiprofessional team training in advanced cardiac life support, trauma team training and neonatal resuscitation in Denmark. The challenges of addressing all aspects of team skills, the education of the facilitators, and establishment of evaluation strategies to document the effect of the different types of training on patient safety are discussed. PMID:15465962

Implementation of team training in medical education in Denmark.

PubMed

Østergaard, H T; Østergaard, D; Lippert, A

2004-10-01

In the field of medicine, team training aiming at improving team skills such as leadership, communication, co-operation, and followership at the individual and the team level seems to reduce risk of serious events and therefore increase patient safety. The preferred educational method for this type of training is simulation. Team training is not, however, used routinely in the hospital. In this paper, we describe a framework for the development of a team training course based on need assessment, learning objectives, educational methods including full-scale simulation and evaluations strategies. The use of this framework is illustrated by the present multiprofessional team training in advanced cardiac life support, trauma team training and neonatal resuscitation in Denmark. The challenges of addressing all aspects of team skills, the education of the facilitators, and establishment of evaluation strategies to document the effect of the different types of training on patient safety are discussed.

Implementation of team training in medical education in Denmark.

PubMed

Østergaard, H T; Østergaard, D; Lippert, A

2008-10-01

In the field of medicine, team training aiming at improving team skills such as leadership, communication, co-operation, and followership at the individual and the team level seems to reduce risk of serious events and therefore increase patient safety. The preferred educational method for this type of training is simulation. Team training is not, however, used routinely in the hospital. In this paper, we describe a framework for the development of a team training course based on need assessment, learning objectives, educational methods including full-scale simulation and evaluations strategies. The use of this framework is illustrated by the present multiprofessional team training in advanced cardiac life support, trauma team training and neonatal resuscitation in Denmark. The challenges of addressing all aspects of team skills, the education of the facilitators, and establishment of evaluation strategies to document the effect of the different types of training on patient safety are discussed.

Use of simulation technology in Australian Defence Force resuscitation training.

PubMed

Hendrickse, A D; Ellis, A M; Morris, R W

2001-06-01

Realistic training of health personnel for the resuscitation of military casualties is problematic. There are few opportunities for personnel to obtain the necessary experience unless working in a busy emergency or trauma environment. Even so, the specific nature of military trauma means that many aspects of casualty management may not be adequately covered in the civilian domain. This paper discusses the use of advanced simulation technology in the training of military resuscitation teams. Such training has been available to members of the Australian Defence Force (ADF) for two years.

Whats the story? Information needs of trauma teams.

PubMed

Sarcevic, Aleksandra; Burd, Randall S

2008-11-06

This paper reports on information needs of trauma teams based on an ethnographic study in an urban teaching hospital. We focus on questions posed by trauma team members during ten trauma events. We identify major categories of questions, as well as information seekers and providers. In addition to categories known from other critical care settings, we found categories unique to trauma settings. Based on these findings, we discuss implications for information technology support for trauma teams.

“What’s the Story?” Information Needs of Trauma Teams

PubMed Central

Sarcevic, Aleksandra; Burd, Randall S.

2008-01-01

This paper reports on information needs of trauma teams based on an ethnographic study in an urban teaching hospital. We focus on questions posed by trauma team members during ten trauma events. We identify major categories of questions, as well as information seekers and providers. In addition to categories known from other critical care settings, we found categories unique to trauma settings. Based on these findings, we discuss implications for information technology support for trauma teams. PMID:18999288

What is the impact of multidisciplinary team simulation training on team performance and efficiency of patient care? An integrative review.

PubMed

Murphy, Margaret; Curtis, Kate; McCloughen, Andrea

2016-02-01

In hospital emergencies require a structured team approach to facilitate simultaneous input into immediate resuscitation, stabilisation and prioritisation of care. Efforts to improve teamwork in the health care context include multidisciplinary simulation-based resuscitation team training, yet there is limited evidence demonstrating the value of these programmes.(1) We aimed to determine the current state of knowledge about the key components and impacts of multidisciplinary simulation-based resuscitation team training by conducting an integrative review of the literature. A systematic search using electronic (three databases) and hand searching methods for primary research published between 1980 and 2014 was undertaken; followed by a rigorous screening and quality appraisal process. The included articles were assessed for similarities and differences; the content was grouped and synthesised to form three main categories of findings. Eleven primary research articles representing a variety of simulation-based resuscitation team training were included. Five studies involved trauma teams; two described resuscitation teams in the context of intensive care and operating theatres and one focused on the anaesthetic team. Simulation is an effective method to train resuscitation teams in the management of crisis scenarios and has the potential to improve team performance in the areas of communication, teamwork and leadership. Team training improves the performance of the resuscitation team in simulated emergency scenarios. However, the transferability of educational outcomes to the clinical setting needs to be more clearly demonstrated. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Development of an otitis media strategy in the Pacific: key informant perspectivesThe Matthew effect in New Zealand rural hospital trauma and emergency care: why rural simulation-based education matters.

PubMed

Gutenstein, Marc; Kiuru, Sampsa

2018-06-08

We describe a phenomenon of self-reinforcing inequality between New Zealand rural hospitals and urban trauma centres. Rural doctors work in remote geographical locations, with rare exposure to managing critical injuries, and with little direct support when they do. Paradoxically, but for the same reasons, they also have little access to the intensive training resources and specialist oversight of their university hospital colleagues. In keeping with international experience, we propose that using simulation-based education for rural hospital trauma and emergency team training will mitigate this effect. Along with several different organisations in New Zealand, the University of Otago rural postgraduate programme is developing inter-professional simulation content to address this challenge and open new avenues for research.

High-performing trauma teams: frequency of behavioral markers of a shared mental model displayed by team leaders and quality of medical performance.

PubMed

Johnsen, Bjørn Helge; Westli, Heidi Kristina; Espevik, Roar; Wisborg, Torben; Brattebø, Guttorm

2017-11-10

High quality team leadership is important for the outcome of medical emergencies. However, the behavioral marker of leadership are not well defined. The present study investigated frequency of behavioral markers of shared mental models (SMM) on quality of medical management. Training video recordings of 27 trauma teams simulating emergencies were analyzed according to team -leader's frequency of shared mental model behavioral markers. The results showed a positive correlation of quality of medical management with leaders sharing information without an explicit demand for the information ("push" of information) and with leaders communicating their situational awareness (SA) and demonstrating implicit supporting behavior. When separating the sample into higher versus lower performing teams, the higher performing teams had leaders who displayed a greater frequency of "push" of information and communication of SA and supportive behavior. No difference was found for the behavioral marker of team initiative, measured as bringing up suggestions to other teammembers. The results of this study emphasize the team leader's role in initiating and updating a team's shared mental model. Team leaders should also set expectations for acceptable interaction patterns (e.g., promoting information exchange) and create a team climate that encourages behaviors, such as mutual performance monitoring, backup behavior, and adaptability to enhance SMM.

Evaluating trauma team performance in a Level I trauma center: Validation of the trauma team communication assessment (TTCA-24).

PubMed

DeMoor, Stephanie; Abdel-Rehim, Shady; Olmsted, Richard; Myers, John G; Parker-Raley, Jessica

2017-07-01

Nontechnical skills (NTS), such as team communication, are well-recognized determinants of trauma team performance and good patient care. Measuring these competencies during trauma resuscitations is essential, yet few valid and reliable tools are available. We aimed to demonstrate that the Trauma Team Communication Assessment (TTCA-24) is a valid and reliable instrument that measures communication effectiveness during activations. Two tools with adequate psychometric strength (Trauma Nontechnical Skills Scale [T-NOTECHS], Team Emergency Assessment Measure [TEAM]) were identified during a systematic review of medical literature and compared with TTCA-24. Three coders used each tool to evaluate 35 stable and 35 unstable patient activations (defined according to Advanced Trauma Life Support criteria). Interrater reliability was calculated between coders using the intraclass correlation coefficient. Spearman rank correlation coefficient was used to establish concurrent validity between TTCA-24 and the other two validated tools. Coders achieved an intraclass correlation coefficient of 0.87 for stable patient activations and 0.78 for unstable activations scoring excellent on the interrater agreement guidelines. The median score for each assessment showed good team communication for all 70 videos (TEAM, 39.8 of 54; T-NOTECHS, 17.4 of 25; and TTCA-24, 87.4 of 96). A significant correlation between TTTC-24 and T-NOTECHS was revealed (p = 0.029), but no significant correlation between TTCA-24 and TEAM (p = 0.77). Team communication was rated slightly better across all assessments for stable versus unstable patient activations, but not statistically significant. TTCA-24 correlated with T-NOTECHS, an instrument measuring nontechnical skills for trauma teams, but not TEAM, a tool that assesses communication in generic emergency settings. TTCA-24 is a reliable and valid assessment that can be a useful adjunct when evaluating interpersonal and team communication during trauma activations. Diagnostic tests or criteria, level II.

KSC-2009-5275

NASA Image and Video Library

2009-10-01

CAPE CANAVERAL, Fla. – At NASA's Kennedy Space Center in Florida, volunteers portraying astronauts are loaded into a helicopter as part of a Mode II-IV exercise that allows teams to practice an emergency response at Launch Pad 39A, including helicopter evacuation to local hospitals. The exercise involves NASA fire rescue personnel, volunteers portraying astronauts with simulated injuries, helicopters and personnel from the Air Force’s 920th Rescue Wing and medical trauma teams at three central Florida hospitals. The Space Shuttle Program and U.S. Air Force are conducting the emergency simulation. Photo credit: NASA/Troy Cryder

KSC-2009-5271

NASA Image and Video Library

2009-10-01

CAPE CANAVERAL, Fla. – At NASA's Kennedy Space Center in Florida, volunteers portraying astronauts are taking part in a Mode II-IV exercise that allows teams to practice an emergency response at Launch Pad 39A, including helicopter evacuation to local hospitals. The exercise involves NASA fire rescue personnel, volunteers portraying astronauts with simulated injuries, helicopters and personnel from the Air Force’s 920th Rescue Wing and medical trauma teams at three central Florida hospitals. The Space Shuttle Program and U.S. Air Force are conducting the emergency simulation. Photo credit: NASA/Troy Cryder

KSC-2009-5276

NASA Image and Video Library

2009-10-01

CAPE CANAVERAL, Fla. – At NASA's Kennedy Space Center in Florida, volunteers portraying astronauts are transported to helicopters as part of a Mode II-IV exercise that allows teams to practice an emergency response at Launch Pad 39A, including helicopter evacuation to local hospitals. The exercise involves NASA fire rescue personnel, volunteers portraying astronauts with simulated injuries, helicopters and personnel from the Air Force’s 920th Rescue Wing and medical trauma teams at three central Florida hospitals. The Space Shuttle Program and U.S. Air Force are conducting the emergency simulation. Photo credit: NASA/Troy Cryder

KSC-2009-5285

NASA Image and Video Library

2009-10-01

CAPE CANAVERAL, Fla. – At NASA's Kennedy Space Center in Florida, volunteers portraying astronauts are transported to ambulances as part of a Mode II-IV exercise that allows teams to practice an emergency response at Launch Pad 39A, including helicopter evacuation to local hospitals. The exercise involves NASA fire rescue personnel, volunteers portraying astronauts with simulated injuries, helicopters and personnel from the Air Force’s 920th Rescue Wing and medical trauma teams at three central Florida hospitals. The Space Shuttle Program and U.S. Air Force are conducting the emergency simulation. Photo credit: NASA/Jack Pfaller

Video registration of trauma team performance in the emergency department: the results of a 2-year analysis in a Level 1 trauma center.

PubMed

Lubbert, Pieter H W; Kaasschieter, Edgar G; Hoorntje, Lidewij E; Leenen, Loek P H

2009-12-01

Trauma teams responsible for the first response to patients with multiple injuries upon arrival in a hospital consist of medical specialists or resident physicians. We hypothesized that 24-hour video registration in the trauma room would allow for precise evaluation of team functioning and deviations from Advanced Trauma Life Support (ATLS) protocols. We analyzed all video registrations of trauma patients who visited the emergency room of a Level I trauma center in the Netherlands between September 1, 2000, and September 1, 2002. Analysis was performed with a score list based on ATLS protocols. From a total of 1,256 trauma room presentations, we found a total of 387 video registrations suitable for analysis. The majority of patients had an injury severity score lower than 17 (264 patients), whereas 123 patients were classified as multiple injuries (injury severity score >or=17). Errors in team organization (omission of prehospital report, no evident leadership, unorganized resuscitation, not working according to protocol, and no continued supervision of the patient) lead to significantly more deviations in the treatment than when team organization was uncomplicated. Video registration of diagnostic and therapeutic procedures by a multidisciplinary trauma team facilitates an accurate analysis of possible deviations from protocol. In addition to identifying technical errors, the role of the team leader can clearly be analyzed and related to team actions. Registration strongly depends on availability of video tapes, timely started registration, and hardware functioning. The results from this study were used to develop a training program for trauma teams in our hospital that specifically focuses on the team leader's functioning.

C-STARS Baltimore Simulation Center Military Trauma Training Program: Training for High Performance Trauma Teams

DTIC Science & Technology

2013-09-19

for October 2010 to September 2013 Air Force Research Laboratory 711th Human Performance Wing School of Aerospace Medicine Air Force...WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) USAF School of Aerospace Medicine Air Force Expeditionary Medical Skills...Patient denies any performance enhancers or herbal use. BP – 110/68, P 124, R –28 shallow, and sweating from exercise. Patient states he never

KSC-2009-5278

NASA Image and Video Library

2009-10-01

CAPE CANAVERAL, Fla. – At NASA's Kennedy Space Center in Florida, volunteers portraying astronauts are transported to helicopters as part of a Mode II-IV exercise that allows teams to practice an emergency response at Launch Pad 39A, including helicopter evacuation to local hospitals. The exercise allows teams to practice an emergency response at Launch Pad 39A, including helicopter evacuation to local hospitals. The exercise involves NASA fire rescue personnel, volunteers portraying astronauts with simulated injuries, helicopters and personnel from the Air Force’s 920th Rescue Wing and medical trauma teams at three central Florida hospitals. The Space Shuttle Program and U.S. Air Force are conducting the emergency simulation. Photo credit: NASA/Troy Cryder

Training forward surgical teams for deployment: the US Army Trauma Training Center.

PubMed

Valdiri, Linda A; Andrews-Arce, Virginia E; Seery, Jason M

2015-04-01

Since the late 1980s, the US Army has been deploying forward surgical teams to the most intense areas of conflict to care for personnel injured in combat. The forward surgical team is a 20-person medical team that is highly mobile, extremely agile, and has relatively little need of outside support to perform its surgical mission. In order to perform this mission, however, team training and trauma training are required. The large majority of these teams do not routinely train together to provide patient care, and that training currently takes place at the US Army Trauma Training Center (ATTC). The training staff of the ATTC is a specially selected 10-person team made up of active duty personnel from the Army Medical Department assigned to the University of Miami/Jackson Memorial Hospital Ryder Trauma Center in Miami, Florida. The ATTC team of instructors trains as many as 11 forward surgical teams in 2-week rotations per year so that the teams are ready to perform their mission in a deployed setting. Since the first forward surgical team was trained at the ATTC in January 2002, more than 112 forward surgical teams and other similar-sized Department of Defense forward resuscitative and surgical units have rotated through trauma training at the Ryder Trauma Center in preparation for deployment overseas. ©2015 American Association of Critical-Care Nurses.

The Trauma Time-Out: Evaluating the Effectiveness of Protocol-Based Information Dissemination in the Traumatically Injured Patient.

PubMed

Nolan, Heather R; Fitzgerald, Michael; Howard, Brett; Jarrard, Joey; Vaughn, Danny

Procedural time-outs are widely accepted safety standards that are protocolized in nearly all hospital systems. The trauma time-out, however, has been largely unstudied in the existing literature and does not have a standard protocol outlined by any of the major trauma surgery organizations. The goal of this study was to evaluate our institution's use of the trauma time-out and assess how trauma team members viewed its effectiveness. A multiple-answer survey was sent to trauma team members at a Level I trauma center. Questions included items directed at background, experience, opinions, and write-in responses. Most responders were experienced trauma team members who regularly participated in trauma codes. All respondents noted the total time required to complete the time-out was less than 5 min, with the majority saying it took less than 1 min. Seventy-five percent agreed that trauma time-outs should continue, with 92% noting that it improved understanding of patient presentation and prehospital evaluation. Seventy-seven percent said it improved understanding of other team member's roles, and 75% stated it improved patient care. Subgroups of physicians and nurses were statistically similar; yet, physicians did note that it improved their understanding of the team member's function more frequently than nurses. The trauma time-out can be an excellent tool to improve patient care and team understanding of the incoming trauma patient. Although used widely at multiple levels of trauma institutions, development of a documented protocol can be the next step in creating a unified safety standard.

KSC-2009-5270

NASA Image and Video Library

2009-10-01

CAPE CANAVERAL, Fla. – At NASA's Kennedy Space Center in Florida, volunteers portraying astronauts are helped with the launch-and-entry suits. The volunteers are taking part in a Mode II-IV exercise that allows teams to practice an emergency response at Launch Pad 39A, including helicopter evacuation to local hospitals. The exercise involves NASA fire rescue personnel, volunteers portraying astronauts with simulated injuries, helicopters and personnel from the Air Force’s 920th Rescue Wing and medical trauma teams at three central Florida hospitals. The Space Shuttle Program and U.S. Air Force are conducting the emergency simulation. Photo credit: NASA/Troy Cryder

KSC-2009-5284

NASA Image and Video Library

2009-10-01

CAPE CANAVERAL, Fla. – At NASA's Kennedy Space Center in Florida, volunteers portraying astronauts are transported to and from a triage site as part of a Mode II-IV exercise that allows teams to practice an emergency response at Launch Pad 39A, including helicopter evacuation to local hospitals. The exercise involves NASA fire rescue personnel, volunteers portraying astronauts with simulated injuries, helicopters and personnel from the Air Force’s 920th Rescue Wing and medical trauma teams at three central Florida hospitals. The Space Shuttle Program and U.S. Air Force are conducting the emergency simulation. Photo credit: NASA/Jack Pfaller

[The radiologist physician in major trauma evaluation].

PubMed

Motta-Ramírez, Gaspar Alberto

2016-01-01

Trauma is the most common cause of death in young adults. A multidisciplinary trauma team consists of at least a surgical team, an anesthesiology team, radiologic team, and an emergency department team. Recognize the integration of multidisciplinary medical team in managing the trauma patient and which must include the radiologist physician responsible for the institutional approach to the systematization of the trauma patient regarding any radiological and imaging study with emphasis on the FAST (del inglés, Focused Assessment with Sonography in Trauma)/USTA, Whole body computed tomography. Ultrasound is a cross-sectional method available for use in patients with major trauma. Whole-body multidetector computed tomography became the imaging modality of choice in the late 1990s. In patients with major trauma, examination FAST often is the initial imaging examination, extended to extraabdominal regions. Patients who have multitrauma from blunt mechanisms often require multiple diagnostic examinations, including Computed Tomography imaging of the torso as well as abdominopelvic Computed Tomography angiography. Multiphasic Whole-body trauma imaging is feasible, helps detect clinically relevant vascular injuries, and results in diagnostic image quality in the majority of patients. Computed Tomography has gained importance in the early diagnostic phase of trauma care in the emergency room. With a single continuous acquisition, whole-body computed tomography angiography is able to demonstrate all potentially injured organs, as well as vascular and bone structures, from the circle of Willis to the symphysis pubis.

Norwegian trauma team leaders - training and experience: A national point prevalence study

PubMed Central

2011-01-01

Background The treatment of trauma victims is a complex multi-professional task in a stressful environment. We previously found that trauma team members perceive leadership as the most important human factor. The aim of the present study was to assess the experience and education of Norwegian trauma team leaders, and allow them to describe their perceived educational needs. Methods We conducted an anonymous descriptive study using a point prevalence methodology based on written questionnaires. All 45 hospitals in Norway receiving severely injured trauma victims were contacted on a randomly selected weeknight during November 2009. Team leaders were asked to specify what trauma related training programs they had participated in, how much experience they had, and what further training they wished, if any. Results Response rate was 82%. Slightly more than half of the team leaders were residents. The median working experience as a surgeon among team leaders was 7.5 years. Sixty-eight percent had participated in multi-professional training in non-technical skills, while 54% had passed the advanced trauma life support(ATLS) course. Fifty-one percent were trained in damage control surgery. A median of one course per team leader was needed to comply with the new proposed national standards. Team leaders considered training in damage control surgery the most needed educational objective. Conclusions Level of experience among team leaders was highly variable and their educational background insufficient according to international and proposed national standards. Proposed national standards should be urgently implemented to ensure equal access to high quality trauma care. PMID:21975088

The Effect of Availability of Manpower on Trauma Resuscitation Times in a Tertiary Academic Hospital.

PubMed

Tan, Timothy Xin Zhong; Quek, Nathaniel Xin Ern; Koh, Zhi Xiong; Nadkarni, Nivedita; Singaram, Kanageswari; Ho, Andrew Fu Wah; Ong, Marcus Eng Hock; Wong, Ting Hway

2016-01-01

For trauma patients, delays to assessment, resuscitation, and definitive care affect outcomes. We studied the effects of resuscitation area occupancy and trauma team size on trauma team resuscitation speed in an observational study at a tertiary academic institution in Singapore. From January 2014 to January 2015, resuscitation videos of trauma team activated patients with an Injury Severity Score of 9 or more were extracted for review within 14 days by independent reviewers. Exclusion criteria were patients dead on arrival, inter-hospital transfers, and up-triaged patients. Data captured included manpower availability (trauma team size and resuscitation area occupancy), assessment (airway, breathing, circulation, logroll), interventions (vascular access, imaging), and process-of-care time intervals (time to assessment/intervention/adjuncts, time to imaging, and total time in the emergency department). Clinical data were obtained by chart review and from the trauma registry. Videos of 70 patients were reviewed over a 13-month period. The median time spent in the emergency department was 154.9 minutes (IQR 130.7-207.5) and the median resuscitation team size was 7, with larger team sizes correlating with faster process-of-care time intervals: time to airway assessment (p = 0.08) and time to disposition (p = 0.04). The mean resuscitation area occupancy rate (RAOR) was 1.89±2.49, and the RAOR was positively correlated with time spent in the emergency department (p = 0.009). Our results suggest that adequate staffing for trauma teams and resuscitation room occupancy are correlated with faster trauma resuscitation and reduced time spent in the emergency department.

The Incidence of Fever in US Critical Care Air Transport Team Combat Trauma Patients Evacuated from the Theater between March 2009 and March 2010

DTIC Science & Technology

2013-11-01

THE INCIDENCE OF FEVER IN US CRITICAL CARE AIR TRANSPORT TEAM COMBAT TRAUMA PATIENTS EVACUATED FROM THE THEATER BETWEEN MARCH 2009 AND MARCH 2010...Critical Care Air Transport Teams (CCATTs). Fever after trauma is correlated with surgical complications and infection. The purposes of this study are...248 trauma patients met the inclusion criteria, and 101 trauma patients (40%) had fever . The mean age was 28 years, and 98% of patients were men. The

KSC-2011-2030

NASA Image and Video Library

2011-03-01

CAPE CANAVERAL, Fla. – Volunteers portraying injured astronauts are loaded onto a helicopter as part of an emergency exit, or Mode II/IV, exercise that allows teams to practice an emergency response at Launch Pad 39A at NASA's Kennedy Space Center in Florida. The exercise involves NASA fire rescue personnel, volunteers portraying astronauts with simulated injuries, helicopters and personnel from the Air Force’s 920th Rescue Wing, and medical trauma teams at three Central Florida hospitals. The drill allows teams to practice an emergency response at the launch pad, including helicopter evacuation to local hospitals. Photo credit: NASA/Kim Shiflett

KSC-2011-2026

NASA Image and Video Library

2011-03-01

CAPE CANAVERAL, Fla. – Volunteers portraying injured astronauts are transported to a helicopter as part of an emergency exit, or Mode II/IV, exercise that allows teams to practice an emergency response at Launch Pad 39A at NASA's Kennedy Space Center in Florida. The exercise involves NASA fire rescue personnel, volunteers portraying astronauts with simulated injuries, helicopters and personnel from the Air Force’s 920th Rescue Wing, and medical trauma teams at three Central Florida hospitals. The drill allows teams to practice an emergency response at the launch pad, including helicopter evacuation to local hospitals. Photo credit: NASA/Kim Shiflett

KSC-2011-2029

NASA Image and Video Library

2011-03-01

CAPE CANAVERAL, Fla. – Volunteers portraying injured astronauts are transported to a helicopter as part of an emergency exit, or Mode II/IV, exercise that allows teams to practice an emergency response at Launch Pad 39A at NASA's Kennedy Space Center in Florida. The exercise involves NASA fire rescue personnel, volunteers portraying astronauts with simulated injuries, helicopters and personnel from the Air Force’s 920th Rescue Wing, and medical trauma teams at three Central Florida hospitals. The drill allows teams to practice an emergency response at the launch pad, including helicopter evacuation to local hospitals. Photo credit: NASA/Kim Shiflett

KSC-2011-2027

NASA Image and Video Library

2011-03-01

CAPE CANAVERAL, Fla. – Volunteers portraying injured astronauts are loaded onto a helicopter as part of an emergency exit, or Mode II/IV, exercise that allows teams to practice an emergency response at Launch Pad 39A at NASA's Kennedy Space Center in Florida. The exercise involves NASA fire rescue personnel, volunteers portraying astronauts with simulated injuries, helicopters and personnel from the Air Force’s 920th Rescue Wing, and medical trauma teams at three Central Florida hospitals. The drill allows teams to practice an emergency response at the launch pad, including helicopter evacuation to local hospitals. Photo credit: NASA/Kim Shiflett

[Optimized resource mobilization and quality of treatment of severely injured patients through a structured trauma room alarm system].

PubMed

Spering, C; Roessler, M; Kurlemann, T; Dresing, K; Stürmer, K M; Lehmann, W; Sehmisch, S

2017-12-12

The treatment of severely injured patients in the trauma resuscitation unit (TRU) requires an interdisciplinary and highly professional trauma team approach. The complete team needs to be waiting for the patient in the TRU on arrival. Treating severely injured patients in the TRU, the trauma team connects the initial preclinical emergency stabilization with the subsequent sophisticated treatment. Thus, the trauma team depends on concise information from the emergency personnel at the scene to provide its leader with further information as well as an accurate alarm including all departments necessary to stabilize the patient in the TRU. Aiming at an accurate and most efficient trauma team alarm, this study was designed to provide and analyze an alarm system which mobilizes the trauma team in a stepwise fashion depending on the pattern of injuries and the threat to life. The trauma team alarm system was analyzed in a prospective data acquisition at a level I trauma center over a period of 12 months. Evaluation followed the acquisition phase and provided comparison to the status prior to the establishment of the alarm system. All items underwent statistical testing using t‑tests (p < 0.05). The data of 775 TRU patients showed a significant reduction of false information on the patients status prior to arrival. It also showed an increase in punctual arrival in the TRU of the emergency teams. False alarms were significantly reduced (from 11.9% to 2.7%, p > 0.01). The duration from arrival of the patient in the TRU to the initial multislice computed tomography (CT) scan was reduced by 6 min while the total period of treatment in the TRU was reduced by 17 min. After the alarm system to gradually mobilize the trauma team was put into action, team members left the TRU if unneeded prior to finishing the initial treatment in only 4% of the cases. The patient fatality rate was 8.8% (injury severity score, ISS = 23 points) after establishment of the alarm system compared to 12.9% (ISS = 25 points) before. The implementation of an accurate and patient status-based alarm system to mobilize the trauma team can improve the quality of treatment while the duration of treatment of the severely injured patients in the TRU can be decreased. It also provides a most efficient mobilization of personnel resources while sustaining patient safety.

The Effect of Availability of Manpower on Trauma Resuscitation Times in a Tertiary Academic Hospital

PubMed Central

Quek, Nathaniel Xin Ern; Koh, Zhi Xiong; Nadkarni, Nivedita; Singaram, Kanageswari; Ho, Andrew Fu Wah; Ong, Marcus Eng Hock

2016-01-01

Background For trauma patients, delays to assessment, resuscitation, and definitive care affect outcomes. We studied the effects of resuscitation area occupancy and trauma team size on trauma team resuscitation speed in an observational study at a tertiary academic institution in Singapore. Methods From January 2014 to January 2015, resuscitation videos of trauma team activated patients with an Injury Severity Score of 9 or more were extracted for review within 14 days by independent reviewers. Exclusion criteria were patients dead on arrival, inter-hospital transfers, and up-triaged patients. Data captured included manpower availability (trauma team size and resuscitation area occupancy), assessment (airway, breathing, circulation, logroll), interventions (vascular access, imaging), and process-of-care time intervals (time to assessment/intervention/adjuncts, time to imaging, and total time in the emergency department). Clinical data were obtained by chart review and from the trauma registry. Results Videos of 70 patients were reviewed over a 13-month period. The median time spent in the emergency department was 154.9 minutes (IQR 130.7–207.5) and the median resuscitation team size was 7, with larger team sizes correlating with faster process-of-care time intervals: time to airway assessment (p = 0.08) and time to disposition (p = 0.04). The mean resuscitation area occupancy rate (RAOR) was 1.89±2.49, and the RAOR was positively correlated with time spent in the emergency department (p = 0.009). Conclusion Our results suggest that adequate staffing for trauma teams and resuscitation room occupancy are correlated with faster trauma resuscitation and reduced time spent in the emergency department. PMID:27136299

KSC-2011-2025

NASA Image and Video Library

2011-03-01

CAPE CANAVERAL, Fla. – An emergency exit, or Mode II/IV, exercise is under way near Launch Pad 39A at NASA's Kennedy Space Center in Florida. The exercise involves NASA fire rescue personnel, volunteers portraying astronauts with simulated injuries, helicopters and personnel from the Air Force’s 920th Rescue Wing, and medical trauma teams at three Central Florida hospitals. The drill allows teams to practice an emergency response at the launch pad, including helicopter evacuation to local hospitals. Photo credit: NASA/Kim Shiflett

KSC-2011-2018

NASA Image and Video Library

2011-03-01

CAPE CANAVERAL, Fla. – An emergency exit, or Mode II/IV, exercise is under way in a bunker of Launch Pad 39A at NASA's Kennedy Space Center in Florida. The exercise involves NASA fire rescue personnel, volunteers portraying astronauts with simulated injuries, helicopters and personnel from the Air Force’s 920th Rescue Wing, and medical trauma teams at three Central Florida hospitals. The drill allows teams to practice an emergency response at the launch pad, including helicopter evacuation to local hospitals. Photo credit: NASA/Kim Shiflett

KSC-2011-2024

NASA Image and Video Library

2011-03-01

CAPE CANAVERAL, Fla. – An emergency exit, or Mode II/IV, exercise is under way near Launch Pad 39A at NASA's Kennedy Space Center in Florida. The exercise involves NASA fire rescue personnel, volunteers portraying astronauts with simulated injuries, helicopters and personnel from the Air Force’s 920th Rescue Wing, and medical trauma teams at three Central Florida hospitals. The drill allows teams to practice an emergency response at the launch pad, including helicopter evacuation to local hospitals. Photo credit: NASA/Kim Shiflett

Taxonomy of Trauma Leadership Skills: A Framework for Leadership Training and Assessment.

PubMed

Leenstra, Nico F; Jung, Oliver C; Johnson, Addie; Wendt, Klaus W; Tulleken, Jaap E

2016-02-01

Good leadership is essential for optimal trauma team performance, and targeted training of leadership skills is necessary to achieve such leadership proficiency. To address the need for a taxonomy of leadership skills that specifies the skill components to be learned and the behaviors by which they can be assessed across the five phases of trauma care, the authors developed the Taxonomy of Trauma Leadership Skills (TTLS). Critical incident interviews were conducted with trauma team leaders and members from different specialties-emergency physicians, trauma surgeons, anesthesiologists, and emergency ward nurses-at three teaching hospitals in the Netherlands during January-June 2013. Data were iteratively analyzed for examples of excellent leadership skills at each phase of trauma care. Using the grounded theory approach, elements of excellent leadership skills were identified and classified. Elements and behavioral markers were sorted and categorized using multiple raters. In a two-round verification process in late 2013, the taxonomy was reviewed and rated by trauma team leaders and members from the multiple specialties for its coverage of essential items. Data were gathered from 28 interviews and 14 raters. The TTLS details 5 skill categories (information coordination, decision making, action coordination, communication management, and coaching and team development) and 37 skill elements. The skill elements are captured by 67 behavioral markers. The three-level taxonomy is presented according to five phases of trauma care. The TTLS provides a framework for teaching, learning, and assessing team leadership skills in trauma care and other complex, acute care situations.

Effectiveness of trauma team on medical resource utilization and quality of care for patients with major trauma.

PubMed

Wang, Chih-Jung; Yen, Shu-Ting; Huang, Shih-Fang; Hsu, Su-Chen; Ying, Jeremy C; Shan, Yan-Shen

2017-07-24

Trauma is one of the leading causes of death in Taiwan, and its medical expenditure escalated drastically. This study aimed to explore the effectiveness of trauma team, which was established in September 2010, on medical resource utilization and quality of care among major trauma patients. This was a retrospective study, using trauma registry data bank and inpatient medical service charge databases. Study subjects were major trauma patients admitted to a medical center in Tainan during 2009 and 2013, and was divided into case group (from January, 2011 to August, 2013) and comparison group (from January, 2009 to August, 2010). Significant reductions in several items of medical resource utilization were identified after the establishment of trauma team. In the sub-group of patients who survived to discharge, examination, radiology and operation charges declined significantly. The radiation and examination charges reduced significantly in the subcategories of ISS = 16 ~ 24 and ISS > 24 respectively. However, no significant effectiveness on quality of care was identified. The establishment of trauma team is effective in containing medical resource utilization. In order to verify the effectiveness on quality of care, extended time frame and extra study subjects are needed.

Leadership and Teamwork in Trauma and Resuscitation.

PubMed

Ford, Kelsey; Menchine, Michael; Burner, Elizabeth; Arora, Sanjay; Inaba, Kenji; Demetriades, Demetrios; Yersin, Bertrand

2016-09-01

Leadership skills are described by the American College of Surgeons' Advanced Trauma Life Support (ATLS) course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders. We searched the PubMed database using the keywords "leadership" and then either "trauma" or "resuscitation" as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1) how leadership affects patient care; 2) which tools are available to measure leadership; and 3) methods to train physicians to become better leaders. We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS) is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ) was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs included didactic teaching followed by simulations. Although programs differed in length, intensity, and training level of participants, all programs demonstrated improved team performance. Despite the relative paucity of literature on leadership in resuscitations, this review found leadership improves processes of care in trauma and can be enhanced through dedicated training. Future research is needed to validate leadership assessment scales, develop optimal training mechanisms, and demonstrate leadership's effect on patient-level outcome.

Radiation dose from initial trauma assessment and resuscitation: review of the literature.

PubMed

Hui, Catherine M; MacGregor, John H; Tien, Homer C; Kortbeek, John B

2009-04-01

Trauma care benefits from the use of imaging technologies. Trauma patients and trauma team members are exposed to radiation during the continuum of care. Knowledge of exposure amounts and effects are important for trauma team members. We performed a review of the published literature; keywords included "trauma," "patients," "trauma team members," "wounds," "injuries," "radiation," "exposure," "dose" and "computed tomography" (CT). We also reviewed the Board on Radiation Effects Research (BEIR VII) report, published in 2005 and 2006. We found no randomized controlled trials or studies. Relevant studies demonstrated that CT accounts for the single largest radiation exposure in trauma patients. Exposure to 100 mSv could result in a solid organ cancer or leukemia in 1 of 100 people. Trauma team members do not exceed the acceptable occupation radiation exposure determined by the National Council of Radiation Protection and Management. Modern imaging technologies such as 16- and 64-slice CT scanners may decrease radiation exposure. Multiple injured trauma patients receive a substantial dose of radiation. Radiation exposure is cumulative. The low individual risk of cancer becomes a greater public health issue when multiplied by a large number of examinations. Though CT scans are an invaluable resource and are becoming more easily accessible, they should not replace careful clinical examination and should be used only in appropriate patients.

The effect of a nurse team leader on communication and leadership in major trauma resuscitations.

PubMed

Clements, Alana; Curtis, Kate; Horvat, Leanne; Shaban, Ramon Z

2015-01-01

Effective assessment and resuscitation of trauma patients requires an organised, multidisciplinary team. Literature evaluating leadership roles of nurses in trauma resuscitation and their effect on team performance is scarce. To assess the effect of allocating the most senior nurse as team leader of trauma patient assessment and resuscitation on communication, documentation and perceptions of leadership within an Australian emergency department. The study design was a pre-post-test survey of emergency nursing staff (working at resuscitation room level) perceptions of leadership, communication, and documentation before and after the implementation of a nurse leader role. Patient records were audited focussing on initial resuscitation assessment, treatment, and nursing clinical entry. Descriptive statistical analyses were performed. Communication trended towards improvement. All (100%) respondents post-test stated they had a good to excellent understanding of their role, compared to 93.2% pre-study. A decrease (58.1-12.5%) in 'intimidating personality' as a negative aspect of communication. Nursing leadership had a 6.7% increase in the proportion of those who reported nursing leadership to be good to excellent. Accuracy of clinical documentation improved (P = 0.025). Trauma nurse team leaders improve some aspects of communication and leadership. Development of trauma nurse leaders should be encouraged within trauma team training programmes. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Protocol compliance and time management in blunt trauma resuscitation.

PubMed

Spanjersberg, W R; Bergs, E A; Mushkudiani, N; Klimek, M; Schipper, I B

2009-01-01

To study advanced trauma life support (ATLS) protocol adherence prospectively in trauma resuscitation and to analyse time management of daily multidisciplinary trauma resuscitation at a level 1 trauma centre, for both moderately and severely injured patients. All victims of severe blunt trauma were consecutively included. Patients with a revised trauma score (RTS) of 12 were resuscitated by a "minor trauma" team and patients with an RTS of less than 12 were resuscitated by a "severe trauma" team. Digital video recordings were used to analyse protocol compliance and time management during initial assessment. From 1 May to 1 September 2003, 193 resuscitations were included. The "minor trauma" team assessed 119 patients, with a mean injury severity score (ISS) of 7 (range 1-45). Overall protocol compliance was 42%, ranging from 0% for thoracic percussion to 93% for thoracic auscultation. The median resuscitation time was 45.9 minutes (range 39.7-55.9). The "severe team" assessed 74 patients, with a mean ISS of 22 (range 1-59). Overall protocol compliance was 53%, ranging from 4% for thoracic percussion to 95% for thoracic auscultation. Resuscitation took 34.8 minutes median (range 21.6-44.1). Results showed the current trauma resuscitation to be ATLS-like, with sometimes very low protocol compliance rates. Timing of secondary survey and radiology and thus time efficiency remains a challenge in all trauma patients. To assess the effect of trauma resuscitation protocols on outcome, protocol adherence needs to be improved.

The impact of patient volume on surgical trauma training in a Scandinavian trauma centre.

PubMed

Gaarder, Christine; Skaga, Nils Oddvar; Eken, Torsten; Pillgram-Larsen, Johan; Buanes, Trond; Naess, Paal Aksel

2005-11-01

Some of the problems faced in trauma surgery are increasing non-operative management of abdominal injuries, decreasing work hours and increasing sub-specialisation. We wanted to document the experience of trauma team leaders at the largest trauma centre in Norway, hypothesising that the patient volume would be inadequate to secure optimal trauma care. Patients registered in the hospital based Trauma Registry during the 2-year period from 1 August 2000 to 31 July 2002 were included. Of a total of 1667 patients registered, 645 patients (39%) had an Injury Severity Score (ISS)>15. Abdominal injuries were diagnosed in 205 patients with a median ISS of 30. An average trauma team leader assessed a total of 119 trauma cases a year (46 patients with ISS>15) and participated in 10 trauma laparotomies. Although the total number of trauma cases seems adequate, the experience of the trauma team leaders with challenging abdominal injuries is limited. With increasing sub-specialisation and general surgery vanishing, fewer surgical specialties provide operative competence in dealing with complicated torso trauma. A system of additional education and quality assurance measures is a prerequisite of high quality, and has consequently been introduced in our institution.

[Teamwork and leadership in the trauma room. Trauma room management from a psychological perspective].

PubMed

Passauer-Baierl, S; Hofinger, G

2011-09-01

The treatment of patients in the trauma room places extraordinary demands on the multidisciplinary and multiprofessional team with regard to expert qualifications and teamwork. The present study triangulates data extracted from observation, interviews and questionnaires. In general, team climate and teamwork are good, yet some problems could be identified. Not all team members-especially younger physicians and nurses-feel free to express their doubts and uncertainties. Furthermore, the treatment plan is not always clear for all team members. Absent or unclear leadership is seen as a main problem when a treatment proceeds negatively. The establishment of a team leader is therefore recommended.

Team communication patterns in emergency resuscitation: a mixed methods qualitative analysis.

PubMed

Calder, Lisa Anne; Mastoras, George; Rahimpour, Mitra; Sohmer, Benjamin; Weitzman, Brian; Cwinn, A Adam; Hobin, Tara; Parush, Avi

2017-12-01

In order to enhance patient safety during resuscitation of critically ill patients, we need to optimize team communication and enhance team situational awareness but little is known about resuscitation team communication patterns. The objective of this study is to understand how teams communicate during resuscitation; specifically to assess for a shared mental model (organized understanding of a team's relationships) and information needs. We triangulated 3 methods to evaluate resuscitation team communication at a tertiary care academic trauma center: (1) interviews; (2) simulated resuscitation observations; (3) live resuscitation observations. We interviewed 18 resuscitation team members about shared mental models, roles and goals of team members and procedural expectations. We observed 30 simulated resuscitation video recordings and documented the timing, source and destination of communication and the information category. We observed 12 live resuscitations in the emergency department and recorded baseline characteristics of the type of resuscitations, nature of teams present and type and content of information exchanges. The data were analyzed using a qualitative communication analysis method. We found that resuscitation team members described a shared mental model. Respondents understood the roles and goals of each team member in order to provide rapid, efficient and life-saving care with an overall need for situational awareness. The information flow described in the interviews was reflected during the simulated and live resuscitations with the most responsible physician and charting nurse being central to team communication. We consolidated communicated information into six categories: (1) time; (2) patient status; (3) patient history; (4) interventions; (5) assistance and consultations; 6) team members present. Resuscitation team members expressed a shared mental model and prioritized situational awareness. Our findings support a need for cognitive aids to enhance team communication during resuscitations.

KSC-2011-2020

NASA Image and Video Library

2011-03-01

CAPE CANAVERAL, Fla. – On Launch Pad 39A at NASA's Kennedy Space Center in Florida, an emergency exit, or Mode II/IV, exercise is under way. Seen here are M-113 armored personnel carriers near the slidewire basked landing site. The exercise involves NASA fire rescue personnel, volunteers portraying astronauts with simulated injuries, helicopters and personnel from the Air Force’s 920th Rescue Wing, and medical trauma teams at three Central Florida hospitals. The drill allows teams to practice an emergency response at the launch pad, including helicopter evacuation to local hospitals. Photo credit: NASA/Kim Shiflett

A crew resource management program tailored to trauma resuscitation improves team behavior and communication.

PubMed

Hughes, K Michael; Benenson, Ronald S; Krichten, Amy E; Clancy, Keith D; Ryan, James Patrick; Hammond, Christopher

2014-09-01

Crew Resource Management (CRM) is a team-building communication process first implemented in the aviation industry to improve safety. It has been used in health care, particularly in surgical and intensive care settings, to improve team dynamics and reduce errors. We adapted a CRM process for implementation in the trauma resuscitation area. An interdisciplinary steering committee developed our CRM process to include a didactic classroom program based on a preimplementation survey of our trauma team members. Implementation with new cultural and process expectations followed. The Human Factors Attitude Survey and Communication and Teamwork Skills assessment tool were used to design, evaluate, and validate our CRM program. The initial trauma communication survey was completed by 160 team members (49% response). Twenty-five trauma resuscitations were observed and scored using Communication and Teamwork Skills. Areas of concern were identified and 324 staff completed our 3-hour CRM course during a 3-month period. After CRM training, 132 communication surveys and 38 Communication and Teamwork Skills observations were completed. In the post-CRM survey, respondents indicated improvement in accuracy of field to medical command information (p = 0.029); accuracy of emergency department medical command information to the resuscitation area (p = 0.002); and team leader identity, communication of plan, and role assignment (p = 0.001). After CRM training, staff were more likely to speak up when patient safety was a concern (p = 0.002). Crew Resource Management in the trauma resuscitation area enhances team dynamics, communication, and, ostensibly, patient safety. Philosophy and culture of CRM should be compulsory components of trauma programs and in resuscitation of injured patients. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Trauma leadership: does perception drive reality?

PubMed

Sakran, Joseph V; Finneman, Bo; Maxwell, Chris; Sonnad, Seema S; Sarani, Babak; Pascual, Jose; Kim, Patrick; Schwab, C William; Sims, Carrie

2012-01-01

Leadership plays a key role in trauma team management and might affect the efficiency of patient care. Our hypothesis was that a positive relationship exists between the trauma team members' perception of leadership and the efficiency of the injured patient's initial evaluation. We conducted a prospective observational study evaluating trauma attending leadership (TAL) over 5 months at a level 1 trauma center. After the completion of patient care, trauma team members evaluated the TAL's ability using a modified Campbell Leadership Descriptor Survey tool. Scores ranged from 18 (ineffective leader) to 72 (perfect score). Clinical efficiency was measured prospectively by recording the time needed to complete an advanced trauma life support (ATLS)-directed resuscitation. Assessment times across Leadership score groups were compared using Kruskal-Wallis and Mann-Whitney tests (p < 0.05, statistically significant). Seven attending physicians were included with a postfellowship experience ranging from ≤1 to 11 years. The average leadership score was 59.8 (range, 27-72). Leadership scores were divided into 3 groups post facto: low (18-45), medium (46-67), and high (68-72). The teams directed by surgeons with low scores took significantly longer than teams directed by surgeons with high scores to complete the secondary survey (14 ± 4 minutes in contrast to 11 ± 2 minutes, p < 0.009) and to transport the patient for CT evaluation (19 ± 5 minutes in contrast to 14 ± 4 minutes; p < 0.001). Attending surgeon experience also affected clinical efficiency with teams directed by less experienced surgeons taking significantly longer to complete the primary survey (p < 0.05). The trauma team's perception of leadership is associated positively with clinical efficiency. As such, more formal leadership training could potentially improve patient care and should be included in surgical education. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Compliance with barrier precautions during paediatric trauma resuscitations.

PubMed

Kelleher, Deirdre C; Carter, Elizabeth A; Waterhouse, Lauren J; Burd, Randall S

2013-03-01

Barrier precautions protect patients and providers from blood-borne pathogens. Although barrier precaution compliance has been shown to be low among adult trauma teams, it has not been evaluated during paediatric resuscitations in which perceived risk of disease transmission may be low. The purpose of this study was to identify factors associated with compliance with barrier precautions during paediatric trauma resuscitations. Video recordings of resuscitations performed on injured children (<18 years old) were reviewed to determine compliance with an established policy requiring gowns and gloves. Depending on activation level, trauma team members included up to six physicians, four nurses, and a respiratory therapist. Multivariate logistic regression was used to determine the effect of team role, resuscitation factors, and injury mechanism on barrier precaution compliance. Over twelve weeks, 1138 trauma team members participated in 128 resuscitations (4.7% penetrating injuries, 9.4% highest level activations). Compliance with barrier precautions was 81.3%, with higher compliance seen among roles primarily at the bedside compared to positions not primarily at the bedside (90.7% vs. 65.1%, p<0.001). Bedside residents (98.4%) and surgical fellows (97.6%) had the highest compliance, while surgical attendings (20.8%) had the lowest (p<0.001). Controlling for role, increased compliance was observed during resuscitations of patients with penetrating injuries (OR=3.97 [95% CI: 1.35-11.70], p=0.01), during resuscitations triaged to the highest activation level (OR=2.61 [95% CI: 1.34-5.10], p=0.005), and among team members present before patient arrival (OR=4.14 [95% CI: 2.29-7.39], p<0.001). Compliance with barrier precautions varies by trauma team role. Team members have higher compliance when treating children with penetrating and high acuity injuries and when arriving before the patient. Interventions integrating barrier precautions into the workflow of team members are needed to reduce this variability and improve compliance with universal precautions during paediatric trauma resuscitations. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Leadership and Teamwork in Trauma and Resuscitation

PubMed Central

Ford, Kelsey; Menchine, Michael; Burner, Elizabeth; Arora, Sanjay; Inaba, Kenji; Demetriades, Demetrios; Yersin, Bertrand

2016-01-01

Introduction Leadership skills are described by the American College of Surgeons’ Advanced Trauma Life Support (ATLS) course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders. Methods We searched the PubMed database using the keywords “leadership” and then either “trauma” or “resuscitation” as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1) how leadership affects patient care; 2) which tools are available to measure leadership; and 3) methods to train physicians to become better leaders. Results We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS) is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ) was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs included didactic teaching followed by simulations. Although programs differed in length, intensity, and training level of participants, all programs demonstrated improved team performance. Conclusion Despite the relative paucity of literature on leadership in resuscitations, this review found leadership improves processes of care in trauma and can be enhanced through dedicated training. Future research is needed to validate leadership assessment scales, develop optimal training mechanisms, and demonstrate leadership’s effect on patient-level outcome. PMID:27625718

Examining participant perceptions of an interprofessional simulation-based trauma team training for medical and nursing students.

PubMed

Jakobsen, Rune Bruhn; Gran, Sarah Frandsen; Grimsmo, Bergsvein; Arntzen, Kari; Fosse, Erik; Frich, Jan C; Hjortdahl, Per

2018-01-01

High quality care relies on interprofessional teamwork. We developed a short simulation-based course for final year medical, nursing and nursing anaesthesia students, using scenarios from emergency medicine. The aim of this paper is to describe the adaptation of an interprofessional simulation course in an undergraduate setting and to report participants' experiences with the course and students' learning outcomes. We evaluated the course collecting responses from students through questionnaires with both closed-ended and open-ended questions, supplemented by the facilitators' assessment of students' performance. Our data is based on responses from 310 students and 16 facilitators who contributed through three evaluation phases. In the analysis, we found that students reported emotional activation and learning outcomes within the domains self-insight and stress management, understanding of the leadership role, insight into teamwork, and skills in team communication. In subsequent questionnaire studies students reported having gained insights about communication, teamwork and leadership, and they believed they would be better leaders of teams and/or team members after having completed the course. Facilitators' observations suggested a progress in students' non-technical skills during the course. The facilitators observed that nursing anaesthesia students seemed to be more comfortable in finding their role in the team than the two other groups. In conclusion, we found that an interprofessional simulation-based emergency team training course with a focus on leadership, communication and teamwork, was feasible to run on a regular basis for large groups of students. The course improved the students' team skills and received a favourable evaluation from both students and faculty.

Traumatic atlantooccipital dislocation injury in children.

PubMed

Nichols, J; West, J S

1994-10-01

The tragedy of trauma turns into triumph when the surgery team members' efforts result in victory for the patient. Nowhere is this more true than in successful pediatric trauma care. Giving a child a second chance at life and the family an opportunity for a new beginning is the highest reward for the trauma team's years of professional training and practice. Traumatic atlantoocipital dislocation injury usually results in death, but recent neurosurgery trauma advances are increasing pediatric survival rates.

Factors associated with delay in trauma team activation and impact on patient outcomes.

PubMed

Connolly, Rory; Woo, Michael Y; Lampron, Jacinthe; Perry, Jeffrey J

2017-09-05

Trauma code activation is initiated by emergency physicians using physiological and anatomical criteria, mechanism of injury, and patient demographic factors. Our objective was to identify factors associated with delayed trauma team activation. We assessed consecutive cases from a regional trauma database from January 2008 to March 2014. We defined a delay in trauma code activation as a time greater than 30 minutes from the time of arrival. We conducted univariate analysis for factors potentially influencing trauma team activation, and we subsequently used multiple logistic regression analysis models for delayed activation in relation to mortality, length of stay, and time to operative management. Patients totalling 846 were included for our analysis; 4.1% (35/846) of trauma codes were activated after 30 minutes. Mean age was 40.8 years in the early group versus 49.2 in the delayed group (p=0.01). Patients were over age 70 years in 7.6% in the early activation group versus 17.1% in the delayed group (p=0.04). There was no significant difference in sex, type of injury, injury severity, or time from injury between the two groups. There was no significant difference in mortality, median length of stay, or median time to operative management. Delayed activation is linked with increasing age with no clear link to increased mortality. Given the severe injuries in the delayed cohort that required activation of the trauma team, further emphasis on the older trauma patient and interventions to recognize this vulnerable population should be made.

Blunt chest trauma in a non-specialist centre: Right treatment, right place?

PubMed

Maher, Lesley; Jayathissa, Sisira

2016-12-01

To compare patient characteristics, management and outcomes for patients admitted with isolated blunt chest trauma, managed by medical or surgical teams. We reviewed adult patients admitted with blunt chest trauma between 1 September 2006 and 31 August 2011 to a secondary hospital in New Zealand. Inclusion criteria were: blunt chest trauma, with at least one radiologically demonstrated rib fracture. The primary outcome was in-hospital mortality, and secondary outcomes were development of pneumonia, and use of analgesia. Seventy-two patients were included. Thirty-three patients were managed by medical teams and 39 by surgical teams. In-hospital mortality was greater amongst medical patients 5/33 (15%) versus surgical 0/39 (0%); P = 0.012. Pneumonia occurred in 15/33 (45%); medical patients versus surgical 2/39 (5%), P <0.001. Use of epidural, regional or patient-controlled analgesia was greater in the group managed by surgical teams (12/39 [30.7%] vs 1/33 [3%] P = 0.002). Medically managed patients were older (median 73 vs 63 years; P = 0.02), had a higher Charlson Comorbidity Index (median 5 vs 3; P = 0.013). The mechanism of injury for medically managed patients was more likely to be low trauma fall compared to surgically managed patients (28/33 [85%] vs 9/39 [27%]; P <0.0001). Amongst patients with isolated blunt chest trauma, those managed by medical teams were older, had more comorbidities and were more likely to have become injured with a low trauma fall than those managed by surgical teams. They had less access to analgesic options, developed pneumonia more often and had higher mortality. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

A stratified response system for the emergency management of the severely injured.

PubMed

Lloyd, D A; Patterson, M; Robson, J; Phillips, B

2001-01-01

A decade ago, there were justifiable criticisms of the delivery of emergency care for injured patients in accident and emergency departments in the UK. To address this, a trauma management system was developed in 1991 at Alder Hey Hospital, Liverpool. This includes a trauma team, communication system, management guidelines and quality assurance. On admission to the accident and emergency department, injured patients are triaged to one of three levels of injury severity, and a multidisciplinary team lead by a paediatric surgeon or senior accident and emergency department physician is activated. The level of injury severity determines the composition of the trauma team. A care pathway based on ATLS/APLS principles has been developed. The response process as well patient management are documented and reviewed at a monthly audit meeting. Currently, more than 80% of eligible patients are managed using the trauma system, with an over-triage rate of about 25%. Regular modifications to the trauma system since its inception in 1991 have resulted in an efficient and effective management structure. Stratification of the trauma response has minimised unnecessary use of the multidisciplinary trauma team and ensures that mobilisation and use of hospital staff and resources are tailored to the needs of the injured patient. Although developed in a specialist children's hospital, the system could be adapted for any acute hospital.

Implementation of recommended trauma system criteria in south-eastern Norway: a cross-sectional hospital survey.

PubMed

Kristiansen, Thomas; Ringdal, Kjetil G; Skotheimsvik, Tarjei; Salthammer, Halvor K; Gaarder, Christine; Naess, Pål A; Lossius, Hans M

2012-01-26

Formalized trauma systems have shown beneficial effects on patient survival and have harvested great recognition among health care professionals. In spite of this, the implementation of trauma systems is challenging and often met with resistance.Recommendations for a national trauma system in Norway were published in 2007. We wanted to assess the level of implementation of these recommendations. A survey of all acute care hospitals that receive severely injured patients in the south-eastern health region of Norway was conducted. A structured questionnaire based on the 2007 national recommendations was used in a telephone interview of hospital trauma personnel between January 17 and 21, 2011. Seventeen trauma system criteria were identified from the recommendations. Nineteen hospitals were included in the study and these received more than 2000 trauma patients annually via their trauma teams. Out of the 17 criteria that had been identified, the hospitals fulfilled a median of 12 criteria. Neither the size of the hospitals nor the distance between the hospitals and the regional trauma centre affected the level of trauma resources available. The hospitals scored lowest on the criteria for transfer of patients to higher level of care and on the training requirements for members of the trauma teams. Our study identifies a major shortcoming in the efforts of regionalizing trauma in our region. The findings indicate that training of personnel and protocols for inter-hospital transfer are the major deficiencies from the national trauma system recommendations. Resources for training of personnel partaking in trauma teams and development of inter-hospital transfer agreements should receive immediate attention.

Interprofessional teamwork in the trauma setting: a scoping review

PubMed Central

2013-01-01

Approximately 70 to 80% of healthcare errors are due to poor team communication and understanding. High-risk environments such as the trauma setting (which covers a broad spectrum of departments in acute services) are where the majority of these errors occur. Despite the emphasis on interprofessional collaborative practice and patient safety, interprofessional teamworking in the trauma setting has received little attention. This paper presents the findings of a scoping review designed to identify the extent and nature of this literature in this setting. The MEDLINE (via OVID, using keywords and MeSH in OVID), and PubMed (via NCBI using MeSH), and CINAHL databases were searched from January 2000 to April 2013 for results of interprofessional teamworking in the trauma setting. A hand search was conducted by reviewing the reference lists of relevant articles. In total, 24 published articles were identified for inclusion in the review. Studies could be categorized into three main areas, and within each area were a number of themes: 1) descriptions of the organization of trauma teams (themes included interaction between team members, and leadership); 2) descriptions of team composition and structure (themes included maintaining team stability and core team members); and 3) evaluation of team work interventions (themes included activities in practice and activities in the classroom setting). Descriptive studies highlighted the fluid nature of team processes, the shared mental models, and the need for teamwork and communication. Evaluative studies placed a greater emphasis on specialized roles and individual tasks and activities. This reflects a multiprofessional as opposed to an interprofessional model of teamwork. Some of the characteristics of high-performing interprofessional teams described in this review are also evident in effective teams in the community rehabilitation and intermediate care setting. These characteristics may well be pertinent to other settings, and so provide a useful foundation for future investigations. PMID:24188523

Exposing Compassion Fatigue and Burnout Syndrome in a Trauma Team: A Qualitative Study.

PubMed

Berg, Gina M; Harshbarger, Jenni L; Ahlers-Schmidt, Carolyn R; Lippoldt, Diana

2016-01-01

Compassion fatigue (CF) and burnout syndrome (BOS) are identified in trauma, emergency, and critical care nursing practices. The purpose of this qualitative study was to measure CF and BOS in a trauma team and allow them to share perceptions of related stress triggers and coping strategies. Surveys to measure CF and BOS and a focus group allowed a trauma team (12 practitioners) to share perceptions of related stress triggers and coping strategies. More than half scored at risk for CF and BOS. Stress triggers were described as situation (abuse, age of patient) versus injury-related. Personal coping mechanisms were most often reported. Both CF and BOS can be assessed with a simple survey tool. Strategies for developing a program culturally sensitive to CF and BOS are provided.

Assessment of the trauma evaluation and management (TEAM) module in Australia.

PubMed

Ali, Jameel; Danne, Peter; McColl, Geoff

2004-08-01

To assess the immediate effect on trauma-related knowledge of the trauma evaluation and management (TEAM) program applied to medical students in Australia. 73 final year medical students from Melbourne were randomly assigned to two experimental groups (E1 and E2 who completed the TEAM program after a 20 item MCQ pre-test on trauma resuscitation and a second MCQ exam after the TEAM program) and two control groups (C1 and C2 who completed the pre- and post-MCQ exams before completing the TEAM module). All 73 students completed an evaluation questionnaire. Paired and unpaired t-tests were used for within and between groups comparisons. Groups C1 and C2 had similar mean scores in pre- and post-tests ranging from 57.2 to 60.5%. Groups E1 and E2 had similar pre-test scores but increased their post-test scores (pre-test range 53.8-57.1% and post-test 68.8-77.4%, P < 0.05). On a scale of 1-5 with five being the highest, a score of four or greater was assigned by over 74% of the students that the objectives were met, over 80% that trauma knowledge was improved, 25-40% that clinical skills were improved with over 74% overall satisfaction. Over 75% assigned a score of four or greater suggesting the module be mandatory. After the TEAM program there was significant improvement in cognitive skills. The students strongly supported its introduction in the undergraduate curriculum.

Implementation of recommended trauma system criteria in south-eastern Norway: a cross-sectional hospital survey

PubMed Central

2012-01-01

Background Formalized trauma systems have shown beneficial effects on patient survival and have harvested great recognition among health care professionals. In spite of this, the implementation of trauma systems is challenging and often met with resistance. Recommendations for a national trauma system in Norway were published in 2007. We wanted to assess the level of implementation of these recommendations. Methods A survey of all acute care hospitals that receive severely injured patients in the south-eastern health region of Norway was conducted. A structured questionnaire based on the 2007 national recommendations was used in a telephone interview of hospital trauma personnel between January 17 and 21, 2011. Seventeen trauma system criteria were identified from the recommendations. Results Nineteen hospitals were included in the study and these received more than 2000 trauma patients annually via their trauma teams. Out of the 17 criteria that had been identified, the hospitals fulfilled a median of 12 criteria. Neither the size of the hospitals nor the distance between the hospitals and the regional trauma centre affected the level of trauma resources available. The hospitals scored lowest on the criteria for transfer of patients to higher level of care and on the training requirements for members of the trauma teams. Conclusion Our study identifies a major shortcoming in the efforts of regionalizing trauma in our region. The findings indicate that training of personnel and protocols for inter-hospital transfer are the major deficiencies from the national trauma system recommendations. Resources for training of personnel partaking in trauma teams and development of inter-hospital transfer agreements should receive immediate attention. PMID:22281020

The role of physician staffing of helicopter emergency medical services in prehospital trauma response.

PubMed

Garner, Alan A

2004-08-01

The crewing of Helicopter Emergency Medical Service (HEMS) for scene response to trauma patients is generally considered to be controversial, particularly regarding the role of physicians. This is reflected in HEMS in Australia with some services utilizing physician crewing for all prehospital missions. Others however, use physicians for selected missions only whilst others do not use physicians at all. This review seeks to determine whether the literature supports using physicians in addition to paramedics in HEMS teams for prehospital trauma care. Studies were excluded if they compared physician teams with basic life support teams (BLS) teams rather than paramedics. Ambulance officers were considered to be paramedics where they were able to administer intravenous fluids and use a method of airway management beyond bag-valve-mask ventilation. Studies were excluded if the skill set of the ambulance team was not defined, the level of staffing of the helicopter service was not stated, team composition varied without reporting outcomes for each team type, patient outcome data were not reported, or the majority of the transports were interhospital rather than prehospital transports.

Trauma team utilization of universal precautions: if you see something, say something.

PubMed

Peponis, T; Cropano, M C; Larentzakis, A; van der Wilden, M G; Mejaddam, Y A; Sideris, C A; Michailidou, M; Fikry, K; Bramos, A; Janjua, S; Chang, Y; King, D R

2017-02-01

The risks deriving from the lack of compliance with universal safety precautions (USPs) are unequivocal. However, the adoption of these prophylactic precautions by healthcare providers remains unacceptably low. We hypothesized that trauma teams are not routinely adhering to USPs and that a brief educational intervention, followed by real-time peer feedback, would substantially improve compliance rates. This before-and-after interventional study took place in the resuscitation bay of a Level I Trauma Center during trauma team activations. Six USPs were examined: hand washing (before and after patient contact), use of gloves, gowns, eye protection, and masks. Surgery and Emergency Medicine attending physicians, residents, and nurses, who had direct patient contact, were included. Following 162 baseline observations, an educational intervention in the form of brief lectures was conducted, emphasizing the danger to self from dereliction of USPs. Subsequently, 167 post-intervention observations were made after a one-month period of knowledge decay. Finally, real-time feedback was provided by trauma team leaders and study staff. Adherence to prophylactic measures was recorded again. Baseline compliance rates were dismal. Only hand washing prior to patient interaction, the use of eye protection, and the use of masks improved significantly (p < 0.05) after the educational initiative. However, compliance rates remained suboptimal. No difference was noted regarding the three other USPs. Impressively, following real-time behavioral corrections, compliance improved to nearly 90 % for all USPs (p < 0.05). Compliance with OSHA-required USPs during trauma team activations is unacceptably low, but can be dramatically improved through simple educational interventions, combined with real-time peer feedback.

Flexible knowledge repertoires: communication by leaders in trauma teams

PubMed Central

2012-01-01

Background In emergency situations, it is important for the trauma team to efficiently communicate their observations and assessments. One common communication strategy is “closed-loop communication”, which can be described as a transmission model in which feedback is of great importance. The role of the leader is to create a shared goal in order to achieve consensus in the work for the safety of the patient. The purpose of this study was to analyze how formal leaders communicate knowledge, create consensus, and position themselves in relation to others in the team. Methods Sixteen trauma teams were audio- and video-recorded during high fidelity training in an emergency department. Each team consisted of six members: one surgeon or emergency physician (the designated team leader), one anaesthesiologist, one nurse anaesthetist, one enrolled nurse from the theatre ward, one registered nurse and one enrolled nurse from the emergency department (ED). The communication was transcribed and analyzed, inspired by discourse psychology and Strauss’ concept of “negotiated order”. The data were organized and coded in NVivo 9. Results The findings suggest that leaders use coercive, educational, discussing and negotiating strategies to work things through. The leaders in this study used different repertoires to convey their knowledge to the team, in order to create a common goal of the priorities of the work. Changes in repertoires were dependent on the urgency of the situation and the interaction between team members. When using these repertoires, the leaders positioned themselves in different ways, either on an authoritarian or a more egalitarian level. Conclusion This study indicates that communication in trauma teams is complex and consists of more than just transferring messages quickly. It also concerns what the leaders express, and even more importantly, how they speak to and involve other team members. PMID:22747848

11.361 sports injuries in a 15-year survey of a Level I emergency trauma department reveal different severe injury types in the 6 most common team sports.

PubMed

Krutsch, Werner; Krutsch, Volker; Hilber, Franz; Pfeifer, Christian; Baumann, Florian; Weber, Johannes; Schmitz, Paul; Kerschbaum, Maximilian; Nerlich, Michael; Angele, Peter

2018-06-01

 Severe sports-related injuries are a common affliction treated in Level I trauma departments. Detailed knowledge on injury characteristics from different medical settings is essential to improve the development of injury prevention strategies in different team sports.  Team sport injuries were retrospectively analysed in a Level I trauma department registry over 15 years. Injury and treatment data were compared with regard to competition and training exposure. Injury data such as "time of visitation", "type of injury", "multiple injured body regions" and "immediate hospitalisation" helped to define the severity level of each team sports injury.  At the Level I trauma department, 11.361 sports-related injuries were seen over 15 years, of which 34.0 % were sustained during team sports. Soccer injuries were the most common injuries of all team sports (71.4 %). The lower extremity was the most affected body region overall, followed by the upper extremity. Head injuries were mainly seen in Ice hockey and American football and concussion additionally frequently in team handball. Slight injuries like sprains or contusions occurred most frequently in all team sports. In soccer and team handball, injuries sustained in competition were significantly more severe (p < 0.001) than those sustained in practice.Volleyball and basketball had a trend to higher rate of severe injuries sustained during practice sessions.  Depending on the specific injury profile of each team sports, injury prevention strategies should address competitive as well as training situations, whichmay need different strategies. © Georg Thieme Verlag KG Stuttgart · New York.

Multiple trauma in children: critical care overview.

PubMed

Wetzel, Randall C; Burns, R Cartland

2002-11-01

Multiple trauma is more than the sum of the injuries. Management not only of the physiologic injury but also of the pathophysiologic responses, along with integration of the child's emotional and developmental needs and the child's family, forms the basis of trauma care. Multiple trauma in children also elicits profound psychological responses from the healthcare providers involved with these children. This overview will address the pathophysiology of multiple trauma in children and the general principles of trauma management by an integrated trauma team. Trauma is a systemic disease. Multiple trauma stimulates the release of multiple inflammatory mediators. A lethal triad of hypothermia, acidosis, and coagulopathy is the direct result of trauma and secondary injury from the systemic response to trauma. Controlling and responding to the secondary pathophysiologic sequelae of trauma is the cornerstone of trauma management in the multiply injured, critically ill child. Damage control surgery is a new, rational approach to the child with multiple trauma. The selection of children for damage control surgery depends on the severity of injury. Major abdominal vascular injuries and multiple visceral injuries are best considered for this approach. The effective management of childhood multiple trauma requires a combined team approach, consideration of the child and family, an organized trauma system, and an effective quality assurance and improvement mechanism.

Trauma team activation criteria in managing trauma patients at an emergency room in Thailand.

PubMed

Wuthisuthimethawee, P

2017-02-01

Trauma team activation (TTA) criteria were first implemented in the Emergency Department (ED) of Songklanagarind Hospital in 2009 to treat severe trauma patients. To determine the efficacy of the TTA criteria on the acute trauma care process in the ED and the 28-day mortality rate. A 1-year prospective cohort study was conducted at the ED. Trauma patients who were 18 years old and over who met the TTA criteria were enrolled. Demographic data, physiologic parameters, ED length of stay (EDLOS), and the injury severity score (ISS) were recorded. Multiple logistic regression was used to determine the factors affecting 28-day mortality. Institutional review board approval was obtained from the Prince of Songkla University. A total of 80 patients (74 male and 6 female) were eligible with a mean age of 34.3 years old. Shock, penetrating torso injury, and pulse rate >120 beats per minute were the three most common criteria for trauma team consultation. At the ED, 9 patients (11.3 %) were non-survivors, 30 patients (37.5 %) needed immediate operation, and 41 patients (51.2 %) were admitted. All of the arrest patients died (p < 0.0001). The median time of EDLOS was 85 min: 68 min in the non-survivor group and 120 min in the survivor group (p = 0.028). The median ISS was 21.0 (1-75): 25.0 in the non-survivor group and 17.0 in the survivor group. When compared with pilot data prior to TTA implementation, the median time of EDLOS improved from 184 to 85 min and the 28-day mortality rate decreased from 66.7 to 46.3 %. The high ISS was a predictor of death. The trauma team activation criteria improved acute trauma care in the ED which was demonstrated by the decreased EDLOS and mortality rate. A high ISS is the sole parameter predicting mortality.

Integrating technical and non-technical skills coaching in an acute trauma surgery team training: Is it too much?

PubMed

Alken, Alexander; Luursema, Jan-Maarten; Weenk, Mariska; Yauw, Simon; Fluit, Cornelia; van Goor, Harry

2017-08-25

Research on effective integration of technical and non-technical skills in surgery team training is sparse. In a previous study we found that surgical teachers predominantly coached on technical and hardly on non-technical skills during the Definitive Surgical and Anesthetic Trauma Care (DSATC) integrated acute trauma surgery team training. This study aims to investigate whether the priming of teachers could increase the amount of non-technical skills coaching during such a training. Coaching activities of 12 surgical teachers were recorded on audio and video. Six teachers were primed on non-technical skills coaching prior to the training. Six others received no priming and served as controls. Blind observers reviewed the recordings of 2 training scenario's and scored whether the observed behaviors were directed on technical or non-technical skills. We compared the frequency of the non-technical skills coaching between the primed and the non-primed teachers and analyzed for differences according to the trainees' level of experience. Surgical teachers coached trainees during the highly realistic DSATC integrated acute trauma surgery team training. Trainees performed damage control surgery in operating teams on anesthetized porcine models during 6 training scenario's. Twelve experienced surgical teachers participated in this study. Coaching on non-technical skills was limited to about 5%. The primed teachers did not coach more often on non-technical skills than the non-primed teachers. We found no differences in the frequency of non-technical skills coaching based on the trainees' level of experience. Priming experienced surgical teachers does not increase the coaching on non-technical skills. The current DSATC acute trauma surgery team training seems too complex for integrating training on technical and non-technical skills. Patient care, Practice based learning and improvement. Copyright © 2017 Elsevier Inc. All rights reserved.

A pilot study to evaluate the utility of live training (LIVEX) in the operational preparedness of UK military trauma teams.

PubMed

Smith, J E; Withnall, R D J; Rickard, R F; Lamb, D; Sitch, A; Hodgetts, T J

2016-12-01

With the end of UK military operations in Iraq and Afghanistan, it is essential that peacetime training of Defence Medical Services (DMS) trauma teams ensures appropriate future preparedness. A new model of pre-deployment training involves placement of formed military trauma teams into civilian trauma centres. This study evaluates the benefit of 'live training during an exercise period' (LIVEX) for DMS trauma teams. A cross-sectional questionnaire-based survey of participants was conducted. Quantitative data were collected prior to the start and on the final day. Written reports were collected from the coordinators. Thematic analysis was used to identify emergent themes in a supplementary, qualitative analysis. Each team comprised 13 personnel and results should be interpreted with knowledge of this small sample size. The response rate for both the pre-LIVEX and post-LIVEX questionnaire was 100%. By the end of the week, 89% of participants (n=23) stated LIVEX was an 'appropriate or very appropriate' way of preparing for an operational role compared with 40% (n=9) before the exercise (p<0.01). However, completing LIVEX made no difference to participants' personal perception of their own operational preparedness. Thematic analysis suggested greater training benefit for more junior members of the team; from Regulars and Reservists training together; and from two-way exchange of information between DMS and National Health Service medical staffs. Completing LIVEX made no statistically significant difference to participants' personal perception of their own operational preparedness, but the perception of LIVEX as an appropriate training platform improved significantly after conducting the training exercise. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Implementing a Trauma-Informed Model of Care in a Community Acute Mental Health Team.

PubMed

Moloney, Bill; Cameron, Ian; Baker, Ashley; Feeney, Johanna; Korner, Anthony; Kornhaber, Rachel; Cleary, Michelle; McLean, Loyola

2018-04-12

In this paper, we demonstrate the value of implementing a Trauma-Informed Model of Care in a Community Acute Mental Health Team by providing brief intensive treatment (comprising risk interventions, brief counselling, collaborative formulation and pharmacological treatment). The team utilised the Conversational Model (CM), a psychotherapeutic approach for complex trauma. Key features of the CM are described in this paper using a clinical case study. The addition of the Conversational Model approach to practice has enabled better understandings of consumers' capacities and ways to then engage, converse, and intervene. The implementation of this intervention has led to a greater sense of self-efficacy amongst clinicians, who can now articulate a clear counselling model of care.

Efficacy of a two-tiered trauma team activation protocol in a Norwegian trauma centre.

PubMed

Rehn, M; Lossius, H M; Tjosevik, K E; Vetrhus, M; Østebø, O; Eken, T

2012-02-01

A registry-based analysis revealed imprecise informal one-tiered trauma team activation (TTA) in a primary trauma centre. A two-tiered TTA protocol was introduced and analysed to examine its impact on triage precision and resource utilization. Interhospital transfers and patients admitted by non-healthcare personnel were excluded. Undertriage was defined as the fraction of major trauma victims (New Injury Severity Score over 15) admitted without TTA. Overtriage was the fraction of TTA without major trauma. Of 1812 patients, 768 had major trauma. Overall undertriage was reduced from 28·4 to 19·1 per cent (P < 0·001) after system revision. Overall overtriage increased from 61·5 to 71·6 per cent, whereas the mean number of skilled hours spent per overtriaged patient was reduced from 6·5 to 3·5 (P < 0·001) and the number of skilled hours spent per major trauma victim was reduced from 7·4 to 7·1 (P < 0·001). Increasing age increased risk for undertriage and decreased risk for overtriage. Falls increased risk for undertriage and decreased risk for overtriage, whereas motor vehicle-related accidents showed the opposite effects. Patients triaged to a prehospital response involving an anaesthetist had less chance of both undertriage and overtriage. A two-tiered TTA protocol was associated with reduced undertriage and increased overtriage, while trauma team resource consumption was reduced. NCT00876564 (http://www.clinicaltrials.gov). Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Teamwork skills in actual, in situ, and in-center pediatric emergencies: performance levels across settings and perceptions of comparative educational impact.

PubMed

Couto, Thomaz Bittencourt; Kerrey, Benjamin T; Taylor, Regina G; FitzGerald, Michael; Geis, Gary L

2015-04-01

Pediatric emergencies require effective teamwork. These skills are developed and demonstrated in actual emergencies and in simulated environments, including simulation centers (in center) and the real care environment (in situ). Our aims were to compare teamwork performance across these settings and to identify perceived educational strengths and weaknesses between simulated settings. We hypothesized that teamwork performance in actual emergencies and in situ simulations would be higher than for in-center simulations. A retrospective, video-based assessment of teamwork was performed in an academic, pediatric level 1 trauma center, using the Team Emergency Assessment Measure (TEAM) tool (range, 0-44) among emergency department providers (physicians, nurses, respiratory therapists, paramedics, patient care assistants, and pharmacists). A survey-based, cross-sectional assessment was conducted to determine provider perceptions regarding simulation training. One hundred thirty-two videos, 44 from each setting, were reviewed. Mean total TEAM scores were similar and high in all settings (31.2 actual, 31.1 in situ, and 32.3 in-center, P = 0.39). Of 236 providers, 154 (65%) responded to the survey. For teamwork training, in situ simulation was considered more realistic (59% vs. 10%) and more effective (45% vs. 15%) than in-center simulation. In a video-based study in an academic pediatric institution, ratings of teamwork were relatively high among actual resuscitations and 2 simulation settings, substantiating the influence of simulation-based training on instilling a culture of communication and teamwork. On the basis of survey results, providers favored the in situ setting for teamwork training and suggested an expansion of our existing in situ program.

Open Tibia Shaft Fractures and Soft-Tissue Coverage: The Effects of Management by an Orthopaedic Microsurgical Team.

PubMed

VandenBerg, James; Osei, Daniel; Boyer, Martin I; Gardner, Michael J; Ricci, William M; Spraggs-Hughes, Amanda; McAndrew, Christopher M

2017-06-01

To compare the timing of soft-tissue (flap) coverage and occurrence of complications before and after the establishment of an integrated orthopaedic trauma/microsurgical team. Retrospective cohort study. A single level 1 trauma center. Twenty-eight subjects (13 pre- and 15 post-integration) with open tibia shaft fractures (OTA/AO 42A, 42B, and 42C) treated with flap coverage between January 2009 and March 2015. Flap coverage for open tibia shaft fractures treated before ("preintegration") and after ("postintegration") implementation of an integrated orthopaedic trauma/microsurgical team. Time from index injury to flap coverage. The unadjusted median time to coverage was 7 days (95% confidence interval, 5.9-8.1) preintegration, and 6 days (95% confidence interval, 4.6-7.4) postintegration (P = 0.48). For preintegration, 9 (69%) of the patients experienced complications, compared with 7 (47%) postintegration (P = 0.23). After formation of an integrated orthopaedic trauma/microsurgery team, we observed a 1-day decrease in median days to coverage from index injury. Complications overall were lowered in the postintegration group, although statistically insignificant. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

"It takes a village" to raise research productivity: Impact of a Trauma Interdisciplinary Group for Research (TIGR) at an urban, Level 1 trauma center.

PubMed

Nesmith, Elizabeth G; Medeiros, Regina S; Ferdinand, Colville H B; Hawkins, Michael L; Holsten, Steven B; Dong, Yanbin; Zhu, Haidong

2013-07-01

Few interdisciplinary research groups include basic scientists, pharmacists, therapists, nutritionists, lab technicians, as well as trauma patients and families, in addition to clinicians. Increasing interprofessional diversity within scientific teams working to improve trauma care is a goal of national organizations and federal funding agencies like the National Institutes of Health (NIH). This paper describes the design, implementation, and outcomes of a Trauma Interdisciplinary Group for Research (TIGR) at a Level 1 trauma center as it relates to increasing research productivity, with specific examples excerpted from an on-going NIH-funded study. We utilized a pre-test/post-test design with objectives aimed at measuring increases in research productivity following a targeted intervention. A SWOT (strengths, weaknesses, opportunities, threats) analysis was used to develop the intervention which included research skill-building activities, accomplished by adding multidisciplinary investigators to an existing NIH-funded project. The NIH project aimed to test the hypothesis that accelerated biologic aging from chronic stress increases baseline inflammation and reduces inflammatory response to trauma (projected N=150). Pre/Post-TIGR data related to participant screening, recruitment, consent, and research processes were compared. Research productivity was measured through abstracts, publications, and investigator-initiated projects. Research products increased from N =12 to N=42; (~ 400%). Research proposals for federal funding increased from N=0 to N=3, with success rate of 66%. Participant screenings for the NIH-funded study increased from N=40 to N=313. Consents increased from N=14 to N=70. Lab service fees were reduced from $300/participant to $5/participant. Adding diversity to our scientific team via TIGR was exponentially successful in 1) improving research productivity, 2) reducing research costs, and 3) increasing research products and mentoring activities that the team prior to TIGR had not entertained. The team is now well-positioned to apply for more federally funded projects and more trauma clinicians are considering research careers than before.

"It takes a village" to raise research productivity: impact of a Trauma Interdisciplinary Group for Research at an urban, Level 1 trauma center.

PubMed

NeSmith, Elizabeth G; Medeiros, Regina S; Ferdinand, Colville H B; Hawkins, Michael L; Holsten, Steven B; Zhu, Haidong; Dong, Yanbin

2013-07-01

Few interdisciplinary research groups include basic scientists, pharmacists, therapists, nutritionists, laboratory technicians, as well as trauma patients and families, in addition to clinicians. Increasing interprofessional diversity within scientific teams working to improve trauma care is a goal of national organizations and federal funding agencies such as the National Institutes of Health (NIH). This article describes the design, implementation, and outcomes of a Trauma Interdisciplinary Group for Research (TIGR) at a Level 1 trauma center as it relates to increasing research productivity, with specific examples excerpted from an ongoing NIH-funded study. We used a pretest/posttest design with objectives aimed at measuring increases in research productivity following a targeted intervention. A SWOT (strengths, weaknesses, opportunities, and threats) analysis was used to develop the intervention, which included research skill-building activities, accomplished by adding multidisciplinary investigators to an existing NIH-funded project. The NIH project aimed to test the hypothesis that accelerated biologic aging from chronic stress increases baseline inflammation and reduces inflammatory response to trauma (projected n = 150). Pre-TIGR/post-TIGR data related to participant screening, recruitment, consent, and research processes were compared. Research productivity was measured through abstracts, publications, and investigator-initiated projects. Research products increased from 12 to 42 (approximately 400%). Research proposals for federal funding increased from 0 to 3, with success rate of 66%. Participant screenings for the NIH-funded study increased from 40 to 313. Consents increased from 14 to 70. Laboratory service fees were reduced from $300 per participant to $5 per participant. Adding diversity to our scientific team via TIGR was exponentially successful in (1) improving research productivity, (2) reducing research costs, and (3) increasing research products and mentoring activities that the team before TIGR had not entertained. The team is now well positioned to apply for more federally funded projects, and more trauma clinicians are considering research careers than before.

Is trauma centre care helpful for less severely injured patients?

PubMed

Helling, Thomas S; Nelson, Paul W; Moore, B Todd; Kintigh, Denise; Lainhart, Kathy

2005-11-01

Trauma centres have been shown to reduce the number of preventable deaths from serious injuries. This is due largely to the rapid response of surgeons and health care teams to resuscitate, evaluate, and operate if necessary. Less is known about the effectiveness of trauma centre care on those patients who have not incurred immediate life-threatening problems and may not be as critically injured. The purpose of this study was to review the use of physician and hospital resources for this patient population to determine whether trauma team and trauma centre care is helpful or even needed. This was a retrospective study of consecutive trauma patients (n=1592) admitted from 1998 to 2002 to the trauma service of an urban level I trauma centre and recorded in the hospital trauma registry. Patients were triaged in a tiered response to more or less severely injured. All patients' care was directed by trauma surgeons. Of the 1592 patients, 398 (25%) received a full trauma team response (Class I), 1194 were less seriously injured (Class II). The ISS for the Class I patients was 19+/-18 and for Class II patients 10+/-10. Nineteen percent of Class II patients had an ISS>15. Overall mortality in Class II patients was 2% including 20 unexpected deaths. Four hundred and three Class II patients (34%) had multisystem injuries. Of the Class II patients 423 (35%) were sent to the ICU or OR from the ED, 106 of whom required an immediate operation and 345 required an operation prior to discharge. Complications developed in 129 patients (11%), the majority of which were pulmonary. A large proportion of those patients thought initially to be less severely injured required resources available in a trauma centre, including specialty care, intensive care, and operating room accessibility. Over one-third of these patients had multisystem injuries and almost 20% were considered major trauma, needing prioritisation of care and expertise ideally found in a trauma centre environment. Complications developed in a sizable number of patients. This patient population, because of its heterogeneity and propensity for critical illness, deserves the resources of a trauma centre.

Perceived performance and impact of a non-physician-led interprofessional team in a trauma clinic setting.

PubMed

Driessen, Julia; Bellon, Johanna E; Stevans, Joel; Forsythe, Raquel M; Reynolds, Benjamin R; James, A Everette

2017-01-01

Faced with the challenge of meeting the wide degree of post-discharge needs in their trauma population, the University of Pittsburgh Medical Center (UPMC) developed a non-physician-led interprofessional team to provide follow-up care at its UPMC Falk Trauma Clinic. We assessed this model of care using a survey to gauge team member perceptions of this model, and used clinic visit documentation to apply a novel approach to assessing how this model improves the care received by clinic patients. The high level of perceived team performance and cohesion suggests that this model has been successful thus far from a provider perspective. Patients are seen most frequently by audiologists, while approximately half of physical therapy and speech language therapy consults generate a new therapy referral, which is interpreted as a potential change in the patient's care trajectory. The broader message of this analysis is that a collaborative, non-hierarchical team model incorporating rehabilitative specialists, who often operate independently of one another, can be successful in this setting, where patients appear to have a strong and previously under-attended need for rehabilitative intervention.

Evaluation of Trauma Team Performance Using an Advanced Human Patient Simulator for Resuscitation Training

DTIC Science & Technology

2002-06-01

Breathing 1. Breathing assessed 1=3-5minutes 2=ɛminutes a. Auscultation 0- > 60 seconds 1=30-60seconds 2=ណseconds 2. Recognized tension...pneumothorax a. Difference in auscultated breath sounds 0= > 3 m1nutes (time to awareness of difference) b. Time to decompression of ptx 3. Needle...vitals 2. Time to oxygen applied 3 Time to adequate pressure applied to extremity 4 Time to auscultation 5. Time to recognition of pneumothorax 6

Strategic proposal for a national trauma system in France.

PubMed

Gauss, Tobias; Balandraud, Paul; Frandon, Julien; Abba, Julio; Ageron, Francois Xavier; Albaladejo, Pierre; Arvieux, Catherine; Barbois, Sandrine; Bijok, Benjamin; Bobbia, Xavier; Charbit, Jonathan; Cook, Fabrice; David, Jean-Stephane; Maurice, Guillaume De Saint; Duranteau, Jacques; Garrigue, Delphine; Gay, Emmanuel; Geeraerts, Thomas; Ghelfi, Julien; Hamada, Sophie; Harrois, Anatole; Kobeiter, Hicham; Leone, Marc; Levrat, Albrice; Mirek, Sebastien; Nadji, Abdel; Paugam-Burtz, Catherine; Payen, Jean Francois; Perbet, Sebastien; Pirracchio, Romain; Plenier, Isabelle; Pottecher, Julien; Rigal, Sylvain; Riou, Bruno; Savary, Dominique; Secheresse, Thierry; Tazarourte, Karim; Thony, Frederic; Tonetti, Jerome; Tresallet, Christophe; Wey, Pierre-Francois; Picard, Julien; Bouzat, Pierre

2018-05-29

In this road map for trauma in France, we focus on the main challenges for system implementation, surgical and radiology training, and upon innovative training techniques. Regarding system organisation: procedures for triage, designation and certification of trauma centres are mandatory to implement trauma networks on a national scale. Data collection with registries must be created, with a core dataset defined and applied through all registries. Regarding surgical and radiology training, diagnostic-imaging processes should be standardised and the role of the interventional radiologist within the trauma team and the trauma network should be clearly defined. Education in surgery for trauma is crucial and recent changes in medical training in France will promote trauma surgery as a specific sub-specialty. Innovative training techniques should be implemented and be based on common objectives, scenarios and evaluation, so as to improve individual and team performances. The group formulated 14 proposals that should help to structure and improve major trauma management in France over the next 10 years. Copyright © 2018 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

The impact of intensivists' base specialty of training on care process and outcomes of critically ill trauma patients.

PubMed

Matsushima, Kazuhide; Goldwasser, Eleanor R; Schaefer, Eric W; Armen, Scott B; Indeck, Matthew C

2013-09-01

The care of the critically ill trauma patients is provided by intensivists with various base specialties of training. The purpose of this study was to investigate the impact of intensivists' base specialty of training on the disparity of care process and patient outcome. We performed a retrospective review of an institutional trauma registry at an academic level 1 trauma center. Two intensive care unit teams staffed by either board-certified surgery or anesthesiology intensivists were assigned to manage critically ill trauma patients. Both teams provided care, collaborating with a trauma surgeon in house. We compared patient characteristics, care processes, and outcomes between surgery and anesthesiology groups using Wilcoxon tests or chi-square tests, as appropriate. We identified a total of 620 patients. Patient baseline characteristics including age, sex, transfer status, injury type, injury severity score, and Glasgow coma scale were similar between groups. We found no significant difference in care processes and outcomes between groups. In a logistic regression model, intensivists' base specialty of training was not a significant factor for mortality (odds ratio, 1.46; 95% confidence interval; 0.79-2.80; P = 0.22) and major complication (odds ratio, 1.11; 95% confidence interval, 0.73-1.67; P = 0.63). Intensive care unit teams collaborating with trauma surgeons had minimal disparity of care processes and similar patient outcomes regardless of intensivists' base specialty of training. Copyright © 2013 Elsevier Inc. All rights reserved.

Teaching leadership in trauma resuscitation: Immediate feedback from a real-time, competency-based evaluation tool shows long-term improvement in resident performance.

PubMed

Gregg, Shea C; Heffernan, Daithi S; Connolly, Michael D; Stephen, Andrew H; Leuckel, Stephanie N; Harrington, David T; Machan, Jason T; Adams, Charles A; Cioffi, William G

2016-10-01

Limited data exist on how to develop resident leadership and communication skills during actual trauma resuscitations. An evaluation tool was developed to grade senior resident performance as the team leader during full-trauma-team activations. Thirty actions that demonstrated the Accreditation Council for Graduate Medical Education core competencies were graded on a Likert scale of 1 (poor) to 5 (exceptional). These actions were grouped by their respective core competencies on 5 × 7-inch index cards. In Phase 1, baseline performance scores were obtained. In Phase 2, trauma-focused communication in-services were conducted early in the academic year, and immediate, personalized feedback sessions were performed after resuscitations based on the evaluation tool. In Phase 3, residents received only evaluation-based feedback following resuscitations. In Phase 1 (October 2009 to April 2010), 27 evaluations were performed on 10 residents. In Phase 2 (April 2010 to October 2010), 28 evaluations were performed on nine residents. In Phase 3 (October 2010 to January 2012), 44 evaluations were performed on 13 residents. Total scores improved significantly between Phases 1 and 2 (p = 0.003) and remained elevated throughout Phase 3. When analyzing performance by competency, significant improvement between Phases 1 and 2 (p < 0.05) was seen in all competencies (patient care, knowledge, system-based practice, practice-based learning) with the exception of "communication and professionalism" (p = 0.56). Statistically similar scores were observed between Phases 2 and 3 in all competencies with the exception of "medical knowledge," which showed ongoing significant improvement (p = 0.003). Directed resident feedback sessions utilizing data from a real-time, competency-based evaluation tool have allowed us to improve our residents' abilities to lead trauma resuscitations over a 30-month period. Given pressures to maximize clinical educational opportunities among work-hour constraints, such a model may help decrease the need for costly simulation-based training. Therapeutic study, level III.

The 20-minute team--a critical case study from the emergency room.

PubMed

Berlin, Johan M; Carlström, Eric D

2008-08-01

In this article, the difference between team and group is tested empirically. The research question posed is How are teams formed? Three theoretical concepts that distinguish groups from teams are presented: sequentiality, parallelism and synchronicity. The presumption is that groups cooperate sequentially and teams synchronously, while parallel cooperation is a transition between group and team. To answer the question, a longitudinal case study has been made of a trauma team at a university hospital. Data have been collected through interviews and direct observations. Altogether the work of the trauma team has been studied for a period of 5 years (2002-2006). The results indicate that two factors are of central importance for the creation of a team. The first is related to its management and the other to the forms of cooperation. To allow for a team to act rapidly and to reduce friction between different members, clear leadership is required. The studied team developed cooperation with synchronous elements but never attained a level that corresponds to idealized conceptions of teams. This is used as a basis for challenging ideas that teams are harmonious and free from conflicts and that cooperation takes place without friction.

Training Effectiveness of a Wide Area Virtual Environment in Medical Simulation.

PubMed

Wier, Grady S; Tree, Rebekah; Nusr, Rasha

2017-02-01

The success of war fighters and medical personnel handling traumatic injuries largely depends on the quality of training they receive before deployment. The purpose of this study was to gauge the utility of a Wide Area Virtual Environment (WAVE) as a training adjunct by comparing and evaluating student performance, measuring sense of realism, and assessing the impact on student satisfaction with their training exposure in an immersive versus a field environment. This comparative prospective cohort study examined the utility of a three-screen WAVE where subjects were immersed in the training environment with medical simulators. Standard field training commenced for the control group subjects. Medical skills, time to completion, and Team Strategies and Tools to Enhance Performance and Patient Safety objective metrics were assessed for each team (n = 94). In addition, self-efficacy questionnaires were collected for each subject (N = 470). Medical teams received poorer overall team scores (F1,186 = 0.756, P = 0.001), took longer to complete the scenario (F1,186 = 25.15, P = 0.001), and scored lower on The National Registry of Emergency Medical Technicians trauma assessment checklist (F1,186 = 1.13, P = 0.000) in the WAVE versus the field environment. Critical thinking and realism factors within the self-efficacy questionnaires scored higher in the WAVE versus the field [(F1,466 = 8.04, P = 0.005), (F1,465 = 18.57, P = 0.000), and (F1,466 = 53.24, P = 0.000), respectively]. Environmental and emotional stressors may negatively affect critical thinking and clinical skill performance of medical teams. However, by introducing more advanced simulation trainings with added stressors, students may be able to adapt and overcome barriers to performance found in high-stress environments.

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

Penetrating cardiac injury: sustaining health by building team resilience in growing civilian violence.

PubMed

Pol, Manjunath Maruti; Prasad, K Shiv Krishna; Deo, Vishant; Uniyal, Madhur

2016-09-02

Penetrating cardiac injury (PCI) is gradually increasing in developing countries owing to large-scale manufacturing of illegal country-made weapons. These injuries are associated with significant morbidity and mortality. Logistically it is difficult to have all organ-based specialists arrive together and attend every critically injured patient round-the-clock in developing countries. It is therefore important for doctors (physicians, surgeons and anaesthetists) to be trained for adequate management of critically injured patients following trauma. We report the approach towards 2 cases of haemodynamically unstable PCI managed by a team of trauma doctors. Time lag (duration between injury and arrival at hospital) and quick horizontal resuscitation are important considerations in the treatment. By not referring these patients to different hospitals the team actually reduced the time lag, and a quick life-saving surgery by trauma surgeons (trained in torso surgery) offered these almost dying patients a chance of survival. 2016 BMJ Publishing Group Ltd.

The big hurt: Trauma system funding in today's health care environment.

PubMed

Geehan, Douglas

2010-01-01

Trauma systems provide effective care of the injured patient but require major financial costs in readiness and availability of the extensive trauma team and specialized equipment. Traditional billing and collection practices do not fully recoup these costs. Effective use of the standard billing system is vital to the stability of a trauma system; however, a system wide funding mechanism provides an optimal, stable foundation. Efforts to provide sustainable trauma system funding are ongoing. Numerous state initiatives have been successful in funding trauma systems but a universal solution has yet to be found.

Defining and Measuring Decision-Making for the Management of Trauma Patients.

PubMed

Madani, Amin; Gips, Amanda; Razek, Tarek; Deckelbaum, Dan L; Mulder, David S; Grushka, Jeremy R

Effective management of trauma patients is heavily dependent on sound judgment and decision-making. Yet, current methods for training and assessing these advanced cognitive skills are subjective, lack standardization, and are prone to error. This qualitative study aims to define and characterize the cognitive and interpersonal competencies required to optimally manage injured patients. Cognitive and hierarchical task analyses for managing unstable trauma patients were performed using qualitative methods to map the thoughts, behaviors, and practices that characterize expert performance. Trauma team leaders and board-certified trauma surgeons participated in semistructured interviews that were transcribed verbatim. Data were supplemented with content from published literature and prospectively collected field notes from observations of the trauma team during trauma activations. The data were coded and analyzed using grounded theory by 2 independent reviewers. A framework was created based on 14 interviews with experts (lasting 1-2 hours each), 35 field observations (20 [57%] blunt; 15 [43%] penetrating; median Injury Severity Score 20 [13-25]), and 15 literary sources. Experts included 11 trauma surgeons and 3 emergency physicians from 7 Level 1 academic institutions in North America (median years in practice: 12 [8-17]). Twenty-nine competencies were identified, including 17 (59%) related to situation awareness, 6 (21%) involving decision-making, and 6 (21%) requiring interpersonal skills. Of 40 potential errors that were identified, root causes were mapped to errors in situation awareness (20 [50%]), decision-making (10 [25%]), or interpersonal skills (10 [25%]). This study defines cognitive and interpersonal competencies that are essential for the management of trauma patients. This framework may serve as the basis for novel curricula to train and assess decision-making skills, and to develop quality-control metrics to improve team and individual performance. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Pharmacist's impact on acute pain management during trauma resuscitation.

PubMed

Montgomery, Kayla; Hall, A Brad; Keriazes, Georgia

2015-01-01

The timely administration of analgesics is crucial to the comprehensive management of trauma patients. When an emergency department (ED) pharmacist participates in trauma resuscitation, the pharmacist acts as a medication resource for trauma team members and facilitates the timely administration of analgesics. This study measured the impact of a pharmacist on time to first analgesic dose administered during trauma resuscitation. All adult (>18 years) patients who presented to this level II trauma center via activation of the trauma response system between January 1, 2009, and May 31, 2013, were screened for eligibility. For inclusion, patients must have received intravenous fentanyl, morphine, or hydromorphone in the trauma bay. The time to medication administration was defined as the elapsed time from ED arrival to administration of first analgesic. There were 1328 trauma response system activations during the study period; of which 340 patients were included. The most common analgesic administered was fentanyl (62% in both groups). When a pharmacist was participating, the mean time to first analgesic administered was decreased (17 vs 21 minutes; P = .03). Among the 78% of patients with documented pain scores, the overall mean reduction in pain scores from ED arrival to ED discharge was similar between the 2 groups. There was a 2.4 point reduction with a pharmacist versus 2.7 without a pharmacist, using a 0 to 10 numeric pain rating scale. The participation of a clinical pharmacist during trauma resuscitation significantly decreased the time to first analgesic administration in trauma patients. The results of this study supplement the literature supporting the integration of clinical ED pharmacists on trauma teams.

Improving communication in level 1 trauma centers: replacing pagers with smartphones.

PubMed

Joseph, Bellal; Pandit, Viraj; Khreiss, Mohammad; Aziz, Hassan; Kulvatunyou, Narong; Tang, Andrew; Wynne, Julie; O'Keeffe, Terence; Friese, Randall S; Weinstein, Ronald S; Rhee, Peter

2013-03-01

Communication among healthcare providers continues to change, and 90% of healthcare providers are now carrying cellular phones. Compared with pagers, the rate and amount of information immediately available via cellular phones are far superior. Wireless devices such as smartphones are ideal in acute trauma settings as they can transfer patient information quickly in a coordinate manner to all the team members responsible for patient care. A questionnaire survey was distributed among all the trauma surgeons, surgery residents, and nurse practitioners who were a part of the trauma surgery team at a Level 1 trauma center. Answers to each question were recorded on a 5-point Likert scale. The completed survey questionnaires were analyzed using Statistical Package for Social Sciences software (SPSS version 17; SPSS, Inc., Chicago, IL). The respondents had an overall positive experience with the usage of the third-generation (3G) smartphones, with 94% of respondents in favor of having wireless means of communication at a Level 1 trauma center. Of respondents, 78% found the device very user friendly, 98% stated that use of smartphones had improved the speed and quality of communication, 96% indicated that 3G smartphones were a useful teaching tool, 90% of the individuals felt there was improvement in the physician's response time to both routine and critical patients, and 88% of respondents were aware of the rules and regulations of the Health Insurance Portability and Accountability Act. Smartphones in an acute trauma setting are easy to use and improve the means of communication among the team members by providing accurate and reliable information in real time. Smartphones are effective in patient follow-up and as a teaching tool. Strict rules need to be used to govern the use of smartphones to secure the safety and secrecy of patient information.

Emergency operations program is an excellent platform to deal with in-hospital operation disaster.

PubMed

Rogers, Frederick B; McCune, William; Jammula, Shreya; Gross, Brian W; Bradburn, Eric H; Riley, Deborah K; Manning, Jeffrey

2017-01-01

Described herein is the utilization of the hospital's Emergency Operations Plan and incident command structure to mitigate damage caused by the sudden loss of the heating, ventilation, and air conditioning system within the entire operating room suite. The ability to ameliorate a devastating situation that occurred during working hours at a busy Level II trauma center can be ascribed to the dedication of the leadership and clinical teams working seamlessly together. Their concerted efforts were augmented by adherence to an established protocol that had been thoroughly substantiated and practiced during numerous training simulations. This resulted in successful and timely resolution of an internal crisis that crippled the surgical capabilities of the sole trauma center in the county. After thorough investigation and identification of the issues that contributed to the malfunction, redundancies were built into the system to ensure that a similar incident did not occur again.

US Army Two-Surgeon Teams Operating in Remote Afghanistan - An Evaluation of Split-Based Forward Surgical Team Operations

DTIC Science & Technology

2009-04-01

Patient Status ABD (%) Ext (%) Vasc (%) Uro (%) GYN (%) Thor (%) HN (%) Neuro (%) Burn (%) Other (%) Total USF (n 178) 6 (2.6) 125 (54.3) 3 (1.3) 0...Ext, extremity; Vasc, vascular; Uro , urological; GYN, gynecologic; Thor, thoracic; HN, head and neck; Neuro, neurologic. Table 8 Age, Sex, and...Shock Trauma Platoon with a similar patient cohort at Los Angeles County trauma center, found that 12.7% of patients treated by the Surgical Shock

Annual Trauma Anesthesia and Critical Care Symposium (5th) Held in Amsterdam, The Netherlands on 11-12 June 1992

DTIC Science & Technology

1992-10-01

Variations in the Role of the TA/CCS A. The Trauma Team: Leader vs. Member B. Pain Management C. Teacher/Trainer D. Critical Care Transport E... Pain Management Interested individuals should send CV and request for application to: David P. Tarantino, M.D. Director of Education MIEMSS...Supportive Treatment Strategy? Interpleural Regional Analgesia in the Pain Management of Chest Trauma Airway Management with Penetrating Neck Trauma

A Qualitative Study of Multidisciplinary Providers' Experiences With the Transfer Process for Injured Children and Ideas for Improvement.

PubMed

Gawel, Marcie; Emerson, Beth; Giuliano, John S; Rosenberg, Alana; Minges, Karl E; Feder, Shelli; Violano, Pina; Morrell, Patricia; Petersen, Judy; Christison-Lagay, Emily; Auerbach, Marc

2018-02-01

Most injured children initially present to a community hospital, and many will require transfer to a regional pediatric trauma center. The purpose of this study was 1) to explore multidisciplinary providers' experiences with the process of transferring injured children and 2) to describe proposed ideas for process improvement. This qualitative study involved 26 semistructured interviews. Subjects were recruited from 6 community hospital emergency departments and the trauma and transport teams of a level I pediatric trauma center in New Haven, Conn. Participants (n = 34) included interprofessional providers from sending facilities, transport teams, and receiving facilities. Using the constant comparative method, a multidisciplinary team coded transcripts and collectively refined codes to generate recurrent themes across interviews until theoretical saturation was achieved. Participants reported that the transfer process for injured children is complex, stressful, and necessitates collaboration. The transfer process was perceived to involve numerous interrelated components, including professions, disciplines, and institutions. The 5 themes identified as areas to improve this transfer process included 1) Creation of a unified standard operating procedure that crosses institutions/teams, 2) Enhancing 'shared sense making' of all providers, 3) Improving provider confidence, expertise, and skills in caring for pediatric trauma transfer cases, 4) Addressing organization and environmental factors that may impede/delay transfer, and 5) Fostering institutional and personal relationships. Efforts to improve the transfer process for injured children should be guided by the experiences of and input from multidisciplinary frontline emergency providers.

Enhanced care team response to incidents involving major trauma at night: are helicopters the answer?

PubMed

McQueen, Carl; Nutbeam, Tim; Crombie, Nick; Lecky, Fiona; Lawrence, Thomas; Hathaway, Karen; Wheaton, Steve

2015-07-01

Challenges exist in how to deliver enhanced care to patients suffering severe injury in geographically remote areas within regionalised trauma networks at night. The physician led Enhanced Care Teams (ECTs) in the West Midlands region of England do not currently utilise helicopters to respond to incidents at night. This study describes this remote trauma workload at night within the regional network in terms of incident location; injury profile and patient care needs and discusses various solutions to the delivery of ECTs to such incidents, including the need for helicopter based platforms. We present a retrospective analysis of incidents involving Major Trauma occurring in the West Midlands Regional Trauma Network in England over a one year period (1st April 2012 until the 31st March 2013). Anonymised patient records from the Trauma Audit and Research Network (TARN) for patients that had been conveyed to hospital by ambulance/air ambulance were cross-referenced with the West Midlands Ambulance Service NHS Foundation Trust (WMAS) Computer Assisted Dispatch (CAD) archive for the same period. Data were abstracted from the combined dataset relating to injury severity (ISS/ICU admission/death at scene or as inpatient); ECT resource activations/scene attendances; incident location and the need for enhanced level care. A total of 603 incidents involving Major Trauma were identified during night time hours. Enhanced Care Team resources attended scene in 167 cases (27.7%). Of the incidents not attended by an ECT 179 (41.1%) were due to falls and 91 (20.9%) involved a 'Road Traffic Collision'. A total of 36 incidents (6.0% of total at night) occurred in locations identified as being greater than 45min by road from the nearest major trauma centre. In these cases 13 patients had enhanced care needs that could not be addressed at scene by the attending ambulance service personnel. There is limited evidence to support the need for night HEMS operations in the West Midlands regional trauma network. The potential role of night HEMS in other regional trauma networks in England requires further evaluation with specific reference to the incidence of Major Trauma and efficiency of existing road based systems. Copyright © 2015. Published by Elsevier Ltd.

[First aid system for trauma: development and status].

PubMed

Chen, D K; Lin, W C; Zhang, P; Kuang, S J; Huang, W; Wang, T B

2017-04-18

With the great progress of the economy, the level of industrialization has been increasing year by year, which leads to an increase in accidental trauma accidents. Chinese annual death of trauma is already more than 400 000, which makes trauma the fifth most common cause of death, following malignant tumor, heart, brain and respiratory diseases. Trauma is the leading cause of the death of young adults. At the same time, trauma has become a serious social problem in peace time. Trauma throws great treats on human health and life. As an important part in the medical and social security system, the emergency of trauma system occupies a very important position in the emergency medical service system. In European countries as well as the United States and also many other developed countries, trauma service system had a long history, and progressed to an advanced stage. However, Chinese trauma service system started late and is still developing. It has not turned into a complete and standardized system yet. This review summarizes the histories and current situations of the development of traumatic first aid system separately in European countries, the United States and our country. Special attentions are paid to the effects of the pre- and in-hospital emergency care. We also further try to explore the Chinese trauma emergency model that adapts to the situations of China and characteristics of different regions of China. Our review also introduces the trauma service system that suits the situations of China proposed by Professor Jiang Baoguo's team in details, taking Chinese conditions into account, they conducted a thematic study and made an expert consensus on pre-hospital emergency treatment of severe trauma, providing a basic routine and guidance of severe trauma treatment for those pre-hospital emergency physicians. They also advised to establish independent trauma disciplines and trauma specialist training systems, and to build the regional trauma care system as well as the standards for graded treatment, thus establishing a multiple disciplinary team (MDT) of severe trauma. In this way, we can reduce the mortality and disability risks of severe trauma, improve the quality of patients' life, and save more lives.

Staged abdominal re-operation for abdominal trauma.

PubMed

Taviloglu, Korhan

2003-07-01

To review the current developments in staged abdominal re-operation for abdominal trauma. To overview the steps of damage control laparotomy. The ever increasing importance of the resuscitation phase with current intensive care unit (ICU) support techniques should be emphasized. General surgeons should be familiar to staged abdominal re-operation for abdominal trauma and collaborate with ICU teams, interventional radiologists and several other specialties to overcome this entity.

Sports dentistry: A review

PubMed Central

Ramagoni, Naveen Kumar; Singamaneni, Vijaya Kumar; Rao, Saketh Rama; Karthikeyan, Jamini

2014-01-01

Dental trauma in sports is the major linking channel between sports and dentistry. Sports dentistry is the prevention of oral/facial athletic injuries and related oral diseases and manifestations. In children, sports activities were found to be responsible for 13% of overall oral trauma. It is emphasized that there is a great need for “Team Dentist” from high schools to professional teams. In this review, we discuss the relationship between sports and dentistry, and the importance of educating parents, teachers, and children in prevention of injuries related to the sports. PMID:25625070

Using "The Burns Suite" as a Novel High Fidelity Simulation Tool for Interprofessional and Teamwork Training.

PubMed

Sadideen, Hazim; Wilson, David; Moiemen, Naiem; Kneebone, Roger

2016-01-01

Educational theory highlights the importance of contextualized simulation for effective learning. The authors recently published the concept of "The Burns Suite" (TBS) as a novel tool to advance the delivery of burns education for residents/clinicians. Effectively, TBS represents a low-cost, high-fidelity, portable, immersive simulation environment. Recently, simulation-based team training (SBTT) has been advocated as a means to improve interprofessional practice. The authors aimed to explore the role of TBS in SBTT. A realistic pediatric burn resuscitation scenario was designed based on "advanced trauma and life support" and "emergency management of severe burns" principles, refined utilizing expert opinion through cognitive task analysis. The focus of this analysis was on nontechnical and interpersonal skills of clinicians and nurses within the scenario, mirroring what happens in real life. Five-point Likert-type questionnaires were developed for face and content validity. Cronbach's alpha was calculated for scale reliability. Semistructured interviews captured responses for qualitative thematic analysis allowing for data triangulation. Twenty-two participants completed TBS resuscitation scenario. Mean face and content validity ratings were high (4.4 and 4.7 respectively; range 4-5). The internal consistency of questions was high. Qualitative data analysis revealed two new themes. Participants reported that the experience felt particularly authentic because the simulation had high psychological and social fidelity, and there was a demand for such a facility to be made available to improve nontechnical skills and interprofessional relations. TBS provides a realistic, novel tool for SBTT, addressing both nontechnical and interprofessional team skills. Recreating clinical challenge is crucial to optimize SBTT. With a better understanding of the theories underpinning simulation and interprofessional education, future simulation scenarios can be designed to provide unique educational experiences whereby team members will learn with and from other specialties and professions in a safe, controlled environment.

Cohesion and Trauma: An Examination of a Collegiate Women's Volleyball Team

ERIC Educational Resources Information Center

Fletcher, Teresa B.; Meyer, Barbara B.

2009-01-01

This study examined the effects of Adventure Based Counseling (i.e., a low-element challenge program) on the cohesion of a collegiate women's volleyball team. Results suggest postintervention improvements in team cohesion. The support created in the challenge experience also transferred to the players helping one another to grieve the untimely…

The invisible trauma patient: emergency department discharges.

PubMed

Reilly, Patrick M; Schwab, C William; Kauder, Donald R; Dabrowski, G Paul; Gracias, Vicente; Gupta, Rajan; Pryor, John P; Braslow, Benjamin M; Kim, Patrick; Wiebe, Douglas J

2005-04-01

As the malpractice and financial environment has changed, injured patients evaluated by the trauma team and discharged from the emergency department (ED) are now commonplace. The evaluation, care, and disposition of this population has become a significant workload component but is not reported to accrediting organizations and is relatively invisible to hospital administrators. Our objective was to quantify and begin to qualify the evolving picture of the trauma ED discharge population as a work component of trauma service function in an urban, Level I trauma center with an aeromedical program. Trauma registry (contacts, mechanism, transport, injuries, and disposition) and hospital databases (ED closure, occupancy rates) were queried for a 5-year period (1999-2003). Trend analysis provided statistical comparisons for questions of interest. During the 5-year study period, the total number of trauma contacts rose by 18.1% (2,220 in 1999 vs. 2,622 in 2003; trend p < 0.05). This increase in total contacts was not a manifestation of an increase in admissions (1,672 in 1999 vs. 1,544 in 2003) but rather a reflection of a marked increase in patients seen primarily by the trauma team and discharged from the ED (473 in 1999 vs. 1,000 in 2003; trend p < 0.05). These ED discharge patients were increasingly transported by helicopter (12.3% in 1999 vs. 29.2% in 2003; trend p < 0.05) and less frequently from urban areas (57.1% in 1999 vs. 48.1% in 2003; trend p < 0.05) over the course of the study period. Average injury severity of this group increased over the study period (Injury Severity Score of 2.7 +/- 0.1 in 1999 vs. 3.3 +/- 0.1 in 2003; trend p < 0.05). ED length of stay for this group increased 19.8% over the study period (trend p < 0.05), averaging nearly 5 hours in 2003. The total number, relative percentage, and injury severity of patients evaluated by the trauma team and discharged from the ED has significantly increased over the last 5 years, representing nearly 5,000 patient care hours in 2003. Systems to care for these patients in a cost- and resource-efficient fashion should be put in place. The impact of this growing population of patients on the workload of the trauma center should be recognized by accrediting agencies, hospital administration, and Emergency Medical Services.

Medication reconciliation in a rural trauma population.

PubMed

Miller, S Lee; Miller, Stephanie; Balon, Jennifer; Helling, Thomas S

2008-11-01

Medication errors during hospitalization can lead to adverse drug events. Because of preoccupation by health care providers with life-threatening injuries, trauma patients may be particularly prone to medication errors. Medication reconciliation on admission can result in decreased medication errors and adverse drug events in this patient population. The purpose of this study is to determine the accuracy of medication histories obtained on trauma patients by initial health care providers compared to a medication reconciliation process by a designated clinical pharmacist after the patient's admission and secondarily to determine whether trauma-associated factors affected medication accuracy. This was a prospective enrollment study during 13 months in which trauma patients admitted to a Level I trauma center were enrolled in a stepwise medication reconciliation process by the clinical pharmacist. The setting was a rural Level I trauma center. Patients admitted to the trauma service were studied. The intervention was medication reconciliation by a clinical pharmacist. The main outcome measure was accuracy of medication history by initial trauma health care providers compared to a medication reconciliation process by a clinical pharmacist who compared all sources, including telephone calls to pharmacies. Patients taking no medications (whether correctly identified as such or not) were not analyzed in these results. Variables examined included admission medication list accuracy, age, trauma team activation mode, Injury Severity Score, and Glasgow Coma Scale (GCS) score. Two hundred thirty-four patients were enrolled. Eighty-four of 234 patients (36%) had an Injury Severity Score greater than 15. Medications were reconciled within an average of 3 days of admission (range 1 to 8) by the clinical pharmacist. Overall, medications as reconciled by the clinical pharmacist were recorded correctly for 15% of patients. Admission trauma team medication lists were inaccurate in 224 of 234 cases (96%). Admitting nurses' lists were more accurate than the trauma team's (11% versus 4%; 95% confidence interval 2.5% to 11.2%). Errors were found by the clinical pharmacist in medication name, strength, route, and frequency. No patients (0/20) with admission GCS less than 13 had accurate medication lists. Seventy of 84 patients (83%) with an Injury Severity Score greater than 15 had inaccurate medication lists. Ten of 234 patients (4%) were ordered wrong medications, and 1 adverse drug event (hypoglycemia) occurred. The median duration of the reconciliation process was 2 days. Only 12% of cases were completed in 1 day, and almost 25% required 3 or more (maximum 8) days. This study showed that medication history recorded on admission was inaccurate. This patient population overall was susceptible to medication inaccuracies from multiple sources, even with duplication of medication histories by initial health care providers. Medication reconciliation for trauma patients by a clinical pharmacist may improve safety and prevent adverse drug events but did not occur quickly in this setting.

Aorta Balloon Occlusion in Trauma: Three Cases Demonstrating Multidisciplinary Approach Already on Patient’s Arrival to the Emergency Room

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

Hörer, Tal M., E-mail: tal.horer@orebroll.se; Hebron, Dan; Swaid, Forat

PurposeTo describe the usage of aortic balloon occlusion (ABO), based on a multidisciplinary approach in severe trauma patients, emphasizing the role of the interventional radiologist in primary trauma care.MethodsWe briefly discuss the relevant literature, the technical aspects of ABO in trauma, and a multidisciplinary approach to the bleeding trauma patient. We describe three severely injured trauma patients for whom ABO was part of initial trauma management.ResultsThree severely injured multi-trauma patients were treated by ABO as a bridge to surgery and embolization. The procedures were performed by an interventional radiologist in the early stages of trauma management.ConclusionsThe interventional radiologist and themore » multidisciplinary team approach can be activated already on severe trauma patient arrival. ABO usage and other endovascular methods are becoming more widely spread, and can be used early in trauma management, without delay, thus justifying the early activation of this multidisciplinary approach.« less

Development of a prehospital vital signs chart sharing system.

PubMed

Nakada, Taka-aki; Masunaga, Naohisa; Nakao, Shota; Narita, Maiko; Fuse, Takashi; Watanabe, Hiroaki; Mizushima, Yasuaki; Matsuoka, Tetsuya

2016-01-01

Physiological parameters are crucial for the caring of trauma patients. There is a significant loss of prehospital vital signs data of patients during handover between prehospital and in-hospital teams. Effective strategies for reducing the loss remain a challenging research area. We tested whether the newly developed electronic automated prehospital vital signs chart sharing system would increase the amount of prehospital vital signs data shared with a remote trauma center prior to hospital arrival. Fifty trauma patients, transferred to a level I trauma center in Japan, were studied. The primary outcome variable was the number of prehospital vital signs shared with the trauma center prior to hospital arrival. The prehospital vital signs chart sharing system significantly increased the number of prehospital vital signs, including blood pressure, heart rate, and oxygen saturation, shared with the in-hospital team at a remote trauma center prior to patient arrival at the hospital (P < .0001). There were significant differences in prehospital vital signs during ambulance transfer between patients who had severe bleeding and non-severe bleeding within 24 hours after injury onset. Vital signs data collected during ambulance transfer via patient monitors could be automatically converted to easily visible patient charts and effectively shared with the remote trauma center prior to hospital arrival. The prehospital vital signs chart sharing system increased the number of precise vital signs shared prior to patient arrival at the hospital, which can potentially contribute to better trauma care without increasing labor and reduce information loss during clinical handover. Copyright © 2015 Elsevier Inc. All rights reserved.

PubMed

Aléx, Jonas; Gyllencreutz, Lina

2018-02-05

Trauma care at an accident site is of great importance for patient survival. The purpose of the study was to observe the compliance of ambulance nurses with the Prehospital Trauma Life Support (PHTLS) concept of trauma care in a simulation situation. The material consisted of video recordings in trauma simulation and an observation protocol was designed to analyze the video material. The result showed weaknesses in systematic exam and an ineffective use of time at the scene of injury. Development of observation protocols in trauma simulation can ensure the quality of ambulance nurses' compliance with established concepts. Our pilot study shows that insufficiencies in systematic care lead to an ineffective treatment for trauma patients which in turn may increase the risk of complications and mortality.

Disaster response team FAST skills training with a portable ultrasound simulator compared to traditional training: pilot study.

PubMed

Paddock, Michael T; Bailitz, John; Horowitz, Russ; Khishfe, Basem; Cosby, Karen; Sergel, Michelle J

2015-03-01

Pre-hospital focused assessment with sonography in trauma (FAST) has been effectively used to improve patient care in multiple mass casualty events throughout the world. Although requisite FAST knowledge may now be learned remotely by disaster response team members, traditional live instructor and model hands-on FAST skills training remains logistically challenging. The objective of this pilot study was to compare the effectiveness of a novel portable ultrasound (US) simulator with traditional FAST skills training for a deployed mixed provider disaster response team. We randomized participants into one of three training groups stratified by provider role: Group A. Traditional Skills Training, Group B. US Simulator Skills Training, and Group C. Traditional Skills Training Plus US Simulator Skills Training. After skills training, we measured participants' FAST image acquisition and interpretation skills using a standardized direct observation tool (SDOT) with healthy models and review of FAST patient images. Pre- and post-course US and FAST knowledge were also assessed using a previously validated multiple-choice evaluation. We used the ANOVA procedure to determine the statistical significance of differences between the means of each group's skills scores. Paired sample t-tests were used to determine the statistical significance of pre- and post-course mean knowledge scores within groups. We enrolled 36 participants, 12 randomized to each training group. Randomization resulted in similar distribution of participants between training groups with respect to provider role, age, sex, and prior US training. For the FAST SDOT image acquisition and interpretation mean skills scores, there was no statistically significant difference between training groups. For US and FAST mean knowledge scores, there was a statistically significant improvement between pre- and post-course scores within each group, but again there was not a statistically significant difference between training groups. This pilot study of a deployed mixed-provider disaster response team suggests that a novel portable US simulator may provide equivalent skills training in comparison to traditional live instructor and model training. Further studies with a larger sample size and other measures of short- and long-term clinical performance are warranted.

Pause...Before Rushing In: Examining Motivations to Help in Trauma Impacted Communities Internationally

ERIC Educational Resources Information Center

Streets, Barbara Faye; Nicolas, Guerda; Wolford, Karen

2015-01-01

International service learning courses, cultural immersion projects, and international disaster response teams have provided valuable aid, services, supplies and programs to trauma-impacted communities across the globe. Many colleges and universities support global learning and the creation of global citizens, and this ethic is reflected in many…

Surgical and Resuscitation Capabilities for the "Next War" Based on Lessons Learned From "This War".

PubMed

Freel, David; Warr, Bradley J

2016-01-01

The Army gleaned many lessons regarding the provision of medical care to casualties during the past 14 years of combat. Using these lessons learned in the Joint Capabilities and Integration Development process and through the analysis of an integrated process action team, the Army recently approved 3 changes to medical organizations that are intended to provide trauma management farther forward on the battlefield. These changes include the substitution of an emergency medicine trained physician and emergency medicine physician assistant (PA) in lieu of a general medical officer and primary care PA within the brigade combat team; reorganization of the forward surgical team into a forward surgical and resuscitative team; and the modularization of the traditional 248 bed combat support hospital. The Army anticipates that these changes related to personnel, organizations, doctrine, and materiel will enable Army medicine to provide enhanced trauma management closer to the point of a combatant's injury. These modifications are projected to begin in fiscal year 2016.

Can teamwork and situational awareness (SA) in ED resuscitations be improved with a technological cognitive aid? Design and a pilot study of a team situation display.

PubMed

Parush, A; Mastoras, G; Bhandari, A; Momtahan, K; Day, K; Weitzman, B; Sohmer, B; Cwinn, A; Hamstra, S J; Calder, L

2017-12-01

Effective teamwork in ED resuscitations, including information sharing and situational awareness, could be degraded. Technological cognitive aids can facilitate effective teamwork. This study focused on the design of an ED situation display and pilot test its influence on teamwork and situational awareness during simulated resuscitation scenarios. The display design consisted of a central area showing the critical dynamic parameters of the interventions with an events time-line below it. Static information was placed at the sides of the display. We pilot tested whether the situation display could lead to higher scores on the Clinical Teamwork Scale (CTS), improved scores on a context-specific Situational Awareness Global Assessment Technique (SAGAT) tool, and team communication patterns that reflect teamwork and situational awareness. Resuscitation teamwork, as measured by the CTS, was overall better with the presence of the situation display as compared with no situation display. Team members discussed interventions more with the situation display compared with not having the situation display. Situational awareness was better with the situation display only in the trauma scenario. The situation display could be more effective for certain ED team members and in certain cases. Overall, this pilot study implies that a situation display could facilitate better teamwork and team communication in the resuscitation event. Copyright © 2017 Elsevier Inc. All rights reserved.

Comprehensive head and neck trauma screening: the USS Cole experience.

PubMed

Helling, Eric R; Pfannenstiel, Travis J

2005-11-01

A prospective study was designed to determine the incidence of occult head and neck injuries after initial triage of patients following the USS Cole terrorist bombing. All 39 patients evacuated to Landstuhl Regional Medical Center underwent comprehensive head and neck examinations, regardless of known diagnoses at the time of arrival. Appropriate interventions were performed, and detailed summaries were added to the patients' records. Initial triage listed nine of 39 patients as having sustained head and neck injuries. After screening by an otolaryngology team, 23 of 39 patients were identified as having head and neck injuries requiring further care. The majority of head and neck injuries were not initially reported to the head and neck trauma service. Our conclusion is that occult head and neck injuries are common after blast injuries. Early identification and intervention by a subspecialty head and neck trauma team can aid in achieving optimal outcomes after blast injury.

Developing psychological services following facial trauma.

PubMed

Choudhury-Peters, Deba; Dain, Vicky

2016-01-01

Adults presenting to oral and maxillofacial surgery services are at high risk of psychological morbidity. Research by the Institute of Psychotrauma and the centre for oral and maxillofacial surgery trauma clinic at the Royal London hospital (2015) demonstrated nearly 40% of patients met diagnostic criteria for either depression, post traumatic stress disorder (PTSD), anxiety, alcohol misuse, or substance misuse, or were presenting with facial appearance distress. Most facial injury patients were not receiving mental health assessment or treatment, and the maxillofacial team did not have direct access to psychological services. Based on these research findings, an innovative one-year pilot psychology service was designed and implemented within the facial trauma clinic. The project addressed this need by offering collaborative medical and psychological care for all facial injury patients. The project provided brief screening, assessment, and early psychological intervention. The medical team were trained to better recognise and respond to psychological distress.

Developing psychological services following facial trauma

PubMed Central

Choudhury-Peters, Deba; Dain, Vicky

2016-01-01

Adults presenting to oral and maxillofacial surgery services are at high risk of psychological morbidity. Research by the Institute of Psychotrauma and the centre for oral and maxillofacial surgery trauma clinic at the Royal London hospital (2015) demonstrated nearly 40% of patients met diagnostic criteria for either depression, post traumatic stress disorder (PTSD), anxiety, alcohol misuse, or substance misuse, or were presenting with facial appearance distress. Most facial injury patients were not receiving mental health assessment or treatment, and the maxillofacial team did not have direct access to psychological services. Based on these research findings, an innovative one-year pilot psychology service was designed and implemented within the facial trauma clinic. The project addressed this need by offering collaborative medical and psychological care for all facial injury patients. The project provided brief screening, assessment, and early psychological intervention. The medical team were trained to better recognise and respond to psychological distress. PMID:27493750

Healing the Hurt Child: Sean's Story

ERIC Educational Resources Information Center

Conley, Katy

2013-01-01

The Positive Behavior Support Team at Madison Metropolitan School District (Wisconsin) provides consultation and wrap-around services for students who exhibit significant physical or sexual aggression. Several members of the team received training in the Three Pillars of TraumaWise Care curriculum from Reclaiming Youth International. This article…

[Injury severity and pattern at the scene. What is the influence of the mechanism of injury?].

PubMed

Frink, M; Zeckey, C; Haasper, C; Krettek, C; Hildebrand, F

2010-05-01

The mechanism of injury is the major cause for trauma team activation and emergency room resuscitation of trauma victims. To date, it remains unclear to what extent the injury mechanism influences injury pattern and severity. A comprehensive systematic literature search based on Medline was carried out. Only a limited number of studies are available which investigated the influence of injury mechanisms on injury patterns and severity. There are no specific mechanisms for traumatic brain and spine injuries. Injuries to the chest and abdomen most frequently resulted from motor vehicle accidents involving passengers sitting on the side of the impact. Steering wheel deformity correlated with the injury severity. Pelvic fractures occurred most frequently due to motor vehicle accidents. The highest mortality resulted from pedestrians being struck by a vehicle and additional loss of life in the same vehicle compartment. The systematic literature research showed inconsistent results regarding the influence of trauma mechanisms on the resulting injury. Therefore, a treatment algorithm for trauma patients should be independent of the mechanism which is represented in several training programs (e.g. ATLS and PHTLS). However, the mechanism of injury may increase the alertness of the trauma team with respect to injury distribution and severity.

Implications of Perioperative Team Setups for Operating Room Management Decisions.

PubMed

Doll, Dietrich; Kauf, Peter; Wieferich, Katharina; Schiffer, Ralf; Luedi, Markus M

2017-01-01

Team performance has been studied extensively in the perioperative setting, but the managerial impact of interprofessional team performance remains unclear. We hypothesized that the interplay between anesthesiologists and surgeons would affect operating room turnaround times, and teams that worked together over time would become more efficient. We analyzed 13,632 surgical cases at our hospital that involved 64 surgeons and 48 anesthesiologists. We detrended and adjusted the data for potential confounders including age, American Society of Anesthesiologists physical status, and surgical list (scheduled cases of specific surgical specialties). The surgical lists were categorized as ear, nose, and throat surgery; trauma surgery; general surgery; and gynecology. We assessed the relationship between turnaround times and assignment of different anesthesiologists to specific surgeons using a Monte Carlo simulation. We found significant differences in team performances among the different surgical lists but no team learning. We constructed managerial decision tables for the assignment of anesthesiologists to specific surgeons at our hospital. We defined a decision algorithm based on these tables. Our analysis indicated that had this algorithm been used in staffing the operating room for the surgical cases represented in our data, median turnaround times would have a reduction potential of 6.8% (95% confidence interval 6.3% to 7.1%). A surgeon is usually predefined for scheduled surgeries (surgical list). Allocation of the right anesthesiologist to a list and to a surgeon can affect the team performance; thus, this assignment has managerial implications regarding the operating room efficiency affecting turnaround times and thus potentially overutilized time of a list at our hospital.

A comparative approach to deep vein thrombosis risk assessment.

PubMed

Hums, Wendy; Blostein, Paul

2006-01-01

Trauma patients are at risk for developing DVT/PE. The Bronson Trauma Model incorporates a DVT scoring system into the daily routine for all injured patients admitted to the Trauma Care Unit. Dr Paul Blostein added the DVT Risk Assessment spreadsheet to his personal digital assistant and made it available to other members of the team to allow calculation of a patient's DVT risk percentage during daily multidisciplinary rounds in the Trauma Care Unit. The Trauma Program has found the incorporation of the scoring systems into the trauma registry to be a value-added component of our performance improvement process. Bronson's unique model of trauma care, where patients are admitted and discharged from the same room, combined with today's technology of wireless laptops and personal digital assistants, promotes a progressive approach to DVT/PE prophylaxis and performance improvement. Our trauma follow-up program has proven to be effective in reintegrating patients back into the trauma system to optimize their functional status and improve their outcome.

The Influence of Team Functioning and Workload on Sustainability of Trauma-Focused Evidence-Based Psychotherapies.

PubMed

Mohr, David C; Rosen, Craig S; Schnurr, Paula P; Orazem, Robert J; Noorbaloochi, Siamak; Clothier, Barbara A; Eftekhari, Afsoon; Bernardy, Nancy C; Chard, Kathleen M; Crowley, Jill J; Cook, Joan M; Kehle-Forbes, Shannon M; Ruzek, Josef I; Sayer, Nina A

2018-05-25

It has been over a decade since the U.S. Department of Veterans Affairs (VA) began formal dissemination and implementation of two trauma-focused evidence-based psychotherapies (TF-EBPs). The objective of this study was to examine the sustainability of the TF-EBPs and determine whether team functioning and workload were associated with TF-EBP sustainability. This observational study used VA administrative data for 6,251 patients with posttraumatic stress disorder (PTSD) and surveys from 78 providers from 10 purposefully selected PTSD clinical teams located in nine VA medical centers. The outcome was sustainability of TF-EBPs, which was based on British National Health System Sustainability Index scores (possible scores range from 0 to 100.90). Primary predictors included team functioning, workload, and TB-EBP reach to patients with PTSD. Multiple linear regression models were used to examine the influence of team functioning and workload on TF-EBP sustainability after adjustment for covariates that were significantly associated with sustainability. Sustainability Index scores ranged from 53.15 to 100.90 across the 10 teams. Regression models showed that after adjustment for patient and facility characteristics, team functioning was positively associated (B=9.16, p<.001) and workload was negatively associated (B=-.28, p<.05) with TF-EBP sustainability. There was considerable variation across teams in TF-EBP sustainability. The contribution of team functioning and workload to the sustainability of evidence-based mental health care warrants further study.

The impact of a statewide trauma-informed child welfare initiative on children's permanency and maltreatment outcomes.

PubMed

Barto, Beth; Bartlett, Jessica Dym; Von Ende, Adam; Bodian, Ruth; Noroña, Carmen Rosa; Griffin, Jessica; Fraser, Jenifer Goldman; Kinniburgh, Kristine; Spinazzola, Joseph; Montagna, Crystaltina; Todd, Marybeth

2018-05-05

This article presents findings of a state-wide trauma informed child-welfare initiative with the goal of improving well-being, permanency and maltreatment outcomes for traumatized children. The Massachuetts Child Trauma Project (MCTP), funded by the Administration of Children and Families, Children's Bureau was a multi-year project implementing trauma-informed care into child welfare service delivery. The project's implementation design included training and consultation for mental health providers in three evidence-based treatments and training of the child-welfare workforce in trauma-informed case work practice. The learning was integrated between child-welfare and mental health with Trauma Informed Leadership Teams which included leaders from both systems and the greater community. These teams developed incremental steps toward trauma-informed system improvement. This study evaluated whether MCTP was associated with reductions in child abuse and neglect, improvements in placement stability, and higher rates of permanency during the first year of implementation. Children in the intervention group had fewer total substantiated reports of maltreatment, including less physical abuse and neglect than the comparison group by the end of the intervention year. However, children in the intervention group had more maltreatment reports (substantiated or not) and total out-of-home placements than did their counterparts in the comparison group. Assignment to MCTP, however, was not associated with an increase in kinship care or adoption. Overall, the results are promising in reinforcing the importance of mobilizing communities toward improvements in child-welfare service delivery. Copyright © 2018 Elsevier Ltd. All rights reserved.

Using a Checklist to Improve Family Communication in Trauma Care.

PubMed

Dennis, Bradley M; Nolan, Tracy L; Brown, Cecil E; Vogel, Robert L; Flowers, Kristin A; Ashley, Dennis W; Nakayama, Don K

2016-01-01

Modern concepts of patient-centered care emphasize effective communication with patients and families, an essential requirement in acute trauma settings. We hypothesized that using a checklist to guide the initial family conversation would improve the family's perception of the interaction. Institutional Review Board-approved, prospective pre/post study involving families of trauma patients admitted to our Level I trauma center for >24 hours. In the control group, families received information according to existing practices. In the study group, residents gave patient information to a first-degree family member using a checklist that guided the interaction. The checklist included a physician introduction, patient condition, list of known injuries, admission unit or intensive care unit, any consultants involved, plans for additional studies or operations, and opportunity for family to ask questions. An 11-item survey was administered 24 to 48 hours after admission to each group that evaluated the trauma team's communication in the areas of physician introduction, patient condition, ongoing treatment, and family perception of the interaction. Responses were on a Likert scale and analyzed using the Wilcoxon-Mann-Whitney test. There were 130 patients in each group. The study group had significantly (P < 0.05) better responses in 8 of 11 items surveyed: physician spoke to family, physician introduction, understanding of their relative's injuries, admitting unit, consultants involved, urgent surgical procedures required, ongoing diagnostic studies, and understanding of the treatment plan. In conclusion, using a checklist improves the perception of the initial communication between the trauma team and family members of trauma patients, especially their understanding of the treatment plan.

A Video Analysis of Intra- and Interprofessional Leadership Behaviors Within "The Burns Suite": Identifying Key Leadership Models.

PubMed

Sadideen, Hazim; Weldon, Sharon-Marie; Saadeddin, Munir; Loon, Mark; Kneebone, Roger

2016-01-01

Leadership is particularly important in complex highly interprofessional health care contexts involving a number of staff, some from the same specialty (intraprofessional), and others from different specialties (interprofessional). The authors recently published the concept of "The Burns Suite" (TBS) as a novel simulation tool to deliver interprofessional and teamwork training. It is unclear which leadership behaviors are the most important in an interprofessional burns resuscitation scenario, and whether they can be modeled on to current leadership theory. The purpose of this study was to perform a comprehensive video analysis of leadership behaviors within TBS. A total of 3 burns resuscitation simulations within TBS were recorded. The video analysis was grounded-theory inspired. Using predefined criteria, actions/interactions deemed as leadership behaviors were identified. Using an inductive iterative process, 8 main leadership behaviors were identified. Cohen's κ coefficient was used to measure inter-rater agreement and calculated as κ = 0.7 (substantial agreement). Each video was watched 4 times, focusing on 1 of the 4 team members per viewing (senior surgeon, senior nurse, trainee surgeon, and trainee nurse). The frequency and types of leadership behavior of each of the 4 team members were recorded. Statistical significance to assess any differences was assessed using analysis of variance, whereby a p < 0.05 was taken to be significant. Leadership behaviors were triangulated with verbal cues and actions from the videos. All 3 scenarios were successfully completed. The mean scenario length was 22 minutes. A total of 362 leadership behaviors were recorded from the 12 participants. The most evident leadership behaviors of all team members were adhering to guidelines (which effectively equates to following Advanced Trauma and Life Support/Emergency Management of Severe Burns resuscitation guidelines and hence "maintaining standards"), followed by making decisions. Although in terms of total frequency the senior surgeon engaged in more leadership behaviors compared with the entire team, statistically there was no significant difference between all 4 members within the 8 leadership categories. This analysis highlights that "distributed leadership" was predominant, whereby leadership was "distributed" or "shared" among team members. The leadership behaviors within TBS also seemed to fall in line with the "direction, alignment, and commitment" ontology. Effective leadership is essential for successful functioning of work teams and accomplishment of task goals. As the resuscitation of a patient with major burns is a dynamic event, team leaders require flexibility in their leadership behaviors to effectively adapt to changing situations. Understanding leadership behaviors of different team members within an authentic simulation can identify important behaviors required to optimize nontechnical skills in a major resuscitation. Furthermore, attempting to map these behaviors on to leadership models can help further our understanding of leadership theory. Collectively this can aid the development of refined simulation scenarios for team members, and can be extrapolated into other areas of simulation-based team training and interprofessional education. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The “Empty Chairs” Approach to Learning: Simulation-Based Train the Trainer Program in Mzuzu, Malawi

PubMed Central

Sigalet, Elaine; Wishart, Ian; Lufesi, Norman; Haji, Faizal

2017-01-01

Together, a group of Canadian colleagues from St. John's, Newfoundland, Calgary, Alberta (some via Doha) and London, Ontario introduced the first Train the Trainer in Simulation-Based Learning (TTT-SBL) program in Mzuzu Central Hospital and Mzuzu University in Malawi. The team led by Elaine Sigalet (Doha) and consisting of Ian Wishart (Calgary), Faizal Haji (London) and Adam Dubrowski (St. John's) was invited to Malawi by Norman Lufesi to conduct a two-day TTT-SBL course for facilitators who teach an Emergency Triage, Assessment and Treatment (ETAT) plus Trauma course. The following technical report describes this course.  All trainees-facilitators who took part in the first iteration of the TTT-SBL course were asked to participate in teaching an ETAT course and modify it to include elements of simulation. The new format of ETAT resulted in a reduction of time necessary to conduct the course from four days (based on historical data) to 2.5 days. PMID:28580202

Process simulation during the design process makes the difference: process simulations applied to a traditional design.

PubMed

Traversari, Roberto; Goedhart, Rien; Schraagen, Jan Maarten

2013-01-01

The objective is evaluation of a traditionally designed operating room using simulation of various surgical workflows. A literature search showed that there is no evidence for an optimal operating room layout regarding the position and size of an ultraclean ventilation (UCV) canopy with a separate preparation room for laying out instruments and in which patients are induced in the operating room itself. Neither was literature found reporting on process simulation being used for this application. Many technical guidelines and designs have mainly evolved over time, and there is no evidence on whether the proposed measures are also effective for the optimization of the layout for workflows. The study was conducted by applying observational techniques to simulated typical surgical procedures. Process simulations which included complete surgical teams and equipment required for the intervention were carried out for four typical interventions. Four observers used a form to record conflicts with the clean area boundaries and the height of the supply bridge. Preferences for particular layouts were discussed with the surgical team after each simulated procedure. We established that a clean area measuring 3 × 3 m and a supply bridge height of 2.05 m was satisfactory for most situations, provided a movable operation table is used. The only cases in which conflicts with the supply bridge were observed were during the use of a surgical robot (Da Vinci) and a surgical microscope. During multiple trauma interventions, bottlenecks regarding the dimensions of the clean area will probably arise. The process simulation of four typical interventions has led to significantly different operating room layouts than were arrived at through the traditional design process. Evidence-based design, human factors, work environment, operating room, traditional design, process simulation, surgical workflowsPreferred Citation: Traversari, R., Goedhart, R., & Schraagen, J. M. (2013). Process simulation during the design process makes the difference: Process simulations applied to a traditional design. Health Environments Research & Design Journal 6(2), pp 58-76.

[Injury of subclavian artery in severe trauma of the shoulder girdle and chest].

PubMed

Samokhvalov, I M; Reva, V A; Pronchenko, A A; Petrov, A N

2013-01-01

The authors consider one of possible variants of surgical treatment of shoulder girdle trauma, which is accompanied by an injury of the main artery. It is based on the application of the principle of staged surgical treatment (damage control orthopedic). The well-timed sufficient diagnostics and treatment of bone-arterial trauma, coordinated work of several surgical teams, the appropriate postoperative management of patients with the using of postponed high-technology intervention allowed obtaining an optimal functional result for extremely severe multitrauma of the chest and limb.

Open pneumothorax resulting from blunt thoracic trauma: a case report.

PubMed

McClintick, Colleen M

2008-01-01

Cases of open pneumothorax have been documented as early as 326 BC. Until the last 50 years, understanding of the epidemiology and treatment of penetrating chest trauma has arisen from military surgery. A better understanding of cardiopulmonary dynamics, advances in ventilatory support, and improvement in surgical technique have drastically improved treatment and increased the survival rate of patients with penetrating thoracic trauma. Open pneumothorax is rare in blunt chest trauma, but can occur when injury results in a substantial loss of the chest wall. This case study presents an adolescent who sustained a large open pneumothorax as a result of being run over by a car. Early and appropriate surgical intervention coupled with coordinated efforts by all members of the trauma team resulted in a positive outcome for this patient.

Implementation of a Post-Code Pause: Extending Post-Event Debriefing to Include Silence.

PubMed

Copeland, Darcy; Liska, Heather

2016-01-01

This project arose out of a need to address two issues at our hospital: we lacked a formal debriefing process for code/trauma events and the emergency department wanted to address the psychological and spiritual needs of code/trauma responders. We developed a debriefing process for code/trauma events that intentionally included mechanisms to facilitate recognition, acknowledgment, and, when needed, responses to the psychological and spiritual needs of responders. A post-code pause process was implemented in the emergency department with the aims of standardizing a debriefing process, encouraging a supportive team-based culture, improving transition back to "normal" activities after responding to code/trauma events, and providing responders an opportunity to express reverence for patients involved in code/trauma events. The post-code pause process incorporates a moment of silence and the addition of two simple questions to a traditional operational debrief. Implementation of post-code pauses was feasible despite the fast paced nature of the department. At the end of the 1-year pilot period, staff members reported increases in feeling supported by peers and leaders, their ability to pay homage to patients, and having time to regroup prior to returning to their assignment. There was a decrease in the number of respondents reporting having thoughts or feelings associated with the event within 24 hr. The pauses create a mechanism for operational team debriefing, provide an opportunity for staff members to honor their work and their patients, and support an environment in which the psychological and spiritual effects of responding to code/trauma events can be acknowledged.

Does the presence of an emergency physician influence pre-hospital time, pre-hospital interventions and the mortality of severely injured patients? A matched-pair analysis based on the trauma registry of the German Trauma Society (TraumaRegister DGU®).

PubMed

Bieler, Dan; Franke, Axel; Lefering, Rolf; Hentsch, Sebastian; Willms, Arnulf; Kulla, Martin; Kollig, Erwin

2017-01-01

The role of emergency physicians in the pre-hospital management of severely injured patients remains controversial. In Germany and Austria, an emergency physician is present at the scene of an emergency situation or is called to such a scene in order to provide pre-hospital care to severely injured patients in approximately 95% of all cases. By contrast, in the United States and the United Kingdom, paramedics, i.e. non-physician teams, usually provide care to an injured person both at the scene of an incident and en route to an appropriate hospital. We investigated whether physician or non-physician care offers more benefits and what type of on-site care improves outcome. In a matched-pair analysis using data from the trauma registry of the German Trauma Society, we retrospectively (2002-2011) analysed the pre-hospital management of severely injured patients (ISS ≥16) by physician and non-physician teams. Matching criteria were age, overall injury severity, the presence of relevant injuries to the head, chest, abdomen or extremities, the cause of trauma, the level of consciousness, and the presence of shock. Each of the two groups, i.e. patients who were attended by an emergency physician and those who received non-physician care, consisted of 1235 subjects. There was no significant difference between the two groups in pre-hospital time (61.1 [SD 28.9] minutes for the physician group and 61.9 [SD 30.9] minutes for non-physician group). Significant differences were found in the number of pre-hospital procedures such as fluid administration, analgosedation and intubation. There was a highly significant difference (p<0.001) in the number of patients who received no intervention at all applying to 348 patients (28.2%) treated by non-physician teams and to only 31 patients (2.5%) in the physician-treated group. By contrast, there was no significant difference in mortality within the first 24h and in mortality during hospitalisation. This retrospective analysis does not allow definitive conclusions to be drawn about the optimal model of pre-hospital care. It shows, however, that there was no significant difference in mortality although patients who were attended by non-physician teams received fewer pre-hospital interventions with similar scene times. Copyright © 2016 Elsevier Ltd. All rights reserved.

Does Size and Location of the Vital Signs Monitor Matter? A Study of Two Trauma Centers

PubMed Central

Sarcevic, Aleksandra; Marsic, Ivan; Burd, Randall S.

2010-01-01

We report the results of an observational study in which we compared how the size and location of the vital signs monitor impact teamwork at two trauma centers. Our observations focused on three factors: information exchange, situational awareness, and ergonomic issues. We found that the smaller display was difficult to view and required more team communication and workarounds, such as periodic verbal reports. The larger and closer display, although accessible to more team members, did not uniformly improve team’s situational awareness because vital signals were not verbalized and the monitor was often ignored. We suggest introducing multiple larger and closer displays, while keeping the practice of periodic verbal reporting. PMID:21347070

The effect of the introduction of a regional major trauma network on triage decisions made by a physician-staffed helicopter emergency medical service.

PubMed

Chesters, Adam; Fenton, Ronan

2015-12-01

A major trauma network (MTN) has been in place in the East of England, with a single hospital operating as the major trauma centre (MTC). The primary aim of this retrospective cohort study was to determine whether triage destination decisions with regard to trauma patients made by a helicopter-based doctor-paramedic team are affected by the introduction of a regional trauma network. In addition, we will describe and discuss the logistics of transfer of injured patients attended by the service. This is a retrospective database review that was carried out over two 12-month periods. The first period was before the introduction of an MTN, and the second was after its introduction. All patients who were conveyed to an MTC were identified. Nontrauma patients were excluded. The MTN trauma triage tool was retrospectively applied. A comparative analysis of the two cohorts was carried out. For the group of patients conveyed to the regional MTC, additional follow-up information was obtained. This included patient survival at 30 days and the final injury severity score for each patient. A total of 220 cases were identified in which a major trauma patient was conveyed to an MTC. There were 94 cases in the year before the introduction of the MTN (cohort 1) and 124 in the year during which the MTN was active (cohort 2). There was no significant difference in the number of patients conveyed to each MTC between cohort 1 and cohort 2. The trauma triage tool status was 'positive' in 52.1% of cases in cohort 1 and 55.6% of cases in cohort 2 (P=0.60). Advice of the consultant on call was more commonly used for patients in cohort 2 than for those in cohort 1 (66.9 vs. 40.6%; P<0. 01). The introduction of a regional MTN has not significantly affected the triage decisions made by our physician-paramedic teams.

Trauma-related self-defining memories and future goals in Dissociative Identity Disorder.

PubMed

Huntjens, Rafaële J C; Wessel, Ineke; Ostafin, Brian D; Boelen, Paul A; Behrens, Friederike; van Minnen, Agnes

2016-12-01

This study examined the content of self-defining autobiographical memories in different identities in patients with Dissociative Identity Disorder (DID) and comparison groups of patients with PTSD, healthy controls, and DID simulators. Consistent with the DID trauma model, analyses of objective ratings showed that DID patients in trauma identities retrieved more negative and trauma-related self-defining memories than DID patients in avoidant identities. Inconsistent with the DID trauma model, DID patients' self-rated trauma-relatedness of self-defining memories and future life goals did not differ between trauma identities and trauma avoidant identities. That is, the DID patients did not seem to be "shut off" from their trauma while in their avoidant identity. Furthermore, DID patients in both identities reported a higher proportion of avoidance goals compared to PTSD patients, with the latter group scoring comparably to healthy controls. The simulators behaved according to the instructions to respond differently in each identity (i.e., to report memories and goals consistent with the identity tested). The discrepant task behavior by DID patients and simulators indicated that DID patients did not seem to intentionally produce the hypothesized differences in performance between identities. In conclusion, for patients with DID (i.e., in both identities) and patients with PTSD, trauma played a central role in the retrieval of self-defining memories and in the formulation of life goals. Copyright © 2016 Elsevier Ltd. All rights reserved.

Hyper-Realistic, Team-Centered Fleet Surgical Team Training Provides Sustained Improvements in Performance.

PubMed

Hoang, Tuan N; Kang, Jeff; Siriratsivawong, Kris; LaPorta, Anthony; Heck, Amber; Ferraro, Jessica; Robinson, Douglas; Walsh, Jonathan

2016-01-01

The high-stress, fast-paced environment of combat casualty care relies on effective teamwork and communication which translates into quality patient care. A training course was developed for U.S. Navy Fleet Surgical Teams to address these aspects of patient care by emphasizing efficiency and appropriate patient care. An effective training course provides knowledge and skills to pass the course evaluation and sustain the knowledge and skills acquired over time. The course included classroom didactic hours, and hands-on simulation sessions. A pretest was administered before the course, a posttest upon completion, and a sustainment test 5 months following course completion. The evaluation process measured changes in patient time to disposition and critical errors made during patient care. Naval Base San Diego, with resuscitation and surgical simulations carried out within the shipboard medical spaces. United States Navy medical personnel including physicians of various specialties, corpsmen, nurses, and nurse anesthetists deploying aboard ships. Time to disposition improved significantly, 11 ± 3 minutes, from pretest to posttest, and critical errors improved by 4 ± 1 errors per encounter. From posttest to sustainment test, time to disposition increased by 3 ± 1, and critical errors decreased by 1 ± 1. This course showed value in improving teamwork and communication skills of participants, immediately upon completion of the course, and after 5 months had passed. Therefore, with ongoing sustainment activities within 6 months, this course can substantially improve trauma care provided by shipboard deployed Navy medical personnel to wounded service members. Published by Elsevier Inc.

The standardized live patient and mechanical patient models--their roles in trauma teaching.

PubMed

Ali, Jameel; Al Ahmadi, Khalid; Williams, Jack Ivan; Cherry, Robert Allen

2009-01-01

We have previously demonstrated improved medical student performance using standardized live patient models in the Trauma Evaluation and Management (TEAM) program. The trauma manikin has also been offered as an option for teaching trauma skills in this program. In this study, we compare performance using both models. Final year medical students were randomly assigned to three groups: group I (n = 22) with neither model, group II (n = 24) with patient model, and group III (n = 24) with mechanical model using the same clinical scenario. All students completed pre-TEAM and post-TEAM multiple choice question (MCQ) exams and an evaluation questionnaire scoring five items on a scale of 1 to 5 with 5 being the highest. The items were objectives were met, knowledge improved, skills improved, overall satisfaction, and course should be mandatory. Students (groups II and III) then switched models, rating preferences in six categories: more challenging, more interesting, more dynamic, more enjoyable learning, more realistic, and overall better model. Scores were analyzed by ANOVA with p < 0.05 being considered statistically significant. All groups had similar scores (means % +/- SD)in the pretest (group I - 50.8 +/- 7.4, group II - 51.3 +/- 6.4, group III - 51.1 +/- 6.6). All groups improved their post-test scores but groups II and III scored higher than group I with no difference in scores between groups II and III (group I - 77.5 +/- 3.8, group II - 84.8 +/- 3.6, group III - 86.3 +/- 3.2). The percent of students scoring 5 in the questionnaire are as follows: objectives met - 100% for all groups; knowledge improved: group I - 91%, group II - 96%, group III - 92%; skills improved: group I - 9%, group II - 83%, group III - 96%; overall satisfaction: group I - 91%, group II - 92%, group III - 92%; should be mandatory: group I - 32%, group II - 96%, group III - 100%. Student preferences (48 students) are as follows: the mechanical model was more challenging (44 of 48); more interesting (40 of 48); more dynamic (46 of 48); more enjoyable (48 of 48); more realistic (32/48), and better overall model (42 of 48). Using the TEAM program, we have demonstrated that improvement in knowledge and skills are equally enhanced by using mechanical or patient models in trauma teaching. However, students overwhelmingly preferred the mechanical model.

The Role of Stent-Grafts in the Management of Aortic Trauma

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

Rousseau, Herve, E-mail: rousseau.h@chu-toulouse.fr; Elaassar, Omar; Marcheix, Bertrand

Stent graft has resulted in major advances in the treatment of trauma patients with blunt traumatic aortic injury (TAI) and has become the preferred method of treatment at many trauma centers. In this review, we provide an overview of the place of stent grafts for the management of this disease. As a whole, TEVAR repair of TAIs offers a survival advantage and reduction in major morbidity, including paraplegia, compared with open surgery. However, endovascular procedures in trauma require a sophisticated multidisciplinary and experienced team approach. More research and development of TAI-specific endograft devices is needed and large, multicenter studies willmore » help to clarify the role of TEVAR compared with open repair of TAI.« less

Role of ENT Surgeon in Managing Battle Trauma During Deployment.

PubMed

Rajguru, Renu

2013-01-01

With technological improvements in body armour and increasing use of improvised explosive devices, it is the injuries to head, face and neck are the cause for maximum fatalities as military personnel are surviving wounds that would have otherwise been fatal. The priorities of battlefield surgical treatment are to save life, eyesight and limbs and then to give the best functional and aesthetic outcome for other wounds. Modern day battlefields pose unique demands on the deployed surgical teams and management of head and neck wounds demands multispecialty approach. Optimal result will depend on teamwork of head and neck trauma management team, which should also include otolaryngologist. Data collected by various deployed HFN surgical teams is studied and quoted in the article to give factual figures. Otorhinolaryngology becomes a crucial sub-speciality in the care of the injured and military otorhinolaryngologists need to be trained and deployed accordingly. The otolaryngologist's clinical knowledge base and surgical domain allows the ENT surgeon to uniquely contribute in response to mass casualty incident. Military planners need to recognize the felt need and respond by deploying teams of specialist head and neck surgeons which should also include otorhinolaryngologists.

[Human factors and crisis resource management: improving patient safety].

PubMed

Rall, M; Oberfrank, S

2013-10-01

A continuing high number of patients suffer harm from medical treatment. In 60-70% of the cases the sources of harm can be attributed to the field of human factors (HFs) and teamwork; nevertheless, those topics are still neither part of medical education nor of basic and advanced training even though it has been known for many years and it has meanwhile also been demonstrated for surgical specialties that training in human factors and teamwork considerably reduces surgical mortality.Besides the medical field, the concept of crisis resource management (CRM) has already proven its worth in many other industries by improving teamwork and reducing errors in the domain of human factors. One of the best ways to learn about CRM and HFs is realistic simulation team training with well-trained instructors in CRM and HF. The educational concept of the HOTT (hand over team training) courses for trauma room training offered by the DGU integrates these elements based on the current state of science. It is time to establish such training for all medical teams in emergency medicine and operative care. Accompanying safety measures, such as the development of a positive culture of safety in every department and the use of effective critical incident reporting systems (CIRs) should be pursued.

Maximizing efficiency on trauma surgeon rounds.

PubMed

Ramaniuk, Aliaksandr; Dickson, Barbara J; Mahoney, Sean; O'Mara, Michael S

2017-01-01

Rounding by trauma surgeons is a complex multidisciplinary team-based process in the inpatient setting. Implementation of lean methodology aims to increase understanding of the value stream and eliminate nonvalue-added (NVA) components. We hypothesized that analysis of trauma rounds with education and intervention would improve surgeon efficacy. Level 1 trauma center with 4300 admissions per year. Average non-intensive care unit census was 55. Five full-time attending trauma surgeons were evaluated. Value-added (VA) and NVA components of rounding were identified. The components of each patient interaction during daily rounds were documented. Summary data were presented to the surgeons. An action plan of improvement was provided at group and individual interventions. Change plans were presented to the multidisciplinary team. Data were recollected 6 mo after intervention. The percent of interactions with NVA components decreased (16.0% to 10.7%, P = 0.0001). There was no change between the two periods in time of evaluation of individual patients (4.0 and 3.5 min, P = 0.43). Overall time to complete rounds did not change. There was a reduction in the number of interactions containing NVA components (odds ratio = 2.5). The trauma surgeons were able to reduce the NVA components of rounds. We did not see a decrease in rounding time or individual patient time. This implies that surgeons were able to reinvest freed time into patient care, or that the NVA components were somehow not increasing process time. Direct intervention for isolated improvements can be effective in the rounding process, and efforts should be focused upon improving the value of time spent rather than reducing time invested. Copyright © 2016 Elsevier Inc. All rights reserved.

Evacuation Priorities in Mass Casualty Terror-Related Events

PubMed Central

Einav, Sharon; Feigenberg, Zvi; Weissman, Charles; Zaichik, Daniel; Caspi, Guy; Kotler, Doron; Freund, Herbert R.

2004-01-01

Objective: To assess evacuation priorities during terror-related mass casualty incidents (MCIs) and their implications for hospital organization/contingency planning. Summary Background Data: Trauma guidelines recommend evacuation of critically injured patients to Level I trauma centers. The recent MCIs in Israel offered an opportunity to study the impositions placed on a prehospital emergency medical service (EMS) regarding evacuation priorities in these circumstances. Methods: A retrospective analysis of medical evacuations from MCIs (29.9.2000–31.9.2002) performed by the Israeli National EMS rescue teams. Results: Thirty-three MCIs yielded data on 1156 casualties. Only 57% (506) of the 1123 available and mobilized ambulances were needed to provide 612 evacuations. Rescue teams arrived on scene within <5 minutes and evacuated the last urgent casualty within 15–20 minutes. The majority of non-urgent and urgent patients were transported to medical centers close to the event. Less than half of the urgent casualties were evacuated to more distant trauma centers. Independent variables predicting evacuation to a trauma center were its being the hospital closest to the event (OR 249.2, P < 0.001), evacuation within <10 minutes of the event (OR 9.3, P = 0.003), and having an urgent patient on the ambulance (OR 5.6, P < 0.001). Conclusions: Hospitals nearby terror-induced MCIs play a major role in trauma patient care. Thus, all hospitals should be included in contingency plans for MCIs. Further research into the implications of evacuation of the most severely injured casualties to the nearest hospital while evacuating all other casualties to various hospitals in the area is needed. The challenges posed by terror-induced MCIs require consideration of a paradigm shift in trauma care. PMID:15075645

The role of trauma team leaders in missed injuries: does specialty matter?

PubMed

Leeper, W Robert; Leeper, Terrence John; Vogt, Kelly Nancy; Charyk-Stewart, Tanya; Gray, Daryl Kenneth; Parry, Neil Geordie

2013-09-01

Previous studies have identified missed injuries as a common and potentially preventable occurrence in trauma care. Several patient- and injury-related variables have been identified, which predict for missed injuries; however, differences in rate and severity of missed injuries between surgeon and nonsurgeon trauma team leaders (TTLs) have not previously been reported. A retrospective review was conducted on a random sample of 10% of all trauma patients (Injury Severity Score [ISS] > 12) from 1999 to 2009 at a Canadian Level I trauma center. Missed injuries were defined as those identified greater than 24 hours after presentation and were independently adjudicated by two reviewers. TTLs were identified as either surgeons or nonsurgeons. Of our total trauma population of 2,956 patients, 300 charts were randomly pulled for detailed review. Missed injuries occurred in 46 patients (15%). Most common missed injuries were fractures (n = 32, 70%) and thoracic injuries (n = 23, 50%). The majority of missed injuries resulted in minor morbidity with only 5 (11%) requiring operative intervention. On univariate analysis, higher ISS (p < 0.01), higher maximum Abbreviated Injury Scale (MAIS) score of the thorax (p < 0.01), and nonsurgeon TTL status were predictive of missed injuries (p = 0.02). Multivariable logistic regression revealed that, after adjustment for age, ISS, and severe head injuries, the presence of a nonsurgeon TTL was associated with an increased odds of missed injury (odds ratio, 2.15; 95% confidence interval, 1.10-4.20). Missed injuries occurred in 15% of patients. A unique finding was the increased odds of missed injury with nonsurgeon TTLs. Further research should be undertaken to explore this relationship, elucidate potential causes, and propose interventions to narrow this discrepancy between TTL provider types. Therapeutic study, level IV. Prognostic and epidemiologic study, level III.

Effect of Advanced Trauma Life Support program on medical interns' performance in simulated trauma patient management.

PubMed

Ahmadi, Koorosh; Sedaghat, Mohammad; Safdarian, Mahdi; Hashemian, Amir-Masoud; Nezamdoust, Zahra; Vaseie, Mohammad; Rahimi-Movaghar, Vafa

2013-01-01

Since appropriate and time-table methods in trauma care have an important impact on patients'outcome, we evaluated the effect of Advanced Trauma Life Support (ATLS) program on medical interns' performance in simulated trauma patient management. A descriptive and analytical study before and after the training was conducted on 24 randomly selected undergraduate medical interns from Imam Reza Hospital in Mashhad, Iran. On the first day, we assessed interns' clinical knowledge and their practical skill performance in confronting simulated trauma patients. After 2 days of ATLS training, we performed the same study and evaluated their score again on the fourth day. The two findings, pre- and post- ATLS periods, were compared through SPSS version 15.0 software. P values less than 0.05 were considered statistically significant. Our findings showed that interns'ability in all the three tasks improved after the training course. On the fourth day after training, there was a statistically significant increase in interns' clinical knowledge of ATLS procedures, the sequence of procedures and skill performance in trauma situations (P less than 0.001, P equal to 0.016 and P equal to 0.01 respectively). ATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns.

Developing team cognition: A role for simulation

PubMed Central

Fernandez, Rosemarie; Shah, Sachita; Rosenman, Elizabeth D.; Kozlowski, Steve W. J.; Parker, Sarah Henrickson; Grand, James A.

2016-01-01

SUMMARY STATEMENT Simulation has had a major impact in the advancement of healthcare team training and assessment. To date, the majority of simulation-based training and assessment focuses on the teamwork behaviors that impact team performance, often ignoring critical cognitive, motivational, and affective team processes. Evidence from team science research demonstrates a strong relationship between team cognition and team performance and suggests a role for simulation in the development of this team-level construct. In this article we synthesize research from the broader team science literature to provide foundational knowledge regarding team cognition and highlight best practices for using simulation to target team cognition. PMID:28704287

Resources planning for radiological incidents management

NASA Astrophysics Data System (ADS)

Hamid, Amy Hamijah binti Ab.; Rozan, Mohd Zaidi Abd; Ibrahim, Roliana; Deris, Safaai; Yunus, Muhd. Noor Muhd.

2017-01-01

Disastrous radiation and nuclear meltdown require an intricate scale of emergency health and social care capacity planning framework. In Malaysia, multiple agencies are responsible for implementing radiological and nuclear safety and security. This research project focused on the Radiological Trauma Triage (RTT) System. This system applies patient's classification based on their injury and level of radiation sickness. This classification prioritizes on the diagnostic and treatment of the casualties which include resources estimation of the medical delivery system supply and demand. Also, this system consists of the leading rescue agency organization and disaster coordinator, as well as the technical support and radiological medical response teams. This research implemented and developed the resources planning simulator for radiological incidents management. The objective of the simulator is to assist the authorities in planning their resources while managing the radiological incidents within the Internal Treatment Area (ITA), Reception Area Treatment (RAT) and Hospital Care Treatment (HCT) phases. The majority (75%) of the stakeholders and experts, who had been interviewed, witnessed and accepted that the simulator would be effective to resolve various types of disaster and resources management issues.

Restraint status improves the predictive value of motor vehicle crash criteria for pediatric trauma team activation.

PubMed

Bozeman, Andrew P; Dassinger, Melvin S; Recicar, John F; Smith, Samuel D; Rettiganti, Mallikarjuna R; Nick, Todd G; Maxson, Robert T

2012-12-01

Most trauma centers incorporate mechanistic criteria (MC) into their algorithm for trauma team activation (TTA). We hypothesized that characteristics of the crash are less reliable than restraint status in predicting significant injury and the need for TTA. We identified 271 patients (age, <15 y) admitted with a diagnosis of motor vehicle crash. Mechanistic criteria and restraint status of each patient were recorded. Both MC and MC plus restraint status were evaluated as separate measures for appropriately predicting TTA based on treatment outcomes and injury scores. Improper restraint alone predicted a need for TTA with an odds ratios of 2.69 (P = .002). MC plus improper restraint predicted the need for TTA with an odds ratio of 2.52 (P = .002). In contrast, the odds ratio when using MC alone was 1.65 (P = .16). When the 5 MC were evaluated individually as predictive of TTA, ejection, death of occupant, and intrusion more than 18 inches were statistically significant. Improper restraint is an independent predictor of necessitating TTA in this single-institution study. Copyright © 2012 Elsevier Inc. All rights reserved.

[Pediatric multiple trauma].

PubMed

Auner, B; Marzi, I

2014-05-01

Multiple trauma in children is rare so that even large trauma centers will only treat a small number of cases. Nevertheless, accidents are the most common cause of death in childhood whereby the causes are mostly traffic accidents and falls. Head trauma is the most common form of injury and the degree of severity is mostly decisive for the prognosis. Knowledge on possible causes of injury and injury patterns as well as consideration of anatomical and physiological characteristics are of great importance for treatment. The differences compared to adults are greater the younger the child is. Decompression and stopping bleeding are the main priorities before surgical fracture stabilization. The treatment of a severely injured child should be carried out by an interdisciplinary team in an approved trauma center with expertise in pediatrics. An inadequate primary assessment involves a high risk of early mortality. On the other hand children have a better prognosis than adults with comparable injuries.

Interprofessional Simulations Promote Knowledge Retention and Enhance Perceptions of Teamwork Skills in a Surgical-Trauma-Burn Intensive Care Unit Setting.

PubMed

George, Katie L; Quatrara, Beth

The current state of health care encompasses highly acute, complex patients, managed with ever-changing technology. The ability to function proficiently in critical care relies on knowledge, technical skills, and interprofessional teamwork. Integration of these factors can improve patient outcomes. Simulation provides "hands-on" practice and allows for the integration of teamwork into knowledge/skill training. However, simulation can require a significant investment of time, effort, and financial resources. The Institute of Medicine recommendations from 2015 include "strengthening the evidence base for interprofessional education (IPE)" and "linking IPE with changes in collaborative behavior." In one surgical-trauma-burn intensive care unit (STBICU), no IPE existed. The highly acute and diverse nature of the patients served by the unit highlights the importance of appropriate training. This is heightened during critical event situations where patients deteriorate rapidly and the team intervenes swiftly. The aims of this study were to (1) evaluate knowledge retention and analyze changes in perceptions of teamwork among nurses and resident physicians in a STBICU setting after completion of an interprofessional critical event simulation and (2) provide insight for future interprofessional simulations (IPSs), including the ideal frequency of such training, associated cost, and potential effect on nursing turnover. A comparison-cohort pilot study was developed to evaluate knowledge retention and analyze changes in perceptions of teamwork. A 1-hour critical event IPS was held for nurses and resident physicians in a STBICU setting. A traumatic brain injury patient with elevated intracranial pressure, rapid deterioration, and cardiac arrest was utilized for the simulation scenario. The simulation required the team to use interventions to reduce elevated intracranial pressure and then perform cardiac resuscitation according to Advanced Cardiac Life Support guidelines. A semistructured debriefing guided by the TENTS tool highlighted important aspects of teamwork. Participants took knowledge and Teamwork Skills Scale (TSS) pretests, posttests, and 1-month posttests. Mean scores were calculated for each time point (pre, post, and 1-month post), and paired t tests were used to evaluate changes. Mean knowledge test and TSS scores both significantly increased after the simulation and remained significantly elevated at 1-month follow-up. Participants recommended retraining intervals of 3 to 6 months. Cost of each simulation was estimated to be $324.44. Analysis of nursing turnover rates did not demonstrate a statistically significant reduction in turnover; however, confounding factors were not controlled for. Significant improvements on both knowledge test and TSS scores demonstrate the effectiveness of the intervention, and retention of the information gained and teamwork skills learned. Participants valued the intervention and recommended to increase the frequency of training. Future studies should develop a framework for "best practice" IPS, analyze the relationship with nursing turnover, and ultimately seek correlations between IPS and improved patient outcomes.

Relevancy of Serum Calcium in Predicting Blood Product Transfusion in Trauma

DTIC Science & Technology

2017-08-10

reduction. Most pre-hospital or field medical criteria used to predict blood product needs in trauma patients rely on a combination of physiological ...This effect was age specific for the subject group aged 40 years and below. Patients with normal blood pressure could give medical teams a false...transfusion, as well as transfusion of more than four units within 4 hours, even after controlling for other clinical variables. This effect was age

Trauma-Informed Care in the Massachusetts Child Trauma Project.

PubMed

Bartlett, Jessica Dym; Barto, Beth; Griffin, Jessica L; Fraser, Jenifer Goldman; Hodgdon, Hilary; Bodian, Ruth

2016-05-01

Child maltreatment is a serious public health concern, and its detrimental effects can be compounded by traumatic experiences associated with the child welfare (CW) system. Trauma-informed care (TIC) is a promising strategy for addressing traumatized children's needs, but research on the impact of TIC in CW is limited. This study examines initial findings of the Massachusetts Child Trauma Project, a statewide TIC initiative in the CW system and mental health network. After 1 year of implementation, Trauma-Informed Leadership Teams in CW offices emerged as key structures for TIC systems integration, and mental health providers' participation in evidence-based treatment (EBT) learning collaboratives was linked to improvements in trauma-informed individual and agency practices. After approximately 6 months of EBT treatment, children had fewer posttraumatic symptoms and behavior problems compared to baseline. Barriers to TIC that emerged included scarce resources for trauma-related work in the CW agency and few mental providers providing EBTs to young children. Future research might explore variations in TIC across service system components as well as the potential for differential effects across EBT models disseminated through TIC. © The Author(s) 2015.

A major trauma course based on posters, audio-guides and simulation improves the management skills of medical students: Evaluation via medical simulator.

PubMed

Cuisinier, Adrien; Schilte, Clotilde; Declety, Philippe; Picard, Julien; Berger, Karine; Bouzat, Pierre; Falcon, Dominique; Bosson, Jean Luc; Payen, Jean-François; Albaladejo, Pierre

2015-12-01

Medical competence requires the acquisition of theoretical knowledge and technical skills. Severe trauma management teaching is poorly developed during internship. Nevertheless, the basics of major trauma management should be acquired by every future physician. For this reason, the major trauma course (MTC), an educational course in major traumatology, has been developed for medical students. Our objective was to evaluate, via a high fidelity medical simulator, the impact of the MTC on medical student skills concerning major trauma management. The MTC contains 3 teaching modalities: posters with associated audio-guides, a procedural workshop on airway management and a teaching session using a medical simulator. Skills evaluation was performed 1 month before (step 1) and 1 month after (step 3) the MTC (step 2). Nineteen students were individually evaluated on 2 different major trauma scenarios. The primary endpoint was the difference between steps 1 and 3, in a combined score evaluating: admission, equipment, monitoring and safety (skill set 1) and systematic clinical examinations (skill set 2). After the course, the combined primary outcome score improved by 47% (P<0.01). Scenario choice or the order of use had no significant influence on the skill set evaluations. This study shows improvement in student skills for major trauma management, which we attribute mainly to the major trauma course developed in our institution. Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Communication technology in trauma centers: a national survey.

PubMed

Xiao, Yan; Kim, Young-Ju; Gardner, Sharyn D; Faraj, Samer; MacKenzie, Colin F

2006-01-01

The relationship between information and communication technology (ICT) and trauma work coordination has long been recognized. The purpose of the study was to investigate the type and frequency of use of various ICTs to activate and organize trauma teams in level I/II trauma centers. In a cross-sectional survey, questionnaires were mailed to trauma directors and clinicians in 457 trauma centers in the United States. Responses were received from 254 directors and 767 clinicians. Communication with pre-hospital care providers was conducted predominantly via shortwave radio (67.3%). The primary communication methods used to reach trauma surgeons were manual (56.7%) and computerized group page (36.6%). Computerized group page (53.7%) and regular telephone (49.8%) were cited as the most advantageous devices; e-mail (52.3%) and dry erase whiteboard (52.1%) were selected as the least advantageous. Attending surgeons preferred less overhead paging and more cellular phone communication than did emergency medicine physicians and nurses. Cellular phones have become an important part of hospital-field communication. In high-volume trauma centers, there is a need for more accurate methods of communicating with field personnel and among hospital care providers.

A Geographic Simulation Model for the Treatment of Trauma Patients in Disasters.

PubMed

Carr, Brendan G; Walsh, Lauren; Williams, Justin C; Pryor, John P; Branas, Charles C

2016-08-01

Though the US civilian trauma care system plays a critical role in disaster response, there is currently no systems-based strategy that enables hospital emergency management and local and regional emergency planners to quantify, and potentially prepare for, surges in trauma care demand that accompany mass-casualty disasters. A proof-of-concept model that estimates the geographic distributions of patients, trauma center resource usage, and mortality rates for varying disaster sizes, in and around the 25 largest US cities, is presented. The model was designed to be scalable, and its inputs can be modified depending on the planning assumptions of different locales and for different types of mass-casualty events. To demonstrate the model's potential application to real-life planning scenarios, sample disaster responses for 25 major US cities were investigated using a hybrid of geographic information systems and dynamic simulation-optimization. In each city, a simulated, fast-onset disaster epicenter, such as might occur with a bombing, was located randomly within one mile of its population center. Patients then were assigned and transported, in simulation, via the new model to Level 1, 2, and 3 trauma centers, in and around each city, over a 48-hour period for disaster scenario sizes of 100, 500, 5000, and 10,000 casualties. Across all 25 cities, total mean mortality rates ranged from 26.3% in the smallest disaster scenario to 41.9% in the largest. Out-of-hospital mortality rates increased (from 21.3% to 38.5%) while in-hospital mortality rates decreased (from 5.0% to 3.4%) as disaster scenario sizes increased. The mean number of trauma centers involved ranged from 3.0 in the smallest disaster scenario to 63.4 in the largest. Cities that were less geographically isolated with more concentrated trauma centers in their surrounding regions had lower total and out-of-hospital mortality rates. The nine US cities listed as being the most likely targets of terrorist attacks involved, on average, more trauma centers and had lower mortality rates compared with the remaining 16 cities. The disaster response simulation model discussed here may offer insights to emergency planners and health systems in more realistically planning for mass-casualty events. Longer wait and transport times needed to distribute high numbers of patients to distant trauma centers in fast-onset disasters may create predictable increases in mortality and trauma center resource consumption. The results of the modeled scenarios indicate the need for a systems-based approach to trauma care management during disasters, since the local trauma center network was often too small to provide adequate care for the projected patient surge. Simulation of out-of-hospital resources that might be called upon during disasters, as well as guidance in the appropriate execution of mutual aid agreements and prevention of over-response, could be of value to preparedness planners and emergency response leaders. Study assumptions and limitations are discussed. Carr BG , Walsh L , Williams JC , Pryor JP , Branas CC . A geographic simulation model for the treatment of trauma patients in disasters. Prehosp Disaster Med. 2016;31(4):413-421.

A cross-sectional study of knife injuries at a London major trauma centre.

PubMed

Pallett, J R; Sutherland, E; Glucksman, E; Tunnicliff, M; Keep, J W

2014-01-01

No national recording systems for knife injuries exist in the UK. Understanding the true size and nature of the problem of knife injuries is the first stage in reducing the burden of this injury. The aim of this study was to survey every knife injury seen in a single inner city emergency department (ED) over a one-year period. A cross-sectional observational study was performed of all patients attending with a knife injury to the ED of a London major trauma centre in 2011. Demographic characteristics, patterns of injury, morbidity and mortality data were collected. A total of 938 knife injuries were identified from 127,191 attendances (0.77% of all visits) with a case fatality rate of 0.53%. A quarter (24%) of the major trauma team's caseload was for knife injuries. Overall, 44% of injuries were selfreported as assaults, 49% as accidents and 8% as deliberate self-harm. The highest age specific incident rate occurred in the 16-24 year age category (263/100,000). Multiple injuries were seen in 19% of cases, of which only 81% were recorded as assaults. The mean length of stay for those admitted to hospital was 3.04 days. Intrathoracic injury was seen in 26% of cases of chest trauma and 24% of abdominal injuries had a second additional chest injury. Violent intentional injuries are a significant contributory factor to the workload of the major trauma team at this centre. This paper contributes to a more comprehensive understanding of the nature of these injuries seen in the ED.

Intubated Trauma Patients Do Not Require Full Trauma Team Activation when Effectively Triaged.

PubMed

Harbrecht, Brian G; Franklin, Glen A; Smith, Jason W; Benns, Matthew V; Miller, Keith R; Nash, Nicholas A; Bozeman, Matthew C; Coleman, Royce; O'Brien, Dan; Richardson, J David

2016-04-01

Full trauma team activation in evaluating injured patients is based on triage criteria and associated with significant costs and resources that should be focused on patients who truly need them. Overtriage leads to inefficient care, particularly when resources are finite, and it diverts care from other vital areas. Although shock and gunshot wounds to the abdomen are accepted indicators for full trauma activation, intubation as the sole criterion is controversial. We evaluated our experience to assess if intubation alone merited the highest level of trauma activation. All trauma patients from 2012 to 2013 were assessed for level of activation, injury characteristics, presence of intubation, and outcomes. Of 5,881 patients, 646 (11%) were level 1 (full) and 2,823 (48%) were level 2 (partial) activations. Level 1 patients were younger (40 ± 17 vs 45 ± 20 years), had more penetrating injuries (42% vs 9%), and had higher mortality (26% vs 8%)(p < 0.001). Intubated level 2 patients (n = 513), compared with intubated level 1 patients (n = 320), had higher systolic blood pressure (133 ± 44 vs 90 ± 58 mmHg), lower Injury Severity Score (21 ± 13 vs 25 ± 16), more falls (25% vs 3%), fewer penetrating injuries (11% vs 23%), and lower mortality (31% vs 48%)(p < 0.01). Fewer intubated level patients went directly to the operating room from the emergency department (ED)(16% vs 33%), and most who did had a craniotomy (63% vs 13%). Only 3% of intubated level 2 patients underwent laparotomy compared with 20% of intubated level 1 patients (p < 0.001). The ED lengths of stay before obtaining a head CT (47 ± 26 vs 48 ± 31 minutes) and craniotomy (109 ± 61 vs 102 ± 46 minutes) were similar. Deaths in intubated level 2 patients were primarily from fatal brain injuries. When appropriately triaged, selected intubated trauma patients do not require full trauma activation to receive timely, efficient care. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Trauma care in Africa: a status report from Botswana, guided by the World Health Organization's "Guidelines for Essential Trauma Care".

PubMed

Hanche-Olsen, Terje Peder; Alemu, Lulseged; Viste, Asgaut; Wisborg, Torben; Hansen, Kari S

2012-10-01

Trauma represents a significant and increasing challenge to health care systems all over the world. This study aimed to evaluate the trauma care capabilities of Botswana, a middle-income African country, by applying the World Health Organization's Guidelines for Essential Trauma Care. All 27 government (16 primary, 9 district, 2 referral) hospitals were surveyed. A questionnaire and checklist, based on "Guidelines for Essential Trauma Care" and locally adapted, were developed as situation analysis tools. The questionnaire assessed local trauma organization, capacity, and the presence of quality improvement activity. The checklist assessed physical availability of equipment and timely availability of trauma-related skills. Information was collected by interviews with hospital administrators, key personnel within trauma care, and through on-site physical inspection. Hospitals in Botswana are reasonably well supplied with human and physical resources for trauma care, although deficiencies were noted. At the primary and district levels, both capacity and equipment for airway/breathing management and vascular access was limited. Trauma administrative functions were largely absent at all levels. No hospital in Botswana had any plans for trauma education, separate from or incorporated into other improvement activities. Team organization was nonexistent, and training activities in the emergency room were limited. This study draws a picture of trauma care capabilities of an entire African country. Despite good organizational structures, Botswana has room for substantial improvement. Administrative functions, training, and human and physical resources could be improved. By applying the guidelines, this study creates an objective foundation for improved trauma care in Botswana.

Focused and Corrective Feedback Versus Structured and Supported Debriefing in a Simulation-Based Cardiac Arrest Team Training: A Pilot Randomized Controlled Study.

PubMed

Kim, Ji-Hoon; Kim, Young-Min; Park, Seong Heui; Ju, Eun A; Choi, Se Min; Hong, Tai Yong

2017-06-01

The aim of the study was to compare the educational impact of two postsimulation debriefing methods-focused and corrective feedback (FCF) versus Structured and Supported Debriefing (SSD)-on team dynamics in simulation-based cardiac arrest team training. This was a pilot randomized controlled study conducted at a simulation center. Fourth-year medical students were randomly assigned to the FCF or SSD group, with each team composed of six students and a confederate. Each team participated in two simulations and the assigned debriefing (FCF or SSD) sessions and then underwent a test simulation. Two trained raters blindly assessed all of the recorded simulations using checklists. The primary outcome was the improvement in team dynamics scores between baseline and test simulation. The secondary outcomes were improvements before and after training in team clinical performance scores, self-assessed comprehension of and confidence in cardiac arrest management and team dynamics, as well as evaluations of the postsimulation debriefing intervention. In total, 95 students participated [FCF (8 teams, n = 47) and SSD (8 teams, n = 48)]. The SSD team dynamics score during the test simulation was higher than at baseline [baseline: 74.5 (65.9-80.9), test: 85.0 (71.9-87.6), P = 0.035]. However, there were no differences in the improvement in the team dynamics or team clinical performance scores between the two groups (P = 0.328, respectively). There was no significant difference in improvement in team dynamics scores during the test simulation compared with baseline between the SSD and FCF groups in a simulation-based cardiac arrest team training in fourth-year Korean medical students.

Team Communication Influence on Procedure Performance: Findings From Interprofessional Simulations with Nursing and Medical Students.

PubMed

Reising, Deanna L; Carr, Douglas E; Gindling, Sally; Barnes, Roxie; Garletts, Derrick; Ozdogan, Zulfukar

Interprofessional team performance is believed to be dependent on the development of effective team communication skills. Yet, little evidence exists in undergraduate nursing programs on whether team communication skills affect team performance. A secondary analysis of a larger study on interprofessional student teams in simulations was conducted to determine if there is a relationship between team communication and team procedure performance. The results showed a positive, significant correlation between interprofessional team communication ratings and procedure accuracy in the simulation. Interprofessional team training in communication skills for nursing and medical students improves the procedure accuracy in a simulated setting.

Does trauma team activation associate with the time to CT scan for those suspected of serious head injuries?

PubMed

Rados, Alma; Tiruta, Corina; Xiao, Zhengwen; Kortbeek, John B; Tourigny, Paul; Ball, Chad G; Kirkpatrick, Andrew W

2013-11-18

Traumatic brain injury (TBI) constitutes the leading cause of posttraumatic mortality. Practically, the major interventions required to treat TBI predicate expedited transfer to CT after excluding other immediately life-threatening conditions. At our center, trauma responses variably consist of either full trauma activation (FTA) including an attending trauma surgeon or a non-trauma team response (NTTR). We sought to explore whether FTAs expedited the time to CT head (TTCTH). Retrospective review of augmented demographics of 88 serious head injuries identified from a Regional Trauma Registry within one year at a level I trauma center. The inclusion criteria consisted of a diagnosis of head injury recorded as intubated or GCS < 13; and CT-head scanning after arriving the emergency department. Data was analyzed using STATA. There were 58 FTAs and 30 NTTRs; 86% of FTAs and 17% of NTTRs were intubated prehospital out of 101 charts reviewed in detail; 13 were excluded due to missing data. Although FTAs were more seriously injured (median ISS 29, MAIS head 19, GCS score at scene 6.0), NTTRs were also severely injured (median ISS 25, MAIS head 21, GCS at scene 10) and older (median 54 vs. 26 years). Median TTCTH was double without dedicated FTA (median 50 vs. 26 minutes, p < 0.001), despite similar justifiable delays (53% NTTR, 52% FTA). Without FTA, most delays (69%) were for emergency intubation. TTCTH after securing the airway was longer for NTTR group (median 38 vs. 26 minutes, p =0.0013). Even with no requirements for ED interventions, TTCTH for FTA was less than half versus NTTR (25 vs. 61 minutes, p =0.0013). Multivariate regression analysis indicated age and FTA with an attending surgeon as significant predictors of TTCTH, although the majority of variability in TTCTH was not explained by these two variables (R² = 0.33). Full trauma activations involving attending trauma surgeons were quicker at transferring serious head injury patients to CT. Patients with FTA were younger and more seriously injured. Discerning the reasons for delays to CT should be used to refine protocols aimed at minimizing unnecessary delays and enhancing workforce efficiency and clinical outcome.

Diagnostic peritoneal lavage - slideshow

MedlinePlus

... to the abdomen is a major component of traumatic injury and can be deadly. Blunt trauma can occur ... A.M. Editorial team. Related MedlinePlus Health Topics Wounds and Injuries A.D.A.M., Inc. is accredited by ...

Utility of simultaneous interventional radiology and operative surgery in a dedicated suite for seriously injured patients.

PubMed

D'Amours, Scott K; Rastogi, Pratik; Ball, Chad G

2013-12-01

In recent years, combined interventional radiology and operative suites have been proposed and are now becoming operational in select trauma centres. Given the infancy of this technology, this review aims to review the rationale, benefits and challenges of hybrid suites in the management of seriously injured patients. No specific studies exist that investigate outcomes within hybrid trauma suites. Endovascular and interventional radiology techniques have been successfully employed in thoracic, abdominal, pelvic and extremity trauma. Although the association between delayed haemorrhage control and poorer patient outcomes is intuitive, most supporting scientific data are outdated. The hybrid suite model offers the potential to expedite haemorrhage control through synergistic operative, interventional radiology and resuscitative platforms. Maximizing the utility of these suites requires trained multidisciplinary teams, ergonomic and workplace considerations, as well as a fundamental paradigm shift of trauma care. This often translates into a more damage-control orientated philosophy. Hybrid suites offer tremendous potential to expedite haemorrhage control in trauma patients. Outcome evaluations from trauma units that currently have operational hybrid suites are required to establish clearer guidelines and criteria for patient management.

[First aid for multiple trauma patients: investigative survey in the Firenze-Bologna area].

PubMed

Crescioli, G L; Donati, D; Federici, A; Rasero, L

1999-01-01

Overall mortality ascribable to multiple traumas, that in Italy is responsible for about 8,000 death/year, is strictly dependent on the function of the so called Trauma Care System. This study reports on an epidemiological survey conducted in the urban area of Florence along a 23-month period (from Jan 97 to Nov 99), with the aim to identify the typology of traumas and the first aid care delivered to the person until hospital admission. These data were compared to those collected in the urban area of Bologna because the composition of the first-aid team is different, being nurses, in Bologna, an integral component of the first aid system. On a total of 118 multiple traumas, 17% was represented by isolated head trauma, while in 72% involvement of other organs was present in addition to the head; 11% of cases were abdominal or thoracic traumas, 1% of lower extremities. In 46% the cause of trauma was a car accident. The complexity of care delivered to the person with trauma was less in the Florence survey, as indicated by the immobilization of patients, performed in only 11% of cases as compared to 47% in Bologna, by the application of the cervical collar, applied in 12% versus 62% of traumas. Although the two samples are not strictly comparable, these data suggest that the presence of nurses in the Trauma Care System can be one of the elements of improvement of the quality of delivered care.

Virtual reality-based simulation training for ventriculostomy: an evidence-based approach.

PubMed

Schirmer, Clemens M; Elder, J Bradley; Roitberg, Ben; Lobel, Darlene A

2013-10-01

Virtual reality (VR) simulation-based technologies play an important role in neurosurgical resident training. The Congress of Neurological Surgeons (CNS) Simulation Committee developed a simulation-based curriculum incorporating VR simulators to train residents in the management of common neurosurgical disorders. To enhance neurosurgical resident training for ventriculostomy placement using simulation-based training. A course-based neurosurgical simulation curriculum was introduced at the Neurosurgical Simulation Symposium at the 2011 and 2012 CNS annual meetings. A trauma module was developed to teach ventriculostomy placement as one of the neurosurgical procedures commonly performed in the management of traumatic brain injury. The course offered both didactic and simulator-based instruction, incorporating written and practical pretests and posttests and questionnaires to assess improvement in skill level and to validate the simulators as teaching tools. Fourteen trainees participated in the didactic component of the trauma module. Written scores improved significantly from pretest (75%) to posttest (87.5%; P < .05). Seven participants completed the ventriculostomy simulation. Significant improvements were observed in anatomy (P < .04), burr hole placement (P < .03), final location of the catheter (P = .05), and procedure completion time (P < .004). Senior residents planned a significantly better trajectory (P < .01); junior participants improved most in terms of identifying the relevant anatomy (P < .03) and the time required to complete the procedure (P < .04). VR ventriculostomy placement as part of the CNS simulation trauma module complements standard training techniques for residents in the management of neurosurgical trauma. Improvement in didactic and hands-on knowledge by course participants demonstrates the usefulness of the VR simulator as a training tool.

Non-operative management of hepatic trauma and the interventional radiology: an update review.

PubMed

Pereira, Bruno Monteiro Tavares

2013-10-01

The growing trend to manage hepatic injuries nonoperatively has been increasing demand for advanced endovascular interventions. This brings up the necessity for general and trauma surgeons to update their knowledge in such matter. Effective treatment mandates a multispecialty team effort that is usually led by the trauma surgeon and includes vascular surgery, orthopedics, and, increasingly, interventional radiology. The focus on hemorrhage control and the angiographer's unique access to vascular structures gives interventional radiology (IR) an important and increasingly recognized role in the treatment of patients with hemodynamic instability. Our aim is to review the basic concepts of IR primarily in hepatic trauma and secondarily in some other special situations. A liver vascular anatomy review is also needed for better understanding the roles of IR. As a final point we propose a guideline for the operative/nonoperative management of traumatic hepatic injuries. The benefit of multidisciplinary approach (TAE) appears to be a powerful weapon in the medical arsenal against the high mortality of injured trauma liver patients.

A 'mixed reality' simulator concept for future Medical Emergency Response Team training.

PubMed

Stone, Robert J; Guest, R; Mahoney, P; Lamb, D; Gibson, C

2017-08-01

The UK Defence Medical Service's Pre-Hospital Emergency Care (PHEC) capability includes rapid-deployment Medical Emergency Response Teams (MERTs) comprising tri-service trauma consultants, paramedics and specialised nurses, all of whom are qualified to administer emergency care under extreme conditions to improve the survival prospects of combat casualties. The pre-deployment training of MERT personnel is designed to foster individual knowledge, skills and abilities in PHEC and in small team performance and cohesion in 'mission-specific' contexts. Until now, the provision of airborne pre-deployment MERT training had been dependent on either the availability of an operational aircraft (eg, the CH-47 Chinook helicopter) or access to one of only two ground-based facsimiles of the Chinook 's rear cargo/passenger cabin. Although MERT training has high priority, there will always be competition with other military taskings for access to helicopter assets (and for other platforms in other branches of the Armed Forces). This paper describes the development of an inexpensive, reconfigurable and transportable MERT training concept based on 'mixed reality' technologies-in effect the 'blending' of real-world objects of training relevance with virtual reality reconstructions of operational contexts. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Talk the Talk: Implementing a Communication Curriculum for Surgical Residents.

PubMed

Newcomb, Anna B; Trickey, Amber W; Porrey, Melissa; Wright, Jeffrey; Piscitani, Franco; Graling, Paula; Dort, Jonathan

The Accreditation Council for Graduate Medical Education milestones provide a framework of specific interpersonal and communication skills that surgical trainees should aim to master. However, training and assessment of resident nontechnical skills remains challenging. We aimed to develop and implement a curriculum incorporating interactive learning principles such as group discussion and simulation-based scenarios to formalize instruction in patient-centered communication skills, and to identify best practices when building such a program. The curriculum is presented in quarterly modules over a 2-year cycle. Using our surgical simulation center for the training, we focused on proven strategies for interacting with patients and other providers. We trained and used former patients as standardized participants (SPs) in communication scenarios. Surgical simulation center in a 900-bed tertiary care hospital. Program learners were general surgery residents (postgraduate year 1-5). Trauma Survivors Network volunteers served as SPs in simulation scenarios. We identified several important lessons: (1) designing and implementing a new curriculum is a challenging process with multiple barriers and complexities; (2) several readily available facilitators can ease the implementation process; (3) with the right approach, learners, faculty, and colleagues are enthusiastic and engaged participants; (4) learners increasingly agree that communication skills can be improved with practice and appreciate the curriculum value; (5) patient SPs can be valuable members of the team; and importantly (6) the culture of patient-physician communication appears to shift with the implementation of such a curriculum. Our approach using Trauma Survivors Network volunteers as SPs could be reproduced in other institutions with similar programs. Faculty enthusiasm and support is strong, and learner participation is active. Continued focus on patient and family communication skills would enhance patient care for institutions providing such education as well as for institutions where residents continue on in fellowships or begin their surgical practice. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Residents' perspectives of the value of a simulation curriculum in a general surgery residency program: a multimethod study of stakeholder feedback.

PubMed

Wehbe-Janek, Hania; Colbert, Colleen Y; Govednik-Horny, Cara; White, Bobbie Ann A; Thomas, Scott; Shabahang, Mohsen

2012-06-01

Simulation has altered surgical curricula throughout residency programs. The purpose of this multimethod study was to explore residents' perceptions of simulation within surgical residency as relevant stakeholder feedback and program evaluation of the surgery simulation curriculum. Focus groups were held with a sample of surgery residents (n = 25) at a university-affiliated program. Residents participated in focus groups based on level of training and completed questionnaires regarding simulation curricula. Groups were facilitated by nonsurgeon faculty. Residents were asked: "What is the role of simulation in surgical education?" An interdisciplinary team recorded narrative data and performed content analyses. Quantitative data from questionnaires were summarized using descriptive statistics and frequencies. Major themes from the qualitative data included: concerns regarding simulation in surgical education (28%), exposure to situations and technical skills in a low-stress learning environment (24%), pressure by external agencies (19%), an educational tool (17%), and quality assurance for patient care (12%). Laparoscopy and cadaver lab were the most prevalent simulation training during residency, in addition to trauma simulations, central lines/chest tubes/IV access, and stapling lab. In response to the statement: "ACGME should require a simulation curriculum in surgery residency," 52.1% responded favorably and 47.8% responded nonfavorably. Residents acknowledge the value of simulation in patient safety, quality, and exposure to procedures before clinical experience, but remain divided on efficacy and requirement of simulation within curricula. The greater challenge to residency programs may be strategic implementation of simulation curricula within the right training context. Copyright © 2012 Mosby, Inc. All rights reserved.

Multidisciplinary team approach to traumatic spinal cord injuries: a single institution's quality improvement project.

PubMed

Alizo, Georgina; Sciarretta, Jason D; Gibson, Stefanie; Muertos, Keely; Holmes, Sharon; Denittis, Felicia; Cheatle, Joseph; Davis, John; Pepe, Antonio

2018-04-01

A stepwise multidisciplinary team (MDT) approach to the injured trauma patient has been reported to have an overall benefit, with reduction in mortality and improved morbidity. Based on clinical experience, we hypothesized that implementation of a dedicated Spinal Cord Injury Service (SCIS) would impact outcomes of a patient specific population on the trauma service. The trauma center registry was retrospectively queried, from January 2011 through December 2015, for patients presenting with a spinal cord injury. In 2013, a twice weekly rounding SCIS MDT was initiated. This new multidisciplinary service, the post-SCIS, was compared to the 2011-2012 pre-SCIS. The two groups were compared across patient demographics, mechanism of injury, surgical procedures, and disposition at discharge. The primary outcome was mortality. Secondary endpoints also included the incidence of complications, hospital length of stay (HLOS), ICU LOS, ventilator free days, and all hospital-acquired infectious complications. Logistic regression and Student's t test were used to analyze data. Ninety-five patients were identified. Of these patients, 41 (43%) pre-SCIS and 54 (57%) post-SCIS patients were compared. Mean age was 46.9 years and 79% male. Overall, adjusted mortality rate between the two groups was significant with the implementation of the post-SCIS (p = 0.033). In comparison, the post-SCIS revealed shorter HLOS (23 vs 34.8 days, p = 0.004), increased ventilator free days (20.2 vs 63.3 days, p < 0.001), and less nosocomial infections (1.8 vs 22%, p = 0.002). While the post-SCIS mean ICU LOS was shorter (12 vs 17.9 days, p = 0.089), this relationship was not significant. The application of an SCIS team in addition to the trauma service suggests that a structured coordinated approach can have an expected improvement in hospital outcomes and shorter length of stays. We believe that this clinical collaboration provides distinct specialist perspectives and, therefore, optimizes quality improvement. Level of evidence Epidemiologic study, level III.

Medical coverage of winter Nordic sports: an overview from the field.

PubMed

Gaul, Lawrence W

2010-01-01

Traveling with sports teams requires flexibility and a wide range of knowledge, as well as problem-solving abilities. Dominating the medical types of problems in the Nordic sports are the respiratory illnesses, especially asthma and upper respiratory infections (URI). Additionally, the team physician must have an awareness of antidoping issues. This overview highlights many of the issues encountered traveling domestically as well as internationally with high-level Nordic teams. Helpful links are included to facilitate the care of all levels of athletes. Additionally, a few side issues such as altitude illness and minor trauma are mentioned.

Forward Surgical Team Experience (FSTE) Is Associated With Increased Confidence With Combat Surgeon Trauma Skills.

PubMed

Mancini, D Joshua; Smith, Brian P; Polk, Travis M; Schwab, C William

2018-05-08

Little is known regarding the confidence of military surgeons prior to combat zone deployment. Military surgeons are frequently deployed without peers experienced in combat surgery. We hypothesized that forward surgical team experience (FSTE) increases surgeon confidence with critical skill sets. We conducted a national survey of military affiliated personnel. We used a novel survey instrument that was piloted and validated by experienced military surgeons to collect demographics, education, practice patterns, and confidence parameters for trauma and surgical critical care skills. Skills were defined as crucial operative techniques for hemorrhage control and resuscitation. Surveyors were blinded to participants, and surveys were returned electronically via REDCap database. Data were analyzed with SPSS using appropriate models. Significance was considered p < 0.05. Of 174 distributed surveys, 86 were completed. Nine individuals failed to characterize their FSTE, thus leaving a sample size of 77. At the time of first deployment, 78.4% were alone or with less experienced surgeons and 53.2% had less than 2 yr of post-residency practice. The respondents' confidence in damage control techniques and seven other trauma skills increased relative to FSTE. After adjusting for years of practice, number of trauma resuscitations performed per month and pre-deployment training, there remained a significant positive association between FSTE and confidence in damage control, thoracic surgery, extremity/junctional hemorrhage control, trauma systems administration, adult critical care and airway management. Training programs and years of general surgery practice do not replace FSTE among military surgeons. Pre-deployment training that mimics FST skill sets should be developed to improve military surgeon confidence and outcomes. Prognostic and Epidemiologic, Level IV.

Dental and General Trauma in Team Handball.

PubMed

Petrović, Mateja; Kühl, Sebastian; Šlaj, Martina; Connert, Thomas; Filippi, Andreas

Handball has developed into a much faster and high-impact sport over the past few years because of rule changes. Fast sports with close body contact are especially prone to orofacial trauma. Handball belongs to a category of sports with medium risk for dental trauma. Even so, there is only little literature on this subject. The aim of this study was to examine the prevalence and the type of injuries, especially the occurrence of orofacial trauma, habits of wearing mouthguards, as well as degree of familiarity with the tooth rescue box. For this purpose, 77.1% (n=542/703) of all top athletes and coaches from the two highest Swiss leagues (National League A and National League B), namely 507 professional players and 35 coaches, were personally interviewed using a standardized questionnaire. 19.7% (n=100/507) of the players experienced dental trauma in their handball careers, with 40.8% (n=51/125) crown fractures being the most frequent by far. In spite of the relatively high risk of lip or dental trauma, only 5.7% (n=29/507) of the players wear mouthguards. The results of this study show that dental trauma is common among Swiss handball players. In spite of the high risk of dental trauma, the mouthguard as prevention is not adequately known, and correct procedure following dental trauma is rarely known at all.

Videotape review leads to rapid and sustained learning.

PubMed

Scherer, Lynette A; Chang, Michael C; Meredith, J Wayne; Battistella, Felix D

2003-06-01

Performance review using videotapes is a strategy employed to improve future performance. We postulated that videotape review of trauma resuscitations would improve compliance with a treatment algorithm. Trauma resuscitations were taped and reviewed during a 6-month period. For 3 months, team members were given verbal feedback regarding performance. During the next 3 months, new teams attended videotape reviews of their performance. Data on targeted behaviors were compared between the two groups. Behavior did not change after 3 months of verbal feedback; however, behavior improved after 1 month of videotape feedback (P <0.05) and total time to disposition was reduced by 50% (P <0.01). This response was sustained for the remainder of the study. Videotape review can be an important learning tool as it was more effective than verbal feedback in achieving behavioral changes and algorithm compliance. Videotape review can be an important quality assurance adjunct, as improved algorithm compliance should be associated with improved patient care.

Evaluation of TEAM dynamics before and after remote simulation training utilizing CERTAIN platform.

PubMed

Pennington, Kelly M; Dong, Yue; Coville, Hongchuan H; Wang, Bo; Gajic, Ognjen; Kelm, Diana J

2018-12-01

The current study examines the feasibility and potential effects of long distance, remote simulation training on team dynamics. The study design was a prospective study evaluating team dynamics before and after remote simulation. Study subjects consisted of interdisciplinary teams (attending physicians, physicians in training, advanced care practitioners, and/or nurses). The study was conducted at nine training sites in eight countries. Study subjects completed 2-3 simulation scenarios of acute crises before and after training with the Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN). Pre- and post-CERTAIN training simulations were evaluated by two independent reviewers utilizing the Team Emergency Assessment Measure (TEAM), which is a 11-item questionnaire that has been validated for assessing teamwork in the intensive care unit. Any discrepancies of greater than 1 point between the two reviewers on any question on the TEAM assessment were sent to a third reviewer to judge. The score that was deemed discordant by the third judge was eliminated. Pre- and post-CERTAIN training TEAM scores were averaged and compared. Of the nine teams evaluated, six teams demonstrated an overall improvement in global team performance following CERTAIN virtual training. For each of the 11 TEAM assessments, a trend toward improvement following CERTAIN training was noted; however, no assessment had universal improvement. 'Team composure and control' had the least absolute score improvement following CERTAIN training. The greatest improvement in the TEAM assessment scores was in the 'team's ability to complete tasks in a timely manner' and in the 'team leader's communication to the team'. The assessment of team dynamics using long distance, virtual simulation training appears to be feasible and may result in improved team performance during simulated patient crises; however, language and video quality were the two largest barriers noted during the review process.

Oxidative stress in severe pulmonary trauma in critical ill patients. Antioxidant therapy in patients with multiple trauma--a review.

PubMed

Bedreag, Ovidiu Horea; Rogobete, Alexandru Florin; Sarandan, Mirela; Cradigati, Alina Carmen; Papurica, Marius; Dumbuleu, Maria Corina; Chira, Alexandru Mihai; Rosu, Oana Maria; Sandesc, Dorel

2015-01-01

Multiple trauma patients require extremely good management and thus, the trauma team needs to be prepared and to be up to date with the new standards of intensive therapy. Oxidative stress and free radicals represent an extremely aggressive factor to cells, having a direct consequence upon the severity of lung inflammation. Pulmonary tissue is damaged by oxidative stress, leading to biosynthesis of mediators that exacerbate inflammation modulators. The subsequent inflammation spreads throughout the body, leading most of the time to multiple organ dysfunction and death. In this paper, we briefly present an update of biochemical effects of oxidative stress and free radical damage to the pulmonary tissue in patients in critical condition in the intensive care unit. Also, we would like to present a series of active substances that substantially reduce the aggressiveness of free radicals, increasing the chances of survival.

The KSC Simulation Team practices for contingencies in Firing Room 1

NASA Technical Reports Server (NTRS)

1998-01-01

In Firing Room 1 at KSC, Shuttle launch team members put the Shuttle system through an integrated simulation. The control room is set up with software used to simulate flight and ground systems in the launch configuration. A Simulation Team, comprised of KSC engineers, introduce 12 or more major problems to prepare the launch team for worst-case scenarios. Such tests and simulations keep the Shuttle launch team sharp and ready for liftoff. The next liftoff is targeted for Oct. 29.

Non-compliance with ACS-COT recommended criteria for full trauma team activation is associated with undertriage deaths.

PubMed

Tignanelli, Christopher J; Vander Kolk, Wayne E; Mikhail, Judy N; Delano, Matthew J; Hemmila, Mark R

2017-11-21

The appropriate triage of acutely injured patients within a trauma system is associated with improved rates of mortality and optimal resource utilization. The American College of Surgeons Committee on Trauma (ACS-COT) put forward six minimum criteria (ACS-6) for full trauma team activation (TTA). We hypothesized that ACS-COT verified trauma center compliance with these criteria is associated with low under-triage rates and improved overall mortality. Data from a state-wide collaborative quality initiative was utilized. We used data collected from 2014 through 2016 at 29 ACS verified level 1 and 2 trauma centers. Inclusion criteria were: adult patients (≥16 years) and ISS ≥5. Quantitative data existed to analyze four of the ACS-6 criteria (ED SBP≤90 mmHg, respiratory compromise/intubation, central GSW, and GCS<9). Patients were considered to be under-triaged if they had major trauma (ISS>15) and did not receive a full TTA. 51,792 patients were included in the study. Compliance with ACS-6 minimum criteria for full TTA varied from 51% to 82%. Presence of any ACS-6 criteria was associated with a high intervention rate and significant risk of mortality (OR 16.7, 95% CI 15.2-18.3, p<0.001). Of the 1004 deaths that were not a full activation, 433 (43%) were classified as under-triaged, and 301 (30%) had at least one ACS-6 criteria present. Under-triaged patients with any ACS-6 criteria were more likely to die than those who were not under-triaged (30% vs 21%, p=0.001). GCS<9 and need for emergent intubation were the ACS-6 criteria most frequently associated with under-triage mortality. Compliance with ACS-COT minimum criteria for full TTA remains sub-optimal and undertriage is associated with increased mortality. This data suggests that the most efficient quality improvement measure around triage should be ensuring compliance with the ACS-6 criteria. This study suggests that practice pattern modification to more strictly adhere to the minimum ACS-COT criteria for full TTA will save lives. Diagnostic Tests or Criteria, Level III.

The impact of major trauma network triage systems on patients with major burns.

PubMed

Nizamoglu, Metin; O'Connor, Edmund Fitzgerald; Bache, Sarah; Theodorakopoulou, Evgenia; Sen, Sankhya; Sherren, Peter; Barnes, David; Dziewulski, Peter

2016-12-01

Trauma is a leading cause of death and disability worldwide. Patients presenting with severe trauma and burns benefit from specifically trained multidisciplinary teams. Regional trauma systems have shown improved outcomes for trauma patients. The aim of this study is to determine whether the development of major trauma systems have improved the management of patients with major burns. A retrospective study was performed over a four-year period reviewing all major burns in adults and children received at a regional burns centre in the UK before and after the implementation of the regional trauma systems and major trauma centres (MTC). Comparisons were drawn between three areas: (1) Patients presenting before the introduction of MTC and after the introduction of MTC. (2) Patients referred from MTC and non-MTC within the region, following the introduction of MTC. (3) Patients referred using the urban trauma protocol and the rural trauma protocol. Following the introduction of regional trauma systems and major trauma centres (MTC), isolated burn patients seen at our regional burns centre did not show any significant improvement in transfer times, admission resuscitation parameters, organ dysfunction or survival when referred from a MTC compared to a non-MTC emergency department. There was also no significant difference in survival when comparing referrals from all hospitals pre and post establishment of the major trauma network. No significant outcome benefit was demonstrated for burns patients referred via MTCs compared to non-MTCs. We suggest further research is needed to ascertain whether burns patients benefit from prolonged transfer times to a MTC compared to those seen at their local hospitals prior to transfer to a regional burns unit for further specialist care. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

The impact of leadership and team behavior on standard of care delivered during human patient simulation: a pilot study for undergraduate medical students.

PubMed

Carlson, Jim; Min, Elana; Bridges, Diane

2009-01-01

Methodology to train team behavior during simulation has received increased attention, but standard performance measures are lacking, especially at the undergraduate level. Our purposes were to develop a reliable team behavior measurement tool and explore the relationship between team behavior and the delivery of an appropriate standard of care specific to the simulated case. Authors developed a unique team measurement tool based on previous work. Trainees participated in a simulated event involving the presentation of acute dyspnea. Performance was rated by separate raters using the team behavior measurement tool. Interrater reliability was assessed. The relationship between team behavior and the standard of care delivered was explored. The instrument proved to be reliable for this case and group of raters. Team behaviors had a positive relationship with the standard of medical care delivered specific to the simulated case. The methods used provide a possible method for training and assessing team performance during simulation.

The Battered Teacher

ERIC Educational Resources Information Center

Bloch, Alfred M.

1977-01-01

Methods for the prevention and control of stress and trauma in physically assaulted teachers include preparedness training, formation of crisis intervention teams, and morale-improving techniques such as staff support, rotation of teaching assignments, and direct access to schoolboards for grievance reports. (MJB)

Impact of crisis resource management simulation-based training for interprofessional and interdisciplinary teams: A systematic review.

PubMed

Fung, Lillia; Boet, Sylvain; Bould, M Dylan; Qosa, Haytham; Perrier, Laure; Tricco, Andrea; Tavares, Walter; Reeves, Scott

2015-01-01

Crisis resource management (CRM) abilities are important for different healthcare providers to effectively manage critical clinical events. This study aims to review the effectiveness of simulation-based CRM training for interprofessional and interdisciplinary teams compared to other instructional methods (e.g., didactics). Interprofessional teams are composed of several professions (e.g., nurse, physician, midwife) while interdisciplinary teams are composed of several disciplines from the same profession (e.g., cardiologist, anaesthesiologist, orthopaedist). Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and ERIC were searched using terms related to CRM, crisis management, crew resource management, teamwork, and simulation. Trials comparing simulation-based CRM team training versus any other methods of education were included. The educational interventions involved interprofessional or interdisciplinary healthcare teams. The initial search identified 7456 publications; 12 studies were included. Simulation-based CRM team training was associated with significant improvements in CRM skill acquisition in all but two studies when compared to didactic case-based CRM training or simulation without CRM training. Of the 12 included studies, one showed significant improvements in team behaviours in the workplace, while two studies demonstrated sustained reductions in adverse patient outcomes after a single simulation-based CRM team intervention. In conclusion, CRM simulation-based training for interprofessional and interdisciplinary teams show promise in teaching CRM in the simulator when compared to didactic case-based CRM education or simulation without CRM teaching. More research, however, is required to demonstrate transfer of learning to workplaces and potential impact on patient outcomes.

Simulation-based Randomized Comparative Assessment of Out-of-Hospital Cardiac Arrest Resuscitation Bundle Completion by Emergency Medical Service Teams Using Standard Life Support or an Experimental Automation-assisted Approach.

PubMed

Choi, Bryan; Asselin, Nicholas; Pettit, Catherine C; Dannecker, Max; Machan, Jason T; Merck, Derek L; Merck, Lisa H; Suner, Selim; Williams, Kenneth A; Jay, Gregory D; Kobayashi, Leo

2016-12-01

Effective resuscitation of out-of-hospital cardiac arrest (OHCA) patients is challenging. Alternative resuscitative approaches using electromechanical adjuncts may improve provider performance. Investigators applied simulation to study the effect of an experimental automation-assisted, goal-directed OHCA management protocol on EMS providers' resuscitation performance relative to standard protocols and equipment. Two-provider (emergency medical technicians (EMT)-B and EMT-I/C/P) teams were randomized to control or experimental group. Each team engaged in 3 simulations: baseline simulation (standard roles); repeat simulation (standard roles); and abbreviated repeat simulation (reversed roles, i.e., basic life support provider performing ALS tasks). Control teams used standard OHCA protocols and equipment (with high-performance cardiopulmonary resuscitation training intervention); for second and third simulations, experimental teams performed chest compression, defibrillation, airway, pulmonary ventilation, vascular access, medication, and transport tasks with goal-directed protocol and resuscitation-automating devices. Videorecorders and simulator logs collected resuscitation data. Ten control and 10 experimental teams comprised 20 EMT-B's; 1 EMT-I, 8 EMT-C's, and 11 EMT-P's; study groups were not fully matched. Both groups suboptimally performed chest compressions and ventilations at baseline. For their second simulations, control teams performed similarly except for reduced on-scene time, and experimental teams improved their chest compressions (P=0.03), pulmonary ventilations (P<0.01), and medication administration (P=0.02); changes in their performance of chest compression, defibrillation, airway, and transport tasks did not attain significance against control teams' changes. Experimental teams maintained performance improvements during reversed-role simulations. Simulation-based investigation into OHCA resuscitation revealed considerable variability and improvable deficiencies in small EMS teams. Goal-directed, automation-assisted OHCA management augmented select resuscitation bundle element performance without comprehensive improvement.

Difficult airway response team: a novel quality improvement program for managing hospital-wide airway emergencies.

PubMed

Mark, Lynette J; Herzer, Kurt R; Cover, Renee; Pandian, Vinciya; Bhatti, Nasir I; Berkow, Lauren C; Haut, Elliott R; Hillel, Alexander T; Miller, Christina R; Feller-Kopman, David J; Schiavi, Adam J; Xie, Yanjun J; Lim, Christine; Holzmueller, Christine; Ahmad, Mueen; Thomas, Pradeep; Flint, Paul W; Mirski, Marek A

2015-07-01

Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. We developed a quality improvement program-the Difficult Airway Response Team (DART)-to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had 3 core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a Web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index >40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous or current tracheostomy. Twenty-three patients (6%) required emergent surgical airways. Sixty-two patients (17%) were stabilized and transported to the operating room for definitive airway management. There were no airway management-related deaths, sentinel events, or malpractice claims in adult patients managed by DART. Five in situ simulations conducted in the first program year improved DART's teamwork, communication, and response times and increased the functionality of the difficult airway carts. Over the 5-year period, we conducted 18 airway courses, through which >200 providers were trained. DART is a comprehensive program for improving difficult airway management. Future studies will examine the comparative effectiveness of the DART program and evaluate how DART has impacted patient outcomes, operational efficiency, and costs of care.

Difficult Airway Response Team: A Novel Quality Improvement Program for Managing Hospital-Wide Airway Emergencies

PubMed Central

Mark, Lynette J.; Herzer, Kurt R.; Cover, Renee; Pandian, Vinciya; Bhatti, Nasir I.; Berkow, Lauren C.; Haut, Elliott R.; Hillel, Alexander T.; Miller, Christina R.; Feller-Kopman, David J.; Schiavi, Adam J.; Xie, Yanjun J.; Lim, Christine; Holzmueller, Christine; Ahmad, Mueen; Thomas, Pradeep; Flint, Paul W.; Mirski, Marek A.

2015-01-01

Background Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. Methods We developed a quality improvement program—the Difficult Airway Response Team (DART)—to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had three core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. Results Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index > 40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous or current tracheostomy. Twenty-three patients (6%) required emergent surgical airways. Sixty-two patients (17%) were stabilized and transported to the operating room for definitive airway management. There were no airway management-related deaths, sentinel events, or malpractice claims in adult patients managed by DART. Five in situ simulations conducted in the first program year improved DART's teamwork, communication, and response times and increased the functionality of the difficult airway carts. Over the 5-year period, we conducted 18 airway courses, through which more than 200 providers were trained. Conclusions DART is a comprehensive program for improving difficult airway management. Future studies will examine the comparative effectiveness of the DART program and evaluate how DART has impacted patient outcomes, operational efficiency, and costs of care. PMID:26086513

A survey assessment of the level of preparedness for domestic terrorism and mass casualty incidents among Eastern Association for the Surgery of Trauma members.

PubMed

Ciraulo, David L; Frykberg, Eric R; Feliciano, David V; Knuth, Thomas E; Richart, Charles M; Westmoreland, Christy D; Williams, Kathryn A

2004-05-01

The goal of this survey was to establish a benchmark for trauma surgeons' level of operational understanding of the command structure for a pre-hospital incident, a mass casualty incident (MCI), and weapons of mass destruction (WMD). The survey was distributed before the World Trade Center destruction on September 11, 2001. The survey was developed by the authors and reviewed by a statistician for clarity and performance. The survey was sent to the membership of the 2000 Eastern Association for the Surgery of Trauma spring mailing, with two subsequent mailings and a final sampling at the Eastern Association for the Surgery of Trauma 2001 meeting. Of 723 surveys mailed, 243 were returned and statistically analyzed (significance indicated by p < 0.05). No statistical difference existed between level of designation of a trauma center (state or American College of Surgeons) and a facility's level of pre-paredness for MCIs or WMD. Physicians in communities with chemical plants, railways, and waterway traffic were statistically more likely to work at facilities with internal disaster plans addressing chemical and biological threats. Across all variables, physicians with military training were significantly better prepared for response to catastrophic events. With the exception of cyanide (50%), less than 30% of the membership was prepared to manage exposure to a nerve agent, less than 50% was prepared to manage illness from intentional biological exposure, and only 73% understood and were prepared to manage blast injury. Mobile medical response teams were present in 46% of the respondents' facilities, but only 30% of those teams deployed a trauma surgeon. Approximately 70% of the membership had been involved in an MCI, although only 60% understood the command structure for a prehospital incident. Only 33% of the membership had training regarding hazardous materials. Of interest, 76% and 65%, respectively, felt that education about MCIs and WMD should be included in residency training. A facility's level of pre-paredness for MCIs or WMD was not related to level of designation as a trauma center, but may be positively influenced by local physicians with prior military background. Benchmark information from this survey will provide the architecture for the development and implementation of further training in these areas for trauma surgeons.

A novel prospective approach to evaluate trauma recidivism: the concept of the past trauma history.

PubMed

McCoy, Andrew M; Como, John J; Greene, Gregory; Laskey, Sara L; Claridge, Jeffrey A

2013-07-01

The purpose of this study was to determine the incidence and burden of trauma recidivism at a regional Level 1 trauma center by incorporating the concept of the past trauma history (PTHx) into the general trauma history. All trauma patients who met prehospital trauma criteria and activated the trauma team during a 13-month period were asked about their PTHx, that is, their history of injury in the previous 5 years. A recidivist presented more than once for separate severe injuries. Recurrent recidivists presented multiple times during the study period. Of the 4,971 trauma activations during the study period, 1,246 (25.2%) were identified as recidivists. Recidivists were 75% male, 62% white, 36% unemployed, 26% uninsured, and 90% unmarried. The recidivism rate among admitted patients was 23.4% compared with 29.3% in those discharged from the emergency department. The highest recidivism rates were noted in patients who reported alcohol or illegal drug use on the day of injury and in victims of interpersonal violence (IPV), defined as those who sustained gunshot wounds, stab wounds, or assaults, Those involved in IPV were more likely to have been involved in IPV at the previous trauma than those with other trauma mechanisms. Key risk factors for recidivism among all patients were male sex and single marital status. Seventy-three patients (1.5%) were recurrent recidivists, representing 157 unique encounters. This is the highest trauma recidivism rate reported on a large population of all consecutive trauma activations at a regional Level 1 trauma center. These data illustrate the tremendous burden of recidivism in the modern era, more than previously recognized. Efforts specifically targeting those involved in IPV may reduce recidivism rates. Incorporating the concept of the PTHx into the general history of the trauma patient is feasible and provides valuable information to the provider. Prognostic study, level II.

Enhancing the population impact of collaborative care interventions: Mixed method development and implementation of stepped care targeting posttraumatic stress disorder and related comorbidities after acute trauma

PubMed Central

Zatzick, Douglas; Rivara, Frederick; Jurkovich, Gregory; Russo, Joan; Trusz, Sarah Geiss; Wang, Jin; Wagner, Amy; Stephens, Kari; Dunn, Chris; Uehara, Edwina; Petrie, Megan; Engel, Charles; Davydow, Dimitri; Katon, Wayne

2011-01-01

Objective To develop and implement a stepped collaborative care intervention targeting PTSD and related co-morbidities to enhance the population impact of early trauma-focused interventions. Method We describe the design and implementation of the Trauma Survivors Outcomes & Support Study (TSOS II). An interdisciplinary treatment development team was comprised of trauma surgical, clinical psychiatric and mental health services “change agents” who spanned the boundaries between front-line trauma center clinical care and acute care policy. Mixed method clinical epidemiologic and clinical ethnographic studies informed the development of PTSD screening and intervention procedures. Results Two-hundred and seven acutely injured trauma survivors with high early PTSD symptom levels were randomized into the study. The stepped collaborative care model integrated care management (i.e., posttraumatic concern elicitation and amelioration, motivational interviewing, and behavioral activation) with cognitive behavioral therapy and pharmacotherapy targeting PTSD. The model was feasibly implemented by front-line acute care MSW and ARNP providers. Conclusions Stepped care protocols targeting PTSD may enhance the population impact of early interventions developed for survivors of individual and mass trauma by extending the reach of collaborative care interventions to acute care medical settings and other non-specialty posttraumatic contexts. PMID:21596205

Registry based trauma outcome: perspective of a developing country.

PubMed

Zafar, H; Rehmani, R; Raja, A J; Ali, A; Ahmed, M

2002-09-01

To report trauma outcome from a developing country based on the Trauma and Injury Severity Scoring (TRISS) method and compare the outcome with the registry data from Major Trauma Outcome Study (MTOS). Registry based audit of all trauma patients over two years. Emergency room of a teaching university hospital. 279 injured patients meeting trauma team activation criteria including all deaths in the emergency room. TRISS methodology to compare expected and observed outcome. W, M, and Z statistics and comparison with MTOS data. 279 patients meeting the trauma triage criteria presented to the emergency room, 235 (84.2%) were men and 44 (15.8%) women. Blunt injury accounted for 204 (73.1%) and penetrating for 75 (26.9%) patients. Seventy two patients had injury severity score of more than 15. Only 18 (6.4%) patients were transported in an ambulance. A total of 142 (50.9%) patients were transferred from other hospitals with a mean prehospital delay of 7.1 hours. M statistic of our study subset was 0.97, indicating a good match between our patients and MTOS cohort. There were 18 deaths with only one unexpected survivor. The expected number of deaths based on MTOS dataset should have been 12. Present injury severity instruments using MTOS coefficients do not accurately correlate with observed survival rates in a developing country.

The Journey of Harmless Bullet: The Perioperative Care of Penetrating Cardiac Injury

PubMed Central

Abou-Leila, Ahmad; Voronov, Gennadiy

2017-01-01

Traumatic injuries to the heart contribute significantly to trauma are associated with high mortality. Cardiac gunshot wounds (GSW) are considered more lethal compared to other injuries and present several unique challenges to the anesthesia management and perioperative care. We are reporting a rare case of a trauma victim who survived a GSW to the heart. We will discuss the perioperative care of penetrating cardiac injuries, the role of the anesthesia team in resuscitation, safe anesthesia induction, cardiopulmonary bypass management, and the essential role of intraoperative transesophageal echocardiogram imaging. PMID:28928592

Team Cognition in Experienced Command-and-Control Teams

ERIC Educational Resources Information Center

Cooke, Nancy J.; Gorman, Jamie C.; Duran, Jasmine L.; Taylor, Amanda R.

2007-01-01

Team cognition in experienced command-and-control teams is examined in an UAV (Uninhabited Aerial Vehicle) simulation. Five 3-person teams with experience working together in a command-and-control setting were compared to 10 inexperienced teams. Each team participated in five 40-min missions of a simulation in which interdependent team members…

Medical Team Training: Using Simulation as a Teaching Strategy for Group Work

ERIC Educational Resources Information Center

Moyer, Michael R.; Brown, Rhonda Douglas

2011-01-01

Described is an innovative approach currently being used to inspire group work, specifically a medical team training model, referred to as The Simulation Model, which includes as its major components: (1) Prior Training in Group Work of Medical Team Members; (2) Simulation in Teams or Groups; (3) Multidisciplinary Teamwork; (4) Team Leader…

Blunt traumatic injury during pregnancy: a descriptive analysis from a level 1 trauma center.

PubMed

Al-Thani, Hassan; El-Menyar, Ayman; Sathian, Brijesh; Mekkodathil, Ahammed; Thomas, Sam; Mollazehi, Monira; Al-Sulaiti, Maryam; Abdelrahman, Husham

2018-03-27

The precise incidence of trauma in pregnancy is not well-known, but trauma is estimated to complicate nearly 1 in 12 pregnancies and it is the leading non-obstetrical cause of maternal death. A retrospective study of all pregnant women presented to national level 1 trauma center from July 2013 to June 2015 was conducted. Descriptive and inferential statistics applied for data analysis. Across the study period, a total of 95 pregnant women were presented to the trauma center. The average incidence rate of traumatic injuries was 250 per 1000 women of childbearing age presented to the Hamad Trauma Center. The mean age of patients was 30.4 ± SD 5.6 years, with age ranging from 20 to 42 years. The mean gestational age at the time of injury was 24.7 ± 8.7 weeks which ranged from 5 to 37 weeks. The majority (47.7%) was in the third trimester of the pregnancy. In addition, the large majority of injuries was due to MVCs (74.7%) followed by falls (15.8%). Trauma during pregnancy is not an uncommon event particularly in the traffic-related crashes. As it is a complex condition for trauma surgeons and obstetrician, an appropriate management protocol and multidisciplinary team are needed to improve the outcome and save lives of both the mother and fetus.

Cardiac and great vessel injuries after chest trauma: our 10-year experience.

PubMed

Onan, Burak; Demirhan, Recep; Öz, Kürşad; Onan, Ismihan Selen

2011-09-01

Cardiovascular injuries after trauma present with high mortality. The aim of the study was to present our experience in cardiac and great vessel injuries after chest trauma. During the 10-year period, 104 patients with cardiac (n=94) and great vessel (n=10) injuries presented to our hospital. The demographic data, mechanism of injury, location of injury, other associated injuries, timing of surgical intervention, surgical approach, and clinical outcome were reviewed. Eighty-eight (84.6%) males presented after chest trauma. The mean age of the patients was 32.5±8.2 years (range: 12-76). Penetrating injuries (62.5%) were the most common cause of trauma. Computed tomography was performed in most cases and echocardiography was used in some stable cases. Cardiac injuries mostly included the right ventricle (58.5%). Great vessel injuries involved the subclavian vein in 6, innominate vein in 1, vena cava in 1, and descending aorta in 2 patients. Early operations after admission to the emergency were performed in 75.9% of the patients. Thoracotomy was performed in 89.5% of the patients. Operative mortality was significantly high in penetrating injuries (p=0.01). Clinicians should suspect cardiac and great vessel trauma in every patient presenting to the emergency unit after chest trauma. Computed tomography and echocardiography are beneficial in the management of chest trauma. Operative timing depends on hemodynamic status, and a multidisciplinary team approach improves the patient's prognosis.

Function of "nontrauma" surgeons in level I trauma centers in the United States.

PubMed

Pate, J W

1997-06-01

Although the general "trauma" surgeon is usually the team leader in level I trauma centers, the use of surgical subspecialists and nonsurgeons is frequently ill-defined. This study was done to gain data in regard to actual use of subspecialists in busy centers. First, a survey of the patterns of staffing in 140 trauma centers was elicited by mail questionnaire, supplemented by telephone cells. Second, records of 400 consecutive patients at the Elvis Presley Trauma Center were reviewed to determine the use of subspecialists during the first 24 hours of care of individual patients. There were differences in the use of surgical subspecialists and nonsurgeons at different centers: in receiving, admitting, operating, and critical care areas and in privileges for admission and attending of inpatients. Consultation "guidelines" are used for many specific injuries. At our center, a mean of 1.92 subspecialists, in addition to general surgeons, were involved in the early care of each patient. Problems exist in many centers regarding the use of subspecialists, especially for management of facial and chest injuries. In some centers nonsurgeons function in the intensive care unit, and as admitting and attending physicians of trauma patients.

[Management of pediatric multiple trauma patients. Perspective of the pediatric intensive care unit].

PubMed

Carreras González, E; Rey Galán, C; Concha Torre, A; Cañadas Palaz, S; Serrano González, A; Cambra Lasaosa, F J

2007-08-01

To study the epidemiology and management of pediatric trauma patients as well as the organizational, human and technical resources dedicated to these children from the perspective of the pediatric intensive care unit (PICU). A standardized data collection form was sent to 43 PICUs in Spain. Items inquired about the existence of training courses, trauma clinical practice guidelines and trauma registers, and which physician was in charge of trauma patients. Data on casuistics, the age of trauma patients, and the availability of human and technical resources, were also recorded. Twenty-four PICUs completed the questionnaire. The PICU physician was responsible for trauma patient care in 66% of the hospitals. No training courses were available in 59% of the hospitals. No trauma register was available in 62% of the hospitals. Trauma patients represented 11% of PICU admissions, and most patients were aged up to 14 years old. An anesthetist was always at the hospital in 100% of the hospitals. A radiologist and traumatologist were always at the hospital in 91%, a neurosurgeon in 66% and a pediatric surgeon in 50%. The remaining surgical and medical specialties were on call. Continuous intracranial pressure monitoring was available in 87% of the PICUs, jugular venous saturation monitoring in 54% and continuous electroencephalogram and transcranial Doppler ultrasound in 50%. Computed tomography and ultrasound were available at all times in all hospitals. Magnetic nuclear resonance and echocardiography were available at all times in 44% of the hospitals, and arteriography in 42%. In Spain, the organization of pediatric trauma management is based on pediatric teams under the supervision of a PICU physician. Some hospitals show a lack of technical and human resources. Therefore, the minimum criteria required to consider a hospital as a pediatric trauma center should be established. Trauma training courses are required.

Exploring the characteristics of high-performing hospitals that influence trauma triage and transfer.

PubMed

Gagliardi, Anna R; Nathens, Avery B

2015-02-01

Many trauma patients might be first cared for at nondesignated centers before transfer to a trauma center. Limited research has investigated determinants of timely triage and transfer to identify those amenable to quality improvement. This study explored factors influencing timely triage and transfer in a regional trauma system. Centers (n = 15) with both long and short transfer times (emergency department length of stay before transfer) in Ontario were identified using a regional trauma registry. Physicians and nurses in these centers were interviewed with a view to determining factors that either impeded or enabled rapid decisions regarding the need for transfer to a trauma center. A grounded theory approach and constant comparative technique were used to collect and analyze data. Nineteen physicians and eight nurses participated. Clinician level (experience, training, personality, fear of judgment, nursing role), institutional level (guidelines, continuing education, trauma infrastructure, human resources) and system-level (bed availability, referral center, air transport, communication with trauma centers) factors influenced timely decision making. Participants offered several recommendations to improve care. These included guidelines for transfer, a "no refusal" policy at trauma centers, improved air transport and referral center services, as well as further regionalization. Additional features of hospitals with shorter transfer times included coaching of new staff, team meetings, leadership engagement, sharing of performance data, and minimum work hours for physicians. Numerous interacting factors that may influence trauma triage and transfer were identified. These findings can be used by policy makers, health care managers, and clinicians in emergency departments or trauma centers to evaluate and improve trauma triage and transfer, or plan new services. The findings can also be used by researchers to examine the relevance of these factors in other settings or to implement and evaluate the impact of interventions informed by recommendations generated here.

A Simulation-based Approach to Measuring Team Situational Awareness in Emergency Medicine: A Multicenter, Observational Study.

PubMed

Rosenman, Elizabeth D; Dixon, Aurora J; Webb, Jessica M; Brolliar, Sarah; Golden, Simon J; Jones, Kerin A; Shah, Sachita; Grand, James A; Kozlowski, Steve W J; Chao, Georgia T; Fernandez, Rosemarie

2018-02-01

Team situational awareness (TSA) is critical for effective teamwork and supports dynamic decision making in unpredictable, time-pressured situations. Simulation provides a platform for developing and assessing TSA, but these efforts are limited by suboptimal measurement approaches. The objective of this study was to develop and evaluate a novel approach to TSA measurement in interprofessional emergency medicine (EM) teams. We performed a multicenter, prospective, simulation-based observational study to evaluate an approach to TSA measurement. Interprofessional emergency medical teams, consisting of EM resident physicians, nurses, and medical students, were recruited from the University of Washington (Seattle, WA) and Wayne State University (Detroit, MI). Each team completed a simulated emergency resuscitation scenario. Immediately following the simulation, team members completed a TSA measure, a team perception of shared understanding measure, and a team leader effectiveness measure. Subject matter expert reviews and pilot testing of the TSA measure provided evidence of content and response process validity. Simulations were recorded and independently coded for team performance using a previously validated measure. The relationships between the TSA measure and other variables (team clinical performance, team perception of shared understanding, team leader effectiveness, and team experience) were explored. The TSA agreement metric was indexed by averaging the pairwise agreement for each dyad on a team and then averaging across dyads to yield agreement at the team level. For the team perception of shared understanding and team leadership effectiveness measures, individual team member scores were aggregated within a team to create a single team score. We computed descriptive statistics for all outcomes. We calculated Pearson's product-moment correlations to determine bivariate correlations between outcome variables with two-tailed significance testing (p < 0.05). A total of 123 participants were recruited and formed three-person teams (n = 41 teams). All teams completed the assessment scenario and postsimulation measures. TSA agreement ranged from 0.19 to 0.9 and had a mean (±SD) of 0.61 (±0.17). TSA correlated with team clinical performance (p < 0.05) but did not correlate with team perception of shared understanding, team leader effectiveness, or team experience. Team situational awareness supports adaptive teams and is critical for high reliability organizations such as healthcare systems. Simulation can provide a platform for research aimed at understanding and measuring TSA. This study provides a feasible method for simulation-based assessment of TSA in interdisciplinary teams that addresses prior measure limitations and is appropriate for use in highly dynamic, uncertain situations commonly encountered in emergency department systems. Future research is needed to understand the development of and interactions between individual-, team-, and system (distributed)-level cognitive processes. © 2017 by the Society for Academic Emergency Medicine.

Clinical practice guidelines for the management of acute limb compartment syndrome following trauma.

PubMed

Wall, Christopher J; Lynch, Joan; Harris, Ian A; Richardson, Martin D; Brand, Caroline; Lowe, Adrian J; Sugrue, Michael

2010-03-01

Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency, and is associated with significant morbidity if not managed appropriately. There is variation in management of acute limb compartment syndrome in Australia. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma were developed in accordance with Australian National Health and Medical Research Council recommendations. The guidelines were based on critically appraised literature evidence and the consensus opinion of a multidisciplinary team involved in trauma management who met in a nominal panel process. Recommendations were developed for key decision nodes in the patient care pathway, including methods of diagnosis in alert and unconscious patients, appropriate assessment of compartment pressure, timing and technique of fasciotomy, fasciotomy wound management, and prevention of compartment syndrome in patients with limb injuries. The recommendations were largely consensus based in the absence of well-designed clinical trial evidence. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma have been developed that will support consistency in management and optimize patient health outcomes.

Study regarding the survival of patients suffering a traumatic cardiac arrest.

PubMed

Georgescu, V; Tudorache, O; Nicolau, M; Strambu, V

2015-01-01

Severe trauma is the most frequent cause of death in young people, in civilized countries with major social and vital costs. The speed of diagnostic decision making and the precocity of treatment approaches are both essential and depend on the specialists' colaboration. The present study aims to emphasize the actual situation of medical interventions in case of cardiorespiratory arrest due to trauma. 1387 patients who suffered a cardio respiratory arrest both traumatic and non-traumatic were included in order to point out the place of traumatic arrest. Resuscitation of such patients is considered useless and resource consumer by many trauma practitioners who are reporting survival rates of 0%-3.5%. As the determinant of lesions, trauma etiology was as it follows car accidents - 43%, high falls - 30%, suicidal attempts - 3%, domestic violence - 3%, other causes - 21%. Hypovolemia remains the major cause of cardiac arrest and death and that is why the efforts of emergency providers (trauma team) must be oriented towards "hidden death" in order to avoid it. This condition could be revealed and solved easier with minimal diagnostic and therapeutic maneuvers in the emergency department.

Is it Trauma- or Fantasy-based? Comparing dissociative identity disorder, post-traumatic stress disorder, simulators, and controls.

PubMed

Vissia, E M; Giesen, M E; Chalavi, S; Nijenhuis, E R S; Draijer, N; Brand, B L; Reinders, A A T S

2016-08-01

The Trauma Model of dissociative identity disorder (DID) posits that DID is etiologically related to chronic neglect and physical and/or sexual abuse in childhood. In contrast, the Fantasy Model posits that DID can be simulated and is mediated by high suggestibility, fantasy proneness, and sociocultural influences. To date, these two models have not been jointly tested in individuals with DID in an empirical manner. This study included matched groups [patients (n = 33) and controls (n = 32)] that were compared on psychological Trauma and Fantasy measures: diagnosed genuine DID (DID-G, n = 17), DID-simulating healthy controls (DID-S, n = 16), individuals with post-traumatic stress disorder (PTSD, n = 16), and healthy controls (HC, n = 16). Additionally, personality-state-dependent measures were obtained for DID-G and DID-S; both neutral personality states (NPS) and trauma-related personality states (TPS) were tested. For Trauma measures, the DID-G group had the highest scores, with TPS higher than NPS, followed by the PTSD, DID-S, and HC groups. The DID-G group was not more fantasy-prone or suggestible and did not generate more false memories. Malingering measures were inconclusive. Evidence consistently supported the Trauma Model of DID and challenges the core hypothesis of the Fantasy Model. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The effectiveness of crisis resource management and team debriefing in resuscitation education of nursing students: A randomised controlled trial.

PubMed

Coppens, Imgard; Verhaeghe, Sofie; Van Hecke, Ann; Beeckman, Dimitri

2018-01-01

The aim of this study was to investigate (i) whether integrating a course on crisis resource management principles and team debriefings in simulation training, increases self-efficacy, team efficacy and technical skills of nursing students in resuscitation settings and (ii) which phases contribute the most to these outcomes. Crisis resource management principles have been introduced in health care to optimise teamwork. Simulation training offers patient safe training opportunities. There is evidence that simulation training increases self-efficacy and team efficacy but the contribution of the different phases like crisis resource management principles, simulation training and debriefing on self-efficacy, team efficacy and technical skills is not clear. Randomised controlled trial in a convenience sample (n = 116) in Belgium. Data were collected between February 2015-April 2015. Participants in the intervention group (n = 60) completed a course on crisis resource management principles, followed by a simulation training session, a team debriefing and a second simulation training session. Participants in the control group (n = 56) only completed two simulation training sessions. The outcomes self-efficacy, team efficacy and technical skills were assessed after each simulation training. An ancillary analysis of the learning effect was conducted. The intervention group increased on self-efficacy (2.13%, p = .02) and team efficacy (9.92%, p < .001); the control group only increased significantly on team efficacy (4.5%, p = .001). The intervention group scored significantly higher on team efficacy (8.49%, p < .001) compared to the control group. Combining crisis resource management principles and team debriefings in simulation training increases self-efficacy and team efficacy. The debriefing phase contributes the most to these effects. By partnering with healthcare settings, it becomes possible to offer interdisciplinary simulation training that can increase patient safety. © 2017 John Wiley & Sons Ltd.

Cervical Spine Collar Removal by Emergency Room Nurses: A Quality Improvement Project.

PubMed

Fontaine, Guillaume; Forgione, Massimo; Lusignan, Francis; Lanoue, Marc-André; Drouin, Simon

2018-05-01

The Canadian C-Spine Rule (CCR) is a clinical decision aid to facilitate the safe removal of cervical collars in the alert, orientated, low-risk adult trauma patient. Few health care settings have assessed initiatives to train charge nurses to use the CCR. This practice improvement project conducted in a secondary trauma center in Canada aimed to (1) train charge nurses of the emergency room to use the CCR, (2) monitor its use throughout the project period, and (3) compare the assessments of the charge nurses with those of emergency physicians. The project began with the creation of an interdisciplinary team. Clinical guidelines were established by the interdisciplinary project team. Nine charge nurses of the emergency room were then trained to use the CCR (3 on each 8-hour shift). The use of the CCR was monitored throughout the project period, from June 1 to October 5, 2016. The 3 aims of this practice improvement project were attained successfully. Over a 5-month period, 114 patients were assessed with the CCR. Charge nurses removed the cervical collars for 54 of 114 patients (47%). A perfect agreement rate (114 of 114 patients, 100%) was attained between the assessments of the nurses and those of physicians. This project shows that the charge nurses of a secondary trauma center can use the CCR safely on alert, orientated, and low-risk adult trauma patients as demonstrated by the agreement in the assessments of emergency room nurses and physicians. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

A review of virtual reality based training simulators for orthopaedic surgery.

PubMed

Vaughan, Neil; Dubey, Venketesh N; Wainwright, Thomas W; Middleton, Robert G

2016-02-01

This review presents current virtual reality based training simulators for hip, knee and other orthopaedic surgery, including elective and trauma surgical procedures. There have not been any reviews focussing on hip and knee orthopaedic simulators. A comparison of existing simulator features is provided to identify what is missing and what is required to improve upon current simulators. In total 11 hip replacements pre-operative planning tools were analysed, plus 9 hip trauma fracture training simulators. Additionally 9 knee arthroscopy simulators and 8 other orthopaedic simulators were included for comparison. The findings are that for orthopaedic surgery simulators in general, there is increasing use of patient-specific virtual models which reduce the learning curve. Modelling is also being used for patient-specific implant design and manufacture. Simulators are being increasingly validated for assessment as well as training. There are very few training simulators available for hip replacement, yet more advanced virtual reality is being used for other procedures such as hip trauma and drilling. Training simulators for hip replacement and orthopaedic surgery in general lag behind other surgical procedures for which virtual reality has become more common. Further developments are required to bring hip replacement training simulation up to date with other procedures. This suggests there is a gap in the market for a new high fidelity hip replacement and resurfacing training simulator. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

Survey on the occurrence of dental trauma and preventive strategies among Brazilian professional soccer players

PubMed Central

CORREA, Marcos Britto; SCHUCH, Helena Silveira; COLLARES, Kauê; TORRIANI, Dione Dias; HALLAL, Pedro Curi; DEMARCO, Flavio Fernando

2010-01-01

Objectives The aims of this study were to verify the occurrence of dental injuries in professional Brazilian soccer players, the level of knowledge of the teams' medical departments about mouthguards, and the conducts adopted in cases of dental trauma during the match. Material and methods Closed questionnaires were sent to the physicians in charge of the medical departments of the 40 teams enrolled in the first and second divisions of the Brazilian professional soccer league in 2007. The data obtained were subjected to descriptive analysis to determine absolute and relative frequencies of answers for each one of the questions. Results Physicians from 38 (95%) of the 40 teams in the first and second divisions answered the questionnaires and 71.1% reported the occurrence of some type of dental injury during soccer practice, dental fractures (74.1%) and avulsions (59.3%) being the most prevalent ones. Regarding emergency conducts, approximately 50% answered that a successful replantation could be obtained in periods from 6 to 24 h after injury, and 27.8% were not able to answer this question. Regarding mouthguard use, 48.6% of the physicians did not know about mouthguards, and only 21.6% usually recommended their use by the soccer players. Among the physicians who do not recommend the use of mouthguards, 50% justified that it was not necessary. Almost 50% of the medical departments do not have a dentist as part of the health professional staff. Conclusions It was possible to conclude that dental injuries are common during professional soccer practice and that there is a lack of information in the medical departments related to the emergency conducts and prevention of dental trauma. PMID:21308287

Simulation for the training of human performance and technical skills: the intersection of how we will train health care professionals in the future.

PubMed

Hamman, William R; Beaubien, Jeffrey M; Beaudin-Seiler, Beth M

2009-12-01

The aims of this research are to begin to understand health care teams in their operational environment, establish metrics of performance for these teams, and validate a series of scenarios in simulation that elicit team and technical skills. The focus is on defining the team model that will function in the operational environment in which health care professionals work. Simulations were performed across the United States in 70- to 1000-bed hospitals. Multidisciplinary health care teams analyzed more than 300 hours of videos of health care professionals performing simulations of team-based medical care in several different disciplines. Raters were trained to enhance inter-rater reliability. The study validated event sets that trigger team dynamics and established metrics for team-based care. Team skills were identified and modified using simulation scenarios that employed the event-set-design process. Specific skills (technical and team) were identified by criticality measurement and task analysis methodology. In situ simulation, which includes a purposeful and Socratic Method of debriefing, is a powerful intervention that can overcome inertia found in clinician behavior and latent environmental systems that present a challenge to quality and patient safety. In situ simulation can increase awareness of risks, personalize the risks, and encourage the reflection, effort, and attention needed to make changes to both behaviors and to systems.

Development and evaluation of a decision-based simulation for assessment of team skills.

PubMed

Andrew, Brandon; Plachta, Stephen; Salud, Lawrence; Pugh, Carla M

2012-08-01

There is a need to train and evaluate a wide variety of nontechnical surgical skills. The goal of this project was to develop and evaluate a decision-based simulation to assess team skills. The decision-based exercise used our previously validated Laparoscopic Ventral Hernia simulator and a newly developed team evaluation survey. Five teams of 3 surgical residents (N = 15) were tasked with repairing a 10 × 10-cm right upper quadrant hernia. During the simulation, independent observers (N = 6) completed a 6-item survey assessing: (1) work quality; (2) communication; and (3) team effectiveness. After the simulation, team members self-rated their performance by using the same survey. Survey reliability revealed a Cronbach's alpha of r = .811. Significant differences were found when we compared team members' (T) and observers' (O) ratings for communication (T = 4.33/5.00 vs O = 3.00/5.00, P < .01) and work quality (T = 4.33/5.00 vs O = 3.33/5.00, P < .05). The team with the greatest survey ratings was the only group to successfully complete the task. The team evaluation survey had good reliability and correlated with task performance on the simulator. Our current and previous work provides strong evidence that nontechnical and team related skills can be assessed without simulating a crisis situation. Copyright © 2012 Mosby, Inc. All rights reserved.

NEWS Ltd.: Simulations for Trust Development.

ERIC Educational Resources Information Center

Ruhe, John A.; Allen, William R.

2001-01-01

Examines some of the unique problems faced by global teams and describes two simulations that have been successfully used to assist students in understanding key elements in effective global and cross-cultural team management. The first simulation focuses on a virtual global team situation; the second, using the same teams at a later date, expands…

Impact of Hypobarism During Simulated Transport on Critical Care Air Transport Team Performance

DTIC Science & Technology

2017-04-26

AFRL-SA-WP-SR-2017-0008 Impact of Hypobarism During Simulated Transport on Critical Care Air Transport Team Performance Dina...July 2014 – November 2016 4. TITLE AND SUBTITLE Impact of Hypobarism During Simulated Transport on Critical Care Air Transport Team Performance 5a...During Critical Care Air Transport Team Advanced Course validation, three-member teams consisting of a physician, nurse, and respiratory therapist

Use of human patient simulation and the situation awareness global assessment technique in practical trauma skills assessment.

PubMed

Hogan, Michael P; Pace, David E; Hapgood, Joanne; Boone, Darrell C

2006-11-01

Situation awareness (SA) is defined as the perception of elements in the environment within a volume of time and space, the comprehension of their meaning, and the projection of their status in the near future. This construct is vital to decision making in intense, dynamic environments. It has been used in aviation as it relates to pilot performance, but has not been applied to medical education. The most widely used objective tool for measuring trainee SA is the Situation Awareness Global Assessment Technique (SAGAT). The purpose of this study was to design and validate SAGAT for assessment of practical trauma skills, and to compare SAGAT results to traditional checklist style scoring. Using the Human Patient Simulator, we designed SAGAT for practical trauma skills assessment based on Advanced Trauma Life Support objectives. Sixteen subjects (four staff surgeons, four senior residents, four junior residents, and four medical students) participated in three scenarios each. They were assessed using SAGAT and traditional checklist assessment. A questionnaire was used to assess possible confounding factors in attaining SA and overall trainee satisfaction. SAGAT was found to show significant difference (analysis of variance; p < 0.001) in scores based on level of training lending statistical support to construct validity. SAGAT was likewise found to display reliability (Cronbach's alpha 0.767), and significant scoring correlation with traditional checklist performance measures (Pearson's coefficient 0.806). The questionnaire revealed no confounding factors and universal satisfaction with the human patient simulator and SAGAT. SAGAT is a valid, reliable assessment tool for trauma trainees in the dynamic clinical environment created by human patient simulation. Information provided by SAGAT could provide specific feedback, direct individualized teaching, and support curriculum change. Introduction of SAGAT could improve the current assessment model for practical trauma education.

Collaboration in Complex Medical Systems

NASA Technical Reports Server (NTRS)

Xiao, Yan; Mankenzie, Colin F.

1998-01-01

Improving our understanding of collaborative work in complex environments has the potential for developing effective supporting technologies, personnel training paradigms, and design principles for multi-crew workplaces. USing a sophisticated audio-video-data acquisition system and a corresponding analysis system, the researchers at University of Maryland have been able to study in detail team performance during real trauma patient resuscitation. The first study reported here was on coordination mechanisms and on characteristics of coordination breakdowns. One of the key findings was that implicit communications were an important coordination mechanism (e.g. through the use of shared workspace and event space). The second study was on the sources of uncertainty during resuscitation. Although incoming trauma patients' status is inherently uncertain, the findings suggest that much of the uncertainty felt by care providers was related to communication and coordination. These two studies demonstrate the value of and need for creating a real-life laboratory for studying team performance with the use of comprehensive and integrated data acquisition and analysis tools.

Perioperative and acute care outcomes in morbidly obese patients with acetabular fractures at a Level 1 trauma center

PubMed Central

Vincent, Heather K.; Haupt, Edward; Tang, Sonya; Egwuatu, Adaeze; Vlasak, Richard; Horodyski, MaryBeth; Carden, Donna; Sadisivan, Kalia K.

2014-01-01

Background Controversy exists regarding obesity-related injury severity and clinical outcomes after orthopedic trauma. Purpose The purposes of this study were to expand our understanding of the effect of morbid obesity on perioperative and acute care outcomes after acetabular fracture. Methods This was a retrospective review of patients with acetabular fracture after trauma. Non-morbidly obese (BMI < 35 kg/m2) and morbidly obese (BMI ≥ 35 kg/m2; N = 81). Injury severity scores and Glasgow Coma Scale scores (GCS) were collected. Perioperative and acute care outcomes were positioning and operative time, extra fractures, estimated blood loss, complications, hospital charges, ventilator days, transfusions, length of stay (LOS) and discharge destination. Positioning and operative times were longer in morbidly obese patients (p < 0.05). No other differences existed between groups. Conclusions Orthopedic trauma surgeons and care teams can expect similar acute care outcomes in morbidly obese and non-morbidly obese patients with acetabular fracture. PMID:25104886

Blood Component Therapy in Trauma Guided with the Utilization of the Perfusionist and Thromboelastography

PubMed Central

Walsh, Mark; Thomas, Scott G.; Howard, Janet C.; Evans, Edward; Guyer, Kirk; Medvecz, Andrew; Swearingen, Andrew; Navari, Rudolph M.; Ploplis, Victoria; Castellino, Francis J.

2011-01-01

Abstract: 25–35% of all seriously injured multiple trauma patients are coagulopathic upon arrival to the emergency department, and therefore early diagnosis and intervention on this subset of patients is important. In addition to standard plasma based tests of coagulation, the thromboelastogram (TEG®) has resurfaced as an ideal test in the trauma population to help guide the clinician in the administration of blood components in a goal directed fashion. We describe how thromboelastographic analysis is used to assist in the management of trauma patients with coagulopathies presenting to the emergency department, in surgery, and in the postoperative period. Indications for the utilization of the TEG® and platelet mapping as point of care testing that can guide blood component therapy in a goal directed fashion in the trauma population are presented with emphasis on the more common reasons such as massive transfusion protocol, the management of traumatic brain injury with bleeding, the diagnosis and management of trauma in patients on platelet antagonists, the utilization of recombinant FVIIa, and the management of coagulopathy in terminal trauma patients in preparation for organ donation. The TEG® allows for judicious and protocol assisted utilization of blood components in a setting that has recently gained acceptance. In our program, the inclusion of the perfusionist with expertise in performing and interpreting TEG® analysis allows the multidisciplinary trauma team to more effectively manage blood products and resuscitation in this population. PMID:22164456

[Challenges of implementing a geriatric trauma network : A regional structure].

PubMed

Schoeneberg, Carsten; Hussmann, Bjoern; Wesemann, Thomas; Pientka, Ludger; Vollmar, Marie-Christin; Bienek, Christine; Steinmann, Markus; Buecking, Benjamin; Lendemans, Sven

2018-04-01

At present, there is a high percentage and increasing tendency of patients presenting with orthogeriatric injuries. Moreover, significant comorbidities often exist, requiring increased interdisciplinary treatment. These developments have led the German Society of Trauma Surgery, in cooperation with the German Society of Geriatrics, to establish geriatric trauma centers. As a conglomerate hospital at two locations, we are cooperating with two external geriatric clinics. In 2015, a geriatric trauma center certification in the form of a conglomerate network structure was agreed upon for the first time in Germany. For this purpose, the requirements for certification were observed. Both structure and organization were defined in a manual according to DIN EN ISO 9001:2015. Between 2008 and 2016, an increase of 70% was seen in geriatric trauma cases in our hospital, with a rise of up to 360% in specific diagnoses. The necessary standards and regulations were compiled and evaluated from our hospitals. After successful certification, improvements were necessary, followed by a planned re-audit. These were prepared by multiprofessional interdisciplinary teams and implemented at all locations. A network structure can be an alternative to classical cooperation between trauma and geriatric units in one clinic and help reduce possible staffing shortage. Due to the lack of scientific evidence, future evaluations of the geriatric trauma register should reveal whether network structures in geriatric trauma surgery lead to a valid improvement in medical care.

Psychological Distress After Orthopedic Trauma: Prevalence in Patients and Implications for Rehabilitation.

PubMed

Vincent, Heather K; Horodyski, MaryBeth; Vincent, Kevin R; Brisbane, Sonya T; Sadasivan, Kalia K

2015-09-01

Orthopedic trauma is an unforeseen life-changing event. Serious injuries include multiple fractures and amputation. Physical rehabilitation has traditionally focused on addressing functional deficits after traumatic injury, but important psychological factors also can dramatically affect acute and long-term recovery. This review presents the effects of orthopedic trauma on psychological distress, potential interventions for distress reduction after trauma, and implications for participation in rehabilitation. Survivors commonly experience post-traumatic stress syndrome, depression, and anxiety, all of which interfere with functional gains and quality of life. More than 50% of survivors have psychological distress that can last decades after the physical injury has been treated. Early identification of patients with distress can help care teams provide the resources and support to offset the distress. Several options that help trauma patients navigate their short-term recovery include holistic approaches, pastoral care, coping skills, mindfulness, peer visitation, and educational resources. The long-term physical and mental health of the trauma survivor can be enhanced by strategies that connect the survivor to a network of people with similar experiences or injuries, facilitate support groups, and social support networking (The Trauma Survivors Network). Rehabilitation specialists can help optimize patient outcomes and quality of life by participating in and advocating these strategies. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Principles of Surgical Treatment in the Midface Trauma - Theory and Practice

PubMed Central

VRINCEANU, Daniela; BANICA, Bogdan

2014-01-01

Introduction: Facial trauma is a common injury in the urban setting. Many studies have been published on the epidemiology and treatment of facial fractures, but few of them conducted in emergencies hospital as ours. The purpose of this study was to present theory and practice in surgical treatment of midface trauma. Materials and method: We will present a retrospective study and a cases series report with our personal experience in diagnosis and treatment of middle floor facial trauma. Craniofacial trauma in context of polytrauma involves a screening condition assessment of the patient to prioritize lesions and frequently require a multidisciplinary approach: neurosurgeon, ENT surgeon, maxillo-facial surgeon, ophthalmologist, plastic surgeon and so on. Axial and coronal CT are mandatory and three-dimensional CT reconstruction can be extremely useful. Surgical indication in middle floor facial trauma is given by functional and aesthetic deficits. Results: We will present the surgical principles we use in treatment of fractured nose, in fractures of maxilla, in fractures of the zygomatic arch with or without zygoma body fractures and fractures of the floor of orbit. Discussions: The surgical technique was imposed by coexisting lesions of neuro and viscerocranium, by the complexity of the fracture, by functional or aesthetic deficits and by our surgical experience. Conclusions: The main principles in middle face trauma are an accurate and complete lesions evaluation; mixed surgery team with maxillofacial surgeon and neurosurgeon. PMID:25705306

The practicality of including the systemic inflammatory response syndrome in the definition of polytrauma: experience of a level one trauma centre.

PubMed

Butcher, Nerida E; Balogh, Zsolt J

2013-01-01

The systemic inflammatory response syndrome (SIRS) has been advocated as a significant predictor of outcome in trauma. Recent trauma literature has proposed SIRS as a surrogate for physiological derangements characteristic of polytrauma with some authors recommending its inclusion into the definition of polytrauma. The practicality of daily SIRS collection outside of specifically designed prospective trials is unknown. The purpose of this study was to assess the availability of SIRS variables and its appropriateness for inclusion into a definition of polytrauma. We hypothesised SIRS variables would be readily available and easy to collect, thus represent an appropriate inclusion into the definition of polytrauma. A prospective observational study of all trauma team activation patients over 7-months (August 2009 to February 2010) at a University affiliated level-1 urban trauma centre. SIRS data (temperature>38°C or <36°C; Pulse >90 bpm; RR>20/min or a PaCO(2)<32 mmHg; WCC>12.0×10(9)L(-1), or <4.0×10(9)L(-1), or the presence of >10 immature bands) collected from presentation, at 24 h intervals until 72 h post injury. Inclusion criteria were all patients generating a trauma team activation response age >16. 336 patients met inclusion criteria. In 46% (155/336) serial SIRS scores could not be calculated due to missing data. Lowest rates of missing data observed on admission [3% (11/336)]. Stratified by ISS>15 (132/336), in 7% (9/132) serial SIRS scores could not be calculated due to missing data. In 123 patients ISS>15 with complete data, 81% (100/123) developed SIRS. For Abbreviated Injury Scale (AIS)>2 in at least 2 body regions (64/336) in 5% (3/64) serial SIRS scores could not be calculated, with 92% (56/61) of patients with complete data developing SIRS. For Direct ICU admissions [25% (85/336)] 5% (4/85) of patients could not have serial SIRS calculated [mean ISS 15(±11)] and 90% (73/81) developed SIRS at least once over 72 h. Based on the experience of our level-1 trauma centre, the practicability of including SIRS into the definition of polytrauma as a surrogate for physiological derangement appears questionable even in prospective fashion. Copyright © 2012 Elsevier Ltd. All rights reserved.

Intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care: a descriptive qualitative study.

PubMed

Ballangrud, Randi; Hall-Lord, Marie Louise; Persenius, Mona; Hedelin, Birgitta

2014-08-01

To describe intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care. Failures in team processes are found to be contributory factors to incidents in an intensive care environment. Simulation-based training is recommended as a method to make health-care personnel aware of the importance of team working and to improve their competencies. The study uses a qualitative descriptive design. Individual qualitative interviews were conducted with 18 intensive care nurses from May to December 2009, all of which had attended a simulation-based team training programme. The interviews were analysed by qualitative content analysis. One main category emerged to illuminate the intensive care nurse perception: "training increases awareness of clinical practice and acknowledges the importance of structured work in teams". Three generic categories were found: "realistic training contributes to safe care", "reflection and openness motivates learning" and "finding a common understanding of team performance". Simulation-based team training makes intensive care nurses more prepared to care for severely ill patients. Team training creates a common understanding of how to work in teams with regard to patient safety. Copyright © 2014 Elsevier Ltd. All rights reserved.

Challenges of interprofessional team training: a qualitative analysis of residents' perceptions.

PubMed

van Schaik, Sandrijn; Plant, Jennifer; O'Brien, Bridget

2015-01-01

Simulation-based interprofessional team training is thought to improve patient care. Participating teams often consist of both experienced providers and trainees, which likely impacts team dynamics, particularly when a resident leads the team. Although similar team composition is found in real-life, debriefing after simulations puts a spotlight on team interactions and in particular on residents in the role of team leader. The goal of the current study was to explore residents' perceptions of simulation-based interprofessional team training. This was a secondary analysis of a study of residents in the pediatric residency training program at the University of California, San Francisco (United States) leading interprofessional teams in simulated resuscitations, followed by facilitated debriefing. Residents participated in individual, semi-structured, audio-recorded interviews within one month of the simulation. The original study aimed to examine residents' self-assessment of leadership skills, and during analysis we encountered numerous comments regarding the interprofessional nature of the simulation training. We therefore performed a secondary analysis of the interview transcripts. We followed an iterative process to create a coding scheme, and used interprofessional learning and practice as sensitizing concepts to extract relevant themes. 16 residents participated in the study. Residents felt that simulated resuscitations were helpful but anxiety provoking, largely due to interprofessional dynamics. They embraced the interprofessional training opportunity and appreciated hearing other healthcare providers' perspectives, but questioned the value of interprofessional debriefing. They identified the need to maintain positive relationships with colleagues in light of the teams' complex hierarchy as a barrier to candid feedback. Pediatric residents in our study appreciated the opportunity to participate in interprofessional team training but were conflicted about the value of feedback and debriefing in this setting. These data indicate that the optimal approach to such interprofessional education activities deserves further study.

Trauma care at rural level III trauma centers in a state trauma system.

PubMed

Helling, Thomas S

2007-02-01

Although much has been written about the benefits of trauma center care, most experiences are urban with large numbers of patients. Little is known about the smaller, rural trauma centers and how they function both independently and as part of a larger trauma system. The state of Missouri has designated three levels of trauma care. The cornerstone of rural trauma care is the state-designated Level III trauma center. These centers are required to have the presence of a trauma team and trauma surgeon but do not require orthopedic or neurosurgical coverage. The purpose of this retrospective study was to determine how Level III trauma centers compared with Level I and Level II centers in the Missouri trauma system and, secondly, how trauma surgeon experience at these centers might shape future educational efforts to optimize rural trauma care. During a 2-year period in 2002 and 2003, the state trauma registry was queried on all trauma admissions for centers in the trauma system. Demographics and patient care outcomes were assessed by level of designation. Trauma admissions to the Level III centers were examined for acuity, severity, and type of injury. The experiences with chest, abdominal, and neurologic trauma were examined in detail. A total of 24,392 patients from 26 trauma centers were examined, including all eight Level III centers. Acuity and severity of injuries were higher at Level I and II centers. A total of 2,910 patients were seen at the 8 Level III centers. Overall deaths were significantly lower at Level III centers (Level I, 4% versus Level II, 4% versus Level III, 2%, p < 0.001). Numbers of patients dying within 24 hours were no different among levels of trauma care (Level I, 37% versus Level II, 30% versus Level III, 32%). Among Level III centers 45 (1.5%) patients were admitted in shock, and 48 (2%) had a Glasgow Coma Scale score <9. Twenty-six patients had a surgical head injury (7 epidural, 19 subdural hematomas). Twenty-eight patients (1%) needed a chest or abdominal operation. There were 15 spleen and 12 liver injuries with an Abbreviated Injury Score of 4 or 5. Level III trauma centers performed as expected in a state trauma system. Acuity and severity were less as was corresponding mortality. There were a paucity of life-threatening head, chest, and abdominal injuries, which provide a challenge to the rural trauma surgeon to maintain necessary skills in management of these critical injuries.

When teams shift among processes: insights from simulation and optimization.

PubMed

Kennedy, Deanna M; McComb, Sara A

2014-09-01

This article introduces process shifts to study the temporal interplay among transition and action processes espoused in the recurring phase model proposed by Marks, Mathieu, and Zacarro (2001). Process shifts are those points in time when teams complete a focal process and change to another process. By using team communication patterns to measure process shifts, this research explores (a) when teams shift among different transition processes and initiate action processes and (b) the potential of different interventions, such as communication directives, to manipulate process shift timing and order and, ultimately, team performance. Virtual experiments are employed to compare data from observed laboratory teams not receiving interventions, simulated teams receiving interventions, and optimal simulated teams generated using genetic algorithm procedures. Our results offer insights about the potential for different interventions to affect team performance. Moreover, certain interventions may promote discussions about key issues (e.g., tactical strategies) and facilitate shifting among transition processes in a manner that emulates optimal simulated teams' communication patterns. Thus, we contribute to theory regarding team processes in 2 important ways. First, we present process shifts as a way to explore the timing of when teams shift from transition to action processes. Second, we use virtual experimentation to identify those interventions with the greatest potential to affect performance by changing when teams shift among processes. Additionally, we employ computational methods including neural networks, simulation, and optimization, thereby demonstrating their applicability in conducting team research. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Putting the MeaT into TeaM Training: Development, Delivery, and Evaluation of a Surgical Team-Training Workshop.

PubMed

Seymour, Neal E; Paige, John T; Arora, Sonal; Fernandez, Gladys L; Aggarwal, Rajesh; Tsuda, Shawn T; Powers, Kinga A; Langlois, Gerard; Stefanidis, Dimitrios

2016-01-01

Despite importance to patient care, team training is infrequently used in surgical education. To address this, a workshop was developed by the Association for Surgical Education Simulation Committee to teach team training using high-fidelity patient simulators and the American College of Surgeons-Association of Program Directors in Surgery team-training curriculum. Workshops were conducted at 3 national meetings. Participants completed preworkshop and postworkshop questionnaires to define experience, confidence in using simulation, intention to implement, as well as workshop content quality. The course consisted of (A) a didactic review of Preparation, Implementation, and Debriefing and (B) facilitated small group simulation sessions followed by debriefings. Of 78 participants, 51 completed the workshops. Overall, 65% indicated that residents at their institutions used patient simulation, but only 33% used the American College of Surgeons-the Association of Program Directors in Surgery team-training modules. The workshop increased confidence to implement simulation team training (3.4 ± 1.3 vs 4.5 ± 0.9). Quality and importance were rated highly (5.4 ± 00.6, highest score = 6). Preparation for simulation-based team training is possible in this workshop setting, although the effect on actual implementation remains to be determined. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

KSC-98pc970

NASA Image and Video Library

1998-08-20

In Firing Room 1 at KSC, Shuttle launch team members put the Shuttle system through an integrated simulation. The control room is set up with software used to simulate flight and ground systems in the launch configuration. A Simulation Team, comprised of KSC engineers, introduce 12 or more major problems to prepare the launch team for worst-case scenarios. Such tests and simulations keep the Shuttle launch team sharp and ready for liftoff. The next liftoff is targeted for Oct. 29

Using the Everest Team Simulation to Teach Threshold Concepts

ERIC Educational Resources Information Center

Nichols, Elizabeth; Wright, April L.

2015-01-01

This resource review focuses on "Leadership and Team Simulation: Everest V2" released by Harvard Business Publishing. The review describes the simulation's story line of a commercial team expedition climbing to the summit of Mount Everest along with the simulation's architecture and key features. Building on Wright and Gilmore's (2012)…

A Mirror for Managers: Using Simulation to Develop Management Teams. Technical Report 23.

ERIC Educational Resources Information Center

Kaplan, Robert E.; And Others

Although simulation is among the least common of the many methods consultants employ to stimulate team development, realistic simulation can help in the diagnosis of management teams. Simulations fill a gap in the repertoire of data collection methods for organizational diagnosis and development by affording an opportunity for direct observation…

[Surgical therapeutic strategy in vital risk polytrauma with multiple organ injuries, case report].

PubMed

Munteanu, Iulia; Stefan, S; Isloi, Anca; Coca, I C; Baroi, Genoveva; Radu, L; Lăpuşneanu, A; Tamaş, Camelia

2008-01-01

The medical interest for trauma pathology is incresing, due to the gravity of the given injuries. The surgical therapeutic strategy used is directly related to the localization and to the type of the trauma. The supplementary lesions and their vital risk also matter. The multidisciplinary team approach is the key to resolve this type of lesions with a good outcome. We recently observed an increasing tendency toward the rise of number and variety of patients with trauma, due to the great diversity of the etiopathogenic agents. The most important factor, during the assessment of a politraumatised patient is to diagnose correctly the functional deficits of vital organs and establish the vital prognosis. It is necessary to adopt the best and fast therapeutic strategy in order to obtain rapid life-saving decisions.

Social work in oncology-managing vicarious trauma-the positive impact of professional supervision.

PubMed

Joubert, Lynette; Hocking, Alison; Hampson, Ralph

2013-01-01

This exploratory study focused on the experience and management of vicarious trauma in a team of social workers (N = 16) at a specialist cancer hospital in Melbourne. Respondents completed the Traumatic Stress Institute Belief Scale (TSIBS), the Professional Quality of Life Scale (ProQOL), and participated in four focus groups. The results from the TSIBS and the ProQol scales confirm that there is a stress associated with the social work role within a cancer service, as demonstrated by the high scores related to stress. However at the same time the results indicated a high level of satisfaction which acted as a mitigating factor. The study also highlighted the importance of supervision and management support. A model for clinical social work supervision is proposed to reduce the risks associated with vicarious trauma.

Improving Collaboration Among Social Work and Nursing Students Through Interprofessional Simulation.

PubMed

Kuehn, Mary Beth; Huehn, Susan; Smalling, Susan

2017-08-01

This project implemented first-time simulation with nursing and social work students. Students participated in a contextual learning experience through a patient simulation of interprofessional practice as a health care team member and reflection through debriefing and open response comments. Simulation offers a means to practice interprofessional collaboration prior to entering practice. Participants reported an increased understanding of the scope of practice of other team members through their reflections following simulation. In addition, participants reported increased comprehension of team dynamics and their relationship to improved patient care. Overall, the simulation encouraged development of the skills necessary to function as part of a collaborative, interprofessional team.

What whiteboards in a trauma center operating suite can teach us about emergency department communication.

PubMed

Xiao, Yan; Schenkel, Stephen; Faraj, Samer; Mackenzie, Colin F; Moss, Jacqueline

2007-10-01

Highly reliable, efficient collaborative work relies on excellent communication. We seek to understand how a traditional whiteboard is used as a versatile information artifact to support communication in rapid-paced, highly dynamic collaborative work. The similar communicative demands of the trauma operating suite and an emergency department (ED) make the findings applicable to both settings. We took photographs and observed staff's interaction with a whiteboard in a 6-bed surgical suite dedicated to trauma service. We analyzed the integral role of artifacts in cognitive activities as when workers configure and manage visual spaces to simplify their cognitive tasks. We further identified characteristics of the whiteboard as a communicative information artifact in supporting coordination in fast-paced environments. We identified 8 ways in which the whiteboard was used by physicians, nurses, and with other personnel to support collaborative work: task management, team attention management, task status tracking, task articulation, resource planning and tracking, synchronous and asynchronous communication, multidisciplinary problem solving and negotiation, and socialization and team building. The whiteboard was highly communicative because of its location and installation method, high interactivity and usability, high expressiveness, and ability to visualize transition points to support work handoffs. Traditional information artifacts such as whiteboards play significant roles in supporting collaborative work. How these artifacts are used provides insights into complicated information needs of teamwork in highly dynamic, high-risk settings such as an ED.

The importance of the command-physician in trauma resuscitation.

PubMed

Hoff, W S; Reilly, P M; Rotondo, M F; DiGiacomo, J C; Schwab, C W

1997-11-01

Definitive trauma team leadership, although difficult to measure, has been shown to improve trauma resuscitation performance. The purpose of this study was to evaluate the effect of an identified command-physician on resuscitation performance. In addition, the leadership capability of four physician combinations functioning as command-physician was studied. Retrospective review. Videotapes of trauma resuscitations performed at a Level I trauma center over a 25-month period were reviewed. The presence of an identified command-physician was determined by multidisciplinary consensus. Resuscitation performance was measured by compliance with three objective criteria: primary survey, secondary survey, and definitive plan; and two subjective criteria: orderliness, and adherence to Advanced Trauma Life Support protocol. Performance was then analyzed (1) as a function of the presence or absence of a command-physician, and (2) between four identified physician combinations: AF (attending surgeon + trauma fellow); F (trauma fellow); ASR (attending surgeon + senior surgical resident); SR (senior surgical resident). Chi square and the Mann-Whitney U tests were applied. A total of 425 trauma resuscitations were reviewed. A command-physician was identified (CP[Pos]) in 365 resuscitations (85.7%); no command-physician was identified (CP[NEG]) in 60 (14.3%). Compliance with completion of secondary survey (81.4%) and formulation of a definitive plan (89.6%) was significantly higher in the CP(POS) group. Subjective scores for orderliness and adherence to Advanced Trauma Life Support protocol were significantly higher in the CP(POS) group. In the CP(POS) resuscitations, formulation of a definitive plan was lower in SR when compared with the other three physician combinations. An identified command-physician enhances trauma resuscitation performance. Completion of the primary and secondary survey is not affected by the physician combination. Prompt formulation of a definitive plan is facilitated by the active involvement of an attending traumatologist or a properly mentored trauma fellow.

KSC-98pc969

NASA Image and Video Library

1998-08-19

KENNEDY SPACE CENTER, FLA. -- In Firing Room 1 at KSC, Shuttle launch team members put the Shuttle system through an integrated simulation. The control room is set up with software used to simulate flight and ground systems in the launch configuration. A Simulation Team, comprisING KSC engineers, introduce 12 or more major problems to prepare the launch team for worst-case scenarios. Such tests and simulations keep the Shuttle launch team sharp and ready for liftoff. The next liftoff is targeted for Oct. 29.

KSC-98pc971

NASA Image and Video Library

1998-08-20

KENNEDY SPACE CENTER, FLA. -- In Firing Room 1 at KSC, Shuttle launch team members put the Shuttle system through an integrated simulation. The control room is set up with software used to simulate flight and ground systems in the launch configuration. A Simulation Team, comprising KSC engineers, introduce 12 or more major problems to prepare the launch team for worst-case scenarios. Such tests and simulations keep the Shuttle launch team sharp and ready for liftoff. The next liftoff is targeted for Oct. 29

Study regarding the survival of patients suffering a traumatic cardiac arrest

PubMed Central

Georgescu, V; Tudorache, O; Nicolau, M; Strambu, V

2015-01-01

Severe trauma is the most frequent cause of death in young people, in civilized countries with major social and vital costs. The speed of diagnostic decision making and the precocity of treatment approaches are both essential and depend on the specialists’ colaboration. The present study aims to emphasize the actual situation of medical interventions in case of cardiorespiratory arrest due to trauma. 1387 patients who suffered a cardio respiratory arrest both traumatic and non-traumatic were included in order to point out the place of traumatic arrest. Resuscitation of such patients is considered useless and resource consumer by many trauma practitioners who are reporting survival rates of 0%-3.5%. As the determinant of lesions, trauma etiology was as it follows car accidents – 43%, high falls – 30%, suicidal attempts – 3%, domestic violence – 3%, other causes – 21%. Hypovolemia remains the major cause of cardiac arrest and death and that is why the efforts of emergency providers (trauma team) must be oriented towards “hidden death” in order to avoid it. This condition could be revealed and solved easier with minimal diagnostic and therapeutic maneuvers in the emergency department. PMID:26366226

A multicenter, randomized controlled trial of immediate total-body CT scanning in trauma patients (REACT-2)

PubMed Central

2012-01-01

Background Computed tomography (CT) scanning has become essential in the early diagnostic phase of trauma care because of its high diagnostic accuracy. The introduction of multi-slice CT scanners and infrastructural improvements made total-body CT scanning technically feasible and its usage is currently becoming common practice in several trauma centers. However, literature provides limited evidence whether immediate total-body CT leads to better clinical outcome then conventional radiographic imaging supplemented with selective CT scanning in trauma patients. The aim of the REACT-2 trial is to determine the value of immediate total-body CT scanning in trauma patients. Methods/design The REACT-2 trial is an international, multicenter randomized clinical trial. All participating trauma centers have a multi-slice CT scanner located in the trauma room or at the Emergency Department (ED). All adult, non-pregnant, severely injured trauma patients according to predefined criteria will be included. Patients in whom direct scanning will hamper necessary cardiopulmonary resuscitation or who require an immediate operation because of imminent death (both as judged by the trauma team leader) are excluded. Randomization will be computer assisted. The intervention group will receive a contrast-enhanced total-body CT scan (head to pelvis) during the primary survey. The control group will be evaluated according to local conventional trauma imaging protocols (based on ATLS guidelines) supplemented with selective CT scanning. Primary outcome will be in-hospital mortality. Secondary outcomes are differences in mortality and morbidity during the first year post trauma, several trauma work-up time intervals, radiation exposure, general health and quality of life at 6 and 12 months post trauma and cost-effectiveness. Discussion The REACT-2 trial is a multicenter randomized clinical trial that will provide evidence on the value of immediate total-body CT scanning during the primary survey of severely injured trauma patients. If immediate total-body CT scanning is found to be the best imaging strategy in severely injured trauma patients it could replace conventional imaging supplemented with CT in this specific group. Trial Registration ClinicalTrials.gov: (NCT01523626). PMID:22458247

Exploring Mechanisms for Effective Technology-Enhanced Simulation-based Education in Wilderness Medicine: A Systematic Review.

PubMed

MacKinnon, Ralph; Aitken, Deborah; Humphries, Christopher

2015-12-17

 Technology-enhanced simulation is well-established in healthcare teaching curricula, including those regarding wilderness medicine. Compellingly, the evidence base for the value of this educational modality to improve learner competencies and patient outcomes are increasing.  The aim was to systematically review the characteristics of technology-enhanced simulation presented in the wilderness medicine literature to date. Then, the secondary aim was to explore how this technology has been used and if the use of this technology has been associated with improved learner or patient outcomes.  EMBASE and MEDLINE were systematically searched from 1946 to 2014, for articles on the provision of technology-enhanced simulation to teach wilderness medicine. Working independently, the team evaluated the information on the criteria of learners, setting, instructional design, content, and outcomes.  From a pool of 37 articles, 11 publications were eligible for systematic review. The majority of learners in the included publications were medical students, settings included both indoors and outdoors, and the main focus clinical content was initial trauma management with some including leadership skills. The most prevalent instructional design components were clinical variation and cognitive interactivity, with learner satisfaction as the main outcome.  The results confirm that the current provision of wilderness medicine utilizing technology-enhanced simulation is aligned with instructional design characteristics that have been used to achieve effective learning. Future research should aim to demonstrate the translation of learning into the clinical field to produce improved learner outcomes and create improved patient outcomes.

Cultural Vignette: Vietnamese Americans.

ERIC Educational Resources Information Center

Boyer, Mary Ellen; And Others

This booklet, developed as part of a multicultural research project conducted in the San Diego Community College District, presents the findings of a nine-member research team on various aspects of the history and culture of Vietnamese Americans. The areas covered are: (1) the Vietnamese as immigrant, which includes a discussion of the trauma and…

[From rehabilitation to re-adaptation, preparing the return home].

PubMed

Froger, Jérôme; Jourdan, Claire; Dabek, Marie-Christine; Petitqueux, Sophie; Gardes, Raphaël; Dupeyron, Arnaud

2017-03-01

After a serious head trauma, the return home constitutes a key moment in the patient's reintegration. It is prepared by a multi-disciplinary team throughout the rehabilitation and re-adaptation process, taking into account the patient's prognosis for recovery. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Mass Casualty Response of a Modern Deployed Head and Neck Surgical Team

DTIC Science & Technology

2010-07-01

tures (maxilla, mandible, frontal sinus), and miscellaneous injuries such as a parotid duct injury. Based on review of the operative log, 6 patients...trained to consider subtle head and neck injuries such as facial nerve or parotid duct transection. The flexibility to operate alongside other trauma

Maximizing Patient Thermoregulation in US Army Forward Surgical Teams

DTIC Science & Technology

2008-01-01

Vermassen FE. Coagulopathy, hypothermia and acidosis in trauma patients: the rationale for damage control surgery. Acta Chir Belg. 2002;102(5):313-316...bypass. J Cardiothorac Vasc Anesth. 2000;14(5):501- 505. 41. Janicki PK, Higgins MS, Janssen J, Johnson RF, Beattie C. Comparison of two different

School Mental Health's Response to Terrorism and Disaster.

ERIC Educational Resources Information Center

Weist, Mark D.; Sander, Mark A.; Lever, Nancy A.; Rosner, Leah E.; Pruitt, David B.; Lowie, Jennifer Axelrod; Hill, Susan; Lombardo, Sylvie; Christodulu, Kristin V.

2002-01-01

Explores the response of school mental health to terrorism and disaster, reviewing literature on child and adult reactions to trauma, discussing the development of crisis response teams, and presenting strategies for schools to respond to crises and disaster. One elementary school's experiences in response to the September 11th attacks are…

Narrative and Structure in Consultation

ERIC Educational Resources Information Center

Hadley, David

2012-01-01

This article explores the process of consultation to professional networks, teams, groups and individuals concerned with the mental health of children and young people in the care system, and those adopted. Frequently there are significant elements of early trauma suffered by the young people and disruption in the professional organisation. The…

A Lawyer/Therapist Team Approach to Divorce.

ERIC Educational Resources Information Center

Black, Melvin; Joffe, Wendy

The high incidence of divorce today has surfaced the emotional/legal issues involved in the divorce process. Mental health clinicians recognize the severe emotional trauma which divorced couples experience. The interdependency of the marital relationship is severed and each member must face that loss. A continuing relationship is often required…

Using multimedia tools and high-fidelity simulations to improve medical students' resuscitation performance: an observational study

PubMed Central

Wang, Candice; Huang, Chin-Chou; Lin, Shing-Jong; Chen, Jaw-Wen

2016-01-01

Objectives The goal of our study was to shed light on educational methods to strengthen medical students' cardiopulmonary resuscitation (CPR) leadership and team skills in order to optimise CPR understanding and success using didactic videos and high-fidelity simulations. Design An observational study. Setting A tertiary medical centre in Northern Taiwan. Participants A total of 104 5–7th year medical students, including 72 men and 32 women. Interventions We provided the medical students with a 2-hour training session on advanced CPR. During each class, we divided the students into 1–2 groups; each group consisted of 4–6 team members. Medical student teams were trained by using either method A or B. Method A started with an instructional CPR video followed by a first CPR simulation. Method B started with a first CPR simulation followed by an instructional CPR video. All students then participated in a second CPR simulation. Outcome measures Student teams were assessed with checklist rating scores in leadership, teamwork and team member skills, global rating scores by an attending physician and video-recording evaluation by 2 independent individuals. Results The 104 medical students were divided into 22 teams. We trained 11 teams using method A and 11 using method B. Total second CPR simulation scores were significantly higher than first CPR simulation scores in leadership (p<0.001), teamwork (p<0.001) and team member skills (p<0.001). For methods A and B students' first CPR simulation scores were similar, but method A students' second CPR simulation scores were significantly higher than those of method B in leadership skills (p=0.034), specifically in the support subcategory (p=0.049). Conclusions Although both teaching strategies improved leadership, teamwork and team member performance, video exposure followed by CPR simulation further increased students' leadership skills compared with CPR simulation followed by video exposure. PMID:27678539

Pre-Operative Diet Impacts the Adipose Tissue Response to Surgical Trauma

PubMed Central

Nguyen, Binh; Tao, Ming; Yu, Peng; Mauro, Christine; Seidman, Michael A.; Wang, Yaoyu E.; Mitchell, James; Ozaki, C. Keith

2012-01-01

Background Short-term changes in pre-operative nutrition can have profound effects on surgery related outcomes such as ischemia reperfusions injury in pre-clinical models. Dietary interventions that lend protection against stress in animal models (e.g. fasting, dietary restriction [DR]) impact adipose tissue quality/quantity. Adipose tissue holds high surgical relevance due to its anatomic location and high tissue volume, and it is ubiquitously traumatized during surgery. Yet the response of adipose tissue to trauma under clinically relevant circumstances including dietary status remains poorly defined. We hypothesized that pre-operative diet alters the adipose tissue response to surgical trauma. Methods A novel mouse model of adipose tissue surgical trauma was employed. Dietary conditions (diet induced obesity [DIO], pre-operative DR) were modulated prior to application of surgical adipose tissue trauma in the context of clinically common scenarios (different ages, simulated bacterial wound contamination). Local/distant adipose tissue phenotypic responses were measured as represented by gene expression of inflammatory, tissue remodeling/growth, and metabolic markers. Results Surgical trauma had a profound effect on adipose tissue phenotype at the site of trauma. Milder but significant distal effects on non-traumatized adipose tissue were also observed. DIO exacerbated the inflammatory aspects of this response, and pre-operative DR tended to reverse these changes. Age and LPS-simulated bacterial contamination also impacted the adipose tissue response to trauma, with young adult animals and LPS treatment exacerbating the proinflammatory response. Conclusions Surgical trauma dramatically impacts both local and distal adipose tissue biology. Short-term pre-operative DR may offer a strategy to attenuate this response. PMID:23274098

A Human Factors Analysis of Technical and Team Skills Among Surgical Trainees During Procedural Simulations in a Simulated Operating Theatre

PubMed Central

Moorthy, Krishna; Munz, Yaron; Adams, Sally; Pandey, Vikas; Darzi, Ara

2005-01-01

Background: High-risk organizations such as aviation rely on simulations for the training and assessment of technical and team performance. The aim of this study was to develop a simulated environment for surgical trainees using similar principles. Methods: A total of 27 surgical trainees carried out a simulated procedure in a Simulated Operating Theatre with a standardized OR team. Observation of OR events was carried out by an unobtrusive data collection system: clinical data recorder. Assessment of performance consisted of blinded rating of technical skills, a checklist of technical events, an assessment of communication, and a global rating of team skills by a human factors expert and trained surgical research fellows. The participants underwent a debriefing session, and the face validity of the simulated environment was evaluated. Results: While technical skills rating discriminated between surgeons according to experience (P = 0.002), there were no differences in terms of the checklist and team skills (P = 0.70). While all trainees were observed to gown/glove and handle sharps correctly, low scores were observed for some key features of communication with other team members. Low scores were obtained by the entire cohort for vigilance. Interobserver reliability was 0.90 and 0.89 for technical and team skills ratings. Conclusions: The simulated operating theatre could serve as an environment for the development of surgical competence among surgical trainees. Objective, structured, and multimodal assessment of performance during simulated procedures could serve as a basis for focused feedback during training of technical and team skills. PMID:16244534

Examining pediatric resuscitation education using simulation and scripted debriefing: a multicenter randomized trial.

PubMed

Cheng, Adam; Hunt, Elizabeth A; Donoghue, Aaron; Nelson-McMillan, Kristen; Nishisaki, Akira; Leflore, Judy; Eppich, Walter; Moyer, Mike; Brett-Fleegler, Marisa; Kleinman, Monica; Anderson, Jodee; Adler, Mark; Braga, Matthew; Kost, Susanne; Stryjewski, Glenn; Min, Steve; Podraza, John; Lopreiato, Joseph; Hamilton, Melinda Fiedor; Stone, Kimberly; Reid, Jennifer; Hopkins, Jeffrey; Manos, Jennifer; Duff, Jonathan; Richard, Matthew; Nadkarni, Vinay M

2013-06-01

Resuscitation training programs use simulation and debriefing as an educational modality with limited standardization of debriefing format and content. Our study attempted to address this issue by using a debriefing script to standardize debriefings. To determine whether use of a scripted debriefing by novice instructors and/or simulator physical realism affects knowledge and performance in simulated cardiopulmonary arrests. DESIGN Prospective, randomized, factorial study design. The study was conducted from 2008 to 2011 at 14 Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing (EXPRESS) network simulation programs. Interprofessional health care teams participated in 2 simulated cardiopulmonary arrests, before and after debriefing. We randomized 97 participants (23 teams) to nonscripted low-realism; 93 participants (22 teams) to scripted low-realism; 103 participants (23 teams) to nonscripted high-realism; and 94 participants (22 teams) to scripted high-realism groups. INTERVENTION Participants were randomized to 1 of 4 arms: permutations of scripted vs nonscripted debriefing and high-realism vs low-realism simulators. Percentage difference (0%-100%) in multiple choice question (MCQ) test (individual scores), Behavioral Assessment Tool (BAT) (team leader performance), and the Clinical Performance Tool (CPT) (team performance) scores postintervention vs preintervention comparison (PPC). There was no significant difference at baseline in nonscripted vs scripted groups for MCQ (P = .87), BAT (P = .99), and CPT (P = .95) scores. Scripted debriefing showed greater improvement in knowledge (mean [95% CI] MCQ-PPC, 5.3% [4.1%-6.5%] vs 3.6% [2.3%-4.7%]; P = .04) and team leader behavioral performance (median [interquartile range (IQR)] BAT-PPC, 16% [7.4%-28.5%] vs 8% [0.2%-31.6%]; P = .03). Their improvement in clinical performance during simulated cardiopulmonary arrests was not significantly different (median [IQR] CPT-PPC, 7.9% [4.8%-15.1%] vs 6.7% [2.8%-12.7%], P = .18). Level of physical realism of the simulator had no independent effect on these outcomes. The use of a standardized script by novice instructors to facilitate team debriefings improves acquisition of knowledge and team leader behavioral performance during subsequent simulated cardiopulmonary arrests. Implementation of debriefing scripts in resuscitation courses may help to improve learning outcomes and standardize delivery of debriefing, particularly for novice instructors.

The Impact of Goal Setting on Team Simulation Experience.

ERIC Educational Resources Information Center

Fandt, Patricia M.; And Others

1990-01-01

Describes a study that examined the effects of goal setting on undergraduate students competing in a computerized business simulation. Group cohesiveness is discussed, treatments for the experimental and control groups are described, perceived team success is measured, and team simulation performance is evaluated. (30 references) (LRW)

Establishing a legal service for major trauma patients at a major trauma centre in the UK.

PubMed

Seligman, William H; Thompson, Julian; Thould, Hannah E; Tan, Charlotte; Dinsmore, Andrew; Lockey, David J

2017-09-01

Major trauma causes unanticipated critical illness and patients have often made few arrangements for what are sudden and life-changing circumstances. This can lead to financial, housing, insurance, legal and employment issues for patients and their families.A UK law firm worked with the major trauma services to develop a free and comprehensive legal service for major trauma patients and their families at a major trauma centre (MTC) in the UK. In 2013, a legal service was established at North Bristol NHS Trust. Referrals are made by trauma nurse practitioners and it operates within a strict ethical framework. A retrospective analysis of the activity of this legal service between September 2013 and October 2015 was undertaken. 66 major trauma patients were seen by the legal teams at the MTC. 535 hours of free legal advice were provided on non-compensation issues-an average of 8 hours per patient. This initiative confirms a demand for the early availability of legal advice for major trauma patients to address a range of non-compensation issues as well as for identification of potential compensation claims. The availability of advice at the MTC is convenient for relatives who may be spending the majority of their time with injured relatives in hospital. More data are needed to establish the rehabilitation and health effects of receiving non-compensation advice after major injury; however, the utilisation of this service suggests that it should be considered at the UK MTCs. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The evolution of computed tomography from organ-selective to whole-body scanning in managing unconscious patients with multiple trauma

PubMed Central

Hong, Zhi-Jie; Chen, Cheng-Jueng; Yu, Jyh-Cherng; Chan, De-Chuan; Chou, Yu-Ching; Liang, Chia-Ming; Hsu, Sheng-Der

2016-01-01

Abstract We aimed to evaluate the benefit of whole-body computed tomography (WBCT) scanning for unconscious adult patients suffering from high-energy multiple trauma compared with the conventional stepwise approach of organ-selective CT. Totally, 144 unconscious patients with high-energy multiple trauma from single level I trauma center in North Taiwan were enrolled from January 2009 to December 2013. All patients were managed by a well-trained trauma team and were suitable for CT examination. The enrolled patients are all transferred directly from the scene of an accident, not from other medical institutions with a definitive diagnosis. The scanning regions of WBCT include head, neck, chest, abdomen, and pelvis. We analyzed differences between non-WBCT and WBCT groups, including gender, age, hospital stay, Injury Severity Score, Glasgow Coma Scale, Revised Trauma Score, time in emergency department (ED), medical cost, and survival outcome. Fifty-five patients received the conventional approach for treating trauma, and 89 patients received immediate WBCT scanning after an initial examination. Patients’ time in ED was significantly shorter in the WBCT group in comparison with the non-WBCT group (158.62 ± 80.13 vs 216.56 ± 168.32 min, P = 0.02). After adjusting for all possible confounding factors, we also found that survival outcome of the WBCT group was better than that of the non-WBCT group (odds ratio: 0.21, 95% confidence interval: 0.06–0.75, P = 0.016). Early performing WBCT during initial trauma management is a better approach for treating unconscious patients with high-energy multiple trauma. PMID:27631215

The evolution of computed tomography from organ-selective to whole-body scanning in managing unconscious patients with multiple trauma: A retrospective cohort study.

PubMed

Hong, Zhi-Jie; Chen, Cheng-Jueng; Yu, Jyh-Cherng; Chan, De-Chuan; Chou, Yu-Ching; Liang, Chia-Ming; Hsu, Sheng-Der

2016-09-01

We aimed to evaluate the benefit of whole-body computed tomography (WBCT) scanning for unconscious adult patients suffering from high-energy multiple trauma compared with the conventional stepwise approach of organ-selective CT.Totally, 144 unconscious patients with high-energy multiple trauma from single level I trauma center in North Taiwan were enrolled from January 2009 to December 2013. All patients were managed by a well-trained trauma team and were suitable for CT examination. The enrolled patients are all transferred directly from the scene of an accident, not from other medical institutions with a definitive diagnosis. The scanning regions of WBCT include head, neck, chest, abdomen, and pelvis. We analyzed differences between non-WBCT and WBCT groups, including gender, age, hospital stay, Injury Severity Score, Glasgow Coma Scale, Revised Trauma Score, time in emergency department (ED), medical cost, and survival outcome.Fifty-five patients received the conventional approach for treating trauma, and 89 patients received immediate WBCT scanning after an initial examination. Patients' time in ED was significantly shorter in the WBCT group in comparison with the non-WBCT group (158.62 ± 80.13 vs 216.56 ± 168.32 min, P = 0.02). After adjusting for all possible confounding factors, we also found that survival outcome of the WBCT group was better than that of the non-WBCT group (odds ratio: 0.21, 95% confidence interval: 0.06-0.75, P = 0.016).Early performing WBCT during initial trauma management is a better approach for treating unconscious patients with high-energy multiple trauma.

Action research, simulation, team communication, and bringing the tacit into voice society for simulation in healthcare.

PubMed

Forsythe, Lydia

2009-01-01

In healthcare, professionals usually function in a time-constrained paradigm because of the nature of care delivery functions and the acute patient populations usually in need of emergent and urgent care. This leaves little, if no time for team reflection, or team processing as a collaborative action. Simulation can be used to create a safe space as a structure for recognition and innovation to continue to develop a culture of safety for healthcare delivery and patient care. To create and develop a safe space, three qualitative modified action research institutional review board-approved studies were developed using simulation to explore team communication as an unfolding in the acute care environment of the operating room. An action heuristic was used for data collection by capturing the participants' narratives in the form of collaborative recall and reflection to standardize task, process, and language. During the qualitative simulations, the team participants identified and changed multiple tasks, process, and language items. The simulations contributed to positive changes for task and efficiencies, team interactions, and overall functionality of the team. The studies demonstrated that simulation can be used in healthcare to define safe spaces to practice, reflect, and develop collaborative relationships, which contribute to the realization of a culture of safety.

A metropolitan airport disaster plan--coordination of a multihospital response to provide on-site resuscitation and stabilization before evacuation.

PubMed

Dove, D B; Del Guercio, L R; Stahl, W M; Star, L D; Abelson, L C

1982-07-01

At the John F. Kennedy International Airport in New York City, disaster planning has been an integral part of the airport operations for the past 20 years. The medical component of this disaster planning has focused around the Medical Office at JFK. Through this office, on-site emergency medical teams have been established and trained from all ranks of airport personnel. Following the crash of a Boeing 727 aircraft in 1975, a new concept was added to disaster planning for JFK, which involves bringing the hospital, its facilities, and its personnel to the scene. A new piece of equipment, known as Emergency Mobile Hospital, was developed with the cooperation of the airlines, the operating authority of the airport, and other interested parties. Two such vehicles are now in constant readiness at the airport, and together provide two operating rooms, 12 monitored ICU beds, a 16-bed burn unit, and 72 other beds to be used for on-site stabilization of critically ill patients, before transfer to a definitive care facility. Under the auspices of a single area medical school (New York Medical College) and its affiliated departments of surgery, trauma teams are made available to be airlifted to the scene within 30 minutes of notification. Additional medical teams from other medical school hospitals serve as backup support. The principle of bringing the hospital to the emergency, and of assembling trauma teams for the initial phase, remains the same for Kennedy Airport as for that of any other metropolitan airport.

A novel trauma leadership model reflective of changing times.

PubMed

DʼHuyvetter, Cecile; Cogbill, Thomas H

2014-01-01

As a result of generational changes in the health care workforce, we sought to evaluate our current Trauma Medical Director Leadership model. We assessed the responsibilities, accountability, time requirements, cost, and provider satisfaction with the current leadership model. Three new providers who had recently completed fellowship training were hired, each with unique professional desires, skill sets, and experience. Our goal was to establish a comprehensive, cost-effective, accountable leadership model that enabled provider satisfaction and equalized leadership responsibilities. A 3-pronged team model was established with a Medical Director title and responsibilities rotating per the American College of Surgeons verification cycle to develop leadership skills and lessen hierarchical differences.

[Polytrauma Management - Treatment of Severely Injured Patients in ER and OR].

PubMed

von Rüden, Christian; Bühren, Volker; Perl, Mario

2017-10-01

The adequate treatment of severely injured patients is challenging and can only be successfully executed when it starts at the accident site and is continued in all treatment phases including the early rehabilitation phase. Treatment should be performed by an interdisciplinary team guided by a trauma surgeon in order to adequately manage the severe injuries some of which are life-threatening. Treatment of polytrauma patients is a key task of certified trauma centers and must follow standardized guidelines. For a successful therapy of severely injured patients lifetime training at regular intervals in well-established polytrauma concepts is a mandatory requirement. Georg Thieme Verlag KG Stuttgart · New York.

Psychiatric lessons learned in Kandahar

PubMed Central

Jetly, Rakesh

2011-01-01

Not since the Korean War have the Canadian Forces engaged in combat missions like those in Afghanistan. Combat, asymmetric warfare, violent insurgency and the constant threat of improvised explosive devices all contribute to the psychological stressors experienced by Canadian soldiers. Mental health teams deployed with the soldiers and provided assessment, treatment and education. Lessons learned included refuting the myth that all psychological disorders would be related to trauma; confirming that most patients do well after exposure to trauma; confirming that treating disorders in a war zone requires flexible and creative adaptation of civilian treatment guidelines; and confirming that in a combat mission mental health practice is not limited to the clinical setting. PMID:22099328

Psychiatric lessons learned in Kandahar.

PubMed

Jetly, Rakesh

2011-12-01

Not since the Korean War have the Canadian Forces engaged in combat missions like those in Afghanistan. Combat, asymmetric warfare, violent insurgency and the constant threat of improvised explosive devices all contribute to the psychological stressors experienced by Canadian soldiers. Mental health teams deployed with the soldiers and provided assessment, treatment and education. Lessons learned included refuting the myth that all psychological disorders would be related to trauma; confirming that most patients do well after exposure to trauma; confirming that treating disorders in a war zone requires flexible and creative adaptation of civilian treatment guidelines; and confirming that in a combat mission mental health practice is not limited to the clinical setting.

Human Performance Modeling and Simulation for Launch Team Applications

NASA Technical Reports Server (NTRS)

Peaden, Cary J.; Payne, Stephen J.; Hoblitzell, Richard M., Jr.; Chandler, Faith T.; LaVine, Nils D.; Bagnall, Timothy M.

2006-01-01

This paper describes ongoing research into modeling and simulation of humans for launch team analysis, training, and evaluation. The initial research is sponsored by the National Aeronautics and Space Administration's (NASA)'s Office of Safety and Mission Assurance (OSMA) and NASA's Exploration Program and is focused on current and future launch team operations at Kennedy Space Center (KSC). The paper begins with a description of existing KSC launch team environments and procedures. It then describes the goals of new Simulation and Analysis of Launch Teams (SALT) research. The majority of this paper describes products from the SALT team's initial proof-of-concept effort. These products include a nominal case task analysis and a discrete event model and simulation of launch team performance during the final phase of a shuttle countdown; and a first proof-of-concept training demonstration of launch team communications in which the computer plays most roles, and the trainee plays a role of the trainee's choice. This paper then describes possible next steps for the research team and provides conclusions. This research is expected to have significant value to NASA's Exploration Program.

Pre-hospital and early in-hospital management of severe injuries: changes and trends.

PubMed

Hussmann, Bjoern; Lendemans, Sven

2014-10-01

The pre-hospital and early in-hospital management of most severely injured patients has dramatically changed over the last 20 years. In this context, the factor time has gained more and more attention, particularly in German-speaking countries. While the management in the early 1990s aimed at comprehensive and complete therapy at the accident site, the premise today is to stabilise trauma patients at the accident site and transfer them into the hospital rapidly. In addition, the introduction of training and education programmes such as Pre-hospital Trauma Life Support (PHTLS(®)), Advanced Trauma Life Support (ATLS(®)) concept or the TEAM(®) concept has increased the quality of treatment of most severely injured trauma patients both in the preclinical field and in the emergency trauma room. Today, all emergency surgical procedures in severely injured patients are generally performed in accordance with the Damage Control Orthopaedics (DCO) principle. The advancements described in this article provide examples for the improved quality of the management of severely injured patients in the preclinical field and during the initial in-hospital treatment phase. The implementation of trauma networks, the release of the S3 polytrauma guidelines, and the DGU "Weißbuch" have contributed to a more structured management of most severely injured patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

Telemedicine in acute plastic surgical trauma and burns.

PubMed Central

Jones, S. M.; Milroy, C.; Pickford, M. A.

2004-01-01

BACKGROUND: Telemedicine is a relatively new development within the UK, but is increasingly useful in many areas of medicine including plastic surgery. Plastic surgery centres often work on a hub-and-spoke basis with many district hospitals referring to one tertiary centre. The Queen Victoria Hospital is one such centre receiving calls from more than 28 hospitals in the Southeast of England resulting in approximately 20 referrals a day. OBJECTIVE: A telemedicine system was developed to improve trauma management. This study was designed to establish whether digital images were sufficiently accurate enough to aid decision-making. A store-and-forward telemedicine system was devised and the images of 150 trauma referrals evaluated in terms of injury severity and operative priority by each member of the plastic surgical team. RESULTS: Correlation scores for assessed images were high. Accuracy of "transmitted image" in comparison to injury on examination scored > 97%. Operative priority scores tended to be higher than injury severity. CONCLUSIONS: Telemedicine is an accurate method by which to transfer information on plastic surgical trauma including burns. PMID:15239862

Building team adaptive capacity: the roles of sensegiving and team composition.

PubMed

Randall, Kenneth R; Resick, Christian J; DeChurch, Leslie A

2011-05-01

The current study draws on motivated information processing in groups theory to propose that leadership functions and composition characteristics provide teams with the epistemic and social motivation needed for collective information processing and strategy adaptation. Three-person teams performed a city management decision-making simulation (N=74 teams; 222 individuals). Teams first managed a simulated city that was newly formed and required growth strategies and were then abruptly switched to a second simulated city that was established and required revitalization strategies. Consistent with hypotheses, external sensegiving and team composition enabled distinct aspects of collective information processing. Sensegiving prompted the emergence of team strategy mental models (i.e., cognitive information processing); psychological collectivism facilitated information sharing (i.e., behavioral information processing); and cognitive ability provided the capacity for both the cognitive and behavioral aspects of collective information processing. In turn, team mental models and information sharing enabled reactive strategy adaptation.

[Head trauma patients, towards a new life project].

PubMed

Courteau, Florence; Belorgeot, Marion; Vidal, Peggy; Pellas, Frédéric

2017-03-01

A real transition between intensive care and traditional rehabilitation, the post-intensive care rehabilitation service for patients with brain injuries aims to provide patients with early and intensive rehabilitation. Multi-disciplinary teams support the patients and their families on their journey towards new life projects. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Understanding Teamwork in Trauma Resuscitation through Analysis of Team Errors

ERIC Educational Resources Information Center

Sarcevic, Aleksandra

2009-01-01

An analysis of human errors in complex work settings can lead to important insights into the workspace design. This type of analysis is particularly relevant to safety-critical, socio-technical systems that are highly dynamic, stressful and time-constrained, and where failures can result in catastrophic societal, economic or environmental…

Preparing Global Trauma Nurses for Leadership Roles in Global Trauma Systems.

PubMed

Muñiz, Sol Angelica; Lang, Richard W; Falcon, Lisa; Garces-King, Jasmine; Willard, Suzanne; Peck, Gregory L

Trauma leads to 5.7 million annual deaths globally, accounting for 25%-33% of global unintentional deaths and 90% of the global trauma burden in low- and middle-income countries. The Lancet Commission on Global Surgery and the World Health Organization assert that emergent and essential surgical capacity building and trauma system improvement are essential to address the global burden of trauma. In response, the Rutgers Global Surgery program, the School of Nursing and Medicine, and the Robert Wood Johnson University Hospital faculty collaborated in the first Interprofessional Models in Global Injury Care and Education Symposium in June 2016. This 2-week symposium combined lectures, high-fidelity simulation, small group workshops, site visits to Level I trauma centers, and a 1-day training course from the Panamerican Trauma Society. The aim was to introduce global trauma nurses to trauma leadership and trauma system development. After completing the symposium, 10 nurses from China, Colombia, Kenya, Puerto Rico, and Uruguay were surveyed. Overall, 88.8% of participants reported high levels of satisfaction with the program and 100% stated being very satisfied with trauma lectures. Symposia, such as that developed and offered by Rutgers University, prepare nurses to address trauma within system-based care and facilitate trauma nursing leadership in their respective countries.

Development and evaluation of a trauma decision-making simulator in Oculus virtual reality.

PubMed

Harrington, Cuan M; Kavanagh, Dara O; Quinlan, John F; Ryan, Donncha; Dicker, Patrick; O'Keeffe, Dara; Traynor, Oscar; Tierney, Sean

2018-01-01

Consumer-available virtual-reality technology was launched in 2016 with strong foundations in the entertainment-industry. We developed an innovative medical-training simulator on the Oculus™ Gear-VR platform. This novel application was developed utilising internationally recognised Advanced Trauma Life Support (ATLS) principles, requiring decision-making skills for critically-injured virtual-patients. Participants were recruited in June, 2016 at a single-centre trauma-course (ATLS, Leinster, Ireland) and trialled the platform. Simulator performances were correlated with individual expertise and course-performance measures. A post-intervention questionnaire relating to validity-aspects was completed. Eighteen(81.8%) eligible-candidates and eleven(84.6%) course-instructors voluntarily participated. The survey-responders mean-age was 38.9(±11.0) years with 80.8% male predominance. The instructor-group caused significantly less fatal-errors (p < 0.050) and proportions of incorrect-decisions (p < 0.050). The VR-hardware and trauma-application's mean ratings were 5.09 and 5.04 out of 7 respectively. Participants reported it was an enjoyable method of learning (median-6.0), the learning platform of choice (median-5.0) and a cost-effective training tool (median-5.0). Our research has demonstrated evidence of validity-criteria for a concept application on virtual-reality headsets. We believe that virtual-reality technology is a viable platform for medical-simulation into the future. Copyright © 2017 Elsevier Inc. All rights reserved.

Reconstructive surgery for complex midface trauma using titanium miniplates: Le Fort I fracture of the maxilla, zygomatico-maxillary complex fracture and nasomaxillary complex fracture, resulting from a motor vehicle accident.

PubMed

Nicholoff, T J; Del Castillo, C B; Velmonte, M X

Maxillofacial injuries resulting from trauma can be a challenge to the Maxillo-Facial Surgeon. Frequent causes of these injuries are attributed to automobile accidents, physical altercations, gunshot wounds, home accidents, athletic injuries, work injuries and other injuries. Motor vehicle accidents tend to be the primary cause of most midface fractures and lacerations due to the face hitting the dashboard, windshield and steering wheel or the back of the front seat for passengers in the rear. Seatbelts have been shown to drastically reduce the incidence and severity of these injuries. In the United States seatbelt laws have been enacted in several states thus markedly impacting on the reduction of such trauma. In the Philippines rare is the individual who wears seat belts. Metro city traffic, however, has played a major role in reducing daytime MVA related trauma, as usually there is insufficient speed in traffic areas to cause severe impact damage, the same however cannot be said for night driving, or for driving outside of the city proper where it is not uncommon for drivers to zip into the lane of on-coming traffic in order to overtake the car in front ... often at high speeds. Thus, the potential for severe maxillofacial injuries and other trauma related injuries increases in these circumstances. It is however unfortunate that outside of Metro Manila or other major cities there is no ready access to trauma or tertiary care centers, thus these injuries can be catastrophic if not addressed adequately. With the exception of Le Fort II and III craniofacial fractures, most maxillofacial injuries are not life threatening by themselves, and therefore treatment can be delayed until more serious cerebral or visceral, potentially life threatening injuries are addressed first. Our patient was involved in an MVA in Zambales, seen and stabilized in a provincial primary care center initially, then referred to a provincial secondary care center for further stabilization before his transfer to Manila and then ultimately to our Maxillo-Facial Unit. There was a two week-plus delay in the definitive management because of this. As a result of the delay, fibrous tissue and bone callus formation occurred between the various fracture lines, thus once definitive fracture management was attempted, it took on a more reconstructive nature. Hospital based Oral and Maxillo-Facial Surgeons are uniquely trained to manage all aspects of the maxillo-facial trauma, and their dental background uniquely qualifies them in functional restoration of lower and midface fractures where occlusion plays a most important role. Likewise, their training in clinical medicine which is usually integrated into their residency education (12 months or more) puts them in a unique position to comfortably manage the basic medical needs of these patients. In instances where trauma may affect other regions of the body, an inter-multi-disciplinary approach may be taken or consults called for. In this instance, an opthalmology consult was important. In fresh trauma, often seen in major trauma centers (i.e. overseas), a "Trauma Team" is on standby 24 hours a day, and is prepared to assess and manage trauma patients almost immediately upon their arrival in the ER. The trauma team is usually composed of a Trauma Surgeon who is a general surgeon with subspecialty training in traumatology who assesses and manages the visceral injuries, an Orthopedic Surgeon who manages fractures of the extremities, a Neurosurgeon for cerebral injuries and an Oral and Maxillo-Facial Surgeon for facial injuries. In some institutions, facial trauma call is alternated between the "three major head and neck specialty services", namely Oral and Maxillo-facial Surgery, Otolaryngology-Head & Neck Surgery and Plastic & Reconstructive Surgery. (ABSTRACT TRUNCATED)

Mechanical Evaluation of Retinal Damage Associated With Blunt Craniomaxillofacial Trauma: A Simulation Analysis.

PubMed

Geng, Xiaoqi; Liu, Xiaoyu; Wei, Wei; Wang, Yawei; Wang, Lizhen; Chen, Kinon; Huo, Hongqiang; Zhu, Yuanjie; Fan, Yubo

2018-05-01

To evaluate retinal damage as the result of craniomaxillofacial trauma and explain its pathogenic mechanism using finite element (FE) simulation. Computed tomography (CT) images of an adult man were obtained to construct a FE skull model. A FE skin model was built to cover the outer surface of the skull model. A previously validated FE right eye model was symmetrically copied to create a FE left eye model, and both eye models were assembled to the skull model. An orbital fat model was developed to fill the space between the eye models and the skull model. Simulations of a ball-shaped object striking the frontal bone, temporal bone, brow, and cheekbones were performed, and the resulting absorption of the impact energy, intraocular pressure (IOP), and strains on the macula and ora serrata were analyzed to evaluate retinal injuries. Strain was concentrated in the macular regions (0.18 in average) of both eyes when the frontal bone was struck. The peak strain on the macula of the struck-side eye was higher than that of the other eye (>100%) when the temporal bone was struck, whereas there was little difference (<10%) between the two eyes when the brow and cheekbones were struck. Correlation analysis showed that the retinal strain time histories were highly correlated with the IOP time histories ( r > 0.8 and P = 0.000 in all simulation cases). The risk of retinal damage is variable in craniomaxillofacial trauma depending on the struck region, and the damage is highly related to IOP variation caused by indirect blunt eye trauma. This finite element eye model allows us to evaluate and understand the indirect ocular injury mechanisms in craniomaxillofacial trauma for better clinical diagnosis and treatment.

Contribution of physician assistants/associates to secondary care: a systematic review.

PubMed

Halter, Mary; Wheeler, Carly; Pelone, Ferruccio; Gage, Heather; de Lusignan, Simon; Parle, Jim; Grant, Robert; Gabe, Jonathan; Nice, Laura; Drennan, Vari M

2018-06-19

To appraise and synthesise research on the impact of physician assistants/associates (PA) in secondary care, specifically acute internal medicine, care of the elderly, emergency medicine, trauma and orthopaedics, and mental health. Systematic review. Electronic databases (Medline, Embase, ASSIA, CINAHL, SCOPUS, PsycINFO, Social Policy and Practice, EconLit and Cochrane), reference lists and related articles. Peer-reviewed articles of any study design, published in English, 1995-2017. Blinded parallel processes were used to screen abstracts and full text, data extractions and quality assessments against published guidelines. A narrative synthesis was undertaken. Impact on: patients' experiences and outcomes, service organisation, working practices, other professional groups and costs. 5472 references were identified and 161 read in full; 16 were included-emergency medicine (7), trauma and orthopaedics (6), acute internal medicine (2), mental health (1) and care of the elderly (0). All studies were observational, with variable methodological quality. In emergency medicine and in trauma and orthopaedics, when PAs are added to teams, reduced waiting and process times, lower charges, equivalent readmission rate and good acceptability to staff and patients are reported. Analgesia prescribing, operative complications and mortality outcomes were variable. In internal medicine outcomes of care provided by PAs and doctors were equivalent. PAs have been deployed to increase the capacity of a team, enabling gains in waiting time, throughput, continuity and medical cover. When PAs were compared with medical staff, reassuringly there was little or no negative effect on health outcomes or cost. The difficulty of attributing cause and effect in complex systems where work is organised in teams is highlighted. Further rigorous evaluation is required to address the complexity of the PA role, reporting on more than one setting, and including comparison between PAs and roles for which they are substituting. CRD42016032895. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Working in the Field of Complex Psychological Trauma: A Framework for Personal and Professional Growth, Training, and Supervision.

PubMed

Coleman, Anne Marie; Chouliara, Zoë; Currie, Kay

2018-03-01

The aim of this article is to explore the positive and negative impacts of working therapeutically in complex psychological trauma (CPT), particularly the field of gender-based violence (GBV) and childhood sexual abuse (CSA), from the clinicians' perspective. The focus was on the prospect of positive gains and growth for therapists. Twenty-one clinicians ( n = 21; counselors/psychotherapists and psychologists) from National Health Service (NHS) specialist trauma services, a community mental health team, and specialist sexual assault counseling organization participated. Interpretative phenomenological analysis (IPA) was utilized to conduct single one-off interviews and analysis. Six themes were identified: Called to the work; Connection, Separation, and Oneness; Into and out of the darkness; Chaos into meaning; Reparation not repetition; and Expansion and growth. The first "Therapist Led Framework of Growth in Trauma Work" is presented. Vicarious posttraumatic growth (VPTG) was a key finding, with CPT therapists experiencing a "challenge/benefit/change" growth process. Adoption of actively relational strategies to enhance clinicians' growth process through trauma work is being proposed. The benefits of conceptualizing both the positive and negative impacts of such work for supervision, training, shaping the formal curricula, service management, and continuing professional development (CPD) are being discussed. The need for good practice guidelines on self-care internationally is highlighted.

Saving the On-Scene Time for Out-of-Hospital Cardiac Arrest Patients: The Registered Nurses' Role and Performance in Emergency Medical Service Teams.

PubMed

Lin, Ming-Wei; Wu, Che-Yu; Pan, Chih-Long; Tian, Zhong; Wen, Jyh-Horng; Wen, Jet-Chau

2017-01-01

For out-of-hospital cardiac arrest (OHCA) patients, every second is vital for their life. Shortening the prehospital time is a challenge to emergency medical service (EMS) experts. This study focuses on the on-scene time evaluation of the registered nurses (RNs) participating in already existing EMS teams, in order to explore their role and performance in different EMS cases. In total, 1247 cases were separated into trauma and nontrauma cases. The nontrauma cases were subcategorized into OHCA (NT-O), critical (NT-C), and noncritical (NT-NC) cases, whereas the trauma cases were subcategorized into collar-and-spinal board fixation (T-CS), fracture fixation (T-F), and general trauma (T-G) cases. The average on-scene time of RN-attended cases showed a decrease of 21.05% in NT-O, 3.28% in NT-C, 0% in NT-NC, 18.44% in T-CS, 13.56% in T-F, and 3.46% in T-G compared to non-RN-attended. In NT-O and T-CS cases, the RNs' attendance can notably save the on-scene time with a statistical significance ( P = .016 and .017, resp.). Furthermore, the return of spontaneous circulation within two hours (ROSC 2 h ) rate in the NT-O cases was increased by 12.86%. Based on the findings, the role of RNs in the EMTs could save the golden time in the prehospital medical care in Taiwan.

Orofacial trauma in Brazilian basketball players and level of information concerning trauma and mouthguards.

PubMed

Frontera, Renata Reis; Zanin, Luciane; Ambrosano, Glaucia Maria Bovi; Flório, Flávia Martão

2011-06-01

Orofacial injuries are increasingly considered a public health problem in high impact sports. The purposes of this study were: to assess orofacial trauma (OT) history in basketball players, in relation to wearing mouthguards (MG), facial types, presence of mouth breathing and player's position in the game, also to check athletes' level of knowledge about trauma and MGs. Questionnaires were given to category A-1 adult athletes registered in 2006/07 in the State of São Paulo and Brazilian Basketball Confederation Championships, and National Team members. Of the total sample (n=388), 50% of athletes sustained orofacial injuries; dental trauma accounted for 69.7%, with emphasis on maxillary central incisors, followed by soft tissue (60.8%), in which lip injuries were the most prevalent. No relationship was found between trauma history and player's position (P=0.19), facial type (P=0.97), presence of mouth breathing (P=0.98), but there was statistically significant association between the prevalence of OT and lack of MG use (P≤0.0001). Of all the athletes affected, only 1% wore a MG at the time of the trauma, 26.5% did not know about the MGs and 10.6% did not know their functions. When trauma occurred, 79.6% replied one must look for the tooth at the accident site, 50% knew it must be stored in liquid, as replantation was possible (62.3%) and 75.8% believed elapsed time could influence prognosis. Basketball is a high impact sport with high prevalence of OT, particularly maxillary central incisor and lip injuries, but athletes did not use MGs. There should be more educational campaigns to inform players about orofacial injuries and their prevention in Brazilian basketball. © 2011 John Wiley & Sons A/S.

Comparison of trauma care systems in Asian countries: A systematic literature review.

PubMed

Choi, Se Jin; Oh, Moon Young; Kim, Na Rae; Jung, Yoo Joong; Ro, Young Sun; Shin, Sang Do

2017-12-01

The study aims to compare the trauma care systems in Asian countries. Asian countries were categorised into three groups; 'lower middle-income country', 'upper middle-income country' and 'high-income country'. The Medline/PubMed database was searched for articles published from January 2005 to December 2014 using relevant key words. Articles were excluded if they examined a specific injury mechanism, referred to a specific age group, and/or did not have full text available. We extracted information and variables on pre-hospital and hospital care factors, and regionalised system factors and compared them across countries. A total of 46 articles were identified from 13 countries, including Pakistan, India, Vietnam and Indonesia from lower middle-income countries; the Islamic Republic of Iran, Thailand, China, Malaysia from upper middle-income countries; and Saudi Arabia, the Republic of Korea, Japan, Hong Kong and Singapore from high-income countries. Trauma patients were transported via various methods. In six of the 13 countries, less than 20% of trauma patients were transported by ambulance. Pre-hospital trauma teams primarily comprised emergency medical technicians and paramedics, except in Thailand and China, where they included mainly physicians. In Iran, Pakistan and Vietnam, the proportion of patients who died before reaching hospital exceeded 50%. In only three of the 13 countries was it reported that trauma surgeons were available. In only five of the 13 countries was there a nationwide trauma registry. Trauma care systems were poorly developed and unorganised in most of the selected 13 Asian countries, with the exception of a few highly developed countries. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Effect of a Dedicated Orthopaedic Advanced Practice Provider in a Level I Trauma Center: Analysis of Length of Stay and Cost.

PubMed

Hiza, Elise A; Gottschalk, Michael B; Umpierrez, Erica; Bush, Patricia; Reisman, William M

2015-07-01

The objective of this study is to analyze the effect of an orthopaedic trauma advanced practice provider on length of stay (LOS) and cost in a level I trauma center. The hypothesis of this study is that the addition of a single full-time nurse practitioner (NP) to the orthopaedic trauma team at a level I Trauma center would decrease overall LOS and hospital cost. A retrospective chart review of all patients discharged from the orthopaedic surgery service 1 year before the addition of a NP (pre-NP) and 1 year after the hiring of a NP (post-NP) were reviewed. Chart review included age, gender, LOS, discharge destination, intravenous antibiotic use, wound VAC therapy, admission location, and length of time to surgery. Statistical analysis was performed using the Wilcoxon/Kruskal-Wallis test. The hiring of a NP yielded a statistically significant decrease in the LOS across the following patient subgroups: patients transferred from the trauma service (13.56 compared with 7.02 days, P < 0.001), patients aged 60 years and older (7.34 compared with 5.04 days, P = 0.037), patients discharged to a rehabilitation facility (10.84 compared with 8.31 days, P = 0.002), and patients discharged on antibiotics/wound VAC therapy (15.16 compared with 11.24 days, P = 0.017). Length of time to surgery was also decreased (1.48 compared with 1.31 days, P = 0.37). The addition of a dedicated orthopaedic trauma advanced practice provider at a county level I trauma center resulted in a statistically significant decrease in LOS and thus reduced indirect costs to the hospital. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Effect of dyad training on medical students' cardiopulmonary resuscitation performance.

PubMed

Wang, Candice; Huang, Chin-Chou; Lin, Shing-Jong; Chen, Jaw-Wen

2017-03-01

We investigated the effects of dyadic training on medical students' resuscitation performance during cardiopulmonary resuscitation (CPR) training.We provided students with a 2-hour training session on CPR for simulated cardiac arrest. Student teams were split into double groups (Dyad training groups: Groups A and B) or Single Groups. All groups received 2 CPR simulation rounds. CPR simulation training began with peer demonstration for Group A, and peer observation for Group B. Then the 2 groups switched roles. Single Groups completed CPR simulation without peer observation or demonstration. Teams were then evaluated based on leadership, teamwork, and team member skills.Group B had the highest first simulation round scores overall (P = 0.004) and in teamwork (P = 0.001) and team member skills (P = 0.031). Group B also had the highest second simulation round scores overall (P < 0.001) and in leadership (P = 0.033), teamwork (P < 0.001), and team member skills (P < 0.001). In the first simulation, there were no differences between Dyad training groups with those of Single Groups in overall scores, leadership scores, teamwork scores, and team member scores. In the second simulation, Dyad training groups scored higher in overall scores (P = 0.002), leadership scores (P = 0.044), teamwork scores (P = 0.005), and team member scores (P = 0.008). Dyad training groups also displayed higher improvement in overall scores (P = 0.010) and team member scores (P = 0.022).Dyad training was effective for CPR training. Both peer observation and demonstration for peers in dyad training can improve student resuscitation performance.

Effect of dyad training on medical students’ cardiopulmonary resuscitation performance

PubMed Central

Wang, Candice; Huang, Chin-Chou; Lin, Shing-Jong; Chen, Jaw-Wen

2017-01-01

Abstract We investigated the effects of dyadic training on medical students’ resuscitation performance during cardiopulmonary resuscitation (CPR) training. We provided students with a 2-hour training session on CPR for simulated cardiac arrest. Student teams were split into double groups (Dyad training groups: Groups A and B) or Single Groups. All groups received 2 CPR simulation rounds. CPR simulation training began with peer demonstration for Group A, and peer observation for Group B. Then the 2 groups switched roles. Single Groups completed CPR simulation without peer observation or demonstration. Teams were then evaluated based on leadership, teamwork, and team member skills. Group B had the highest first simulation round scores overall (P = 0.004) and in teamwork (P = 0.001) and team member skills (P = 0.031). Group B also had the highest second simulation round scores overall (P < 0.001) and in leadership (P = 0.033), teamwork (P < 0.001), and team member skills (P < 0.001). In the first simulation, there were no differences between Dyad training groups with those of Single Groups in overall scores, leadership scores, teamwork scores, and team member scores. In the second simulation, Dyad training groups scored higher in overall scores (P = 0.002), leadership scores (P = 0.044), teamwork scores (P = 0.005), and team member scores (P = 0.008). Dyad training groups also displayed higher improvement in overall scores (P = 0.010) and team member scores (P = 0.022). Dyad training was effective for CPR training. Both peer observation and demonstration for peers in dyad training can improve student resuscitation performance. PMID:28353555

Helicopter Evacuation Following a Rural Trauma: An Emergency Medicine Simulation Scenario Using Innovative Simulation Technology

PubMed Central

Whalen, Desmond; Harty, Chris; Ravalia, Mohamed; Renouf, Tia; Alani, Sabrina; Brown, Robert

2016-01-01

The relevance of simulation as a teaching tool for medical professionals working in rural and remote contexts is apparent when low-frequency, high-risk situations are considered. Simulation training has been shown to enhance learning and improve patient outcomes in urban settings. However, there are few simulation scenarios designed to teach rural trauma management during complex medical transportation. In this technical report, we present a scenario using a medevac helicopter (Replica of Sikorsky S-92 designed by Virtual Marine Technology, St. John's, NL) at a rural community. This case can be used for training primary care physicians who are working in a rural or remote setting, or as an innovative addition to emergency medicine and pre-hospital care training programs. PMID:27081585

Inter-professional in-situ simulated team and resuscitation training for patient safety: Description and impact of a programmatic approach.

PubMed

Zimmermann, Katja; Holzinger, Iris Bachmann; Ganassi, Lorena; Esslinger, Peter; Pilgrim, Sina; Allen, Meredith; Burmester, Margarita; Stocker, Martin

2015-10-29

Inter-professional teamwork is key for patient safety and team training is an effective strategy to improve patient outcome. In-situ simulation is a relatively new strategy with emerging efficacy, but best practices for the design, delivery and implementation have yet to be evaluated. Our aim is to describe and evaluate the implementation of an inter-professional in-situ simulated team and resuscitation training in a teaching hospital with a programmatic approach. We designed and implemented a team and resuscitation training program according to Kern's six steps approach for curriculum development. General and specific needs assessments were conducted as independent cross-sectional surveys. Teamwork, technical skills and detection of latent safety threats were defined as specific objectives. Inter-professional in-situ simulation was used as educational strategy. The training was embedded within the workdays of participants and implemented in our highest acuity wards (emergency department, intensive care unit, intermediate care unit). Self-perceived impact and self-efficacy were sampled with an anonymous evaluation questionnaire after every simulated training session. Assessment of team performance was done with the team-based self-assessment tool TeamMonitor applying Van der Vleuten's conceptual framework of longitudinal evaluation after experienced real events. Latent safety threats were reported during training sessions and after experienced real events. The general and specific needs assessments clearly identified the problems, revealed specific training needs and assisted with stakeholder engagement. Ninety-five interdisciplinary staff members of the Children's Hospital participated in 20 in-situ simulated training sessions within 2 years. Participant feedback showed a high effect and acceptance of training with reference to self-perceived impact and self-efficacy. Thirty-five team members experiencing 8 real critical events assessed team performance with TeamMonitor. Team performance assessment with TeamMonitor was feasible and identified specific areas to target future team training sessions. Training sessions as well as experienced real events revealed important latent safety threats that directed system changes. The programmatic approach of Kern's six steps for curriculum development helped to overcome barriers of design, implementation and assessment of an in-situ team and resuscitation training program. This approach may help improve effectiveness and impact of an in-situ simulated training program.

Strategically Leapfrogging Education in Prehospital Trauma Management: Four-Tiered Training Protocols

PubMed Central

Abraham, Rohit; Vyas, Dinesh; Narayan, Mayur; Vyas, Arpita

2016-01-01

Trauma-related injury in fast developing countries are linked to 90% of international mortality rates, which can be greatly reduced by improvements in often non-existent or non-centralized emergency medical systems (EMS)—particularly in the pre-hospital care phase. Traditional trauma training protocols—such as Advanced Trauma Life Support (ATLS), International Trauma Life Support (ITLS), and Basic Life Support (BLS)—have failed to produce an effective pre-hospital ground force of medical first responders. To overcome these barriers, we propose a new four-tiered set of trauma training protocols: Massive Open Online Course (MOOC) Trauma Training, Acute Trauma Training (ATT), Broad Trauma Training (BTT), and Cardiac and Trauma Training (CTT). These standards are specifically differentiated to accommodate the educational and socioeconomic diversity found in fast developing settings, where each free course is taught in native, lay language while ensuring the education standards are maintained by fully incorporating high-fidelity simulation, video-recorded debriefing, and retraining. The innovative pedagogy of this trauma education program utilizes MOOC for global scalability and a “train-the-trainer” approach for exponential growth—both components help fast developing countries reach a critical mass of first responders needed for the base of an evolving EMS. PMID:27419222

Strategically Leapfrogging Education in Prehospital Trauma Management: Four-Tiered Training Protocols.

PubMed

Abraham, Rohit; Vyas, Dinesh; Narayan, Mayur; Vyas, Arpita

2015-12-01

Trauma-related injury in fast developing countries are linked to 90% of international mortality rates, which can be greatly reduced by improvements in often non-existent or non-centralized emergency medical systems (EMS)-particularly in the pre-hospital care phase. Traditional trauma training protocols-such as Advanced Trauma Life Support (ATLS), International Trauma Life Support (ITLS), and Basic Life Support (BLS)-have failed to produce an effective pre-hospital ground force of medical first responders. To overcome these barriers, we propose a new four-tiered set of trauma training protocols: Massive Open Online Course (MOOC) Trauma Training, Acute Trauma Training (ATT), Broad Trauma Training (BTT), and Cardiac and Trauma Training (CTT). These standards are specifically differentiated to accommodate the educational and socioeconomic diversity found in fast developing settings, where each free course is taught in native, lay language while ensuring the education standards are maintained by fully incorporating high-fidelity simulation, video-recorded debriefing, and retraining. The innovative pedagogy of this trauma education program utilizes MOOC for global scalability and a "train-the-trainer" approach for exponential growth-both components help fast developing countries reach a critical mass of first responders needed for the base of an evolving EMS.

Cognitive Aids for Role Definition (CARD) to improve interprofessional team crisis resource management: An exploratory study.

PubMed

Renna, Tania Di; Crooks, Simone; Pigford, Ashlee-Ann; Clarkin, Chantalle; Fraser, Amy B; Bunting, Alexandra C; Bould, M Dylan; Boet, Sylvain

2016-09-01

This study aimed to assess the perceived value of the Cognitive Aids for Role Definition (CARD) protocol for simulated intraoperative cardiac arrests. Sixteen interprofessional operating room teams completed three consecutive simulated intraoperative cardiac arrest scenarios: current standard, no CARD; CARD, no CARD teaching; and CARD, didactic teaching. Each team participated in a focus group interview immediately following the third scenario; data were transcribed verbatim and qualitatively analysed. After 6 months, participants formed eight new teams randomised to two groups (CARD or no CARD) and completed a retention intraoperative cardiac arrest simulation scenario. All simulation sessions were video recorded and expert raters assessed team performance. Qualitative analysis of the 16 focus group interviews revealed 3 thematic dimensions: role definition in crisis management; logistical issues; and the "real life" applicability of CARD. Members of the interprofessional team perceived CARD very positively. Exploratory quantitative analysis found no significant differences in team performance with or without CARD (p > 0.05). In conclusion, qualitative data suggest that the CARD protocol clarifies roles and team coordination during interprofessional crisis management and has the potential to improve the team performance. The concept of a self-organising team with defined roles is promising for patient safety.

An analysis of nursing students' decision-making in teams during simulations of acute patient deterioration.

PubMed

Bucknall, Tracey K; Forbes, Helen; Phillips, Nicole M; Hewitt, Nicky A; Cooper, Simon; Bogossian, Fiona

2016-10-01

The aim of this study was to examine the decision-making of nursing students during team based simulations on patient deterioration to determine the sources of information, the types of decisions made and the influences underpinning their decisions. Missed, misinterpreted or mismanaged physiological signs of deterioration in hospitalized patients lead to costly serious adverse events. Not surprisingly, an increased focus on clinical education and graduate nurse work readiness has resulted. A descriptive exploratory design. Clinical simulation laboratories in three Australian universities were used to run team based simulations with a patient actor. A convenience sample of 97 final-year nursing students completed simulations, with three students forming a team. Four teams from each university were randomly selected for detailed analysis. Cued recall during video review of team based simulation exercises to elicit descriptions of individual and team based decision-making and reflections on performance were audio-recorded post simulation (2012) and transcribed. Students recalled 11 types of decisions, including: information seeking; patient assessment; diagnostic; intervention/treatment; evaluation; escalation; prediction; planning; collaboration; communication and reflective. Patient distress, uncertainty and a lack of knowledge were frequently recalled influences on decisions. Incomplete information, premature diagnosis and a failure to consider alternatives when caring for patients is likely to lead to poor quality decisions. All health professionals have a responsibility in recognizing and responding to clinical deterioration within their scope of practice. A typology of nursing students' decision-making in teams, in this context, highlights the importance of individual knowledge, leadership and communication. © 2016 John Wiley & Sons Ltd.

Abdominal injuries in a major Scandinavian trauma center – performance assessment over an 8 year period

PubMed Central

2014-01-01

Introduction Damage control surgery and damage control resuscitation have reduced mortality in patients with severe abdominal injuries. The shift towards non-operative management in haemodynamically stable patients suffering blunt abdominal trauma has further contributed to the improved results. However, in many countries, low volume of trauma cases and limited exposure to trauma laparotomies constitute a threat to trauma competence. The aim of this study was to evaluate the institutional patient volume and performance for patients with abdominal injuries over an eight-year period. Methods Data from 955 consecutive trauma patients admitted in Oslo University Hospital Ulleval with abdominal injuries during the eight-year period 2002-2009 were retrospectively explored. A separate analysis was performed on all trauma patients undergoing laparotomy during the same period, whether abdominal injuries were identified or not. Variable life-adjusted display (VLAD) was used in order to describe risk-adjusted survival trends throughout the period and the patients admitted before (Period 1) and after (Period 2) the institution of a formal Trauma Service (2005) were compared. Results There was a steady increase in admitted patients with abdominal injuries, while the number of patients undergoing laparotomy was constant exposing the surgical trauma team leaders to an average of 8 trauma laparotomies per year. No increase in missed injuries or failures of non-operative management was detected. Unadjusted mortality rates decreased from period 1 to period 2 for all patients with abdominal injuries as well as for the patients undergoing laparotomy. However, this apparent decrease was not confirmed as significant in TRISS-based analysis of risk-adjusted mortality. VLAD demonstrated a steady performance throughout the study period. Conclusion Even in a high volume trauma center the exposure to abdominal injuries and trauma laparotomies is limited. Due to increasing NOM, an increasing number of patients with abdominal injuries was not accompanied by an increase in number of laparotomies. However, we have demonstrated a stable performance throughout the study period as visualized by VLAD without an increase in missed injuries or failures of NOM. PMID:25097664

Reduced Mortality by Physician-Staffed HEMS Dispatch for Adult Blunt Trauma Patients in Korea

PubMed Central

2016-01-01

The aim of this study was to investigate the efficiency of domestic physician-staffed helicopter emergency medical service (HEMS) for the transport of patients with severe trauma to a hospital. The study included patients with blunt trauma who were transported to our hospital by physician-staffed HEMS (Group P; n = 100) or nonphysician-staffed HEMS (Group NP; n = 80). Basic patient characteristics, transport time, treatment procedures, and medical treatment outcomes assessed using the Trauma and Injury Severity Score (TRISS) were compared between groups. We also assessed patients who were transported to the hospital within 3 h of injury in Groups P (Group P3; n = 50) and NP (Group NP3; n = 74). The severity of injury was higher, transport time was longer, and time from hospital arrival to operation room transfer was shorter for Group P than for Group NP (P < 0.001). Although Group P patients exhibited better medical treatment outcomes compared with Group NP, the difference was not statistically significant (P = 0.134 vs. 0.730). However, the difference in outcomes was statistically significant between Groups P3 and NP3 (P = 0.035 vs. 0.546). Under the current domestic trauma patient transport system in South Korea, physician-staffed HEMS are expected to increase the survival of patients with severe trauma. In particular, better treatment outcomes are expected if dedicated trauma resuscitation teams actively intervene in the medical treatment process from the transport stage and if patients are transported to a hospital to receive definitive care within 3 hours of injury. PMID:27550497

Using video recording to identify management errors in pediatric trauma resuscitation.

PubMed

Oakley, Ed; Stocker, Sergio; Staubli, Georg; Young, Simon

2006-03-01

To determine the ability of video recording to identify management errors in trauma resuscitation and to compare this method with medical record review. The resuscitation of children who presented to the emergency department of the Royal Children's Hospital between February 19, 2001, and August 18, 2002, for whom the trauma team was activated was video recorded. The tapes were analyzed, and management was compared with Advanced Trauma Life Support guidelines. Deviations from these guidelines were recorded as errors. Fifty video recordings were analyzed independently by 2 reviewers. Medical record review was undertaken for a cohort of the most seriously injured patients, and errors were identified. The errors detected with the 2 methods were compared. Ninety resuscitations were video recorded and analyzed. An average of 5.9 errors per resuscitation was identified with this method (range: 1-12 errors). Twenty-five children (28%) had an injury severity score of >11; there was an average of 2.16 errors per patient in this group. Only 10 (20%) of these errors were detected in the medical record review. Medical record review detected an additional 8 errors that were not evident on the video recordings. Concordance between independent reviewers was high, with 93% agreement. Video recording is more effective than medical record review in detecting management errors in pediatric trauma resuscitation. Management errors in pediatric trauma resuscitation are common and often involve basic resuscitation principles. Resuscitation of the most seriously injured children was associated with fewer errors. Video recording is a useful adjunct to trauma resuscitation auditing.

Learning the lessons from conflict: pre-hospital cervical spine stabilisation following ballistic neck trauma.

PubMed

Ramasamy, Arul; Midwinter, Mark; Mahoney, Peter; Clasper, Jon

2009-12-01

Current ATLS protocols dictate that spinal precautions should be in place when a casualty has sustained trauma from a significant mechanism of injury likely to damage the cervical spine. In hostile environments, the application of these precautions can place pre-hospital medical teams at considerable personal risk. It may also prevent or delay the identification of airway problems. In today's global threat from terrorism, this hostile environment is no longer restricted to conflict zones. The aim of this study was to ascertain the incidence of cervical spine injury following penetrating ballistic neck trauma in order to evaluate the need for pre-hospital cervical immobilisation in these casualties. We retrospectively reviewed the medical records of British military casualties of combat, from Iraq and Afghanistan presenting with a penetrating neck injury during the last 5.5 years. For each patient, the mechanism of injury, neurological state on admission, medical and surgical intervention was recorded. During the study period, 90 casualties sustained a penetrating neck injury. The mechanism of injury was by explosion in 66 (73%) and from gunshot wounds in 24 (27%). Cervical spine injuries (either cervical spine fracture or cervical spinal cord injury) were present in 20 of the 90 (22%) casualties, but only 6 of these (7%) actually survived to reach hospital. Four of this six subsequently died from injuries within 72 h. Only 1 (1.8%) of the 56 survivors to reach a surgical facility sustained an unstable cervical spine injury that required surgical stabilisation. This patient later died as result of a co-existing head injury. Penetrating ballistic trauma to the neck is associated with a high mortality rate. Our data suggests that it is very unlikely that penetrating ballistic trauma to the neck will result in an unstable cervical spine in survivors. In a hazardous environment (e.g. shooting incidents or terrorist bombings), the risk/benefit ratio of mandatory spinal immobilisation is unfavourable and may place medical teams at prolonged risk. In addition cervical collars may hide potential life-threatening conditions.

[Evaluation of radiation exposure of personnel in an orthopaedic and trauma operation theatre using the new real-time dosimetry system "dose aware"].

PubMed

Müller, M C; Strauss, A; Pflugmacher, R; Nähle, C P; Pennekamp, P H; Burger, C; Wirtz, D C

2014-08-01

There is a positive correlation between operation time and staff exposure to radiation during intraoperative use of C-arm fluoroscopy. Due to harmful effects of exposure to long-term low-dose radiation for both the patient and the operating team it should be kept to a minimum. AIM of this study was to evaluate a novel dosimeter system called Dose Aware® (DA) enabling radiation exposure feedback of the personal in an orthopaedic and trauma operation theatre in real-time. Within a prospective study over a period of four month, DA was applied by the operation team during 104 orthopaedic and trauma operations in which the C-arm fluoroscope was used in 2D-mode. During ten operation techniques, radiation exposure of the surgeon, the first assistant, the theatre nurse and the anaesthesiologist was evaluated. Seventy-three operations were analysed. The surgeon achieved the highest radiation exposure during dorsolumbar spinal osteosynthesis, kyphoplasty and screw fixation of sacral fractures. The first assistant received a higher radiation exposure compared to the surgeon during plate osteosynthesis of distal radius fractures (157 %), intramedullary nailing of pertrochanteric fractures (143 %) and dorsolumbar spinal osteosynthesis (240 %). During external fixation of ankle fractures (68 %) and screw fixation of sacral fractures (66 %) radiation exposure of the theatre nurse exceeded 50 % of the surgeon's radiation exposure. During plate osteosynthesis of distal radius fractures (157 %) and intramedullary splinting of clavicular fractures (115 %), the anaesthesiologist received a higher radiation exposure than the surgeon. The novel dosimeter system DA provides real-time radiation exposure feedback of the personnel in an orthopaedic and trauma operation theatre for the first time. Data of this study demonstrate that radiation exposure of the personnel depends on the operation type. The first assistant, the theatre nurse and the anaesthesiologist might be exposed to higher radiation doses than the surgeon. DA might help to increase awareness concerning irradiation in an orthopaedic and trauma operation theatre and might enhance staff compliance in using radiation protection techniques. Georg Thieme Verlag KG Stuttgart · New York.

Simulations in nursing practice: toward authentic leadership.

PubMed

Shapira-Lishchinsky, Orly

2014-01-01

Aim  This study explores nurses' ethical decision-making in team simulations in order to identify the benefits of these simulations for authentic leadership. Background  While previous studies have indicated that team simulations may improve ethics in the workplace by reducing the number of errors, those studies focused mainly on clinical aspects and not on nurses' ethical experiences or on the benefits of authentic leadership. Methods  Fifty nurses from 10 health institutions in central Israel participated in the study. Data about nurses' ethical experiences were collected from 10 teams. Qualitative data analysis based on Grounded Theory was applied, using the atlas.ti 5.0 software package. Findings  Simulation findings suggest four main benefits that reflect the underlying components of authentic leadership: self-awareness, relational transparency, balanced information processing and internalized moral perspective. Conclusions  Team-based simulation as a training tool may lead to authentic leadership among nurses. Implications for nursing management  Nursing management should incorporate team simulations into nursing practice to help resolve power conflicts and to develop authentic leadership in nursing. Consequently, errors will decrease, patients' safety will increase and optimal treatment will be provided. © 2012 John Wiley & Sons Ltd.

Compassionate Options for Pediatric EMS (COPE): Addressing Communication Skills.

PubMed

Calhoun, Aaron W; Sutton, Erica R H; Barbee, Anita P; McClure, Beth; Bohnert, Carrie; Forest, Richard; Taillac, Peter; Fallat, Mary E

2017-01-01

Each year, 16,000 children suffer cardiopulmonary arrest, and in one urban study, 2% of pediatric EMS calls were attributed to pediatric arrests. This indicates a need for enhanced educational options for prehospital providers that address how to communicate to families in these difficult situations. In response, our team developed a cellular phone digital application (app) designed to assist EMS providers in self-debriefing these events, thereby improving their communication skills. The goal of this study was to pilot the app using a simulation-based investigative methodology. Video and didactic app content was generated using themes developed from a series of EMS focus groups and evaluated using volunteer EMS providers assessed during two identical nonaccidental trauma simulations. Intervention groups interacted with the app as a team between assessments, and control groups debriefed during that period as they normally would. Communication performance and gap analyses were measured using the Gap-Kalamazoo Consensus Statement Assessment Form. A total of 148 subjects divided into 38 subject groups (18 intervention groups and 20 control groups) were assessed. Comparison of initial intervention group and control group scores showed no statistically significant difference in performance (2.9/5 vs. 3.0/5; p = 0.33). Comparisons made during the second assessment revealed a statistically significant improvement in the intervention group scores, with a moderate to large effect size (3.1/5 control vs. 4.0/5 intervention; p < 0.001, r = 0.69, absolute value). Gap analysis data showed a similar pattern, with gaps of -0.6 and -0.5 (values suggesting team self-over-appraisal of communication abilities) present in both control and intervention groups (p = 0.515) at the initial assessment. This gap persisted in the control group at the time of the second assessment (-0.8), but was significantly reduced (0.04) in the intervention group (p = 0.013, r = 0.41, absolute value). These results suggest that an EMS-centric app containing guiding information regarding compassionate communication skills can be effectively used by EMS providers to self-debrief after difficult events in the absence of a live facilitator, significantly altering their near-term communication patterns. Gap analysis data further imply that engaging with the app in a group context positively impacts the accuracy of each team's self-perception.

Exploring Mechanisms for Effective Technology-Enhanced Simulation-based Education in Wilderness Medicine: A Systematic Review

PubMed Central

MacKinnon, Ralph; Humphries, Christopher

2015-01-01

Background: Technology-enhanced simulation is well-established in healthcare teaching curricula, including those regarding wilderness medicine. Compellingly, the evidence base for the value of this educational modality to improve learner competencies and patient outcomes are increasing. Aims: The aim was to systematically review the characteristics of technology-enhanced simulation presented in the wilderness medicine literature to date. Then, the secondary aim was to explore how this technology has been used and if the use of this technology has been associated with improved learner or patient outcomes. Methods: EMBASE and MEDLINE were systematically searched from 1946 to 2014, for articles on the provision of technology-enhanced simulation to teach wilderness medicine. Working independently, the team evaluated the information on the criteria of learners, setting, instructional design, content, and outcomes. Results: From a pool of 37 articles, 11 publications were eligible for systematic review. The majority of learners in the included publications were medical students, settings included both indoors and outdoors, and the main focus clinical content was initial trauma management with some including leadership skills. The most prevalent instructional design components were clinical variation and cognitive interactivity, with learner satisfaction as the main outcome. Conclusions: The results confirm that the current provision of wilderness medicine utilizing technology-enhanced simulation is aligned with instructional design characteristics that have been used to achieve effective learning. Future research should aim to demonstrate the translation of learning into the clinical field to produce improved learner outcomes and create improved patient outcomes. PMID:26824012

Going DEEP: guidelines for building simulation-based team assessments.

PubMed

Grand, James A; Pearce, Marina; Rench, Tara A; Chao, Georgia T; Fernandez, Rosemarie; Kozlowski, Steve W J

2013-05-01

Whether for team training, research or evaluation, making effective use of simulation-based technologies requires robust, reliable and accurate assessment tools. Extant literature on simulation-based assessment practices has primarily focused on scenario and instructional design; however, relatively little direct guidance has been provided regarding the challenging decisions and fundamental principles related to assessment development and implementation. The objective of this manuscript is to introduce a generalisable assessment framework supplemented by specific guidance on how to construct and ensure valid and reliable simulation-based team assessment tools. The recommendations reflect best practices in assessment and are designed to empower healthcare educators, professionals and researchers with the knowledge to design and employ valid and reliable simulation-based team assessments. Information and actionable recommendations associated with creating assessments of team processes (non-technical 'teamwork' activities) and performance (demonstration of technical proficiency) are presented which provide direct guidance on how to Distinguish the underlying competencies one aims to assess, Elaborate the measures used to capture team member behaviours during simulation activities, Establish the content validity of these measures and Proceduralise the measurement tools in a way that is systematically aligned with the goals of the simulation activity while maintaining methodological rigour (DEEP). The DEEP framework targets fundamental principles and critical activities that are important for effective assessment, and should benefit healthcare educators, professionals and researchers seeking to design or enhance any simulation-based assessment effort.

Management of Pediatric Trauma.

PubMed

2016-08-01

Injury is still the number 1 killer of children ages 1 to 18 years in the United States (http://www.cdc.gov/nchs/fastats/children.htm). Children who sustain injuries with resulting disabilities incur significant costs not only for their health care but also for productivity lost to the economy. The families of children who survive childhood injury with disability face years of emotional and financial hardship, along with a significant societal burden. The entire process of managing childhood injury is enormously complex and varies by region. Only the comprehensive cooperation of a broadly diverse trauma team will have a significant effect on improving the care of injured children. Copyright © 2016 by the American Academy of Pediatrics.

Enhancing Mental Models for Team Effectiveness

DTIC Science & Technology

2011-09-01

person teams. C3Fire, a simulation of forest firefighting, was used as the task environment. Each team was assigned to one of three learning...military, for a total of 27 two-person teams. C3Fire, a functional simulation of forest firefighting, was used as the task environment. The...processes. A more likely explanation for the non-significant findings is that the task and team learning conditions used in this study did not sufficiently

An Invitation to Grieve: Reconsidering Critical Incident Responses by Support Teams in the School Setting

ERIC Educational Resources Information Center

O'Brien, Patrick; Mills, Katrina; Fraser, Amanda; Andersson, John

2011-01-01

This article proposes that consideration could be given to an invitational intervention rather than an expectational intervention when support personnel respond to a critical incident in schools. Intuitively many practitioners know that it is necessary for guidance/counselling personnel to intervene in schools in and following times of trauma.…

Trauma Relief: Nursing Home Outreach in Response to 9/11.

ERIC Educational Resources Information Center

Iwasaki, Michiko; Cavanaugh, Amy

The terrorist attacks on September 11, 2001, affected the psychological health of individuals of all ages in the U.S. Compared to other age groups, older adults often experience more difficulty in obtaining disaster assistance. Therefore, an outreach team was formed specifically to assist nursing home residents as part of a community effort at a…

Submental Orotracheal Intubation in Maxillofacial Fracture Surgery: Report of Two Cases

PubMed Central

Tekelioğlu, Ümit Yaşar; Karabekmez, Furkan Erol; Demirhan, Abdullah; Akkaya, Akcan; Bayır, Hakan; Koçoğlu, Hasan

2013-01-01

Two patients, aged 18 and 28 years, with maxillofacial trauma due to motor vehicle accident, were operated upon by a team of plastic surgeons. In this report we aimed to present our experience with submental intubation procedure in these cases, in which orotracheal or nasotracheal intubation was impossible due to panfacial fracture. PMID:27366379

Emergency Airway Response Team Simulation Training: A Nursing Perspective.

PubMed

Crimlisk, Janet T; Krisciunas, Gintas P; Grillone, Gregory A; Gonzalez, R Mauricio; Winter, Michael R; Griever, Susan C; Fernandes, Eduarda; Medzon, Ron; Blansfield, Joseph S; Blumenthal, Adam

Simulation-based education is an important tool in the training of professionals in the medical field, especially for low-frequency, high-risk events. An interprofessional simulation-based training program was developed to enhance Emergency Airway Response Team (EART) knowledge, team dynamics, and personnel confidence. This quality improvement study evaluated the EART simulation training results of nurse participants. Twenty-four simulation-based classes of 4-hour sessions were conducted during a 12-week period. Sixty-three nurses from the emergency department (ED) and the intensive care units (ICUs) completed the simulation. Participants were evaluated before and after the simulation program with a knowledge-based test and a team dynamics and confidence questionnaire. Additional comparisons were made between ED and ICU nurses and between nurses with previous EART experience and those without previous EART experience. Comparison of presimulation (presim) and postsimulation (postsim) results indicated a statistically significant gain in both team dynamics and confidence and Knowledge Test scores (P < .01). There were no differences in scores between ED and ICU groups in presim or postsim scores; nurses with previous EART experience demonstrated significantly higher presim scores than nurses without EART experience, but there were no differences between these nurse groups at postsim. This project supports the use of simulation training to increase nurses' knowledge, confidence, and team dynamics in an EART response. Importantly, nurses with no previous experience achieved outcome scores similar to nurses who had experience, suggesting that emergency airway simulation is an effective way to train both new and experienced nurses.

Interdisciplinary team interactions: a qualitative study of perceptions of team function in simulated anaesthesia crises.

PubMed

Weller, Jennifer M; Janssen, Anna L; Merry, Alan F; Robinson, Brian

2008-04-01

We placed anaesthesia teams into a stressful environment in order to explore interactions between members of different professional groups and to investigate their perspectives on the impact of these interactions on team performance. Ten anaesthetists, 5 nurses and 5 trained anaesthetic assistants each participated in 2 full-immersion simulations of critical events using a high-fidelity computerised patient simulator. Their perceptions of team interactions were explored through questionnaires and semi-structured interviews. Written questionnaire data and interview transcriptions were entered into N6 qualitative software. Data were analysed by 2 investigators for emerging themes and coded to produce reports on each theme. We found evidence of limited understanding of the roles and capabilities of team members across professional boundaries, different perceptions of appropriate roles and responsibilities for different members of the team, limited sharing of information between team members and limited team input into decision making. There was a perceived impact on task distribution and the optimal utilisation of resources within the team. Effective management of medical emergencies depends on optimal team function. We have identified important factors affecting interactions between different health professionals in the anaesthesia team, and their perceived influences on team function. This provides evidence on which to build appropriate and specific strategies for interdisciplinary team training in operating theatre staff.

Use of Performance Measures to Evaluate, Document Competence and Deterioration of Advanced Surgical Skills Exposure for Trauma (ASSET) Surgical Skills

DTIC Science & Technology

2014-03-01

skills retention. C-STARS . Dr Sharon Henry .. Committee On Trauma of American College of Surgeons Trauma Skills and Beta site Claire Leidy...cadaver sites .. refer to as need to do need a projector and fresh cadavers…11 courses 49 instructors 208 students ..importance of course ..should be...conducted to assess the efficacy of laparoscopic simulation trainers, especially as the technology has rapidly advanced from low-fidelity physical

Improved Clinical Performance and Teamwork of Pediatric Interprofessional Resuscitation Teams With a Simulation-Based Educational Intervention.

PubMed

Gilfoyle, Elaine; Koot, Deanna A; Annear, John C; Bhanji, Farhan; Cheng, Adam; Duff, Jonathan P; Grant, Vincent J; St George-Hyslop, Cecilia E; Delaloye, Nicole J; Kotsakis, Afrothite; McCoy, Carolyn D; Ramsay, Christa E; Weiss, Matthew J; Gottesman, Ronald D

2017-02-01

To measure the effect of a 1-day team training course for pediatric interprofessional resuscitation team members on adherence to Pediatric Advanced Life Support guidelines, team efficiency, and teamwork in a simulated clinical environment. Multicenter prospective interventional study. Four tertiary-care children's hospitals in Canada from June 2011 to January 2015. Interprofessional pediatric resuscitation teams including resident physicians, ICU nurse practitioners, registered nurses, and registered respiratory therapists (n = 300; 51 teams). A 1-day simulation-based team training course was delivered, involving an interactive lecture, group discussions, and four simulated resuscitation scenarios, each followed by a debriefing. The first scenario of the day (PRE) was conducted prior to any team training. The final scenario of the day (POST) was the same scenario, with a slightly modified patient history. All scenarios included standardized distractors designed to elicit and challenge specific teamwork behaviors. Primary outcome measure was change (before and after training) in adherence to Pediatric Advanced Life Support guidelines, as measured by the Clinical Performance Tool. Secondary outcome measures were as follows: 1) change in times to initiation of chest compressions and defibrillation and 2) teamwork performance, as measured by the Clinical Teamwork Scale. Correlation between Clinical Performance Tool and Clinical Teamwork Scale scores was also analyzed. Teams significantly improved Clinical Performance Tool scores (67.3-79.6%; p < 0.0001), time to initiation of chest compressions (60.8-27.1 s; p < 0.0001), time to defibrillation (164.8-122.0 s; p < 0.0001), and Clinical Teamwork Scale scores (56.0-71.8%; p < 0.0001). A positive correlation was found between Clinical Performance Tool and Clinical Teamwork Scale (R = 0.281; p < 0.0001). Participation in a simulation-based team training educational intervention significantly improved surrogate measures of clinical performance, time to initiation of key clinical tasks, and teamwork during simulated pediatric resuscitation. A positive correlation between clinical and teamwork performance suggests that effective teamwork improves clinical performance of resuscitation teams.

Embodied simulation in exposure-based therapies for posttraumatic stress disorder—a possible integration of cognitive behavioral theories, neuroscience, and psychoanalysis

PubMed Central

Peri, Tuvia; Gofman, Mordechai; Tal, Shahar; Tuval-Mashiach, Rivka

2015-01-01

Exposure to the trauma memory is the common denominator of most evidence-based interventions for posttraumatic stress disorder (PTSD). Although exposure-based therapies aim to change associative learning networks and negative cognitions related to the trauma memory, emotional interactions between patient and therapist have not been thoroughly considered in past evaluations of exposure-based therapy. This work focuses on recent discoveries of the mirror-neuron system and the theory of embodied simulation (ES). These conceptualizations may add a new perspective to our understanding of change processes in exposure-based treatments for PTSD patients. It is proposed that during exposure to trauma memories, emotional responses of the patient are transferred to the therapist through ES and then mirrored back to the patient in a modulated way. This process helps to alleviate the patient's sense of loneliness and enhances his or her ability to exert control over painful, trauma-related emotional responses. ES processes may enhance the integration of clinical insights originating in psychoanalytic theories—such as holding, containment, projective identification, and emotional attunement—with cognitive behavioral theories of learning processes in the alleviation of painful emotional responses aroused by trauma memories. These processes are demonstrated through a clinical vignette from an exposure-based therapy with a trauma survivor. Possible clinical implications for the importance of face-to-face relationships during exposure-based therapy are discussed. PMID:26593097

Embodied simulation in exposure-based therapies for posttraumatic stress disorder-a possible integration of cognitive behavioral theories, neuroscience, and psychoanalysis.

PubMed

Peri, Tuvia; Gofman, Mordechai; Tal, Shahar; Tuval-Mashiach, Rivka

2015-01-01

Exposure to the trauma memory is the common denominator of most evidence-based interventions for posttraumatic stress disorder (PTSD). Although exposure-based therapies aim to change associative learning networks and negative cognitions related to the trauma memory, emotional interactions between patient and therapist have not been thoroughly considered in past evaluations of exposure-based therapy. This work focuses on recent discoveries of the mirror-neuron system and the theory of embodied simulation (ES). These conceptualizations may add a new perspective to our understanding of change processes in exposure-based treatments for PTSD patients. It is proposed that during exposure to trauma memories, emotional responses of the patient are transferred to the therapist through ES and then mirrored back to the patient in a modulated way. This process helps to alleviate the patient's sense of loneliness and enhances his or her ability to exert control over painful, trauma-related emotional responses. ES processes may enhance the integration of clinical insights originating in psychoanalytic theories-such as holding, containment, projective identification, and emotional attunement-with cognitive behavioral theories of learning processes in the alleviation of painful emotional responses aroused by trauma memories. These processes are demonstrated through a clinical vignette from an exposure-based therapy with a trauma survivor. Possible clinical implications for the importance of face-to-face relationships during exposure-based therapy are discussed.

The Best Anticoagulation Therapy in Multiple-Trauma Patients with Mechanical Heart Valves: Evaluation of Latest Guidelines and Studies.

PubMed

Moeinipour, Aliasghar; Zarifian, Ahmadreza; Sheikh Andalibi, Mohammad Sobhan; Shamloo, Alireza Sepehri; Ahmadabadi, Ali; Amouzeshi, Ahmad; Hoseinikhah, Hamid

2015-12-22

It is common practice for patients with prosthetic cardiac devices, especially heart valve prosthesis, arterial stents, defibrillators, and pacemaker devices, to use anticoagulation treatment. When these patients suffer from multiple trauma after motor vehicle accidents, the best medical management for this challenging position is mandatory. This strategy should include a rapid diagnosis of all possible multiple organ injuries, with special attention to anticoagulation therapy so as to minimize the risk of thromboembolism complication in prosthetic devices. In this review, we describe the best medical management for patients with multiple trauma who use anticoagulants after heart valve replacement. We searched electronic databases PubMed/Medline, Scopus, Embase, and Google Scholar using the following terms: anticoagulant, warfarin, heparin, and multiple trauma. Also, similar studies suggested by the databases were included. Non-English articles were excluded from the review. For patients who use anticoagulation therapy, teamwork between cardiac surgeons, general surgeons, anesthesiologists, and cardiologists is essential. For optimal medical management, multiple consults between members of this team is mandatory for rapid diagnosis of all possible damaged organs, with special attention to the central nervous system, chest, and abdominal traumas. With this strategy, it is important to take note of anticoagulation drugs to minimize the risk of thromboembolism complications in cardiac devices. The best anticoagulant agents for emergency operations in patients with multiple trauma who are using an anticoagulant after heart valve replacement are fresh frozen plasma (FFP) and prothrombin complex concentrates (PCC).

Multidisciplinary trauma team care in Kandahar, Afghanistan: current injury patterns and care practices.

PubMed

Beckett, Andrew; Pelletier, Pierre; Mamczak, Christiaan; Benfield, Rodd; Elster, Eric

2012-12-01

Multidisciplinary trauma care systems have been shown to improve patient outcomes. Medical care in support of the global war on terror has provided opportunities to refine these systems. We report on the multidisciplinary trauma care system at the Role III Hospital at Kandahar Airfield, Afghanistan. We reviewed the Joint Trauma System Registry, Kandahar database from 1 October 2009 to 31 December 2010 and extracted data regarding patient demographics, clinical variables and outcomes. We also queried the operating room records from 1 January 2009 to 31 December 2010. In the study period of 1 October 2009 to 31 December 2010, 2599 patients presented to the trauma bay, with the most common source of injury being from Improvised Explosive Device (IED) blasts (915), followed by gunshot wounds (GSW) (327). Importantly, 19 patients with triple amputations as a result of injuries from IEDs were seen. 127 patients were massively transfused. The in-hospital mortality was 4.45%. From 1 January 2010 to 31 December 2010, 4106.24 operating room hours were logged to complete 1914 patient cases. The mean number of procedures per case in 2009 was 1.27, compared to 3.11 in 2010. Multinational, multidisciplinary care is required for the large number of severely injured patients seen at Kandahar Airfield. Multidisciplinary trauma care in Kandahar is effective and can be readily employed in combat hospitals in Afghanistan and serve as a model for civilian centres. Published by Elsevier Ltd.

Team Cohesion, Player Attitude, and Performance Expectations in Simulation.

ERIC Educational Resources Information Center

Wellington, William J.; Faria, A. J.

1996-01-01

Examines the relationship of team cohesion, participant attitude, and performance expectations to actual performance results in a simulation competition. Findings indicate a strong relationship between beginning team cohesion and performance expectations and final game performance, but little relationship between beginning participant attitudes…

Using Simulation for Launch Team Training and Evaluation

NASA Technical Reports Server (NTRS)

Peaden, Cary J.

2005-01-01

This document describes some of the histor y and uses of simulation systems and processes for the training and evaluation of Launch Processing, Mission Control, and Mission Management teams. It documents some of the types of simulations that are used at Kennedy Space Center (KSC) today and that could be utilized (and possibly enhanced) for future launch vehicles. This article is intended to provide an initial baseline for further research into simulation for launch team training in the near future.

How formative courses about damage control surgery and non-operative management improved outcome and survival in unstable politrauma patients in a Mountain Trauma Center.

PubMed

Bellanova, Giovanni; Buccelletti, Francesco; Berletti, Riccardo; Cavana, Marco; Folgheraiter, Giorgio; Groppo, Francesca; Marchetti, Chiara; Marzano, Amelia; Massè, Alessandro; Musetti, Antonio; Pelanda, Tina; Ricci, Nicola; Tugnoli, Gregorio; Papadia, Damiano; Ramponi, Claudio

2016-01-01

Aim of this study is to analyze how the starting of Course of Trauma in our hospital improved survival and organization in management of polytraumatized patients. We analysed all major trauma patients (Injury Severity Score (Injury Severity Score (ISS)> 15) treated at Emergency Department of the Santa Chiara Hospital between January 2011 and December 2014. The training courses (TC) were named "management of polytrauma" (MP) and "clinical cases discussion" (CCD), and started in November 2013. We divided the patients between two groups: before November 2013 (pre-TC group) and after November 2013 (post-TC group). MTG's courses (EMC accredited), CCD and MP courses started in November 2013. The target of these courses was the multidisciplinary management of polytrauma patient; the courses were addressed to general surgeons, anaesthesiologists, radiologists, orthopaedics and emergency physicians. Respectively 110 and 78 doctors were formed in CCD's and MP's courses. Patients directly transported to our trauma centre rose from 67.5% to 83% (p<0,005), and E-FAST grew from 15.6% in the pre-TC group to 51.3% in the post-TC group. Time of access in operatory theatre decreased from 62 to 44 minutes. Early Mortality (within 48 hours from the hospital arrival) was 9% in the pre-TC group and 4.5% in the post-tc group (p<0.005). Be needed to complete our goal. Further analysis and possible comparison with other trauma centers be needed to complete our goal Our results show that in our experience the multidisciplinary approach to polytrauma patients increased early survival and improved outcome with an evidence of worker's satisfaction. However, the best practice would ask to start with the approval of procedures and guidelines by the hospital governance, followed by clinical practice changes, in order to create a dedicated emergency and trauma surgery group. Damage Control Surgery, Non Operative Management, Trauma Course, Trauma Team, Trauma Center.

Nontechnical skills performance and care processes in the management of the acute trauma patient.

PubMed

Pucher, Philip H; Aggarwal, Rajesh; Batrick, Nicola; Jenkins, Michael; Darzi, Ara

2014-05-01

Acute trauma management is a complex process, with the effective cooperation among multiple clinicians critical to success. Despite this, the effect of nontechnical skills on performance on outcomes has not been investigated previously in trauma. Trauma calls in an urban, level 1 trauma center were observed directly. Nontechnical performance was measured using T-NOTECHS. Times to disposition and completion of assessment care processes were recorded, as well as any delays or errors. Statistical analysis assessed the effect of T-NOTECHS on performance and outcomes, accounting for Injury Severity Scores (ISS) and time of day as potential confounding factors. Meta-analysis was performed for incidence of delays. Fifty trauma calls were observed, with an ISS of 13 (interquartile range [IQR], 5-25); duration of stay 1 (IQR, 1-8) days; T-NOTECHS, 20.5 (IQR, 18-23); time to disposition, 24 minutes (IQR, 18-42). Trauma calls with low T-NOTECHS scores had a greater time to disposition: 35 minutes (IQR, 23-53) versus 20 (IQR, 16-25; P = .046). ISS showed a significant correlation to duration of stay (r = 0.736; P < .001), but not to T-NOTECHS (r = 0.201; P = .219) or time to disposition (r = 0.113; P = .494). There was no difference between "in-hours" and "out-of-hours" trauma calls for T-NOTECHS scores (21 [IQR, 18-22] vs 20 [IQR, 20-23]; P = .361), or time to disposition (34 minutes [IQR, 24-52] vs 17 [IQR, 15-27]; P = .419). Regression analysis revealed T-NOTECHS as the only factor associated with delays (odds ratio [OR], 0.24; 95% confidence interval [CI], 0.06-0.95). Better teamwork and nontechnical performance are associated with significant decreases in disposition time, an important marker of quality in acute trauma care. Addressing team and nontechnical skills has the potential to improve patient assessment, treatment, and outcomes. Copyright © 2014 Mosby, Inc. All rights reserved.

Crisis Team Management in a Scarce Resource Setting: Angkor Hospital for Children in Siem Reap, Cambodia.

PubMed

Henker, Richard Alynn; Henker, Hiroko; Eng, Hor; O'Donnell, John; Jirativanont, Tachawan

2017-01-01

A crisis team management (CTM) simulation course was developed by volunteers from Health Volunteers Overseas for physicians and nurses at Angkor Hospital for Children (AHC) in Siem Reap, Cambodia. The framework for the course was adapted from crisis resource management (1, 2), crisis team training (3), and TeamSTEPPs© models (4). The CTM course focused on teaching physicians and nurses on the development of team performance knowledge, skills, and attitudes. Challenges to providing this course at AHC included availability of simulation equipment, cultural differences in learning, and language barriers. The purpose of this project was to evaluate the impact of a CTM simulation course at AHC on attitudes and perceptions of participants on concepts related to team performance. Each of the CTM courses consisted of three lectures, including team performance concepts, communication, and debriefing followed by rotation through four simulation scenarios. The evaluation instrument used to evaluate the AHC CTM course was developed for Cambodian staff at AHC based on TeamSTEPPs© instruments evaluating attitude and perceptions of team performance (5). CTM team performance concepts included in lectures, debriefing sessions, and the evaluation instrument were: team structure, leadership, situation monitoring, mutual support, and communication. The Wilcoxon signed-rank test was used to analyze pre- and post-test paired data from participants in the course. Of the 54 participants completing the three CTM courses at AHC, 27 were nurses, 6 were anesthetists, and 21 were physicians. Attitude and perception scores were found to significantly improve ( p  < 0.05) for team structure, leadership, situation monitoring, and communication. Team performance areas that improved the most were: discussion of team performance, communication, and exchange of information. Teaching of non-technical skills can be effective in a setting with scarce resources in a Southeastern Asian country.

Training safer orthopedic surgeons. Construct validation of a virtual-reality simulator for hip fracture surgery.

PubMed

Akhtar, Kashif; Sugand, Kapil; Sperrin, Matthew; Cobb, Justin; Standfield, Nigel; Gupte, Chinmay

2015-01-01

Virtual-reality (VR) simulation in orthopedic training is still in its infancy, and much of the work has been focused on arthroscopy. We evaluated the construct validity of a new VR trauma simulator for performing dynamic hip screw (DHS) fixation of a trochanteric femoral fracture. 30 volunteers were divided into 3 groups according to the number of postgraduate (PG) years and the amount of clinical experience: novice (1-4 PG years; less than 10 DHS procedures); intermediate (5-12 PG years; 10-100 procedures); expert (> 12 PG years; > 100 procedures). Each participant performed a DHS procedure and objective performance metrics were recorded. These data were analyzed with each performance metric taken as the dependent variable in 3 regression models. There were statistically significant differences in performance between groups for (1) number of attempts at guide-wire insertion, (2) total fluoroscopy time, (3) tip-apex distance, (4) probability of screw cutout, and (5) overall simulator score. The intermediate group performed the procedure most quickly, with the lowest fluoroscopy time, the lowest tip-apex distance, the lowest probability of cutout, and the highest simulator score, which correlated with their frequency of exposure to running the trauma lists for hip fracture surgery. This study demonstrates the construct validity of a haptic VR trauma simulator with surgeons undertaking the procedure most frequently performing best on the simulator. VR simulation may be a means of addressing restrictions on working hours and allows trainees to practice technical tasks without putting patients at risk. The VR DHS simulator evaluated in this study may provide valid assessment of technical skill.

Human Simulators and Standardized Patients to Teach Difficult Conversations to Interprofessional Health Care Teams

PubMed Central

Zimmerman, Christine; Kennedy, Christopher; Schremmer, Robert; Smith, Katharine V.

2010-01-01

Objective To design and implement a demonstration project to teach interprofessional teams how to recognize and engage in difficult conversations with patients. Design Interdisciplinary teams consisting of pharmacy students and residents, student nurses, and medical residents responded to preliminary questions regarding difficult conversations, listened to a brief discussion on difficult conversations; formed ad hoc teams and interacted with a standardized patient (mother) and a human simulator (child), discussing the infant's health issues, intimate partner violence, and suicidal thinking; and underwent debriefing. Assessment Participants evaluated the learning methods positively and a majority demonstrated knowledge gains. The project team also learned lessons that will help better design future programs, including an emphasis on simulations over lecture and the importance of debriefing on student learning. Drawbacks included the major time commitment for design and implementation, sustainability, and the lack of resources to replicate the program for all students. Conclusion Simulation is an effective technique to teach interprofessional teams how to engage in difficult conversations with patients. PMID:21088725

Integrating team training strategies into obstetrical emergency simulation training.

PubMed

Daniel, Linda T; Simpson, Ellen K

2009-01-01

Successful management of obstetrical emergencies such as shoulder dystocia requires the coordinated efforts of a multidisciplinary team of professionals. Simulation education provides an opportunity to learn and master simple as well as complex technical skills needed in emergent situations. Team training has been shown to improve the quality of communication among team members and consequently has an enormous impact on human performance. In the healthcare environment, especially obstetrics where the stakes are high, integrating team training into simulation education can advance efforts to create and sustain a culture of safety. With over 7,100 deliveries annually, our 1,100-bed, two-hospital regional healthcare system embarked on this journey to advance the culture of safety.

Methodological Considerations for Research With Black Male Victims of Violent Injury in an Urban Trauma Unit.

PubMed

St Vil, Christopher; Richardson, Joseph; Cooper, Carnell

2018-04-01

There is a body of research over the last three decades that has focused on the etiology of violence among victims of violent injury. This body of literature indicates that Black men are disproportionately represented among victims of violent injury seen in emergency departments and trauma centers across the country. Despite the disproportionate number of low-income young Black men treated for violent injury in urban trauma units and the growing body of literature accompanying it, little is known about the unique methodological challenges violent injury researchers face when conducting research on this vulnerable population in a clinical setting. This article describes the unique and often nuanced methodological difficulties a research team encountered while conducting a longitudinal qualitative study on risk factors for repeat violent injury among low-income young Black male victims of violent injury treated at a Level II trauma center in the Eastern United States. Four methodological challenges are identified: (a) the identification and screening of participants, (b) recruitment and interviewing, (c) understanding hospital culture, policies, and procedures, and (d) retention and attrition of sample. Recommendations to overcome these challenges are offered.

Two Hours of Teamwork Training Improves Teamwork in Simulated Cardiopulmonary Arrest Events.

PubMed

Mahramus, Tara L; Penoyer, Daleen A; Waterval, Eugene M E; Sole, Mary L; Bowe, Eileen M

2016-01-01

Teamwork during cardiopulmonary arrest events is important for resuscitation. Teamwork improvement programs are usually lengthy. This study assessed the effectiveness of a 2-hour teamwork training program. A prospective, pretest/posttest, quasi-experimental design assessed the teamwork training program targeted to resident physicians, nurses, and respiratory therapists. Participants took part in a simulated cardiac arrest. After the simulation, participants and trained observers assessed perceptions of teamwork using the Team Emergency Assessment Measure (TEAM) tool (ratings of 0 [low] to 4 [high]). A debriefing and 45 minutes of teamwork education followed. Participants then took part in a second simulated cardiac arrest scenario. Afterward, participants and observers assessed teamwork. Seventy-three team members participated-resident physicians (25%), registered nurses (32%), and respiratory therapists (41%). The physicians had significantly less experience on code teams (P < .001). Baseline teamwork scores were 2.57 to 2.72. Participants' mean (SD) scores on the TEAM tool for the first and second simulations were 3.2 (0.5) and 3.7 (0.4), respectively (P < .001). Observers' mean (SD) TEAM scores for the first and second simulations were 3.0 (0.5) and 3.7 (0.3), respectively (P < .001). Program evaluations by participants were positive. A 2-hour simulation-based teamwork educational intervention resulted in improved perceptions of teamwork behaviors. Participants reported interactions with other disciplines, teamwork behavior education, and debriefing sessions were beneficial for enhancing the program.

[Team training and assessment in mixed reality-based simulated operating room : Current state of research in the field of simulation in spine surgery exemplified by the ATMEOS project].

PubMed

Stefan, P; Pfandler, M; Wucherer, P; Habert, S; Fürmetz, J; Weidert, S; Euler, E; Eck, U; Lazarovici, M; Weigl, M; Navab, N

2018-04-01

Surgical simulators are being increasingly used as an attractive alternative to clinical training in addition to conventional animal models and human specimens. Typically, surgical simulation technology is designed for the purpose of teaching technical surgical skills (so-called task trainers). Simulator training in surgery is therefore in general limited to the individual training of the surgeon and disregards the participation of the rest of the surgical team. The objective of the project Assessment and Training of Medical Experts based on Objective Standards (ATMEOS) is to develop an immersive simulated operating room environment that enables the training and assessment of multidisciplinary surgical teams under various conditions. Using a mixed reality approach, a synthetic patient model, real surgical instruments and radiation-free virtual X‑ray imaging are combined into a simulation of spinal surgery. In previous research studies, the concept was evaluated in terms of realism, plausibility and immersiveness. In the current research, assessment measurements for technical and non-technical skills are developed and evaluated. The aim is to observe multidisciplinary surgical teams in the simulated operating room during minimally invasive spinal surgery and objectively assess the performance of the individual team members and the entire team. Moreover, the effectiveness of training methods and surgical techniques or success critical factors, e. g. management of crisis situations, can be captured and objectively assessed in the controlled environment.

Multidisciplinary team simulation for the operating theatre: a review of the literature.

PubMed

Tan, Shaw Boon; Pena, Guilherme; Altree, Meryl; Maddern, Guy J

2014-01-01

Analyses of adverse events inside the operating theatre has demonstrated that many errors are caused by failure in non-technical skills and teamwork. While simulation has been used successfully for teaching and improving technical skills, more recently, multidisciplinary simulation has been used for training team skills. We hypothesized that this type of training is feasible and improves team skills in the operating theatre. A systematic search of the literature for studies describing true multidisciplinary operating theatre team simulation was conducted in November and December 2012. We looked at the characteristics and outcomes of the team simulation programmes. 1636 articles were initially retrieved. Utilizing a stepwise evaluation process, 26 articles were included in the review. The studies reveal that multidisciplinary operating theatre simulation has been used to provide training in technical and non-technical skills, to help implement new techniques and technologies, and to identify latent weaknesses within a health system. Most of the studies included are descriptions of training programmes with a low level of evidence. No randomized control trial was identified. Participants' reactions to the training programme were positive in all studies; however, none of them could objectively demonstrate that skills acquired from simulation are transferred to the operating theatre or show a demonstrable benefit in patient outcomes. Multidisciplinary operating room team simulation is feasible and widely accepted by participants. More studies are required to assess the impact of this type of training on operative performance and patient safety. © 2013 Royal Australasian College of Surgeons.

Zero-Fidelity Simulation: Engaging Team Coordination without Physical, Functional, or Psychological Re-Creation

NASA Technical Reports Server (NTRS)

Toups, Zachary O.; Hamilton, William A.; Kerne, Andruid

2012-01-01

Team coordination is essential across domains, enabling efficiency and safety. As technology improves, our temptation is to simulate with ever-higher fidelity, by making simulators re-create reality through their physical interfaces, functionality, and by making participants believe they are undertaking the simulated task. However, high-fidelity simulations often miss salient human-human work practices. We introduce the concept of zero-fidelity simulation (ZFS), a move away from literal high-fidelity mimesis of the concrete environment. ZFS alternatively models cooperation and communication as the basis of simulation. The ZFS Team Coordination Game (TeC) is developed from observation of fire emergency response work practice. We identify ways in which team members are mutually dependent on one another for information, and use these as the basis for the ZFS game design. The design creates a need for cooperation by restricting individual activity and requiring communication. The present research analyzes the design of interdependence in the validated ZFS TeC game. We successfully simulate interdependence between roles in emergency response without simulating the concrete environment.

Extraversion, neuroticism and secondary trauma in Internet child abuse investigators

PubMed Central

2016-01-01

Background Working with victims and perpetrators of child sexual abuse has been shown to cause secondary traumatic stress (STS) in child protection professionals. Aims To examine the role of gender and personality on the development of secondary trauma responses. Methods A study of Internet child abuse investigators (ICAIs) from two UK police forces. Participants completed a personality test together with tests for anxiety, depression, burnout, STS and post-traumatic stress disorder to assess secondary trauma. The data were normally distributed and the results were analysed using an independent t-test, Pearson correlation and linear regression. Results Among 126 study subjects (50 females and 75 males), there was a higher incidence of STS in investigators who were female, introverted and neurotic. However, there were lower levels of STS in the participants in this study than those found in other studies. Conclusions Psychological screening and surveillance of ICAI teams can help to identify risk factors for the development of STS and identify where additional support may be required. PMID:26928859

Using Simulation as an Investigational Methodology to Explore the Impact of Technology on Team Communication and Patient Management: A Pilot Evaluation of the Effect of an Automated Compression Device.

PubMed

Gittinger, Matthew; Brolliar, Sarah M; Grand, James A; Nichol, Graham; Fernandez, Rosemarie

2017-06-01

This pilot study used a simulation-based platform to evaluate the effect of an automated mechanical chest compression device on team communication and patient management. Four-member emergency department interprofessional teams were randomly assigned to perform manual chest compressions (control, n = 6) or automated chest compressions (intervention, n = 6) during a simulated cardiac arrest with 2 phases: phase 1 baseline (ventricular tachycardia), followed by phase 2 (ventricular fibrillation). Patient management was coded using an Advanced Cardiovascular Life Support-based checklist. Team communication was categorized in the following 4 areas: (1) teamwork focus; (2) huddle events, defined as statements focused on re-establishing situation awareness, reinforcing existing plans, and assessing the need to adjust the plan; (3) clinical focus; and (4) profession of team member. Statements were aggregated for each team. At baseline, groups were similar with respect to total communication statements and patient management. During cardiac arrest, the total number of communication statements was greater in teams performing manual compressions (median, 152.3; interquartile range [IQR], 127.6-181.0) as compared with teams using an automated compression device (median, 105; IQR, 99.5-123.9). Huddle events were more frequent in teams performing automated chest compressions (median, 4.0; IQR, 3.1-4.3 vs. 2.0; IQR, 1.4-2.6). Teams randomized to the automated compression intervention had a delay to initial defibrillation (median, 208.3 seconds; IQR, 153.3-222.1 seconds) as compared with control teams (median, 63.2 seconds; IQR, 30.1-397.2 seconds). Use of an automated compression device may impact both team communication and patient management. Simulation-based assessments offer important insights into the effect of technology on healthcare teams.

Blast injury prevalence in skeletal remains: Are there differences between Bosnian war samples and documented combat-related deaths?

PubMed

Dussault, Marie Christine; Hanson, Ian; Smith, Martin J

2017-11-01

Court cases at the International Criminal Tribunal for the Former Yugoslavia (ICTY) have seen questions raised about the recognition and causes of blast-related trauma and the relationship to human rights abuses or combat. During trials, defence teams argued that trauma was combat related and prosecutors argued that trauma was related to executions. We compared a sample of 81 cases (males between 18 and 75) from a Bosnian mass grave investigation linked to the Kravica warehouse killings to published combat-related blast injury data from World War One, Vietnam, Northern Ireland, the first Gulf War, Operation Iraqi Freedom and Afghanistan. We also compared blast fracture injuries from Bosnia to blast fracture injuries sustained in bombings of buildings in two non-combat 'civilian' examples; the Oklahoma City and Birmingham pub bombings. A Chi-squared statistic with a Holm-Bonferroni correction assessed differences between prevalence of blast-related fractures in various body regions, where data were comparable. We found statistically significant differences between the Bosnian and combat contexts. We noted differences in the prevalence of head, torso, vertebral area, and limbs trauma, with a general trend for higher levels of more widespread trauma in the Bosnian sample. We noted that the pattern of trauma in the Bosnian cases resembled the pattern from the bombing in buildings civilian contexts. Variation in trauma patterns can be attributed to the influence of protective armour; the context of the environment; and the type of munition and its injuring mechanism. Blast fracture injuries sustained in the Bosnian sample showed patterns consistent with a lack of body armour, blast effects on people standing in enclosed buildings and the use of explosive munitions. Copyright © 2017 The Chartered Society of Forensic Sciences. Published by Elsevier B.V. All rights reserved.

Trauma surgeon becomes consultant: evaluation of a protocol for management of intermediate-level trauma patients.

PubMed

Fallon, Sara C; Delemos, David; Christopher, Daniel; Frost, Mary; Wesson, David E; Naik-Mathuria, Bindi

2014-01-01

At our level 1 pediatric trauma center, 9-54 intermediate-level ("level 2") trauma activations are received per month. Previously, the surgery team was required to respond to and assume responsibility for all patients who had "level 2" trauma activations. In 8/2011, we implemented a protocol where the emergency room (ER) physician primarily manages these patients with trauma consultation for surgical evaluation or admission. The purpose of this study was to prospectively evaluate the effects of the new protocol to ensure that patient safety and quality of care were maintained. We compared outcomes of patients treated PRE-implementation (10/2010-7/2011) and POST-implementation (9/2011-5/2012), including surgeon consultation rate, utilization of imaging and laboratory testing, ER length of stay, admission rate, and missed injuries or readmissions. Statistical analysis included chi-square and Student's t-test. We identified 472 patients: 179 in the PRE and 293 in the POST period. The populations had similar baseline clinical characteristics. The surgical consultation rate in the POST period was only 42%, with no missed injuries or readmissions. The ER length of stay did not change. However, in the POST period there were significant decreases in the admission rate (73% to 44%) and the mean number of CT scans (1.4 to 1), radiographs (2.4 to 1.7), and laboratory tests (5.1 to 3.3) ordered in the emergency room (all p<0.001). Intermediate-level pediatric trauma patients can be efficiently and safely managed by pediatric emergency room physicians, with surgical consultation only as needed. The protocol change improved resource utilization by decreasing testing and admissions and streamlining resident utilization in an era of reduced duty hours. © 2014.

Pancreatic trauma.

PubMed

Lahiri, R; Bhattacharya, S

2013-05-01

Pancreatic trauma occurs in approximately 4% of all patients sustaining abdominal injuries. The pancreas has an intimate relationship with the major upper abdominal vessels, and there is significant morbidity and mortality associated with severe pancreatic injury. Immediate resuscitation and investigations are essential to delineate the nature of the injury, and to plan further management. If main pancreatic duct injuries are identified, specialised input from a tertiary hepatopancreaticobiliary (HPB) team is advised. A comprehensive online literature search was performed using PubMed. Relevant articles from international journals were selected. The search terms used were: 'pancreatic trauma', 'pancreatic duct injury', 'radiology AND pancreas injury', 'diagnosis of pancreatic trauma', and 'management AND surgery'. Articles that were not published in English were excluded. All articles used were selected on relevance to this review and read by both authors. Pancreatic trauma is rare and associated with injury to other upper abdominal viscera. Patients present with non-specific abdominal findings and serum amylase is of little use in diagnosis. Computed tomography is effective in diagnosing pancreatic injury but not duct disruption, which is most easily seen on endoscopic retrograde cholangiopancreaticography or operative pancreatography. If pancreatic injury is suspected, inspection of the entire pancreas and duodenum is required to ensure full evaluation at laparotomy. The operative management of pancreatic injury depends on the grade of injury found at laparotomy. The most important prognostic factor is main duct disruption and, if found, reconstructive options should be determined by an experienced HPB surgeon. The diagnosis of pancreatic trauma requires a high index of suspicion and detailed imaging studies. Grading pancreatic injury is important to guide operative management. The most important prognostic factor is pancreatic duct disruption and in these cases, experienced HPB surgeons should be involved. Complications following pancreatic trauma are common and the majority can be managed without further surgery.

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

PubMed

Gundrosen, Stine; Andenæs, Ellen; Aadahl, Petter; Thomassen, Gøril

2016-11-14

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

[The hardest battles begin after the war].

PubMed

Sodemann, Morten; Svabo, Arndis; Jacobsen, Arne

2010-01-11

While psychic effects of war trauma are well-described, the somatic long-term consequences of war trauma have not previously been described. In three clinical cases from the Migrant Health Clinic at Odense University Hospital, we describe the complicated somatic problems which can be associated with a refugee status. The cross disciplinary team chose three cases that describe the long-term effects of war trauma. Post-traumatic stress disorder (PTSD) can appear 10-20 years after a primary war-related trauma and secondary trauma after the arrival in Denmark trigger and prolong post-traumatic stress symptoms with a range of somatic symptoms. Warning signs of an underlying PTSD disorder have often been present for many years, but overlooked or ignored. Many patients with PTSD and somatic symptoms loose previously acquired language skills, disintegrate and drop out of the labour market after 3-4 years in Denmark. Somatic symptoms along with PTSD can develop into a seriously complicated condition that requires skilled cross-disciplinary management. Experience from the Cross Disciplinary Migrant Health Clinic shows that by investing time in obtaining a full clinical and social history it is possible to increase the quality of life of these patients. Early screening and early specialized cross disciplinary and cross sectorial management are crucial to secure and maintain integration, but unfortunately the long waiting list to institutions that treat PTSD contributes to the high level of disintegration.

[Safety Culture in Orthopaedic Surgery and Trauma Surgery - Where Are We Today?

PubMed

Münzberg, Matthias; Rüsseler, Miriam; Egerth, Martin; Doepfer, Anna Katharina; Mutschler, Manuel; Stange, Richard; Bouillon, Bertil; Kladny, Bernd; Hoffmann, Reinhard

2018-06-05

The development of a new safety culture in orthopaedics and trauma surgery needs to be based on the knowledge of the status quo. The objective of this research was therefore to perform a survey of orthopaedic and trauma surgeons to achieve a subjective assessment of the frequency and causes of "insecurities" or errors in daily practice. Based on current literature, an online questionnaire was created by a team of experts (26 questions total) and was sent via e-mail to all active members of a medical society (DGOU) in April 2015. This was followed by two reminder e-mails. The survey was completed in May 2015. The results were transmitted electronically, anonymously and voluntarily into a database and evaluated by univariate analyses. 799 active members took part in the survey. 65% of the interviewed people stated that they noticed mistakes in their own clinical work environment at least once a week. The main reasons for these mistakes were "time pressure", "lack of communication", "lack of staff" and "stress". Technical mistakes or lack of knowledge were not of primary importance. The survey indicated that errors in orthopaedics and trauma surgery are observed regularly. "Human factors" were regarded as a major cause. In order to develop a new safety culture in orthopaedics and trauma surgery, new approaches must focus on the human factor. Georg Thieme Verlag KG Stuttgart · New York.

Forecasting a winner for Malaysian Cup 2013 using soccer simulation model

NASA Astrophysics Data System (ADS)

Yusof, Muhammad Mat; Fauzee, Mohd Soffian Omar; Latif, Rozita Abdul

2014-07-01

This paper investigates through soccer simulation the calculation of the probability for each team winning Malaysia Cup 2013. Our methodology used here is we predict the outcomes of individual matches and then we simulate the Malaysia Cup 2013 tournament 5000 times. As match outcomes are always a matter of uncertainty, statistical model, in particular a double Poisson model is used to predict the number of goals scored and conceded for each team. Maximum likelihood estimation is use to measure the attacking strength and defensive weakness for each team. Based on our simulation result, LionXII has a higher probability in becoming the winner, followed by Selangor, ATM, JDT and Kelantan. Meanwhile, T-Team, Negeri Sembilan and Felda United have lower probabilities to win Malaysia Cup 2013. In summary, we find that the probability for each team becominga winner is small, indicating that the level of competitive balance in Malaysia Cup 2013 is quite high.

Development of a Search and Rescue Simulation to Study the Effects of Prolonged Isolation on Team Decision Making

NASA Technical Reports Server (NTRS)

Entin, Elliot E.; Kerrigan, Caroline; Serfaty, Daniel; Young, Philip

1998-01-01

The goals of this project were to identify and investigate aspects of team and individual decision-making and risk-taking behaviors hypothesized to be most affected by prolonged isolation. A key premise driving our research approach is that effects of stressors that impact individual and team cognitive processes in an isolated, confined, and hazardous environment will be projected onto the performance of a simulation task. To elicit and investigate these team behaviors we developed a search and rescue task concept as a scenario domain that would be relevant for isolated crews. We modified the Distributed Dynamic Decision-making (DDD) simulator, a platform that has been extensively used for empirical research in team processes and taskwork performance, to portray the features of a search and rescue scenario and present the task components incorporated into that scenario. The resulting software is called DD-Search and Rescue (Version 1.0). To support the use of the DDD-Search and Rescue simulator in isolated experiment settings, we wrote a player's manual for teaching team members to operate the simulator and play the scenario. We then developed a research design and experiment plan that would allow quantitative measures of individual and team decision making skills using the DDD-Search and Rescue simulator as the experiment platform. A description of these activities and the associated materials that were produced under this contract are contained in this report.

Disaster relief and initial response to the earthquake and tsunami in Meulaboh, Indonesia.

PubMed

Lee, V J; Low, E; Ng, Y Y; Teo, C

2005-10-01

The Singapore Humanitarian Assistance Support Group deployed a team of 32 medical relief workers to Meulaboh, Indonesia to provide medical assistance for victims of the 26 December earthquake and tsunami disaster. The team was deployed at a primary healthcare clinic at an internally displaced persons' (IDP) camp and at the sole hospital's emergency and surgical departments. The team saw a total of 1841 patients, 1371 at the clinic and 446 at the hospital's emergency department, and performed surgery on 24 patients. Tsunami-related trauma cases accounted for 31.8% (142) of cases at the emergency department, 1.6% (22) of cases at the clinic, and 91.7% (22) of surgeries. This paper details the difficulties and lessons learnt by the team, including the lack of important resources for healthcare delivery. Water, sanitation, hygiene, and vector control were some of the problems faced, with the goal to provide the most effective public health for the greatest number of people given the limited resources available.

The role of NIGMS P50 sponsored team science in our understanding of multiple organ failure.

PubMed

Moore, Frederick A; Moore, Ernest E; Billiar, Timothy R; Vodovotz, Yoram; Banerjee, Anirban; Moldawer, Lyle L

2017-09-01

The history of the National Institute of General Medical Sciences (NIGMS) Research Centers in Peri-operative Sciences (RCIPS) is the history of clinical, translational, and basic science research into the etiology and treatment of posttraumatic multiple organ failure (MOF). Born out of the activism of trauma and burn surgeons after the Viet Nam War, the P50 trauma research centers have been a nidus of research advances in the field and the training of future academic physician-scientists in the fields of trauma, burns, sepsis, and critical illness. For over 40 years, research conducted under the aegis of this funding program has led to numerous contributions at both the bedside and at the bench. In fact, it has been this requirement for team science with a clinician-scientist working closely with basic scientists from multiple disciplines that has led the RCIPS to its unrivaled success in the field. This review will briefly highlight some of the major accomplishments of the RCIPS program since its inception, how they have both led and evolved as the field moved steadily forward, and how they are responsible for much of our current understanding of the etiology and pathology of MOF. This review is not intended to be all encompassing nor a historical reference. Rather, it serves as recognition to the foresight and support of many past and present individuals at the NIGMS and at academic institutions who have understood the cost of critical illness and MOF to the individual and to society.

Getting Inside the Expert's Head: An Analysis of Physician Cognitive Processes During Trauma Resuscitations.

PubMed

White, Matthew R; Braund, Heather; Howes, Daniel; Egan, Rylan; Gegenfurtner, Andreas; van Merrienboer, Jeroen J G; Szulewski, Adam

2018-04-23

Crisis resource management skills are integral to leading the resuscitation of a critically ill patient. Despite their importance, crisis resource management skills (and their associated cognitive processes) have traditionally been difficult to study in the real world. The objective of this study was to derive key cognitive processes underpinning expert performance in resuscitation medicine, using a new eye-tracking-based video capture method during clinical cases. During an 18-month period, a sample of 10 trauma resuscitations led by 4 expert trauma team leaders was analyzed. The physician team leaders were outfitted with mobile eye-tracking glasses for each case. After each resuscitation, participants were debriefed with a modified cognitive task analysis, based on a cued-recall protocol, augmented by viewing their own first-person perspective eye-tracking video from the clinical encounter. Eye-tracking technology was successfully applied as a tool to aid in the qualitative analysis of expert performance in a clinical setting. All participants stated that using these methods helped uncover previously unconscious aspects of their cognition. Overall, 5 major themes were derived from the interviews: logistic awareness, managing uncertainty, visual fixation behaviors, selective attendance to information, and anticipatory behaviors. The novel approach of cognitive task analysis augmented by eye tracking allowed the derivation of 5 unique cognitive processes underpinning expert performance in leading a resuscitation. An understanding of these cognitive processes has the potential to enhance educational methods and to create new assessment modalities of these previously tacit aspects of expertise in this field. Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Randomized controlled trial of multidisciplinary team stress and performance in immersive simulation for management of infant in shock: study protocol.

PubMed

Ghazali, Daniel Aiham; Ragot, Stéphanie; Breque, Cyril; Guechi, Youcef; Boureau-Voultoury, Amélie; Petitpas, Franck; Oriot, Denis

2016-03-25

Human error and system failures continue to play a substantial role in adverse outcomes in healthcare. Simulation improves management of patients in critical condition, especially if it is undertaken by a multidisciplinary team. It covers technical skills (technical and therapeutic procedures) and non-technical skills, known as Crisis Resource Management. The relationship between stress and performance is theoretically described by the Yerkes-Dodson law as an inverted U-shaped curve. Performance is very low for a low level of stress and increases with an increased level of stress, up to a point, after which performance decreases and becomes severely impaired. The objectives of this randomized trial are to study the effect of stress on performance and the effect of repeated simulation sessions on performance and stress. This study is a single-center, investigator-initiated randomized controlled trial including 48 participants distributed in 12 multidisciplinary teams. Each team is made up of 4 persons: an emergency physician, a resident, a nurse, and an ambulance driver who usually constitute a French Emergency Medical Service team. Six multidisciplinary teams are planning to undergo 9 simulation sessions over 1 year (experimental group), and 6 multidisciplinary teams are planning to undergo 3 simulation sessions over 1 year (control group). Evidence of the existence of stress will be assessed according to 3 criteria: biological, electrophysiological, and psychological stress. The impact of stress on overall team performance, technical procedure and teamwork will be evaluated. Participant self-assessment of the perceived impact of simulations on clinical practice will be collected. Detection of post-traumatic stress disorder will be performed by self-assessment questionnaire on the 7(th) day and after 1 month. We will concomitantly evaluate technical and non-technical performance, and the impact of stress on both. This is the first randomized trial studying repetition of simulation sessions and its impact on both clinical performance and stress, which is explored by objective and subjective assessments. We expect that stress decreases team performance and that repeated simulation will increase it. We expect no variation of stress parameters regardless of the level of performance. ClinicalTrials.gov registration number NCT02424890.

Using cognitive architectures to study issues in team cognition in a complex task environment

NASA Astrophysics Data System (ADS)

Smart, Paul R.; Sycara, Katia; Tang, Yuqing

2014-05-01

Cognitive social simulation is a computer simulation technique that aims to improve our understanding of the dynamics of socially-situated and socially-distributed cognition. This makes cognitive social simulation techniques particularly appealing as a means to undertake experiments into team cognition. The current paper reports on the results of an ongoing effort to develop a cognitive social simulation capability that can be used to undertake studies into team cognition using the ACT-R cognitive architecture. This capability is intended to support simulation experiments using a team-based problem solving task, which has been used to explore the effect of different organizational environments on collective problem solving performance. The functionality of the ACT-R-based cognitive social simulation capability is presented and a number of areas of future development work are outlined. The paper also describes the motivation for adopting cognitive architectures in the context of social simulation experiments and presents a number of research areas where cognitive social simulation may be useful in developing a better understanding of the dynamics of team cognition. These include the use of cognitive social simulation to study the role of cognitive processes in determining aspects of communicative behavior, as well as the impact of communicative behavior on the shaping of task-relevant cognitive processes (e.g., the social shaping of individual and collective memory as a result of communicative exchanges). We suggest that the ability to perform cognitive social simulation experiments in these areas will help to elucidate some of the complex interactions that exist between cognitive, social, technological and informational factors in the context of team-based problem-solving activities.

Impact of a comprehensive supportive care team on management of hopelessly ill patients with multiple organ failure.

PubMed

Field, B E; Devich, L E; Carlson, R W

1989-08-01

We developed a supportive care team for hopelessly ill patients in an urban emergency/trauma hospital. The team includes a clinical nurse specialist and a faculty physician as well as a chaplain and social worker. The supportive care team provides an alternative to intensive care or conventional ward management of hopelessly ill patients and concentrates on the physical and psychosocial comfort needs of patients and their families. We describe our experience with 20 hopelessly ill patients with multiple organ failure vs a similar group treated before the development of the supportive care team. Although there was no difference in mortality (100 percent), the length of stay in the medical ICU for patients with multiple organ failure decreased by 12 days to 6 days. Additionally, there were 50 percent fewer therapeutic interventions provided by the supportive care team vs intensive care or conventional ward treatment of multiple organ failure patients. We describe the methods that the supportive care team uses in an attempt to meet the physical and psychosocial comfort needs of hopelessly ill multiple organ failure patients and their families. This multidisciplinary approach to the care of the hopelessly ill may have applications in other institutions facing the ethical, medical, and administrative challenges raised by these patients.

Distance Learning Can Be as Effective as Traditional Learning for Medical Students in the Initial Assessment of Trauma Patients.

PubMed

Farahmand, Shervin; Jalili, Ebrahim; Arbab, Mona; Sedaghat, Mojtaba; Shirazi, Mandana; Keshmiri, Fatemeh; Azizpour, Arsalan; Valadkhani, Somayeh; Bagheri-Hariri, Shahram

2016-09-01

Distance learning is expanding and replacing the traditional academic medical settings. Managing trauma patients seems to be a prerequisite skill for medical students. This study has been done to evaluate the efficiency of distance learning on performing the initial assessment and management in trauma patients, compared with the traditional learning among senior medical students. One hundred and twenty senior medical students enrolled in this single-blind quasi-experimental study and were equally divided into the experimental (distance learning) and control group (traditional learning). All participants did a written MCQ before the study. The control group attended a workshop with a 50-minute lecture on initial management of trauma patients and a case simulation scenario followed by a hands-on session. On the other hand, the experimental group was given a DVD with a similar 50-minute lecture and a case simulation scenario, and they also attended a hands-on session to practice the skills. Both groups were evaluated by a trauma station in an objective structured clinical examination (OSCE) after a month. The performance in the experimental group was statistically better (P=0.001) in OSCE. Distance learning seems to be an appropriate adjunct to traditional learning.

The incidence of fever in US Critical Care Air Transport Team combat trauma patients evacuated from the theater between March 2009 and March 2010.

PubMed

Minnick, Joanne M; Bebarta, Vikhyat S; Stanton, Marietta; Lairet, Julio R; King, James; Torres, Pedro; Aden, James; Ramirez, Rosemarie

2013-11-01

Most critically ill injured patients are transported out of the theater by Critical Care Air Transport Teams (CCATTs). Fever after trauma is correlated with surgical complications and infection. The purposes of this study are to identify the incidence of elevated temperature in patients managed in the CCATT environment and to describe the complications reported and the treatments used in these patients. We performed a retrospective review of available records of trauma patients from the combat theater between March 1, 2009, and March 31, 2010, who were transported by the US Air Force CCATT and had an incidence of hyperthermia. We then divided the cohort into 2 groups, patients transported with an elevation in temperature greater than 100.4°F and patients with no documented elevation in temperature. We used a standardized, secure electronic data collection form to abstract the outcomes. Descriptive data collected included injury type, temperature, use of a mechanical ventilator, cooling treatment modalities, antipyretics, intravenous fluid administration, and use of blood products. We also evaluated the incidence of complications during the transport in patients who had a recorded elevation in temperature greater than 100.4°F. A total of 248 trauma patients met the inclusion criteria, and 101 trauma patients (40%) had fever. The mean age was 28 years, and 98% of patients were men. The mechanism of injury was an explosion in 156 patients (63%), blunt injury in 11 (4%), and penetrating injury in 45 (18%), whereas other trauma-related injuries accounted for 36 patients (15%). Of the patients, 209 (84%) had battle-related injuries and 39 (16%) had non-battle-related injuries. Traumatic brain injury was found in 24 patients (24%) with an incidence of elevated temperature. The mean temperature was 101.6°F (range, 100.5°F-103.9°F). After evaluation of therapies and treatments, 80 trauma patients (51%) were intubated on a mechanical ventilator (P < .001). Of the trauma patients with documented fever, 22 (22%) received administration of blood products. Nineteen patients received antipyretics during their flight (19%), 9 received intravenous fluids (9%), and 2 received nonpharmacologic cooling interventions, such as cooling blankets or icepacks. We identified 1 trauma patient with neurologic changes (1%), 6 with hypotension (6%), 48 with tachycardia (48%), 33 with decreased urinary output (33%), and 1 with an episode of shivering or sweating (1%). We did not detect any transfusion reactions or deaths during flight. Fever occurred in 41% of critically ill combat-injured patients evacuated out of the combat theater in Iraq and Afghanistan. Fewer than 20% of patients with a documented elevated temperature received treatments to reduce the temperature. Intubation of patients with ventilators in use during the transport was the only factor significantly associated with fever. Serious complications were rare, and there were no deaths during these transports. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

Utility of the Trauma Symptom Inventory's Atypical Response Scale in Detecting Malingered Post-Traumatic Stress Disorder

ERIC Educational Resources Information Center

Elhai, Jon D.; Gray, Matthew J.; Naifeh, James A.; Butcher, Jimmie J.; Davis, Joanne L.; Falsetti, Sherry A.; Best, Connie L.

2005-01-01

The authors examined the Trauma Symptom Inventorys (TSI) ability to discriminate 88 student post-traumatic stress disorder (PTSD) simulators screened for genuine PTSD from 48 clinical PTSD-diagnosed outpatients. Results demonstrated between-group differences on several TSI clinical scales and the Atypical Response (ATR) validity scale.…

Models and Methods for Adaptive Management of Individual and Team-Based Training Using a Simulator

NASA Astrophysics Data System (ADS)

Lisitsyna, L. S.; Smetyuh, N. P.; Golikov, S. P.

2017-05-01

Research of adaptive individual and team-based training has been analyzed and helped find out that both in Russia and abroad, individual and team-based training and retraining of AASTM operators usually includes: production training, training of general computer and office equipment skills, simulator training including virtual simulators which use computers to simulate real-world manufacturing situation, and, as a rule, the evaluation of AASTM operators’ knowledge determined by completeness and adequacy of their actions under the simulated conditions. Such approach to training and re-training of AASTM operators stipulates only technical training of operators and testing their knowledge based on assessing their actions in a simulated environment.

Trauma and Hypothermia in Antarctica: An Emergency Medicine Marine Simulation Scenario

PubMed Central

Horwood, Chrystal; Skinner, Tate; Brown, Robert; Renouf, Tia; Dubrowski, Adam

2017-01-01

Simulation has been shown to improve both learner knowledge and patient outcomes. Many emergency medicine training programs incorporate simulation into their curricula to provide learners with experiences that are rare to encounter in practice, yet performance with a high degree of competence is critical. One rare encounter, which is depicted in the report, is the management of a trauma patient who was hypothermic after falling from an expedition vessel into the cold Southern Ocean. The unique scenario presented in this technical report incorporates CanMEDS learning objectives including the communicator, health advocate, and collaborator roles. Using medical simulation facilities, marine performance simulation facilities, and a video, this scenario provides teaching that is uncommon in traditional emergency medicine training. As such, it is valuable for trainees who intend to practice rural, remote, or expedition medicine, or provide coverage for ships and marine installations. PMID:28706765

A surgical simulation curriculum for senior medical students based on TeamSTEPPS.

PubMed

Meier, Andreas H; Boehler, Maggie L; McDowell, Chris M; Schwind, Cathy; Markwell, Steve; Roberts, Nicole K; Sanfey, Hilary

2012-08-01

To investigate whether the existing Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) curriculum can effectively teach senior medical students team skills. DESIGN Single-group preintervention and postintervention study. We integrated a TeamSTEPPS module into our existing resident readiness elective. The curriculum included interactive didactic sessions, discussion groups, role-plays, and videotaped immersive simulation scenarios. Improvement of self-assessment scores, multiple-choice examination scores, and performance ratings of videotaped simulation scenarios before and after intervention. The videos were rated by masked reviewers on the basis of a global rating instrument (TeamSTEPPS) and a more detailed nontechnical skills evaluation tool(NOTECHS). Seventeen students participated and completed the study. The self-evaluation scores improved from 12.76 to 16.06 (P < .001). The increase was significant for all of the TeamSTEPPS competencies and highest for leadership skills (from 2.2 to 3.2; P < .001). The multiple-choice score rose from 84.9% to 94.1% (P < .01). The postintervention video ratings were significantly higher for both instruments (TeamSTEPPS, from 2.99 to 3.56; P < .01; and NOTECHS, from 4.07 to 4.59; P < .001). The curriculum led to improved self-evaluation and multiple-choice scores as well as improved team skills during simulated immersive patient encounters. The TeamSTEPPS framework may be suitable for teaching medical students teamwork concepts and improving their competencies. Larger studies using this framework should be considered to further evaluate the generalizability of our results and the effectiveness of TeamSTEPPS for medical students.

[Operative treatment strategies for multiple trauma patients : early total care versus damage control].

PubMed

Klüter, T; Lippross, S; Oestern, S; Weuster, M; Seekamp, A

2013-09-01

The treatment of multiple trauma patients is a great challenge for an interdisciplinary team. After preclinical care and subsequent treatment in the emergency room the order of the interventions is prioritized depending of the individual risk stratification. For planning the surgery management it is essential to distinguish between absolutely essential operations to prevent life-threatening situations for the patient and interventions with shiftable indications, depending on the general condition of the patient. All interventions need to be done without causing significant secondary damage to prohibit hyperinflammation and systemic inflammatory response syndrome. The challenge consists in determination of the appropriate treatment at the right point in time. In general the early primary intervention, early total care, is differentiated from the damage control concept.

[Preclinical treatment of severe burn trauma due to an electric arc on an overhead railway cable].

PubMed

Spelten, O; Wetsch, W A; Hinkelbein, J

2013-09-01

Severe burns due to electrical accidents occur rarely in Germany but represent a challenge for emergency physicians and their team. Apart from extensive burns cardiac arrhythmia, neurological damage caused by electric current and osseous injury corresponding to the trauma mechanism are also common. It is important to perform a survey of the pattern of injuries and treat acute life-threatening conditions immediately in the field. Furthermore, specific conditions related to burns must be considered, e.g. fluid resuscitation, thermal management and analgesia. In addition, a correct strategy for further medical care in an appropriate hospital is essential. Exemplified by this case guidelines for the treatment of severe burns and typical pitfalls are presented.

High-fidelity hybrid simulation of allergic emergencies demonstrates improved preparedness for office emergencies in pediatric allergy clinics.

PubMed

Kennedy, Joshua L; Jones, Stacie M; Porter, Nicholas; White, Marjorie L; Gephardt, Grace; Hill, Travis; Cantrell, Mary; Nick, Todd G; Melguizo, Maria; Smith, Chris; Boateng, Beatrice A; Perry, Tamara T; Scurlock, Amy M; Thompson, Tonya M

2013-01-01

Simulation models that used high-fidelity mannequins have shown promise in medical education, particularly for cases in which the event is uncommon. Allergy physicians encounter emergencies in their offices, and these can be the source of much trepidation. To determine if case-based simulations with high-fidelity mannequins are effective in teaching and retention of emergency management team skills. Allergy clinics were invited to Arkansas Children's Hospital Pediatric Understanding and Learning through Simulation Education center for a 1-day workshop to evaluate skills concerning the management of allergic emergencies. A Clinical Emergency Preparedness Team Performance Evaluation was developed to evaluate the competence of teams in several areas: leadership and/or role clarity, closed-loop communication, team support, situational awareness, and scenario-specific skills. Four cases, which focus on common allergic emergencies, were simulated by using high-fidelity mannequins and standardized patients. Teams were evaluated by multiple reviewers by using video recording and standardized scoring. Ten to 12 months after initial training, an unannounced in situ case was performed to determine retention of the skills training. Clinics showed significant improvements for role clarity, teamwork, situational awareness, and scenario-specific skills during the 1-day workshop (all P < .003). Follow-up in situ scenarios 10-12 months later demonstrated retention of skills training at both clinics (all P ≤ .004). Clinical Emergency Preparedness Team Performance Evaluation scores demonstrated improved team management skills with simulation training in office emergencies. Significant recall of team emergency management skills was demonstrated months after the initial training. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Is non-operative management safe and effective for all splenic blunt trauma? A systematic review

PubMed Central

2013-01-01

Introduction The goal of non-operative management (NOM) for blunt splenic trauma (BST) is to preserve the spleen. The advantages of NOM for minor splenic trauma have been extensively reported, whereas its value for the more severe splenic injuries is still debated. The aim of this systematic review was to evaluate the available published evidence on NOM in patients with splenic trauma and to compare it with the operative management (OM) in terms of mortality, morbidity and duration of hospital stay. Methods For this systematic review we followed the "Preferred Reporting Items for Systematic Reviews and Meta-analyses" statement. A systematic search was performed on PubMed for studies published from January 2000 to December 2011, without language restrictions, which compared NOM vs. OM for splenic trauma injuries and which at least 10 patients with BST. Results We identified 21 non randomized studies: 1 Clinical Controlled Trial and 20 retrospective cohort studies analyzing a total of 16,940 patients with BST. NOM represents the gold standard treatment for minor splenic trauma and is associated with decreased mortality in severe splenic trauma (4.78% vs. 13.5% in NOM and OM, respectively), according to the literature. Of note, in BST treated operatively, concurrent injuries accounted for the higher mortality. In addition, it was not possible to determine post-treatment morbidity in major splenic trauma. The definition of hemodynamic stability varied greatly in the literature depending on the surgeon and the trauma team, representing a further bias. Moreover, data on the remaining analyzed outcomes (hospital stay, number of blood transfusions, abdominal abscesses, overwhelming post-splenectomy infection) were not reported in all included studies or were not comparable, precluding the possibility to perform a meaningful cumulative analysis and comparison. Conclusions NOM of BST, preserving the spleen, is the treatment of choice for the American Association for the Surgery of Trauma grades I and II. Conclusions are more difficult to outline for higher grades of splenic injury, because of the substantial heterogeneity of expertise among different hospitals, and potentially inappropriate comparison groups. PMID:24004931

Is non-operative management safe and effective for all splenic blunt trauma? A systematic review.

PubMed

Cirocchi, Roberto; Boselli, Carlo; Corsi, Alessia; Farinella, Eriberto; Listorti, Chiara; Trastulli, Stefano; Renzi, Claudio; Desiderio, Jacopo; Santoro, Alberto; Cagini, Lucio; Parisi, Amilcare; Redler, Adriano; Noya, Giuseppe; Fingerhut, Abe

2013-09-03

The goal of non-operative management (NOM) for blunt splenic trauma (BST) is to preserve the spleen. The advantages of NOM for minor splenic trauma have been extensively reported, whereas its value for the more severe splenic injuries is still debated. The aim of this systematic review was to evaluate the available published evidence on NOM in patients with splenic trauma and to compare it with the operative management (OM) in terms of mortality, morbidity and duration of hospital stay. For this systematic review we followed the "Preferred Reporting Items for Systematic Reviews and Meta-analyses" statement. A systematic search was performed on PubMed for studies published from January 2000 to December 2011, without language restrictions, which compared NOM vs. OM for splenic trauma injuries and which at least 10 patients with BST. We identified 21 non randomized studies: 1 Clinical Controlled Trial and 20 retrospective cohort studies analyzing a total of 16,940 patients with BST. NOM represents the gold standard treatment for minor splenic trauma and is associated with decreased mortality in severe splenic trauma (4.78% vs. 13.5% in NOM and OM, respectively), according to the literature. Of note, in BST treated operatively, concurrent injuries accounted for the higher mortality. In addition, it was not possible to determine post-treatment morbidity in major splenic trauma. The definition of hemodynamic stability varied greatly in the literature depending on the surgeon and the trauma team, representing a further bias. Moreover, data on the remaining analyzed outcomes (hospital stay, number of blood transfusions, abdominal abscesses, overwhelming post-splenectomy infection) were not reported in all included studies or were not comparable, precluding the possibility to perform a meaningful cumulative analysis and comparison. NOM of BST, preserving the spleen, is the treatment of choice for the American Association for the Surgery of Trauma grades I and II. Conclusions are more difficult to outline for higher grades of splenic injury, because of the substantial heterogeneity of expertise among different hospitals, and potentially inappropriate comparison groups.

High fidelity simulation based team training in urology: a preliminary interdisciplinary study of technical and nontechnical skills in laparoscopic complications management.

PubMed

Lee, Jason Y; Mucksavage, Phillip; Canales, Cecilia; McDougall, Elspeth M; Lin, Sharon

2012-04-01

Simulation based team training provides an opportunity to develop interdisciplinary communication skills and address potential medical errors in a high fidelity, low stakes environment. We evaluated the implementation of a novel simulation based team training scenario and assessed the technical and nontechnical performance of urology and anesthesiology residents. Urology residents were randomly paired with anesthesiology residents to participate in a simulation based team training scenario involving the management of 2 scripted critical events during laparoscopic radical nephrectomy, including the vasovagal response to pneumoperitoneum and renal vein injury during hilar dissection. A novel kidney surgical model and a high fidelity mannequin simulator were used for the simulation. A debriefing session followed each simulation based team training scenario. Assessments of technical and nontechnical performance were made using task specific checklists and global rating scales. A total of 16 residents participated, of whom 94% rated the simulation based team training scenario as useful for communication skill training. Also, 88% of urology residents believed that the kidney surgical model was useful for technical skill training. Urology resident training level correlated with technical performance (p=0.004) and blood loss during renal vein injury management (p=0.022) but not with nontechnical performance. Anesthesia resident training level correlated with nontechnical performance (p=0.036). Urology residents consistently rated themselves higher on nontechnical performance than did faculty (p=0.033). Anesthesia residents did not differ in the self-assessment of nontechnical performance compared to faculty assessments. Residents rated the simulation based team training scenario as useful for interdisciplinary communication skill training. Urology resident training level correlated with technical performance but not with nontechnical performance. Urology residents consistently overestimated their nontechnical performance. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

eFAST for Pneumothorax: Real-Life Application in an Urban Level 1 Center by Trauma Team Members.

PubMed

Maximus, Steven; Figueroa, Cesar; Whealon, Matthew; Pham, Jacqueline; Kuncir, Eric; Barrios, Cristobal

2018-02-01

The focused assessment with sonography for trauma (FAST) examination has become the standard of care for rapid evaluation of trauma patients. Extended FAST (eFAST) is the use of ultrasonography for the detection of pneumothorax (PTX). The exact sensitivity and specificity of eFAST detecting traumatic PTX during practical "real-life" application is yet to be investigated. This is a retrospective review of all trauma patients with a diagnosis of PTX, who were treated at a large level 1 urban trauma center from March 2013 through July 2014. Charts were reviewed for results of imaging, which included eFAST, chest X-ray, and CT scan. The requirement of tube thoracostomy and mechanism of injury were also analyzed. A total of 369 patients with a diagnosis of PTX were identified. A total of 69 patients were excluded, as eFAST was either not performed or not documented, leaving 300 patients identified with PTX. A total of 113 patients had clinically significant PTX (37.6%), requiring immediate tube thoracostomy placement. eFAST yielded a positive diagnosis of PTX in 19 patients (16.8%), and all were clinically significant, requiring tube thoracostomy. Chest X-ray detected clinically significant PTX in 105 patients (92.9%). The literature on the utility of eFAST for PTX in trauma is variable. Our data show that although specific for clinically significant traumatic PTX, it has poor sensitivity when performed by clinicians with variable levels of ultrasound training. We conclude that CT is still the gold standard in detecting PTX, and clinicians performing eFAST should have adequate training.

Barriers to implementing the World Health Organization's Trauma Care Checklist: A Canadian single-center experience.

PubMed

Nolan, Brodie; Zakirova, Rimma; Bridge, Jennifer; Nathens, Avery B

2014-11-01

Management of trauma patients is difficult because of their complexity and acuity. In an effort to improve patient care and reduce morbidity and mortality, the World Health Organization developed a trauma care checklist. Local stakeholder input led to a modified 16-item version that was subsequently piloted. Our study highlights the barriers and challenges associated with implementing this checklist at our hospital. The checklist was piloted over a 6-month period at St. Michael's Hospital, a Level 1 trauma center in Toronto, Canada. At the end of the pilot phase, individual, semistructured interviews were held with trauma team leaders and nursing staff regarding their experiences with the checklist. Axial coding was used to create a typology of attitudes and barriers toward the checklist, and then, vertical coding was used to further explore each identified barrier. Checklist compliance was assessed for the first 7 months. Checklist compliance throughout the pilot phase was 78%. Eight key barriers to implementing the checklist were identified as follows: perceived lack of time for the use of the checklist in critically ill patients, unclear roles, no memory trigger, no one to enforce completion, not understanding its importance or purpose, difficulty finding physicians at the end of resuscitation, staff/trainee changes, and professional hierarchy. The World Health Organization Trauma Care Checklist was a well-received tool; however, consideration of barriers to the implementation and staff adoption must be done for successful integration, with special attention to its use in critically ill patients. Therapeutic/care management, level V.

Lack of evidence to support routine digital rectal examination in pediatric trauma patients.

PubMed

Shlamovitz, Gil Z; Mower, William R; Bergman, Jonathan; Crisp, Jonathan; DeVore, Heather K; Hardy, David; Sargent, Martine; Shroff, Sunil D; Snyder, Eric; Morgan, Marshall T

2007-08-01

Current advanced trauma life support guidelines recommend that a digital rectal examination (DRE) should be performed as part of the initial evaluation of all trauma patients. Our primary goal was to estimate the test characteristics of the DRE in pediatric patients for the following injuries: (1) spinal cord injuries, (2) bowel injuries, (3) rectal injuries, (4) pelvic fractures, and (5) urethral disruptions. We conducted a nonconcurrent, observational, chart review study of a consecutive series of pediatric trauma patients. We enrolled all patients younger than 18 years seen in our ED from January 2003 to February 2005, for whom the trauma team was activated and who had a documented DRE. For each patient, we reviewed all available clinical documents in a computerized medical record system to identify the DRE findings followed by review of radiological reports, operative reports, and discharge summaries to identify specific injuries. Two hundred thirteen patients met our selection criteria and were included in the analysis. We identified 3 patients with spinal cord injury (1% prevalence), 13 patients with bowel injury (6%), 5 patients with rectal injury (2%), 12 patients with a pelvic fracture (6%), and 1 patient with urethral disruption (0.5%). The DRE failed to diagnose (false-negative rate) 66% of spinal cord injuries, 100% of bowel injuries, 100% of rectal wall injuries, 100% of pelvic fractures, and 100% of urethral disruption injuries. The DRE has poor sensitivity for the diagnosis of spinal cord, bowel, rectal, bony pelvis, and urethral injuries. Our findings suggest that the DRE should not be routinely used in pediatric trauma patients.

Educational program in crisis management for cardiac surgery teams including high realism simulation.

PubMed

Stevens, Louis-Mathieu; Cooper, Jeffrey B; Raemer, Daniel B; Schneider, Robert C; Frankel, Allan S; Berry, William R; Agnihotri, Arvind K

2012-07-01

Cardiac surgery demands effective teamwork for safe, high-quality care. The objective of this pilot study was to develop a comprehensive program to sharpen performance of experienced cardiac surgical teams in acute crisis management. We developed and implemented an educational program for cardiac surgery based on high realism acute crisis simulation scenarios and interactive whole-unit workshop. The impact of these interventions was assessed with postintervention questionnaires, preintervention and 6-month postintervention surveys, and structured interviews. The realism of the acute crisis simulation scenarios gradually improved; most participants rated both the simulation and whole-unit workshop as very good or excellent. Repeat simulation training was recommended every 6 to 12 months by 82% of the participants. Participants of the interactive workshop identified 2 areas of highest priority: encouraging speaking up about critical information and interprofessional information sharing. They also stressed the importance of briefings, early communication of surgical plan, knowing members of the team, and continued simulation for practice. The pre/post survey response rates were 70% (55/79) and 66% (52/79), respectively. The concept of working as a team improved between surveys (P = .028), with a trend for improvement in gaining common understanding of the plan before a procedure (P = .075) and appropriate resolution of disagreements (P = .092). Interviewees reported that the training had a positive effect on their personal behaviors and patient care, including speaking up more readily and communicating more clearly. Comprehensive team training using simulation and a whole-unit interactive workshop can be successfully deployed for experienced cardiac surgery teams with demonstrable benefits in participant's perception of team performance. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Effect of obstetric team training on team performance and medical technical skills: a randomised controlled trial.

PubMed

Fransen, A F; van de Ven, J; Merién, A E R; de Wit-Zuurendonk, L D; Houterman, S; Mol, B W; Oei, S G

2012-10-01

To determine whether obstetric team training in a medical simulation centre improves the team performance and utilisation of appropriate medical technical skills of healthcare professionals. Cluster randomised controlled trial. The Netherlands. The obstetric departments of 24 Dutch hospitals. The obstetric departments were randomly assigned to a 1-day session of multiprofessional team training in a medical simulation centre or to no such training. Team training was given with high-fidelity mannequins by an obstetrician and a communication expert. More than 6 months following training, two unannounced simulated scenarios were carried out in the delivery rooms of all 24 obstetric departments. The scenarios, comprising a case of shoulder dystocia and a case of amniotic fluid embolism, were videotaped. The team performance and utilisation of appropriate medical skills were evaluated by two independent experts. Team performance evaluated with the validated Clinical Teamwork Scale (CTS) and the employment of two specific obstetric procedures for the two clinical scenarios in the simulation (delivery of the baby with shoulder dystocia in the maternal all-fours position and conducting a perimortem caesarean section within 5 minutes for the scenario of amniotic fluid embolism). Seventy-four obstetric teams from 12 hospitals in the intervention group underwent teamwork training between November 2009 and July 2010. The teamwork performance in the training group was significantly better in comparison to the nontraining group (median CTS score: 7.5 versus 6.0, respectively; P = 0.014). The use of the predefined obstetric procedures for the two clinical scenarios was also significantly more frequent in the training group compared with the nontraining group (83 versus 46%, respectively; P = 0.009). Team performance and medical technical skills may be significantly improved after multiprofessional obstetric team training in a medical simulation centre. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

The Use of Constructive Modeling and Virtual Simulation in Large-Scale Team Training: A Military Case Study.

ERIC Educational Resources Information Center

Andrews, Dee H.; Dineen, Toni; Bell, Herbert H.

1999-01-01

Discusses the use of constructive modeling and virtual simulation in team training; describes a military application of constructive modeling, including technology issues and communication protocols; considers possible improvements; and discusses applications in team-learning environments other than military, including industry and education. (LRW)

Performance of student software development teams: the influence of personality and identifying as team members

NASA Astrophysics Data System (ADS)

Monaghan, Conal; Bizumic, Boris; Reynolds, Katherine; Smithson, Michael; Johns-Boast, Lynette; van Rooy, Dirk

2015-01-01

One prominent approach in the exploration of the variations in project team performance has been to study two components of the aggregate personalities of the team members: conscientiousness and agreeableness. A second line of research, known as self-categorisation theory, argues that identifying as team members and the team's performance norms should substantially influence the team's performance. This paper explores the influence of both these perspectives in university software engineering project teams. Eighty students worked to complete a piece of software in small project teams during 2007 or 2008. To reduce limitations in statistical analysis, Monte Carlo simulation techniques were employed to extrapolate from the results of the original sample to a larger simulated sample (2043 cases, within 319 teams). The results emphasise the importance of taking into account personality (particularly conscientiousness), and both team identification and the team's norm of performance, in order to cultivate higher levels of performance in student software engineering project teams.

Comparative Effectiveness of Hands-on Versus Computer Simulation-Based Training for Contrast Media Reactions and Teamwork Skills.

PubMed

Wang, Carolyn L; Chinnugounder, Sankar; Hippe, Daniel S; Zaidi, Sadaf; O'Malley, Ryan B; Bhargava, Puneet; Bush, William H

2017-01-01

To assess the performance of interprofessional teams of radiologists, technologists, and nurses trained with high-fidelity hands-on (HO) simulation and computer-based (CB) simulation training for contrast reaction management (CR) and teamwork skills (TS). Nurses, technologists, and radiology residents were randomized into 11 teams of three (one of each). Six teams underwent HO training and five underwent CB training for CR and TS. Participants took written tests before and after training and were further tested using a high-fidelity simulation scenario. HO and CB groups scored similarly on all written tests and each showed improvement after training (P = .002 and P = .018, respectively). During the final scenario test, HO teams tended to receive higher grades than CB teams on CR (95% versus 81%, P = .17) and made fewer errors in epinephrine administration (0/6 versus 2/5, P = .18). HO and CB teams scored similarly on TS (51% versus 52%, P = .66), but overall scores were lower for TS than for CR skills in both the HO (P = .03) and CB teams (P = .06). HO training was more highly rated than CB as an effective educational tool (P = .01) and for effectiveness at teaching CR and team communication skills (P = .02). High-fidelity simulation can be used to both train and test interprofessional teams of radiologists, technologists, and nurses for both CR and TS and is more highly rated as an effective educational tool by participants than similar CB training. However, a single session of either type of training may be inadequate for mastering TS. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Quality of life following trauma before and after implementation of a physician-staffed helicopter.

PubMed

Funder, K S; Rasmussen, L S; Hesselfeldt, R; Siersma, V; Lohse, N; Sonne, A; Wulffeld, S; Steinmetz, J

2017-01-01

Implementation of a physician-staffed helicopter emergency medical service (PS-HEMS) in Denmark was associated with lower 30-day mortality in severely injured trauma patients and less time on social subsidy. However, the reduced 30-day mortality in severely injured patients might be at the expense of a worse functional outcome and quality of life (QoL) in those who survive. The aim of this study was to investigate the effect of a physician-staffed helicopter on long-term QoL in trauma patients. Prospective, observational study including trauma patients who survived at least 3 years after injury. A 5-month period prior to PS-HEMS implementation was compared with the first 12 months after PS-HEMS implementation. QoL was assessed 4.5 years after trauma by the SF-36 questionnaire. Primary endpoint was the Physical Component Summary score. Of the 1994 patients assessed by a trauma team, 1521 were eligible for inclusion in the study. Of these, 566 (37%) gave consent to participate and received a questionnaire by mail, and 402 (71%) of them returned the questionnaire (n = 114 before PS-HEMS; n = 288 after PS-HEMS implementation). Older patients, women and patients with trauma in the after PS-HEMS period were more likely to return the questionnaire. No significant association between QoL and period (before vs. after PS-HEMS) was found; the Physical Component Summary scores were 50.0 and 50.9 in the before and after PS-HEMS periods, respectively (P = 0.47). We also found no difference on multivariable analysis with adjustment for sex, age and injury severity score. No significant difference in QoL among trauma patients was found after implementation of a PS-HEMS. © 2016 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

Clot formation is associated with fibrinogen and platelet forces in a cohort of severely-injured Emergency Department trauma patients

PubMed Central

White, Nathan J.; Newton, Jason C.; Martin, Erika J.; Mohammed, Bassem M.; Contaifer, Daniel; Bostic, Jessica L.; Brophy, Gretchen M.; Spiess, Bruce D.; Pusateri, Anthony E.; Ward, Kevin R.; Brophy, Donald F.

2015-01-01

Introduction Anticoagulation, fibrinogen consumption, fibrinolytic activation, and platelet dysfunction all interact to produce different clot formation responses after trauma. However, the relative contributions of these coagulation components to overall clot formation remains poorly defined. We examined for sources of heterogeneity in clot formation responses after trauma. Methods Blood was sampled in the Emergency Department from patients meeting trauma team activation criteria at an urban trauma center. Plasma prothrombin time (PT) ≥ 18 sec was used to define traumatic coagulopathy. Mean kaolin-activated thrombelastography (TEG) parameters were calculated and tested for heterogeneity using Analysis of Means (ANOM). Discriminant analysis and forward stepwise variable selection with linear regression were used to determine if PT, fibrinogen, platelet contractile force (PCF), and D-Dimer concentration, representing key mechanistic components of coagulopathy, each contribute to heterogeneous TEG responses after trauma. Results Of 95 subjects, 16% met criteria for coagulopathy. Coagulopathic subjects were more severely injured with greater shock, and received more blood products in the first 8 hours compared to non-coagulopathic subjects. Mean (SD) TEG maximal amplitude (MA) was significantly decreased in the coagulopathic group=57.5 (4.7) mm, vs. 62.7 (4.7), T test p<0.001. The MA also exceeded the ANOM predicted upper decision limit for the non-coagulopathic group and the lower decision limit for the coagulopathic group at alpha=0.05, suggesting significant heterogeneity from the overall cohort mean. Fibrinogen and PCF best discriminated TEG MA using discriminant analysis. Fibrinogen, PCF, and D-Dimer were primary covariates for TEG MA using regression analysis. Conclusion Heterogeneity in TEG-based clot formation in Emergency Department trauma patients was linked to changes in MA. Individual parameters representing fibrin polymerization, platelet contractile forces, and fibrinolysis were primarily associated with TEG MA after trauma and should be the focus of early hemostatic therapies. PMID:25643013

Neuro-, Trauma -, or Med/Surg-ICU: Does it matter where polytrauma patients with TBI are admitted? Secondary analysis of AAST-MITC decompressive craniectomy study

PubMed Central

Scalea, Tom; Sperry, Jason; Coimbra, Raul; Vercruysse, Gary; Jurkovich, Gregory J; Nirula, Ram

2016-01-01

Introduction Patients with non-traumatic acute intracranial pathology benefit from neurointensivist care. Similarly, trauma patients with and without TBI fare better when treated by a dedicated trauma team. No study has yet evaluated the role of specialized neurocritical (NICU) and trauma intensive care units (TICU) in the management of TBI patients, and it remains unclear which TBI patients are best served in NICU, TICU, or general (Med/Surg) ICU. Methods This study is a secondary analysis of The American Association for the Surgery of Trauma Multi-Institutional Trials Committee (AAST-MITC) decompressive craniectomy study. Twelve Level 1 trauma centers provided clinical data and head CT scans of patients with Glasgow Coma Scale (GCS) ≤13 and CT evidence of TBI. Non-ICU admissions were excluded. Multivariate logistic regression was performed to measure the association between ICU-type and survival and calculate the probability of death for increasing ISS. Polytrauma patients (ISS > 15) with TBI and isolated TBI patients (other AIS < 3) were analyzed separately. Results There were 3641 patients with CT evidence of TBI with 2951 admitted to an ICU. Prior to adjustment, patient demographics, injury severity, and survival differed significantly by unit type. After adjustment, unit-type, age and ISS remained independent predictors of death. Unit-type modified the effect of ISS on mortality. TBI-polytrauma patients admitted to a TICU had improved survival across increasing ISS (Fig1). Survival for isolated TBI patients was similar between TICU and NICU. Med/Surg ICU carried the greatest probability of death. Conclusion Polytrauma patients with TBI have lower mortality risk when admitted to a Trauma ICU. This survival benefit increases with increasing injury severity. Isolated TBI patients have similar mortality risk when admitted to a Neuro ICU compared to a Trauma ICU. Med/Surg ICU admission carries the highest mortality risk. PMID:28225527

Correlation of Level of Trauma Activation With Emergency Department Intervention.

PubMed

Cooper, Michael C; Srivastava, Geetanjali

2018-06-01

In-hospital trauma team activation criteria are formulated to identify severely injured patients requiring specialized multidisciplinary care. Efficacy of trauma activation (TA) criteria is commonly measured by emergency department (ED) disposition, injury severity score, and mortality. Necessity of critical ED interventions is another measure that has been proposed to evaluate the appropriateness of TA criteria. Two-year retrospective cohort study of 1715 patients from our trauma registry at a Level 1 pediatric trauma center. We abstracted data on acute interventions, level and criterion of TA, ED disposition, and mortality. We report odds ratio (OR) with 95% confidence intervals (CIs), positive predictive value, and frequency of acute interventions. Trauma activation was initiated for 947 (55%) of the 1715 patients. There were 426 ED interventions performed on 235 patients (14%); 67.8% were in level 1 activations; 17.6% in level 2, and 14.6% in level 3. Highest-level activations were highly associated with need for ED interventions (OR, 16.1; 95% CI, 11.5-22.4). The ORs for requiring an ED intervention were low for lower level activations (OR, 0.4; 95% CI, 0.3-0.5), trauma service consults (OR, 0.3; 95% CI, 0.2-0.4), and certain mechanism-based criteria. The ORs for ED intervention for isolated motor vehicle collision (0.2; 95% CI, 0.1-0.7), isolated all-terrain vehicle rollover (0.4; 95% CI, 0.1-1.7), and suspected spinal cord injury (0.5; 95% CI, 0.1-3.7) were significantly lower than 1. Highest-level activation criteria correlate with high utilization of ED resources and interventions. Lower level activation criteria and trauma service consult criteria are not highly correlated with need for ED interventions. Downgrading isolated motor vehicle collision and all-terrain vehicle rollovers and suspected spinal cord injury to lower level activations could decrease the overtriage rate, and adding age-specific bradycardia as a physiologic criterion could improve our undertriage rate.

KSC-04PD-2451

NASA Technical Reports Server (NTRS)

2004-01-01

KENNEDY SPACE CENTER, FLA. During a simulated launch countdown/emergency simulation on Launch Pad 39A, the rescue team moves injured astronaut-suited workers out of the M-113 armored personnel carriers that transported them away from the pad (seen in the distance). Pad team members participated in the four-hour exercise simulating normal launch countdown operations, with the added challenge of a fictitious event causing an evacuation of the vehicle and launch pad. The simulation tested the teams rescue approaches on the Fixed Service Structure, slidewire basket evacuation, triage care and transportation of injured personnel to hospitals, as well as communications and coordination.

KSC-04PD-2450

NASA Technical Reports Server (NTRS)

2004-01-01

KENNEDY SPACE CENTER, FLA. During a simulated launch countdown/emergency simulation on Launch Pad 39A, the rescue team moves injured astronaut-suited workers out of the M-113 armored personnel carriers that transported them away from the pad (seen in the distance). Pad team members participated in the four-hour exercise simulating normal launch countdown operations, with the added challenge of a fictitious event causing an evacuation of the vehicle and launch pad. The simulation tested the teams rescue approaches on the Fixed Service Structure, slidewire basket evacuation, triage care and transportation of injured personnel to hospitals, as well as communications and coordination.

Combat Casualties in Afghanistan Cared for by a Single Forward Surgical Team during the Initial Phases of Operation Enduring Freedom

DTIC Science & Technology

2005-06-01

SW, stab wound. TABLE III ALL SURGICAL PROCEDURES PERFORMED BY THE 274TH FST DURING OEF Category Procedure No. Trauma Nontrauma Total Head Craniotomy ...Sheeting 2 0 2 Soft tissue Total 94 12 106 I&D, wound exploration 73 FB removal 11 Complex laceration closure 9 Abscess drainage 12 STSG 1 Orthopedic Total

Eye TVR: Eye Trauma and Visual Restoration Team

DTIC Science & Technology

2012-03-01

overall goal of this project is to develop a technology for non-invasive neuromodulation of retinal activity. Our approach is to measure the neuronal...technologies, including the millimeter wave source and the flexible multielectrode array, have been developed for non-invasive neuromodulation of retinal...activity. Further work is required to validate the feasibility of the proposed neuromodulation approach. (3) The strategy of joining a multisite

Effectiveness of Telerehabilitation for OIF/OEF Returnees with Combat Related Trauma

DTIC Science & Technology

2015-02-01

Our telerehabilitation care coordination team is organized under Steve Scott, MD, Chief Physical Medicine and Rehabilitation Services VA at the...for communication between care coordinators and study enrollees. Separate “ virtual rooms” have been setup on the 5 VA server to facilitate care...characterize rehabilitation trajectories over time in the areas of function, cognition, psychosocial adjustment, integration into society and mental health

Source Selection Simulation: Intact Team Training on Picking a Provider

DTIC Science & Technology

2015-06-01

seat of a new $100 million stealth fighter before giving her flight simulation time. The ar- gument for source-selection simulation ( SSS ) training is...dynamic is the creation of the SSS Tool. Drawing on his success in using a similar tool in contingency contracting, Long decided we should use a Web...of SSS intact team training. On Sept. 30–Oct. 3, 2014, Professors Long and Elsesser de- livered DAU’s first-ever Intact Team SSS Training to Eglin’s

Do Pediatric Teams Affect Outcomes of Injured Children Requiring Inter-hospital Transport?

PubMed

Calhoun, Amanda; Keller, Martin; Shi, Junxin; Brancato, Celeste; Donovan, Kathy; Kraus, Diana; Leonard, Julie C

2017-01-01

Studies show that pediatric trauma centers produce better outcomes and reduced mortality for injured children. Yet, most children do not have timely access to a pediatric trauma center and require stabilization locally with subsequent transfer. Investigators have demonstrated that pediatric transport teams (PTT) improve outcomes for critically ill children; however, these studies did not differentiate outcomes for injured children. It may be that moderate to severely injured children actually fare worse with PTT due to slower transport times inherent to their remote locations and thus delays in important interventions. The purpose of this study was to determine if outcomes for injured children are affected by use of PTT for inter-hospital transfer. We conducted a retrospective chart review of 1,177 children transferred to a pediatric trauma center for injury care between March 1st, 2012 and December 31st, 2013. We compared children who were transported by PTT (ground/air) to those transported by ground advanced life support (ALS) and air critical care (ACC). We described patient characteristics and transport times. For PTT vs. ALS and ACC, we compared hospital length of stay (LOS), transport interventions and adverse events. 1,177 injured children were transferred by the following modes: 68% ALS, 13% ACC, 11% Ground PTT, and 9% Air PTT. Children transported by PTT were younger and had higher ISS and lower GCS scores. PTT had a longer total transport time, departure preparation time, and patient bedside time. After controlling for age, ISS, GCS, transport mode, distance, and time, we found no significant difference in LOS between PTT vs. ALS and ACC. A subgroup analysis of children with higher ISS scores demonstrated a 65% longer LOS for children transported by ACC vs. PTT. There were no differences between transport teams with regard to acidosis, hypocarbia or hypercarbia, or maintenance of tubes and lines. Children transported by PTT were younger and sicker (vs. ACC and ALS). Despite longer transport times, children transported by PTT did not have a longer hospital LOS or adverse events during transport. However, for those children with higher ISS, transport by ACC resulted in longer hospital LOS vs. PTT.

Multidisciplinary crisis simulations: the way forward for training surgical teams.

PubMed

Undre, Shabnam; Koutantji, Maria; Sevdalis, Nick; Gautama, Sanjay; Selvapatt, Nowlan; Williams, Samantha; Sains, Parvinderpal; McCulloch, Peter; Darzi, Ara; Vincent, Charles

2007-09-01

High-reliability organizations have stressed the importance of non-technical skills for safety and of regularly providing such training to their teams. Recently safety skills training has been applied in the practice of medicine. In this study, we developed and piloted a module using multidisciplinary crisis scenarios in a simulated operating theatre to train entire surgical teams. Twenty teams participated (n = 80); each consisted of a trainee surgeon, anesthetist, operating department practitioner (ODP), and scrub nurse. Crisis scenarios such as difficult intubation, hemorrhage, or cardiac arrest were simulated. Technical and non-technical skills (leadership, communication, team skills, decision making, and vigilance), were assessed by clinical experts and by two psychologists using relevant technical and human factors rating scales. Participants received technical and non-technical feedback, and the whole team received feedback on teamwork. Trainees assessed the training favorably. For technical skills there were no differences between surgical trainees' assessment scores and the assessment scores of the trainers. However, nurses overrated their technical skill. Regarding non-technical skills, leadership and decision making were scored lower than the other three non-technical skills (communication, team skills, and vigilance). Surgeons scored lower than nurses on communication and teamwork skills. Surgeons and anesthetists scored lower than nurses on leadership. Multidisciplinary simulation-based team training is feasible and well received by surgical teams. Non-technical skills can be assessed alongside technical skills, and differences in performance indicate where there is a need for further training. Future work should focus on developing team performance measures for training and on the development and evaluation of systematic training for technical and non-technical skills to enhance team performance and safety in surgery.

Virtual operating room for team training in surgery.

PubMed

Abelson, Jonathan S; Silverman, Elliott; Banfelder, Jason; Naides, Alexandra; Costa, Ricardo; Dakin, Gregory

2015-09-01

We proposed to develop a novel virtual reality (VR) team training system. The objective of this study was to determine the feasibility of creating a VR operating room to simulate a surgical crisis scenario and evaluate the simulator for construct and face validity. We modified ICE STORM (Integrated Clinical Environment; Systems, Training, Operations, Research, Methods), a VR-based system capable of modeling a variety of health care personnel and environments. ICE STORM was used to simulate a standardized surgical crisis scenario, whereby participants needed to correct 4 elements responsible for loss of laparoscopic visualization. The construct and face validity of the environment were measured. Thirty-three participants completed the VR simulation. Attendings completed the simulation in less time than trainees (271 vs 201 seconds, P = .032). Participants felt the training environment was realistic and had a favorable impression of the simulation. All participants felt the workload of the simulation was low. Creation of a VR-based operating room for team training in surgery is feasible and can afford a realistic team training environment. Copyright © 2015 Elsevier Inc. All rights reserved.

Team Culture and Business Strategy Simulation Performance

ERIC Educational Resources Information Center

Ritchie, William J.; Fornaciari, Charles J.; Drew, Stephen A. W.; Marlin, Dan

2013-01-01

Many capstone strategic management courses use computer-based simulations as core pedagogical tools. Simulations are touted as assisting students in developing much-valued skills in strategy formation, implementation, and team management in the pursuit of superior strategic performance. However, despite their rich nature, little is known regarding…

[Estimation of surgical treatment capacity for managing mass casualty incidents based on time needed for life-saving emergency operations].

PubMed

Kanz, K-G; Huber-Wagner, S; Lefering, R; Kay, M; Qvick, M; Biberthaler, P; Mutschler, W

2006-04-01

The surgical treatment capacity of a hospital constitutes a significant restriction in the capability to deal with critically injured patients from multiple or mass casualty incidents (MCI). With regard to the time needed for life-saving operative interventions there are no basic reference values available in the literature, which can aid in detailed planning for management of mass casualty incidents. The data of 20,815 trauma patients, recorded in the trauma registry hosted by the German Association for Trauma Surgery DGU, were analyzed to extract the median duration of life-saving surgical interventions carried out in an operating theatre. Inclusion criteria were an ISS > or = 16 and the performance of relevant ICPM coded procedures within 6 h after trauma room admission. Orthopedic procedures as well as the placement of ICP catheters and chest tubes or performance of laparoscopies were not included. Complete data sets with the required variables were available from 9,988 trauma patients with an ISS > or = 16, and included 7,907 interventions that took place within 6 h after hospital admission. From among 1,228 patients 1,793 operations could be identified as relevant life-saving emergency operations. Acute injury to the abdomen was the major cause accounting for 54.1% of all emergency surgical procedures with a median intervention duration of 137 min followed by head injuries accounting for 26.3% with a median duration of 110 min. Interventions in the pelvis amounted to 11.5% taking an average of 136 min, 5.0% were in the thorax requiring 91 min and 3.1% major amputations with 142 min. The average cut to suture time for all emergency surgical interventions was 130 min. A prerequisite for estimating the surgical operation capacity for critically injured patients of an MCI is the number of OR teams available during and outside of the normal working hours of the hospital. The average operation time of 130 min calculated from investigation of 1,793 emergency life-saving surgical procedures provides a realistic guideline. Used in combination with the number of available OR teams the prospective treatment capacity can be estimated and projected into an actual incident admission capacity. The identification and numerical value of such significant variables are the basis for operations research and realistic planning in emergency and disaster medicine.

Cancellations of (helicopter-transported) mobile medical team dispatches in the Netherlands.

PubMed

Giannakopoulos, Georgios F; Lubbers, Wouter D; Christiaans, Herman M T; van Exter, Pieternel; Bet, Piet; Hugen, Paul J C; Innemee, Gerard; Schubert, Edo; de Lange-Klerk, Elly S M; Goslings, J Carel; Jukema, Gerrolt N

2010-08-01

The trauma centre of the Trauma Center Region North-West Netherlands (TRNWN) has consensus criteria for Mobile Medical Team (MMT) scene dispatch. The MMT can be dispatched by the EMS-dispatch centre or by the on-scene ambulance crew and is transported by helicopter or ground transport. Although much attention has been paid to improve the dispatch criteria, the MMT is often cancelled after being dispatched. The aim of this study was to assess the cancellation rate and the noncompliant dispatches of our MMT and to identify factors associated with this form of primary overtriage. By retrospective analysis of all MMT dispatches in the period from 1 July 2006 till 31 December 2006 using chart review, we conducted a consecutive case review of 605 dispatches. Four hundred and sixty seven of these were included for our study, collecting data related to prehospital triage, patient's condition on-scene and hospital course. Average age was 35.9 years; the majority of the patients were male (65.3%). Four hundred and thirty patients were victims of trauma, sustaining injuries in most cases from blunt trauma (89.3%). After being dispatched, the MMT was cancelled 203 times (43.5%). Statistically significant differences between assists and cancellations were found for overall mortality, mean RTS, GCS and ISS, mean hospitalization, length and amount of ICU admissions (p < 0.001). All dispatches were evaluated by using the MMT-dispatch criteria and mission appropriateness criteria. Almost 26% of all dispatches were neither appropriate, nor met the dispatch criteria. Fourteen missions were appropriate, but did not meet the dispatch criteria. The remaining 318 dispatches had met the dispatch criteria, of which 135 (30.3%) were also appropriate. The calculated additional costs of the cancelled dispatches summed up to a total of 34,448 euro, amounting to 2.2% of the total MMT costs during the study period. In our trauma system, the MMT dispatches are involved with high rates of overtriage. After being dispatched, the MMT is cancelled in almost 50% of all cases. We found an undertriage rate of 4%, which we think is acceptable. All cancellations were justified. The additional costs of the cancelled missions were within an acceptable range. According to this study, it seems to be possible to reduce the overtriage rate of the MMT dispatches, without increasing the undertriage rate to non-acceptable levels.

Building an efficient surgical team using a bench model simulation: construct validity of the Legacy Inanimate System for Endoscopic Team Training (LISETT).

PubMed

Zheng, B; Denk, P M; Martinec, D V; Gatta, P; Whiteford, M H; Swanström, L L

2008-04-01

Complex laparoscopic tasks require collaboration of surgeons as a surgical team. Conventionally, surgical teams are formed shortly before the start of the surgery, and team skills are built during the surgery. There is a need to establish a training simulation to improve surgical team skills without jeopardizing the safety of surgery. The Legacy Inanimate System for Laparoscopic Team Training (LISETT) is a bench simulation designed to enhance surgical team skills. The reported project tested the construct validity of LISETT. The research question was whether the LISETT scores show progressive improvement correlating with the level of surgical training and laparoscopic team experience or not. With LISETT, two surgeons are required to work closely to perform two laparoscopic tasks: peg transportation and suturing. A total of 44 surgical dyad teams were recruited, composed of medical students, residents, laparoscopic fellows, and experienced surgeons. The LISETT scores were calculated according to the speed and accuracy of the movements. The LISETT scores were positively correlated with surgical experience, and the results can be generalized confidently to surgical teams (Pearson's coefficient, 0.73; p = 0.001). To analyze the influences of individual skill and team dynamics on LISETT performance, team quality was rated by team members using communication and cooperation characters after each practice. The LISETT scores are positively correlated with self-rated team quality scores (Pearson's coefficient, 0.39; p = 0.008). The findings proved LISETT to be a valid system for assessing cooperative skills of a surgical team. By increasing practice time, LISETT provides an opportunity to build surgical team skills, which include effective communication and cooperation.

Initial evaluation of the "Trauma surgery course"

PubMed Central

Tugnoli, Gregorio; Ribaldi, Sergio; Casali, Marco; Calderale, Stefano M; Coletti, Massimo; Alifano, Marco; Parri, Sergio N Forti; Villani, Silvia; Biscardi, Andrea; Giordano, M Chiara; Baldoni, Franco

2006-01-01

Background The consequence of the low rate of penetrating injuries in Europe and the increase in non-operative management of blunt trauma is a decrease in surgeons' confidence in managing traumatic injuries has led to the need for new didactic tools. The aim of this retrospective study was to present the Corso di Chirurgia del Politrauma (Trauma Surgery Course), developed as a model for teaching operative trauma techniques, and assess its efficacy. Method the two-day course consisted of theoretical lectures and practical experience on large-sized swine. Data of the first 126 participants were collected and analyzed. Results All of the 126 general surgeons who had participated in the course judged it to be an efficient model to improve knowledge about the surgical treatment of trauma. Conclusion A two-day course, focusing on trauma surgery, with lectures and life-like operation situations, represents a model for simulated training and can be useful to improve surgeons' confidence in managing trauma patients. Cooperation between organizers of similar initiatives would be beneficial and could lead to standardizing and improving such courses. PMID:16759403

Standardised simulation-based emergency and intensive care nursing curriculum to improve nursing students' performance during simulated resuscitation: A quasi-experimental study.

PubMed

Chen, Jie; Yang, Jian; Hu, Fen; Yu, Si-Hong; Yang, Bing-Xiang; Liu, Qian; Zhu, Xiao-Ping

2018-06-01

Simulation-based curriculum has been demonstrated as crucial to nursing education in the development of students' critical thinking and complex clinical skills during a resuscitation simulation. Few studies have comprehensively examined the effectiveness of a standardised simulation-based emergency and intensive care nursing curriculum on the performance of students in a resuscitation simulation. To evaluate the impact of a standardised simulation-based emergency and intensive care nursing curriculum on nursing students' response time in a resuscitation simulation. Two-group, non-randomised quasi-experimental design. A simulation centre in a Chinese University School of Nursing. Third-year nursing students (N = 39) in the Emergency and Intensive Care course were divided into a control group (CG, n = 20) and an experimental group (EG, n = 19). The experimental group participated in a standardised high-technology, simulation-based emergency and intensive care nursing curriculum. The standardised simulation-based curriculum for third-year nursing students consists of three modules: disaster response, emergency care, and intensive care, which include clinical priorities (e.g. triage), basic resuscitation skills, airway/breathing management, circulation management and team work with eighteen lecture hours, six skill-practice hours and twelve simulation hours. The control group took part in the traditional curriculum. This course included the same three modules with thirty-four lecture hours and two skill-practice hours (trauma). Perceived benefits included decreased median (interquartile ranges, IQR) seconds to start compressions [CG 32 (25-75) vs. EG 20 (18-38); p < 0.001] and defibrillation [CG 204 (174-240) vs. EG 167 (162-174); p < 0.001] at the end of the course, compared with compressions [CG 41 (32-49) vs. EG 42 (33-46); p > 0.05] and defibrillation [CG 222 (194-254) vs. EG 221 (214-248); p > 0.05] at the beginning of the course. A simulation-based emergency and intensive care nursing curriculum was created and well received by third-year nursing students and associated with decreased response time in a resuscitation simulation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Simulation-based multiprofessional obstetric anaesthesia training conducted in situ versus off-site leads to similar individual and team outcomes: a randomised educational trial

PubMed Central

Sørensen, Jette Led; van der Vleuten, Cees; Rosthøj, Susanne; Østergaard, Doris; LeBlanc, Vicki; Johansen, Marianne; Ekelund, Kim; Starkopf, Liis; Lindschou, Jane; Gluud, Christian; Weikop, Pia; Ottesen, Bent

2015-01-01

Objective To investigate the effect of in situ simulation (ISS) versus off-site simulation (OSS) on knowledge, patient safety attitude, stress, motivation, perceptions of simulation, team performance and organisational impact. Design Investigator-initiated single-centre randomised superiority educational trial. Setting Obstetrics and anaesthesiology departments, Rigshospitalet, University of Copenhagen, Denmark. Participants 100 participants in teams of 10, comprising midwives, specialised midwives, auxiliary nurses, nurse anaesthetists, operating theatre nurses, and consultant doctors and trainees in obstetrics and anaesthesiology. Interventions Two multiprofessional simulations (clinical management of an emergency caesarean section and a postpartum haemorrhage scenario) were conducted in teams of 10 in the ISS versus the OSS setting. Primary outcome Knowledge assessed by a multiple choice question test. Exploratory outcomes Individual outcomes: scores on the Safety Attitudes Questionnaire, stress measurements (State-Trait Anxiety Inventory, cognitive appraisal and salivary cortisol), Intrinsic Motivation Inventory and perceptions of simulations. Team outcome: video assessment of team performance. Organisational impact: suggestions for organisational changes. Results The trial was conducted from April to June 2013. No differences between the two groups were found for the multiple choice question test, patient safety attitude, stress measurements, motivation or the evaluation of the simulations. The participants in the ISS group scored the authenticity of the simulation significantly higher than did the participants in the OSS group. Expert video assessment of team performance showed no differences between the ISS versus the OSS group. The ISS group provided more ideas and suggestions for changes at the organisational level. Conclusions In this randomised trial, no significant differences were found regarding knowledge, patient safety attitude, motivation or stress measurements when comparing ISS versus OSS. Although participant perception of the authenticity of ISS versus OSS differed significantly, there were no differences in other outcomes between the groups except that the ISS group generated more suggestions for organisational changes. Trial registration number NCT01792674. PMID:26443654

Web-Based Simulation in Psychiatry Residency Training: A Pilot Study

ERIC Educational Resources Information Center

Gorrindo, Tristan; Baer, Lee; Sanders, Kathy M.; Birnbaum, Robert J.; Fromson, John A.; Sutton-Skinner, Kelly M.; Romeo, Sarah A.; Beresin, Eugene V.

2011-01-01

Background: Medical specialties, including surgery, obstetrics, anesthesia, critical care, and trauma, have adopted simulation technology for measuring clinical competency as a routine part of their residency training programs; yet, simulation technologies have rarely been adapted or used for psychiatry training. Objective: The authors describe…

Distributed Observer Network

NASA Technical Reports Server (NTRS)

Conroy, Michael; Mazzone, Rebecca; Little, William; Elfrey, Priscilla; Mann, David; Mabie, Kevin; Cuddy, Thomas; Loundermon, Mario; Spiker, Stephen; McArthur, Frank;

Optimisation of simulated team training through the application of learning theories: a debate for a conceptual framework.

PubMed

Stocker, Martin; Burmester, Margarita; Allen, Meredith

2014-04-03

As a conceptual review, this paper will debate relevant learning theories to inform the development, design and delivery of an effective educational programme for simulated team training relevant to health professionals. Kolb's experiential learning theory is used as the main conceptual framework to define the sequence of activities. Dewey's theory of reflective thought and action, Jarvis modification of Kolb's learning cycle and Schön's reflection-on-action serve as a model to design scenarios for optimal concrete experience and debriefing for challenging participants' beliefs and habits. Bandura's theory of self-efficacy and newer socio-cultural learning models outline that for efficient team training, it is mandatory to introduce the social-cultural context of a team. The ideal simulated team training programme needs a scenario for concrete experience, followed by a debriefing with a critical reflexive observation and abstract conceptualisation phase, and ending with a second scenario for active experimentation. Let them re-experiment to optimise the effect of a simulated training session. Challenge them to the edge: The scenario needs to challenge participants to generate failures and feelings of inadequacy to drive and motivate team members to critical reflect and learn. Not experience itself but the inadequacy and contradictions of habitual experience serve as basis for reflection. Facilitate critical reflection: Facilitators and group members must guide and motivate individual participants through the debriefing session, inciting and empowering learners to challenge their own beliefs and habits. To do this, learners need to feel psychological safe. Let the group talk and critical explore. Motivate with reality and context: Training with multidisciplinary team members, with different levels of expertise, acting in their usual environment (in-situ simulation) on physiological variables is mandatory to introduce cultural context and social conditions to the learning experience. Embedding in situ team training sessions into a teaching programme to enable repeated training and to assess regularly team performance is mandatory for a cultural change of sustained improvement of team performance and patient safety.

Lessons learned from cross-border medical response to the terrorist bombings in Tabba and Ras-el-Satan, Egypt, on 07 October 2004.

PubMed

Leiba, Adi; Blumenfeld, Amir; Hourvitz, Ariel; Weiss, Gali; Peres, Michal; Laor, Dani; Schwartz, Dagan; Arad, Jacob; Goldberg, Avishay; Levi, Yeheskel; Bar-Dayan, Yaron

2005-01-01

Large-scale, terrorist attacks can happen in peripheral areas, which are located close to a country's borders and far from its main medical facilities and involve multi-national casualties and responders. The objective of this study was to analyze the terrorist suicide bombings that occurred on 07 October 2004, near the Israeli-Egyptian border, as representative of such a complex scenario. Data from formal debriefings after the event were processed in order to learn about victim outcomes, resource utilization, critical events, and time course of the emergency response. A total of 185 injured survivors were repatriated: four were severely wounded, 13 were moderately injured, and 168 were mildly injured. Thirty-eight people died. A forward medical team landed at the border town's airport, which provided reinforcement in the field and in the local hospital. Israeli and Egyptian search and rescue teams collaborated at the destruction site. One-hundred sixty-eight injured patients arrived at the small border hospital that rapidly organized itself for the mass-casualty incident, operating as an evacuation "staging hospital". Twenty-three casualties secondarily were distributed to two major trauma centers in the south and the center of Israel, respectively, either by ambulance or by helicopter. Large-scale, terrorist attacks at a peripheral border zone can be handled by international collaboration, reinforcement of medical teams at the site itself and at the peripheral neighboring hospital, rapid rearrangement of an "evacuation hospital", and efficient transport to trauma centers by ambulances, helicopters, and other aircraft.

Disaster preparedness and response improvement: comparison of the 2010 Haiti earthquake-related diagnoses with baseline medical data.

PubMed

van Berlaer, Gerlant; Staes, Tom; Danschutter, Dirk; Ackermans, Ronald; Zannini, Stefano; Rossi, Gabriele; Buyl, Ronald; Gijs, Geert; Debacker, Michel; Hubloue, Ives

2017-10-01

Disaster medicine research generally lacks control groups. This study aims to describe categories of diagnoses encountered by the Belgian First Aid and Support Team after the 2010 Haiti earthquake and extract earthquake-related changes from comparison with comparable baseline data. The hypothesis is that besides earthquake-related trauma, medical problems emerge soon, questioning an appropriate composition of Foreign Medical Teams and Interagency Emergency Health Kits. Using a descriptive cohort study design, diagnoses of patients presenting to the Belgian field hospital were prospectively registered during 4 weeks after the earthquake and compared with those recorded similarly by Médecins Sans Frontières in the same area and time span in previous and later years. Of 7000 triaged postearthquake patients, 3500 were admitted, of whom 2795 were included and analysed. In the fortnight after the earthquake, 90% suffered from injury. In the following fortnight, medical diseases emerged, particularly respiratory (23%) and digestive (14%). More than 53% developed infections within 3 weeks after the event. Médecins Sans Frontières registered 6407 patients in 2009; 6033 in 2011; and 7300 in 2012. A comparison indicates that postearthquake patients suffered significantly less from violence, but more from wounds, respiratory, digestive and ophthalmological diseases. This is the first comparison of postearthquake diagnoses with baseline data. Within 2 weeks after the acute phase of an earthquake, respiratory, digestive and ophthalmological problems will emerge to the prejudice of trauma. This fact should be anticipated when composing Foreign Medical Teams and Interagency Emergency Health Kits to be sent to the disaster site.

COMMUNISM AND THE TRAUMA OF ITS COLLAPSE REVISITED.

PubMed

Schmidt-Löw-Beer, Catherine; Atria, Moira; Davar, Elisha

2015-12-01

This paper focuses on the intertwinement of society and the psyche as a consequence of 70 years of Communist rule and the trauma of its collapse in the 90's. The trauma had profound effects on the psyche. An empirical study that was carried out in 1996/1997, which compared the personality structure of adolescents from Russia and Austria, and a research dialogue in 1999, has been re-evaluated in the light of current political events. One aim that we had was to find out whether we could discover characteristic personality features, resulting from the Communist totalitarian society in Russia, as well as from the trauma of its collapse. This led to the development of the concepts of the "impersonal self" and the "denial mode". The Russians seemed to be frozen in a protective shell with "flat" affects. They were anxious, conflict avoidant, and somewhat lost. Ideas about missing adolescence and the importance of privacy are discussed. Society was shown to not only have intruded into the individual psyche, but also into the members of the intercultural research team in the form of projective identification. The importance of the interaction between society and the individual as a basic psychoanalytic concept dating back to Freud is elaborated. Finally, considerations pertaining to mental health and democracy are presented.

Evaluation of a Trauma-Focused CBT Training Programme for IAPT services.

PubMed

Murray, Hannah

2017-09-01

Therapists in Improving Access to Psychological Therapies (IAPT) services are often expected to treat complex presentations of post-traumatic stress disorder (PTSD), such as individuals with multiple, prolonged or early life trauma histories and significant co-morbidity, for which they have received minimal training. Although high recovery rates for PTSD have been demonstrated in randomized controlled trials, these are not always replicated in routine practice, suggesting that training interventions are required to fill the research-practice gap. This study investigated the outcomes of a therapist training programme on treating PTSD with trauma-focused cognitive behavioural therapy (TF-CBT). Twenty therapists from ten IAPT services participated in the training, which consisted of workshops, webinars and consultation sessions over a 6-month period. Feedback indicated that participants found the training highly acceptable. PTSD knowledge and self- and supervisor-rated competence on TF-CBT measures improved following the training and improvements were maintained a year later. Client outcomes on a PTSD measure improved following the training. Participants reported attempts to disseminate learning from the course back to their teams. The findings indicate that the training programme was successful in improving TF-CBT knowledge, skills and outcomes for IAPT therapists. Tentative support for training 'trauma experts' within IAPT services was found, although institutional constraints and staff turnover may limit the sustainability of the model.

TEAMS. Team Exercise for Action Management Skills: A Semester-Long Team-Management Simulation.

ERIC Educational Resources Information Center

Wagenheim, Gary

A team-oriented approach is replacing the traditional management style in today's organizations. Because team management skills differ, they require different teaching methods. This paper describes an administrator education course designed to develop team management skills from an applied and behavioral viewpoint. Students participate in…

KSC-05PD-0359

NASA Technical Reports Server (NTRS)

2005-01-01

KENNEDY SPACE CENTER, FLA. During an End-to-End (ETE) Mission Management Team (MMT) launch simulation at KSC, Mike Rein, division chief of Media Services, and Lisa Malone, director of External Relations and Business Development at KSC, work the consoles. In Firing Room 1 at KSC, Shuttle launch team members put the Shuttle system through an integrated simulation. The control room is set up with software used to simulate flight and ground systems in the launch configuration. The ETE MMT simulation included L-2 and L-1 day Prelaunch MMT meetings, an external tanking/weather briefing, and a launch countdown. The ETE transitioned to the Johnson Space Center for the flight portion of the simulation, with the STS-114 crew in a simulator at JSC. Such simulations are common before a launch to keep the Shuttle launch team sharp and ready for liftoff.

Simulating a Submarine Hydrothermal Vent

NASA Image and Video Library

2013-01-16

A team of scientists at NASA Jet Propulsion Laboratory is testing whether organic molecules can be brewed in a simulated ocean vent. Pictured here is Lauren White, a member of the NASA Astrobiology Icy Worlds team.

Workload of Team Leaders and Team Members During a Simulated Sepsis Scenario.

PubMed

Tofil, Nancy M; Lin, Yiqun; Zhong, John; Peterson, Dawn Taylor; White, Marjorie Lee; Grant, Vincent; Grant, David J; Gottesman, Ronald; Sudikoff, Stephanie N; Adler, Mark; Marohn, Kimberly; Davidson, Jennifer; Cheng, Adam

2017-09-01

Crisis resource management principles dictate appropriate distribution of mental and/or physical workload so as not to overwhelm any one team member. Workload during pediatric emergencies is not well studied. The National Aeronautics and Space Administration-Task Load Index is a multidimensional tool designed to assess workload validated in multiple settings. Low workload is defined as less than 40, moderate 40-60, and greater than 60 signify high workloads. Our hypothesis is that workload among both team leaders and team members is moderate to high during a simulated pediatric sepsis scenario and that team leaders would have a higher workload than team members. Multicenter observational study. Nine pediatric simulation centers (five United States, three Canada, and one United Kingdom). Team leaders and team members during a 12-minute pediatric sepsis scenario. National Aeronautics and Space Administration-Task Load Index. One hundred twenty-seven teams were recruited from nine sites. One hundred twenty-seven team leaders and 253 team members completed the National Aeronautics and Space Administration-Task Load Index. Team leader had significantly higher overall workload than team member (51 ± 11 vs 44 ± 13; p < 0.01). Team leader had higher workloads in all subcategories except in performance where the values were equal and in physical demand where team members were higher than team leaders (29 ± 22 vs 18 ± 16; p < 0.01). The highest category for each group was mental 73 ± 13 for team leader and 60 ± 20 for team member. For team leader, two categories, mental (73 ± 17) and effort (66 ± 16), were high workload, most domains for team member were moderate workload levels. Team leader and team member are under moderate workloads during a pediatric sepsis scenario with team leader under high workloads (> 60) in the mental demand and effort subscales. Team leader average significantly higher workloads. Consideration of decreasing team leader responsibilities may improve team workload distribution.

Changing incidence and management of penetrating neck injuries in the South East London trauma centre.

PubMed

Harris, R; Olding, C; Lacey, C; Bentley, R; Schulte, K M; Lewis, D; Kandasamy, N; Oakley, R

2012-05-01

A total of 17 cases of penetrating neck injury were managed by the otolaryngology team at King's College Hospital over a 3-year period in the 1980s. In April 2010 King's College Hospital became the major trauma centre for South East London. This prospective cohort study compares the incidence, changing demographic features and treatment outcomes of penetrating neck trauma in South East London over the previous 23 years. Data were collected over a 12-month period (April 2010 to March 2011) and a selective management protocol was introduced to standardise initial investigations and further treatment. The past 23 years have seen a 550% increase in the incidence of penetrating neck injuries in South East London, with a marked increase in gun crime. Only 38% of cases underwent negative neck exploration in 2011 compared with 65% in 1987. Selective conservative management based on the absence of haemodynamic instability or radiological findings reduces length of hospital stay, lightens surgical workload and cuts costs without affecting morbidity or mortality. The increased incidence of penetrating neck injury is a reflection of more interpersonal violence rather than a consequence of the larger South East London trauma centre catchment area. Tackling this problem requires focus on wider issues of community prevention. Sharing of data between the four London trauma centres and the police is needed to help prevent interpersonal violence and develop a universal treatment algorithm for other institutions to follow.

A modern combat trauma.

PubMed

Popivanov, Georgi; Mutafchiyski, V M; Belokonski, E I; Parashkevov, A B; Koutin, G L

2014-03-01

The world remains plagued by wars and terrorist attacks, and improvised explosive devices (IED) are the main weapons of our current enemies, causing almost two-thirds of all combat injuries. We wished to analyse the pattern of blast trauma on the modern battlefield and to compare it with combat gunshot injuries. Analysis of a consecutive series of combat trauma patients presenting to two Bulgarian combat surgical teams in Afghanistan over 11 months. Demographics, injury patterns and Injury Severity Scores (ISS) were compared between blast and gunshot-injured casualties using Fisher's Exact Test. The blast victims had significantly higher median ISS (20.54 vs 9.23) and higher proportion of ISS>16 (60% vs 33.92%, p=0.008) than gunshot cases. They also had more frequent involvement of three or more body regions (47.22% vs 3.58%, p<0.0001). A significantly higher frequency of head (27.27% vs 3.57%), facial (20% vs 0%) and extremities injuries (85.45% vs 42.86%) and burns (12.72% vs 0%) was noted among the victims of explosion (p<0.0001). Based on clinical examination and diagnostic imaging, primary blast injury was identified in 24/55 (43.6%), secondary blast injury in 37 blast cases (67.3%), tertiary in 15 (27.3%) and quaternary blast injury (all burns) in seven (12.72%). Our results corroborate the 'multidimensional' injury pattern of blast trauma. The complexity of the blast trauma demands a good knowledge and a special training of the military surgeons and hospital personnel before deployment.

Update on massive transfusion.

PubMed

Pham, H P; Shaz, B H

2013-12-01

Massive haemorrhage requires massive transfusion (MT) to maintain adequate circulation and haemostasis. For optimal management of massively bleeding patients, regardless of aetiology (trauma, obstetrical, surgical), effective preparation and communication between transfusion and other laboratory services and clinical teams are essential. A well-defined MT protocol is a valuable tool to delineate how blood products are ordered, prepared, and delivered; determine laboratory algorithms to use as transfusion guidelines; and outline duties and facilitate communication between involved personnel. In MT patients, it is crucial to practice damage control resuscitation and to administer blood products early in the resuscitation. Trauma patients are often admitted with early trauma-induced coagulopathy (ETIC), which is associated with mortality; the aetiology of ETIC is likely multifactorial. Current data support that trauma patients treated with higher ratios of plasma and platelet to red blood cell transfusions have improved outcomes, but further clinical investigation is needed. Additionally, tranexamic acid has been shown to decrease the mortality in trauma patients requiring MT. Greater use of cryoprecipitate or fibrinogen concentrate might be beneficial in MT patients from obstetrical causes. The risks and benefits for other therapies (prothrombin complex concentrate, recombinant activated factor VII, or whole blood) are not clearly defined in MT patients. Throughout the resuscitation, the patient should be closely monitored and both metabolic and coagulation abnormalities corrected. Further studies are needed to clarify the optimal ratios of blood products, treatment based on underlying clinical disorder, use of alternative therapies, and integration of laboratory testing results in the management of massively bleeding patients.

Multidisciplinary obstetric simulated emergency scenarios (MOSES): promoting patient safety in obstetrics with teamwork-focused interprofessional simulations.

PubMed

Freeth, Della; Ayida, Gubby; Berridge, Emma Jane; Mackintosh, Nicola; Norris, Beverley; Sadler, Chris; Strachan, Alasdair

2009-01-01

We describe an example of simulation-based interprofessional continuing education, the multidisciplinary obstetric simulated emergency scenarios (MOSES) course, which was designed to enhance nontechnical skills among obstetric teams and, hence, improve patient safety. Participants' perceptions of MOSES courses, their learning, and the transfer of learning to clinical practice were examined. Participants included senior midwives, obstetricians, and obstetric anesthetists, including course faculty from 4 purposively selected delivery suites in England. Telephone or e-mail interviews with MOSES course participants and facilitators were conducted, and video-recorded debriefings that formed integral parts of this 1-day course were analyzed. The team training was well received. Participants were able to check out assumptions and expectations of others and develop respect for different roles within the delivery suite (DS) team. Skillful facilitation of debriefing after each scenario was central to learning. Participants reported acquiring new knowledge or insights, particularly concerning the role of communication and leadership in crisis situations, and they rehearsed unfamiliar skills. Observing peers working in the simulations increased participants' learning by highlighting alternative strategies. The learning achieved by individuals and groups was noticeably dependent on their starting points. Some participants identified limited changes in their behavior in the workplace following the MOSES course. Mechanisms to manage the transfer of learning to the wider team were weakly developed, although 2 DS teams made changes to their regular update training. Interprofessional, team-based simulations promote new learning.

Optimal learning in a virtual patient simulation of cranial nerve palsies: the interaction between social learning context and student aptitude.

PubMed

Johnson, Teresa R; Lyons, Rebecca; Chuah, Joon Hao; Kopper, Regis; Lok, Benjamin C; Cendan, Juan C

2013-01-01

Simulation in medical education provides students with opportunities to practice interviews, examinations, and diagnosis formulation related to complex conditions without risks to patients. To examine differences between individual and team participation on learning outcomes and student perspectives through use of virtual patients (VPs) for teaching cranial nerve (CN) evaluation. Fifty-seven medical students were randomly assigned to complete simulation exercises either as individuals or as members of three-person teams. Students interviewed, examined, and diagnosed VPs with possible CN damage in the neurological exam rehearsal virtual environment (NERVE). Knowledge of CN abnormalities was assessed pre- and post-simulation. Student perspectives of system usability were evaluated post-simulation. An aptitude-treatment interaction (ATI) effect was detected; at pre-test scores ≤ 50%, students in teams scored higher (83%) at post-test than did students as individuals (62%, p = 0.02). Post-simulation, students in teams reported greater confidence in their ability to diagnose CN abnormalities than did students as individuals (p = 0.02; mean rating = 4.0/5.0 and 3.4/5.0, respectively). The ATI effect allows us to begin defining best practices for the integration of VP simulators into the medical curriculum. We are persuaded to implement future NERVE exercises with small teams of medical students.

Optimal learning in a virtual patient simulation of cranial nerve palsies: The interaction between social learning context and student aptitude

PubMed Central

JOHNSON, TERESA R.; LYONS, REBECCA; CHUAH, JOON HAO; KOPPER, REGIS; LOK, BENJAMIN C.; CENDAN, JUAN C.

2013-01-01

Background Simulation in medical education provides students with opportunities to practice interviews, examinations, and diagnosis formulation related to complex conditions without risks to patients. Aim To examine differences between individual and team participation on learning outcomes and student perspectives through use of virtual patients (VPs) for teaching cranial nerve (CN) evaluation. Methods Fifty-seven medical students were randomly assigned to complete simulation exercises either as individuals or as members of three-person teams. Students interviewed, examined, and diagnosed VPs with possible CN damage in the Neurological Exam Rehearsal Virtual Environment (NERVE). Knowledge of CN abnormalities was assessed pre- and post-simulation. Student perspectives of system usability were evaluated post-simulation. Results An aptitude-treatment interaction (ATI) effect was detected; at pre-test scores ≤50%, students in teams scored higher (83%) at post-test than did students as individuals (62%, p = 0.02). Post-simulation, students in teams reported greater confidence in their ability to diagnose CN abnormalities than did students as individuals (p = 0.02; mean rating = 4.0/5.0 and 3.4/5.0, respectively). Conclusion The ATI effect allows us to begin defining best practices for the integration of VP simulators into the medical curriculum. We are persuaded to implement future NERVE exercises with small teams of medical students. PMID:22938679

Optimizing the assessment of pediatric injury severity in low-resource settings: Consensus generation through a modified Delphi analysis.

PubMed

St-Louis, Etienne; Deckelbaum, Dan Leon; Baird, Robert; Razek, Tarek

2017-06-01

Although a plethora of pediatric injury severity scoring systems is available, many of them present important challenges and limitations in the low resource setting. Our aim is to generate consensus among a group of experts regarding the optimal parameters, outcomes, and methods of estimating injury severity for pediatric trauma patients in low resource settings. A systematic review of the literature was conducted to identify and compare existing injury scores used in pediatric patients. Qualitative data was extracted from the systematic review, including scoring parameters, settings and outcomes. In order to establish consensus regarding which of these elements are most adapted to pediatric patients in low-resource settings, they were subjected to a modified Delphi survey for external validation. The Delphi process is a structured communication technique that relies on a panel of experts to develop a systematic, interactive consensus method. We invited a group of 38 experts, including adult and pediatric surgeons, emergency physicians and anesthesiologists trauma team leaders from a level 1 trauma center in Montreal, Canada, and a pediatric referral trauma hospital in Santiago, Chile to participate in two successive rounds of our survey. Consensus was reached regarding various features of an ideal pediatric trauma score. Specifically, our experts agreed pediatric trauma scoring tool should differ from its adult counterpart, that it can be derived from point of care data available at first assessment, that blood pressure is an important variable to include in a predictive model for pediatric trauma outcomes, that blood pressure is a late but specific marker of shock in pediatric patients, that pulse rate is a more sensitive marker of hemodynamic instability than blood pressure, that an assessment of airway status should be included as a predictive variable for pediatric trauma outcomes, that the AVPU classification of neurologic status is simple and reliable in the acute setting, and more so than GCS at all ages. Therefore, we conclude that an opportunity exists to develop a new pediatric trauma score, combining the above consensus-generating ideas, that would be best adapted for use in low-resource settings. Copyright © 2017 Elsevier Ltd. All rights reserved.

Utilizing Telemedicine in the Trauma Intensive Care Unit: Does It Impact Teamwork?

PubMed

Lazzara, Elizabeth H; Benishek, Lauren E; Patzer, Brady; Gregory, Megan E; Hughes, Ashley M; Heyne, Kyle; Salas, Eduardo; Kuchkarian, Fernanda; Marttos, Antonio; Schulman, Carl

2015-08-01

The aim of this study was to examine the impact of a telemedical robot on trauma intensive care unit (TICU) clinician teamwork (i.e., team attitudes, behaviors, and cognitions) during patient rounds. Thirty-two healthcare providers who conduct rounds volunteered to take surveys assessing teamwork attitudes and cognitions at three time periods: (1) the onset of the study, (2) the end of the 30-day control period, and (3) the end of the 30-day experimental period, which immediately followed the control period. Rounds were recorded throughout the 30-day control period and 30-day experimental period to observe provider behaviors. For the initial 30 days, there was no access to telemedicine. For the final 30 days, the rounding healthcare providers had access to the RP-7 robot (Intouch Health Inc., Santa Barbara, CA), a telemedical tool that can facilitate patient rounds conducted away from bedside. Using a one-tailed, one-way repeated-measures analysis of variance (ANOVA) to compare trust at Times 1, 2, and 3, there was no significant effect on trust: F(2, 14)=1.20, p=0.16. When a one-tailed, one-way repeated-measures ANOVA to compare transactive memory systems (TMS) at Times 1, 2, and 3 was conducted, there was no significant effect on TMS: F(2, 15)=1.33, p=0.15. We conducted a one-tailed, one-way repeated-measures ANOVA to compare team psychological safety at Times 1, 2, and 3, and there was no significant effect on team psychological safety: F(2,15)=1.53, p=0.12. There was a significant difference in communication between rounds with and without telemedicine [t(25)=-1.76, p<0.05], such that there was more task-based communication during telerounds. Telemedicine increased task-based communication and did not negatively impact team trust, psychological safety, or TMS during rounds. Telemedicine may offer advantages for some teamwork competencies without sacrificing the efficacy of others and may be adopted by intact rounding teams without hindering teamwork.

Interprofessional team debriefings with or without an instructor after a simulated crisis scenario: An exploratory case study.

PubMed

Boet, Sylvain; Pigford, Ashlee-Ann; Fitzsimmons, Amber; Reeves, Scott; Triby, Emmanuel; Bould, M Dylan

2016-11-01

The value of debriefing after an interprofessional simulated crisis is widely recognised; however, little is known about the content of debriefings and topics that prompt reflection. This study aimed to describe the content and topics that facilitate reflection among learners in two types of interprofessional team debriefings (with or without an instructor) following simulated practice. Interprofessional operating room (OR) teams (one anaesthesia trainee, one surgical trainee, and one staff circulating OR nurse) managed a simulated crisis scenario and were randomised to one of two debriefing groups. Within-team groups used low-level facilitation (i.e., no instructor but a one-page debriefing form based on the Ottawa Global Rating Scale). The instructor-led group used high-level facilitation (i.e., gold standard instructor-led debriefing). All debriefings were recorded, transcribed, and thematically analysed using the inductive qualitative methodology. Thirty-seven interprofessional team-debriefing sessions were included in the analysis. Regardless of group allocation (within-team or instructor-led), the debriefings centred on targeted crisis resource management (CRM) content (i.e., communication, leadership, situation awareness, roles, and responsibilities). In both types of debriefings, three themes emerged as topics for entry points into reflection: (1) the process of the debriefing itself, (2) experience of the simulation model, including simulation fidelity, and (3) perceived performance, including the assessment of CRM. Either with or without an instructor, interprofessional teams focused their debriefing discussion on targeted CRM content. We report topics that allowed learners to enter reflection. This is important for understanding how to maximise learning opportunities when creating education activities for healthcare providers that work in interprofessional settings.

Abusive head trauma and accidental head injury: a 20-year comparative study of referrals to a hospital child protection team

PubMed Central

John, Simon; Vincent, Andrea L; Reed, Peter

2015-01-01

Aim To describe children referred for suspected abusive head trauma (AHT) to a hospital child protection team in Auckland, New Zealand. Methods Comparative review of demographics, histories, injuries, investigations and diagnostic outcomes for referrals under 15 years old from 1991 to 2010. Results Records were available for 345 children. Referrals increased markedly (88 in the first decade, 257 in the second), but the diagnostic ratio was stable: AHT 60%, accidental or natural 29% and uncertain cause 11%. The probability of AHT was similar regardless of socio-economic status or ethnicity. In children under 2 years old with accidental head injuries (75/255, 29%) or AHT (180/255, 71%), characteristics of particular interest for AHT included no history of trauma (88/98, 90%), no evidence of impact to the head (84/93, 90%), complex skull fractures with intracranial injury (22/28, 79%), subdural haemorrhage (160/179, 89%) and hypoxic ischaemic injury (38/39, 97%). In children over 2 years old, these characteristics did not differ significantly between children with accidental head injuries (21/47, 45%) and AHT (26/47, 55%). The mortality of AHT was higher in children over 2 years old (10/26, 38%) than under 2 years (19/180, 11%). Conclusions The striking increase in referrals for AHT probably represents increasing incidence. The decision to refer a hospitalised child with a head injury for assessment for possible AHT should not be influenced by socio-economic status or ethnicity. Children over 2 years old hospitalised for AHT are usually injured by mechanisms involving impact and should be considered at high risk of death. PMID:26130384

Rating competitors before tournament starts: How it's affecting team progression in a soccer tournament

NASA Astrophysics Data System (ADS)

Yusof, Muhammad Mat; Sulaiman, Tajularipin; Khalid, Ruzelan; Hamid, Mohamad Shukri Abdul; Mansor, Rosnalini

2014-12-01

In professional sporting events, rating competitors before tournament start is a well-known approach to distinguish the favorite team and the weaker teams. Various methodologies are used to rate competitors. In this paper, we explore four ways to rate competitors; least squares rating, maximum likelihood strength ratio, standing points in large round robin simulation and previous league rank position. The tournament metric we used to evaluate different types of rating approach is tournament outcome characteristics measure. The tournament outcome characteristics measure is defined by the probability that a particular team in the top 100q pre-tournament rank percentile progress beyond round R, for all q and R. Based on simulation result, we found that different rating approach produces different effect to the team. Our simulation result shows that from eight teams participate in knockout standard seeding, Perak has highest probability to win for tournament that use the least squares rating approach, PKNS has highest probability to win using the maximum likelihood strength ratio and the large round robin simulation approach, while Perak has the highest probability to win a tournament using previous league season approach.

A ward round proforma improves documentation and communication.

PubMed

Alazzawi, Sulaiman; Silk, Zacharia; Saha, Urmila U; Auplish, Sunil; Masterson, Sean

2016-12-02

This article present the results of an audit cycle which evaluated the quality of inpatient ward round documentation in a busy district general hospital before and after the implementation of a standardized proforma which was specifically designed for trauma and orthopaedic patients. In each cycle, 20 case notes were examined and the data analysed to examine three main areas: Diagnosis, management and/or discharge plan Objective assessments including neurovascular status, weight-bearing status, surgical wound review, observations, results of investigations and decision from the daily trauma meeting Logistics of the documentation such as legibility, date and time, name and grade of the doctor and contact number. This audit demonstrated that using a ward round proforma can significantly enhance the quality of documentation and improve communication between multidisciplinary team members.

Lightweight Trauma Module - LTM

NASA Technical Reports Server (NTRS)

Hatfield, Thomas

2008-01-01

Current patient movement items (PMI) supporting the military's Critical Care Air Transport Team (CCATT) mission as well as the Crew Health Care System for space (CHeCS) have significant limitations: size, weight, battery duration, and dated clinical technology. The LTM is a small, 20 lb., system integrating diagnostic and therapeutic clinical capabilities along with onboard data management, communication services and automated care algorithms to meet new Aeromedical Evacuation requirements. The Lightweight Trauma Module is an Impact Instrumentation, Inc. project with strong Industry, DoD, NASA, and Academia partnerships aimed at developing the next generation of smart and rugged critical care tools for hazardous environments ranging from the battlefield to space exploration. The LTM is a combination ventilator/critical care monitor/therapeutic system with integrated automatic control systems. Additional capabilities are provided with small external modules.

Development of the TeamOBS-PPH - targeting clinical performance in postpartum hemorrhage.

PubMed

Brogaard, Lise; Hvidman, Lone; Hinshaw, Kim; Kierkegaard, Ole; Manser, Tanja; Musaeus, Peter; Arafeh, Julie; Daniels, Kay I; Judy, Amy E; Uldbjerg, Niels

2018-06-01

This study aimed to develop a valid and reliable TeamOBS-PPH tool for assessing clinical performance in the management of postpartum hemorrhage (PPH). The tool was evaluated using video-recordings of teams managing PPH in both real-life and simulated settings. A Delphi panel consisting of 12 obstetricians from the UK, Norway, Sweden, Iceland, and Denmark achieved consensus on (i) the elements to include in the assessment tool, (ii) the weighting of each element, and (iii) the final tool. The validity and reliability were evaluated according to Cook and Beckman. (Level 1) Four raters scored four video-recordings of in situ simulations of PPH. (Level 2) Two raters scored 85 video-recordings of real-life teams managing patients with PPH ≥1000 mL in two Danish hospitals. (Level 3) Two raters scored 15 video-recordings of in situ simulations of PPH from a US hospital. The tool was designed with scores from 0 to 100. (Level 1) Teams of novices had a median score of 54 (95% CI 48-60), whereas experienced teams had a median score of 75 (95% CI 71-79; p < 0.001). (Level 2) The intra-rater [intra-class correlation (ICC) = 0.96] and inter-rater (ICC = 0.83) agreements for real-life PPH were strong. The tool was applicable in all cases: atony, retained placenta, and lacerations. (Level 3) The tool was easily adapted to in situ simulation settings in the USA (ICC = 0.86). The TeamOBS-PPH tool appears to be valid and reliable for assessing clinical performance in real-life and simulated settings. The tool will be shared as the free TeamOBS App. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

A Comprehensive, Simulation-Based Approach to Teaching Clinical Skills: The Medical Students’ Perspective

PubMed Central

Evans, Leigh V.; Crimmins, Ashley C.; Bonz, James W.; Gusberg, Richard J.; Tsyrulnik, Alina; Dziura, James D.; Dodge, Kelly L.

2014-01-01

The purpose of this study was to determine if third-year medical students participating in a mandatory 12-week simulation course perceived improvement in decision-making, communication, and teamwork skills. Students participated in or observed 24 acute emergency scenarios. At 4-week intervals, students completed 0-10 point Likert scale questionnaires evaluating the curriculum and role of team leader. Linear contrasts were used to examine changes in outcomes. P-values were Bonferroni-corrected for multiple pairwise comparisons. Student evaluations (n = 96) demonstrated increases from week 4 to 12 in educational value (p = 0.006), decision-making (p < 0.001), communication (p = 0.02), teamwork (p = 0.01), confidence in management (p < 0.001), and translation to clinical experience (p < 0.001). Regarding the team leader role, students reported a decrease in stress (p = 0.001) and increase in ability to facilitate team function (p < 0.001) and awareness of team building (p = <0.001). Ratings demonstrate a positive impact of simulation on both clinical management skills and team leadership skills. A simulation curriculum can enhance the ability to manage acute clinical problems and translates well to the clinical experience. These positive perceptions increase as the exposure to simulation increases. PMID:25506290

Effects of script-based role play in cardiopulmonary resuscitation team training.

PubMed

Chung, Sung Phil; Cho, Junho; Park, Yoo Seok; Kang, Hyung Goo; Kim, Chan Woong; Song, Keun Jeong; Lim, Hoon; Cho, Gyu Chong

2011-08-01

The purpose of this study is to compare the cardiopulmonary resuscitation (CPR) team dynamics and performance between a conventional simulation training group and a script-based training group. This was a prospective randomised controlled trial of educational intervention for CPR team training. Fourteen teams, each consisting of five members, were recruited. The conventional group (C) received training using a didactic lecture and simulation with debriefing, while the script group (S) received training using a resuscitation script. The team activity was evaluated with checklists both before and after 1 week of training. The videotaped simulated resuscitation events were compared in terms of team dynamics and performance aspects. Both groups showed significantly higher leadership scores after training (C: 58.2 ± 9.2 vs. 67.2 ± 9.5, p=0.007; S: 57.9 ± 8.1 vs. 65.4 ± 12.1, p=0.034). However, there were no significant improvements in performance scores in either group after training. There were no differences in the score improvement after training between the two groups in dynamics (C: 9.1 ± 12.6 vs. S: 7.4 ± 13.7, p=0.715), performance (C: 5.5 ± 11.4 vs. S: 4.7 ± 9.6, p=0.838) and total scores (C: 14.6 ± 20.1 vs. S: 12.2 ± 19.5, p=0.726). Script-based CPR team training resulted in comparable improvements in team dynamics scores compared with conventional simulation training. Resuscitation scripts may be used as an adjunct for CPR team training.

The influence of trauma and patient characteristics on provider burnout in VA post-traumatic stress disorder specialty programmes.

PubMed

Garcia, Hector A; McGeary, Cindy A; Finley, Erin P; McGeary, Donald D; Ketchum, Norma S; Peterson, Alan L

2016-03-01

Prolonged exposure (PE) and cognitive processing therapy (CPT) - post-traumatic stress disorder (PTSD) treatments now available at the Veterans Health Administration (VHA) - expose the provider to graphic traumatic material. Little is known about the impact of traumatic material on VHA providers. The purpose of this study was to examine the relationship between trauma content, patient characteristics, and burnout among VHA PTSD Clinical Team (PCT) providers. It was hypothesized that trauma content and patient characteristics would significantly predict burnout in this population. This cross-sectional study consisted of 137 participants. The sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%) with a mean age of 44.3 years (SD = 11.3). Participants completed an electronic survey that assessed demographics, patient characteristics (i.e., anger, personality disorder, malingering), trauma content characteristics (e.g., killing of women and children) as well as burnout as measured by the Maslach Burnout Inventory-General Survey (MBI-GS; Maslach et al., 1996, Burnout inventory manual. Palo Alto: Consulting Psychologist Press). Over half of the study population reported being bothered by trauma content; however, trauma content did not predict burnout. Treating patients with personality disorders and suspected malingering predicted burnout in PCT providers. High numbers (77%) reported perceiving that emotional exhaustion impacted the quality of care they provided. These findings suggest an important role of burnout assessment, prevention, and treatment strategies at the VHA. This paper addresses the impact of provider burnout on perceived quality of care. This paper also addresses potential predictors of burnout in PCT settings. This paper outlines potential remedies to provider burnout in the VHA. © 2015 The British Psychological Society.

Predictive value of focused assessment with sonography for trauma (FAST) for laparotomy in unstable polytrauma Egyptians patients.

PubMed

Elbaih, Adel Hamed; Abu-Elela, Sameh T

2017-12-01

The emergency physicians face significant clinical uncertainty when multiple trauma patients arrive in the emergency department (ED). The priorities for assessment and treatment of polytrauma patients are established in the primary survey. Focused assessment with sonography for trauma (FAST) is very essential clinical skill during trauma resuscitation. Use of point of care ultrasound among the trauma team working in the primary survey in emergency care settings is lacking in Suez Canal University Hospitals even ultrasound machine not available in ED. This study aims to evaluate the accuracy of FAST in hemodynamically unstable polytraumatized patients and to determine its role as an indication of laparotomy. This study is a cross-sectional study included 150 polytrauma patients with a blunt mechanism admitted in Suez Canal University Hospital. Firstly primary survey by airway check, cervical spine securing with neck collar, maintenance of breathing/circulation and management of life threading conditions if present were conducted accordingly to ATLS (advanced trauma life support) guidelines. The patients were assessed in the primary survey using the FAST as a tool to determine the presence of intra-abdominal collection. A total of 150 patients, and FAST scans were performed in all cases. The sensitivity and specificity were 92.6% and 100%, respectively. The negative predictive value was 92%, while the positive predictive value of FAST was 100%. The accuracy of FAST was 96%. FAST is an important method to detect intra-abdominal fluid in the initial assessment in hemodynamically unstable polytrauma patients with high accuracy. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

High-fidelity, simulation-based, interdisciplinary operating room team training at the point of care.

PubMed

Paige, John T; Kozmenko, Valeriy; Yang, Tong; Paragi Gururaja, Ramnarayan; Hilton, Charles W; Cohn, Isidore; Chauvin, Sheila W

2009-02-01

The operating room (OR) is a dynamic, high risk setting requiring effective teamwork for the safe delivery of care. Teamwork in the modern OR, however, is less than ideal. High fidelity simulation is an attractive approach to training key teamwork competencies. We have developed a portable simulation platform, the mobile mock OR (MMOR) that permits bringing team training over long distances to the point of care. We examined the effectiveness of this innovative, simulation-based interdisciplinary operating room (OR) team training model on its participants. All general surgical OR team members at an academic affiliated medical center underwent scenario-based training using a mobile mock OR. Pre- and post-session mean scores were calculated and analyzed for 15 Likert-type items measuring self-efficacy in teamwork competencies using t test. The mean gain in pre-post item scores for 38 participants averaged 0.4 units on a 6-point Likert scale. The significance was demonstrated in 4 of the items: role clarity (Delta = 0.6 units, P = .02), anticipatory response (Delta = 0.6 units, P = .01), cross monitoring (Delta = 0.6 units, P < .01), and team cohesion and interaction (Delta = 0.7 units, P < .01). High-fidelity, simulation-based OR team training at the point of care positively impacts self-efficacy for effective teamwork performance in everyday practice.

Leadership and teamwork in medical emergencies: performance of nursing students and registered nurses in simulated patient scenarios.

PubMed

Endacott, Ruth; Bogossian, Fiona E; Cooper, Simon J; Forbes, Helen; Kain, Victoria J; Young, Susan C; Porter, Joanne E

2015-01-01

To examine nursing students' and registered nurses' teamwork skills whilst managing simulated deteriorating patients. Studies continue to show the lack of timely recognition of patient deterioration. Management of deteriorating patients can be influenced by education and experience. Mixed methods study conducted in two universities and a rural hospital in Victoria, and one university in Queensland, Australia. Three simulation scenarios (chest pain, hypovolaemic shock and respiratory distress) were completed in teams of three by 97 nursing students and 44 registered nurses, equating to a total of 32 student and 15 registered nurse teams. Data were obtained from (1) Objective Structured Clinical Examination rating to assess performance; (2) Team Emergency Assessment Measure scores to assess teamwork; (3) simulation video footage; (4) reflective interview during participants' review of video footage. Qualitative thematic analysis of video and interview data was undertaken. Objective structured clinical examination performance was similar across registered nurses and students (mean 54% and 49%); however, Team Emergency Assessment Measure scores differed significantly between the two groups (57% vs 38%, t = 6·841, p < 0·01). In both groups, there was a correlation between technical (Objective Structured Clinical Examination) and nontechnical (Team Emergency Assessment Measure) scores for the respiratory distress scenario (student teams: r = 0·530, p = 0·004, registered nurse teams r = 0·903, p < 0·01) and hypovolaemia scenario (student teams: r = 0·534, p = 0·02, registered nurse teams: r = 0·535, p = 0·049). Themes generated from the analysis of the combined quantitative and qualitative data were as follows: (1) leadership and followership behaviours; (2) help-seeking behaviours; (3) reliance on previous experience; (4) fixation on a single detail; and (5) team support. There is scope to improve leadership, team work and task management skills for registered nurses and nursing students. Simulation appears to be beneficial in enabling less experienced staff to assess their teamwork skills. There is a need to encourage less experienced staff to become leaders and for all staff to develop improved teamwork skills for medical emergencies. © 2014 John Wiley & Sons Ltd.

Method matters: impact of in-scenario instruction on simulation-based teamwork training.

PubMed

Escher, Cecilia; Rystedt, Hans; Creutzfeldt, Johan; Meurling, Lisbet; Nyström, Sofia; Dahlberg, Johanna; Edelbring, Samuel; Nordahl Amorøe, Torben; Hult, Håkan; Felländer-Tsai, Li; Abrandt-Dahlgren, Madeleine

2017-01-01

The rationale for introducing full-scale patient simulators in training to improve patient safety is to recreate clinical situations in a realistic setting. Although high-fidelity simulators mimic a wide range of human features, simulators differ from the body of a sick patient. The gap between the simulator and the human body implies a need for facilitators to provide information to help participants understand scenarios. The authors aimed at describing different methods that facilitators in our dataset used to provide such extra scenario information and how the different methods to convey information affected how scenarios played out. A descriptive qualitative study was conducted to examine the variation of methods to deliver extra scenario information to participants. A multistage approach was employed. The authors selected film clips from a shared database of 31 scenarios from three participating simulation centers. A multidisciplinary research team performed a collaborative analysis of representative film clips focusing on the interplay between participants, facilitators, and the physical environment. After that, the entire material was revisited to further examine and elaborate the initial findings. The material displayed four distinct methods for facilitators to convey information to participants in simulation-based teamwork training. The choice of method had impact on the participating teams regarding flow of work, pace, and team communication. Facilitators' close access to the teams' activities when present in the simulation suite, either embodied or disembodied in the simulation, facilitated the timing for providing information, which was critical for maintaining the flow of activities in the scenario. The mediation of information by a loudspeaker or an earpiece from the adjacent operator room could be disturbing for team communication. In-scenario instruction is an essential component of simulation-based teamwork training that has been largely overlooked in previous research. The ways in which facilitators convey information about the simulated patient have the potential to shape the simulation activities and thereby serve different learning goals. Although immediate timing to maintain an adequate pace is necessary for professionals to engage in training of medical emergencies, novices may gain from a slower tempo to train complex clinical team tasks systematically.

Dual-energy bone removal computed tomography (BRCT): preliminary report of efficacy of acute intracranial hemorrhage detection.

PubMed

Naruto, Norihito; Tannai, Hidenori; Nishikawa, Kazuma; Yamagishi, Kentaro; Hashimoto, Masahiko; Kawabe, Hideto; Kamisaki, Yuichi; Sumiya, Hisashi; Kuroda, Satoshi; Noguchi, Kyo

2018-02-01

One of the major applications of dual-energy computed tomography (DECT) is automated bone removal (BR). We hypothesized that the visualization of acute intracranial hemorrhage could be improved on BRCT by removing bone as it has the highest density tissue in the head. This preliminary study evaluated the efficacy of a DE BR algorithm for the head CT of trauma patients. Sixteen patients with acute intracranial hemorrhage within 1 day after head trauma were enrolled in this study. All CT examinations were performed on a dual-source dual-energy CT scanner. BRCT images were generated using the Bone Removal Application. Simulated standard CT and BRCT images were visually reviewed in terms of detectability (presence or absence) of acute hemorrhagic lesions. DECT depicted 28 epidural/subdural hemorrhages, 17 contusional hemorrhages, and 7 subarachnoid hemorrhages. In detecting epidural/subdural hemorrhage, BRCT [28/28 (100%)] was significantly superior to simulated standard CT [17/28 (61%)] (p = .001). In detecting contusional hemorrhage, BRCT [17/17 (100%)] was also significantly superior to simulated standard CT [11/17 (65%)] (p = .0092). BRCT was superior to simulated standard CT in detecting acute intracranial hemorrhage. BRCT could improve the detection of small intracranial hemorrhages, particularly those adjacent to bone, by removing bone that can interfere with the visualization of small acute hemorrhage. In an emergency such as head trauma, BRCT can be used as support imaging in combination with simulated standard CT and bone scale CT, although BRCT cannot replace a simulated standard CT.

Eye TVR: Eye Trauma and Visual Restoration Team

DTIC Science & Technology

2013-03-01

distribution unlimited The views, opinions and/or findings contained in this report are those of the author(s) and should not be construed as an...cocktail containing ketamine (54 mg/kg body weight) and xylazine (6 mg/kg body weight). In the meantime, the pupils were dilated with 10...multichannel neural data acquisition was developed using the Visual Basic 6.0 (Microsoft Corp.) and Measurement Studio ActiveX components (National

The National Shipbuilding Research Program. Ergonomic Study of Shipbuilding and Repair

DTIC Science & Technology

2000-10-09

syndrome, tendinitis , epicondylitis, bicipital tendinitis , rotator cuff tendinitis , disorders due to repetitive trauma, repetitive motion syndrome...Health & Safety is peer of all other managing directors. Ex. Mandatory safety rotation of two months in safety patrol group for all workers. Ex...Mandatory safety rotation of two months in safety patrol group for all workers. Ex. Each team reviews each work-related injury for cause and prevention

Efficacy of prehospital critical care teams for severe blunt head injury in the Australian setting.

PubMed

Garner, A; Crooks, J; Lee, A; Bishop, R

2001-07-01

To determine whether prehospital critical care teams (CCT) would result in improved functional outcomes for road trauma related severe head injury in the Australian setting, when compared with standard advanced life support measures provided by paramedics. Retrospective review of 250 patients treated by paramedics and 46 patients treated by CCT transported directly from the accident scene, with a prehospital Glasgow coma scale (GCS)< or =8. CCT-treated patients had longer median prehospital times (113 versus 45 min, P<0.001), and a higher prehospital intubation rate (100% versus 36%, P<0.001) than paramedic-treated patients. On multivariate analysis, revised trauma score > or =4.45 (odds ratio [OR] 2.31, 95% CI: 1.15-4.65), lower injury severity score (OR 1.04, 95% CI: 1.02-1.06), age< or =25 years (OR 1.76, 95% CI: 1.13-2.75), absence of an acute subdural haematoma (OR 3.36, 95% CI: 1.89-5.95) and prehospital treatment by a CCT (OR 2.70, 95% CI: 1.48-4.95) independently predicted better outcome. The range of advanced interventions provided by the CCT were associated with improved functional outcome. Further studies are required to determine the individual factors responsible.

Obstetric team simulation program challenges.

PubMed

Bullough, A S; Wagner, S; Boland, T; Waters, T P; Kim, K; Adams, W

2016-12-01

To describe the challenges associated with the development and assessment of an obstetric emergency team simulation program. The goal was to develop a hybrid, in-situ and high fidelity obstetric emergency team simulation program that incorporated weekly simulation sessions on the labor and delivery unit, and quarterly, education protected sessions in the simulation center. All simulation sessions were video-recorded and reviewed. Labor and delivery unit and simulation center. Medical staff covering labor and delivery, anesthesiology and obstetric residents and obstetric nurses. Assessments included an on-line knowledge multiple-choice questionnaire about the simulation scenarios. This was completed prior to the initial in-situ simulation session and repeated 3 months later, the Clinical Teamwork Scale with inter-rater reliability, participant confidence surveys and subjective participant satisfaction. A web-based curriculum comprising modules on communication skills, team challenges, and team obstetric emergency scenarios was also developed. Over 4 months, only 6 labor and delivery unit in-situ sessions out of a possible 14 sessions were carried out. Four high-fidelity sessions were performed in 2 quarterly education protected meetings in the simulation center. Information technology difficulties led to the completion of only 18 pre/post web-based multiple-choice questionnaires. These test results showed no significant improvement in raw score performance from pre-test to post-test (P=.27). During Clinical Teamwork Scale live and video assessment, trained raters and program faculty were in agreement only 31% and 28% of the time, respectively (Kendall's W=.31, P<.001 and W=.28, P<.001). Participant confidence surveys overall revealed confidence significantly increased (P<.05), from pre-scenario briefing to after post-scenario debriefing. Program feedback indicates a high level of participant satisfaction and improved confidence yet further program refinement is required. Copyright © 2016 Elsevier Inc. All rights reserved.

Using in situ simulation to identify and resolve latent environmental threats to patient safety: case study involving operational changes in a labor and delivery ward.

PubMed

Hamman, William R; Beaudin-Seiler, Beth M; Beaubien, Jeffrey M; Gullickson, Amy M; Orizondo-Korotko, Krystyna; Gross, Amy C; Fuqua, Wayne; Lammers, Richard

2010-01-01

Since the publication of "To Err Is Human" in 1999, health care professionals have looked to high-reliability industries such as aviation for guidance on improving system safety. One of the most widely adopted aviation-derived approaches is simulation-based team training, also known as crew resource management training. In the health care domain, crew resource management training often takes place in custom-built simulation laboratories that are designed to replicate operating rooms or labor and delivery rooms. Unlike these traditional crew resource management training programs, "in situ simulation" occurs on actual patient care units, involves actual health care team members, and uses actual organization processes to train and assess team performance. During the past 24 months, our research team has conducted nearly 40 in situ simulations. In this article, we present the results from 1 such simulation: a patient who experienced a difficult labor that resulted in an emergency caesarian section and hysterectomy. During the simulation, a number of latent environmental threats to safety were identified. This article presents the latent threats and the steps that the hospital has taken to remedy them.

Theoretically-Driven Infrastructure for Supporting Healthcare Teams Training at a Military Treatment Facility

NASA Technical Reports Server (NTRS)

Turner, Robert T.; Parodi, Andrea V.

2011-01-01

The Team Resource Center (TRC) at Naval Medical Center Portsmouth (NMCP) currently hosts a tri-service healthcare teams training course three times annually . The course consists of didactic learning coupled with simulation exercises to provide an interactive educational experience for healthcare professionals. The course is also the foundation of a research program designed to explore the use of simulation technologies for enhancing team training and evaluation. The TRC has adopted theoretical frameworks for evaluating training readiness and efficacy, and is using these frameworks to guide a systematic reconfiguration of the infrastructure supporting healthcare teams training and research initiatives at NMCP.

Introducing a Short Measure of Shared Servant Leadership Impacting Team Performance through Team Behavioral Integration.

PubMed

Sousa, Milton; Van Dierendonck, Dirk

2015-01-01

The research reported in this paper was designed to study the influence of shared servant leadership on team performance through the mediating effect of team behavioral integration, while validating a new short measure of shared servant leadership. A round-robin approach was used to collect data in two similar studies. Study 1 included 244 undergraduate students in 61 teams following an intense HRM business simulation of 2 weeks. The following year, study 2 included 288 students in 72 teams involved in the same simulation. The most important findings were that (1) shared servant leadership was a strong determinant of team behavioral integration, (2) information exchange worked as the main mediating process between shared servant leadership and team performance, and (3) the essence of servant leadership can be captured on the key dimensions of empowerment, humility, stewardship and accountability, allowing for a new promising shortened four-dimensional measure of shared servant leadership.

Generation of Simulated Tracking Data for LADEE Operational Readiness Testing

NASA Technical Reports Server (NTRS)

Woodburn, James; Policastri, Lisa; Owens, Brandon

2015-01-01

Operational Readiness Tests were an important part of the pre-launch preparation for the LADEE mission. The generation of simulated tracking data to stress the Flight Dynamics System and the Flight Dynamics Team was important for satisfying the testing goal of demonstrating that the software and the team were ready to fly the operational mission. The simulated tracking was generated in a manner to incorporate the effects of errors in the baseline dynamical model, errors in maneuver execution and phenomenology associated with various tracking system based components. The ability of the mission team to overcome these challenges in a realistic flight dynamics scenario indicated that the team and flight dynamics system were ready to fly the LADEE mission. Lunar Atmosphere and Dust Environment.

International trauma teleconference: evaluating trauma care and facilitating quality improvement.

PubMed

Parra, Michael W; Castillo, Roberto C; Rodas, Edgar B; Suarez-Becerra, Jose M; Puentes-Manosalva, Fabian E; Wendt, Luke M

2013-09-01

Evaluation, development, and implementation of trauma systems in Latin America are challenging undertakings as no model is currently in place that can be easily replicated throughout the region. The use of teleconferencing has been essential in overcoming other challenges in the medical field and improving medical care. This article describes the use of international videoconferencing in the field of trauma and critical care as a tool to evaluate differences in care based on local resources, as well as facilitating quality improvement and system development in Latin America. In February 2009, the International Trauma and Critical Care Improvement Project was created and held monthly teleconferences between U.S. trauma surgeons and Latin American general surgeons, emergency physicians, and intensivists. In-depth discussions and prospective evaluations of each case presented were conducted by all participants based on resources available. Care rendered was divided in four stages: (1) pre-hospital setting, (2) emergency room or trauma room, (3) operating room, and (4) subsequent postoperative care. Furthermore, the participating institutions completed an electronic survey of trauma resources based on World Health Organization/International Association for Trauma and Surgical Intensive Care guidelines. During a 17-month period, 15 cases in total were presented from a Level I and a Level II U.S. hospital (n=3) and five Latin American hospitals (n=12). Presentations followed the Advanced Trauma Life Support sequence in all U.S. cases but in only 3 of the 12 Latin American cases. The following deficiencies were observed in cases presented from Latin America: pre-hospital communication was nonexistent in all cases; pre-hospital services were absent in 60% of cases presented; lack of trauma team structure was evident in the emergency departments; during the initial evaluation and resuscitation, the Advanced Trauma Life Support protocol was followed one time and the Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage protocol on two occasions; it was determined that imaging resources were adequately used in half of the cases; the initial care was mostly provided by emergency room physicians; and a surgeon, operating room, and intensive care unit were not readily available 83% of the time. The ease of patient flow was cumbersome because of a lack of a structured system for trauma care except for one academic urban center. Adequate trauma resources are present in less than 50% of the time. Multidisciplinary resources, quality improvement programs, protocols, and guidelines were deficient. A well-structured international teleconference can be used as a dynamic window of observation to evaluate and identify deficiencies in trauma care in the Latin American region. These findings can be used to formulate specific recommendations based on local resources. Furthermore, by raising local awareness, leaders could be identified to become the executors of more efficient healthcare policies that can potentially affect trauma care.

Early effectiveness of endoscopic posterior urethra primary alignment.

PubMed

Kim, Fernando J; Pompeo, Alexandre; Sehrt, David; Molina, Wilson R; Mariano da Costa, Renato M; Juliano, Cesar; Moore, Ernest E; Stahel, Philip F

2013-08-01

Posterior urethra primary realignment (PUPR) after complete transection may decrease the gap between the ends of the transected urethra, tamponade the retropubic bleeding, and optimize urinary drainage without the need of suprapubic catheter facilitating concurrent pelvic orthopedic and trauma procedures. Historically, the distorted anatomy after pelvic trauma has been a major surgical challenge. The purpose of the study was to assess the relationship of the severity of the pelvic fracture to the success of endoscopic and immediate PUPR following complete posterior urethral disruption using the Young-Burgess classification system. A review of our Level I trauma center database for patients diagnosed with pelvic fracture and complete posterior urethral disruption from January 2005 to April 2012 was performed. Pelvic fracture severity was categorized according to the Young-Burgees classification system. Management consisted of suprapubic catheter insertion at diagnosis followed by early urethral realignment when the patient was clinically stable. Failure of realignment was defined as inability to achieve urethral continuity with Foley catheterization. Clinical follow-up consisted of radiologic, pressure studies and cystoscopic evaluation. A total of 481 patients with pelvic trauma from our trauma registry were screened initially, and 18 (3.7%) were diagnosed with a complete posterior urethral disruption. A total of 15 primary realignments (83.3%) were performed all within 5 days of trauma. The success rate of early realignment was 100%. There was no correlation between the type of pelvic ring fracture and the success of PUPR. Postoperatively, 8 patients (53.3%) developed urethral strictures, 3 patients (20.0%) developed incontinence, and 7 patients (46.7%) reported erectile dysfunction after the trauma. The mean follow-up of these patients was 31.8 months. Endoscopic PUPR may be an effective option for the treatment of complete posterior urethral disruption and enables urinary drainage to best suit the multispecialty surgical team. The success rate of achieving primary realignment did not appear to be related to the complexity and type of pelvic ring fracture.

The Libyan civil conflict: selected case series of orthopaedic trauma managed in Malta in 2014.

PubMed

Ng, Colin; Mifsud, Max; Borg, Joseph N; Mizzi, Colin

2015-11-20

The purpose of this series of cases was to analyse our management of orthopaedic trauma casualties in the Libyan civil war crisis in the European summer of 2014. We looked at both damage control orthopaedics and for case variety of war trauma at a civilian hospital. Due to our geographical proximity to Libya, Malta was the closest European tertiary referral centre. Having only one Level 1 trauma care hospital in our country, our Trauma and Orthopaedics department played a pivotal role in the management of Libyan battlefield injuries. Our aims were to assess acute outcomes and short term mortality of surgery within the perspective of a damage control orthopaedic strategy whereby aggressive wound management, early fixation using relative stability principles, antibiotic cover with adequate soft tissue cover are paramount. We also aim to describe the variety of war injuries we came across, with a goal for future improvement in regards to service providing. Prospective collection of six interesting cases with severe limb and spinal injuries sustained in Libya during the Libyan civil war between June and November 2014. We applied current trends in the treatment of war injuries, specifically in damage control orthopaedic strategy and converting to definitive treatment where permissible. The majority of our cases were classified as most severe (Type IIIB/C) according to the Gustilo-Anderson classification of open fractures. The injuries treated reflected the type of standard and improved weaponry available in modern warfare affecting both militants and civilians alike with increasing severity and extent of damage. Due to this fact, multidisciplinary team approach to patient centred care was utilised with an ultimate aim of swift recovery and early mobilisation. It also highlighted the difficulties and complex issues required on a hospital management level as a neighbouring country to war zone countries in transforming care of civil trauma to military trauma.

Summaries of Research - Fiscal Year 1985.

DTIC Science & Technology

1986-01-01

emergencies, not trauma-related, 2) diagnosis of dental emergencies, trauma-related, 3) differential diagnosis of soft tissue lesions, 4) definitions of terms...on 49 different soft tissue lesions. Preliminary validation was accomplished by a variety of dentists who input over 200 simulated emergencies. The...non-specific opsonin, that promotes adhesion of fibroblasts to collagen, and influences the attachment of bacteria to soft tissues . As a first step

Members Matter in Team Training: Multilevel and Longitudinal Relationships between Goal Orientation, Self-Regulation, and Team Outcomes

ERIC Educational Resources Information Center

Dierdorff, Erich C.; Ellington, J. Kemp

2012-01-01

Longitudinal data from 338 individuals across 64 teams in a simulation-based team-training context were used to examine the effects of dispositional goal orientation on self-regulated learning (self-efficacy and metacognition). Team goal orientation compositions, as reflected by average goal orientations of team members, were examined for…

Interactions of Team Mental Models and Monitoring Behaviors Predict Team Performance in Simulated Anesthesia Inductions

ERIC Educational Resources Information Center

Burtscher, Michael J.; Kolbe, Michaela; Wacker, Johannes; Manser, Tanja

2011-01-01

In the present study, we investigated how two team mental model properties (similarity vs. accuracy) and two forms of monitoring behavior (team vs. systems) interacted to predict team performance in anesthesia. In particular, we were interested in whether the relationship between monitoring behavior and team performance was moderated by team…

Team Regulation in a Simulated Medical Emergency: An In-Depth Analysis of Cognitive, Metacognitive, and Affective Processes

ERIC Educational Resources Information Center

Duffy, Melissa C.; Azevedo, Roger; Sun, Ning-Zi; Griscom, Sophia E.; Stead, Victoria; Crelinsten, Linda; Wiseman, Jeffrey; Maniatis, Thomas; Lachapelle, Kevin

2015-01-01

This study examined the nature of cognitive, metacognitive, and affective processes among a medical team experiencing difficulty managing a challenging simulated medical emergency case by conducting in-depth analysis of process data. Medical residents participated in a simulation exercise designed to help trainees to develop medical expertise,…

Simulation Models for Developing an Individualized, Performance Criterion Learning Situation. Technical Monograph No. 21.

ERIC Educational Resources Information Center

Anderson, G. Ernest, Jr.

The mission of the simulation team of the Model Elementary Teacher Education Project, 1968-71, was to develop simulation tools and conduct appropriate studies of the anticipated operation of that project. The team focused on the experiences of individual students and on the resources necessary for these experiences to be reasonable. This report…

A Qualitative Exploration of the Influence a Simulated Virtual Team Learning Experience Had on Business School Students' Leadership Competencies

ERIC Educational Resources Information Center

Standard Smith, Kristy

2008-01-01

The purpose of this qualitative study was to explore the influence a simulated virtual team learning experience had on business school students' leadership competencies. The researcher sought to discover the relationship between filling the leadership role in the simulated virtual environment and developing leadership competencies. A…

Incorporating Reflective Practice into Team Simulation Projects for Improved Learning Outcomes

ERIC Educational Resources Information Center

Wills, Katherine V.; Clerkin, Thomas A.

2009-01-01

The use of simulation games in business courses is a popular method for providing undergraduate students with experiences similar to those they might encounter in the business world. As such, in 2003 the authors were pleased to find a classroom simulation tool that combined the decision-making and team experiences of a senior management group with…

Evaluation of a computer-based educational intervention to improve medical teamwork and performance during simulated patient resuscitations.

PubMed

Fernandez, Rosemarie; Pearce, Marina; Grand, James A; Rench, Tara A; Jones, Kerin A; Chao, Georgia T; Kozlowski, Steve W J

2013-11-01

To determine the impact of a low-resource-demand, easily disseminated computer-based teamwork process training intervention on teamwork behaviors and patient care performance in code teams. A randomized comparison trial of computer-based teamwork training versus placebo training was conducted from August 2010 through March 2011. This study was conducted at the simulation suite within the Kado Family Clinical Skills Center, Wayne State University School of Medicine. Participants (n = 231) were fourth-year medical students and first-, second-, and third-year emergency medicine residents at Wayne State University. Each participant was assigned to a team of four to six members (nteams = 45). Teams were randomly assigned to receive either a 25-minute computer-based training module targeting appropriate resuscitation teamwork behaviors or a placebo training module. Teamwork behaviors and patient care behaviors were video recorded during high-fidelity simulated patient resuscitations and coded by trained raters blinded to condition assignment and study hypotheses. Teamwork behavior items (e.g., "chest radiograph findings communicated to team" and "team member assists with intubation preparation") were standardized before combining to create overall teamwork scores. Similarly, patient care items ("chest radiograph correctly interpreted"; "time to start of compressions") were standardized before combining to create overall patient care scores. Subject matter expert reviews and pilot testing of scenario content, teamwork items, and patient care items provided evidence of content validity. When controlling for team members' medically relevant experience, teams in the training condition demonstrated better teamwork (F [1, 42] = 4.81, p < 0.05; ηp = 10%) and patient care (F [1, 42] = 4.66, p < 0.05; ηp = 10%) than did teams in the placebo condition. Computer-based team training positively impacts teamwork and patient care during simulated patient resuscitations. This low-resource team training intervention may help to address the dissemination and sustainability issues associated with larger, more costly team training programs.

Designing Real-time Decision Support for Trauma Resuscitations

PubMed Central

Yadav, Kabir; Chamberlain, James M.; Lewis, Vicki R.; Abts, Natalie; Chawla, Shawn; Hernandez, Angie; Johnson, Justin; Tuveson, Genevieve; Burd, Randall S.

2016-01-01

Background Use of electronic clinical decision support (eCDS) has been recommended to improve implementation of clinical decision rules. Many eCDS tools, however, are designed and implemented without taking into account the context in which clinical work is performed. Implementation of the pediatric traumatic brain injury (TBI) clinical decision rule at one Level I pediatric emergency department includes an electronic questionnaire triggered when ordering a head computed tomography using computerized physician order entry (CPOE). Providers use this CPOE tool in less than 20% of trauma resuscitation cases. A human factors engineering approach could identify the implementation barriers that are limiting the use of this tool. Objectives The objective was to design a pediatric TBI eCDS tool for trauma resuscitation using a human factors approach. The hypothesis was that clinical experts will rate a usability-enhanced eCDS tool better than the existing CPOE tool for user interface design and suitability for clinical use. Methods This mixed-methods study followed usability evaluation principles. Pediatric emergency physicians were surveyed to identify barriers to using the existing eCDS tool. Using standard trauma resuscitation protocols, a hierarchical task analysis of pediatric TBI evaluation was developed. Five clinical experts, all board-certified pediatric emergency medicine faculty members, then iteratively modified the hierarchical task analysis until reaching consensus. The software team developed a prototype eCDS display using the hierarchical task analysis. Three human factors engineers provided feedback on the prototype through a heuristic evaluation, and the software team refined the eCDS tool using a rapid prototyping process. The eCDS tool then underwent iterative usability evaluations by the five clinical experts using video review of 50 trauma resuscitation cases. A final eCDS tool was created based on their feedback, with content analysis of the evaluations performed to ensure all concerns were identified and addressed. Results Among 26 EPs (76% response rate), the main barriers to using the existing tool were that the information displayed is redundant and does not fit clinical workflow. After the prototype eCDS tool was developed based on the trauma resuscitation hierarchical task analysis, the human factors engineers rated it to be better than the CPOE tool for nine of 10 standard user interface design heuristics on a three-point scale. The eCDS tool was also rated better for clinical use on the same scale, in 84% of 50 expert–video pairs, and was rated equivalent in the remainder. Clinical experts also rated barriers to use of the eCDS tool as being low. Conclusions An eCDS tool for diagnostic imaging designed using human factors engineering methods has improved perceived usability among pediatric emergency physicians. PMID:26300010

Simulation-based multiprofessional obstetric anaesthesia training conducted in situ versus off-site leads to similar individual and team outcomes: a randomised educational trial.

PubMed

Sørensen, Jette Led; van der Vleuten, Cees; Rosthøj, Susanne; Østergaard, Doris; LeBlanc, Vicki; Johansen, Marianne; Ekelund, Kim; Starkopf, Liis; Lindschou, Jane; Gluud, Christian; Weikop, Pia; Ottesen, Bent

2015-10-06

To investigate the effect of in situ simulation (ISS) versus off-site simulation (OSS) on knowledge, patient safety attitude, stress, motivation, perceptions of simulation, team performance and organisational impact. Investigator-initiated single-centre randomised superiority educational trial. Obstetrics and anaesthesiology departments, Rigshospitalet, University of Copenhagen, Denmark. 100 participants in teams of 10, comprising midwives, specialised midwives, auxiliary nurses, nurse anaesthetists, operating theatre nurses, and consultant doctors and trainees in obstetrics and anaesthesiology. Two multiprofessional simulations (clinical management of an emergency caesarean section and a postpartum haemorrhage scenario) were conducted in teams of 10 in the ISS versus the OSS setting. Knowledge assessed by a multiple choice question test. Individual outcomes: scores on the Safety Attitudes Questionnaire, stress measurements (State-Trait Anxiety Inventory, cognitive appraisal and salivary cortisol), Intrinsic Motivation Inventory and perceptions of simulations. Team outcome: video assessment of team performance. Organisational impact: suggestions for organisational changes. The trial was conducted from April to June 2013. No differences between the two groups were found for the multiple choice question test, patient safety attitude, stress measurements, motivation or the evaluation of the simulations. The participants in the ISS group scored the authenticity of the simulation significantly higher than did the participants in the OSS group. Expert video assessment of team performance showed no differences between the ISS versus the OSS group. The ISS group provided more ideas and suggestions for changes at the organisational level. In this randomised trial, no significant differences were found regarding knowledge, patient safety attitude, motivation or stress measurements when comparing ISS versus OSS. Although participant perception of the authenticity of ISS versus OSS differed significantly, there were no differences in other outcomes between the groups except that the ISS group generated more suggestions for organisational changes. NCT01792674. 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.

Addressing Dual Patient and Staff Safety Through A Team-Based Standardized Patient Simulation for Agitation Management in the Emergency Department.

PubMed

Wong, Ambrose H; Auerbach, Marc A; Ruppel, Halley; Crispino, Lauren J; Rosenberg, Alana; Iennaco, Joanne D; Vaca, Federico E

2018-06-01

Emergency departments (EDs) have seen harm rise for both patients and health workers from an increasing rate of agitation events. Team effectiveness during care of this population is particularly challenging because fear of physical harm leads to competing interests. Simulation is frequently employed to improve teamwork in medical resuscitations but has not yet been reported to address team-based behavioral emergency care. As part of a larger investigation of agitated patient care, we designed this secondary study to examine the impact of an interprofessional standardized patient simulation for ED agitation management. We used a mixed-methods approach with emergency medicine resident and attending physicians, Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRNs), ED nurses, technicians, and security officers at two hospital sites. After a simulated agitated patient encounter, we conducted uniprofessional and interprofessional focus groups. We undertook structured thematic analysis using a grounded theory approach. Quantitative data consisted of responses to the KidSIM Questionnaire addressing teamwork and simulation-based learning attitudes before and after each session. We reached data saturation with 57 participants. KidSIM scores revealed significant improvements in attitudes toward relevance of simulation, opportunities for interprofessional education, and situation awareness, as well as four of six questions for roles/responsibilities. Two broad themes emerged from the focus groups: (1) a team-based agitated patient simulation addressed dual safety of staff and patients simultaneously and (2) the experience fostered interprofessional discovery and cooperation in agitation management. A team-based simulated agitated patient encounter highlighted the need to consider the dual safety of staff and patients while facilitating interprofessional dialog and learning. Our findings suggest that simulation may be effective to enhance teamwork in behavioral emergency care.

Optimisation of simulated team training through the application of learning theories: a debate for a conceptual framework

PubMed Central

2014-01-01

Background As a conceptual review, this paper will debate relevant learning theories to inform the development, design and delivery of an effective educational programme for simulated team training relevant to health professionals. Discussion Kolb’s experiential learning theory is used as the main conceptual framework to define the sequence of activities. Dewey’s theory of reflective thought and action, Jarvis modification of Kolb’s learning cycle and Schön’s reflection-on-action serve as a model to design scenarios for optimal concrete experience and debriefing for challenging participants’ beliefs and habits. Bandura’s theory of self-efficacy and newer socio-cultural learning models outline that for efficient team training, it is mandatory to introduce the social-cultural context of a team. Summary The ideal simulated team training programme needs a scenario for concrete experience, followed by a debriefing with a critical reflexive observation and abstract conceptualisation phase, and ending with a second scenario for active experimentation. Let them re-experiment to optimise the effect of a simulated training session. Challenge them to the edge: The scenario needs to challenge participants to generate failures and feelings of inadequacy to drive and motivate team members to critical reflect and learn. Not experience itself but the inadequacy and contradictions of habitual experience serve as basis for reflection. Facilitate critical reflection: Facilitators and group members must guide and motivate individual participants through the debriefing session, inciting and empowering learners to challenge their own beliefs and habits. To do this, learners need to feel psychological safe. Let the group talk and critical explore. Motivate with reality and context: Training with multidisciplinary team members, with different levels of expertise, acting in their usual environment (in-situ simulation) on physiological variables is mandatory to introduce cultural context and social conditions to the learning experience. Embedding in situ team training sessions into a teaching programme to enable repeated training and to assess regularly team performance is mandatory for a cultural change of sustained improvement of team performance and patient safety. PMID:24694243

Simulation Exploration Experience 2018 Overview

NASA Technical Reports Server (NTRS)

Paglialonga, Stephen; Elfrey, Priscilla; Crues, Edwin Z.

2018-01-01

The Simulation Exploration Experience (SEE) joins students, industry, professional associations, and faculty together for an annual modeling and simulation (M&S) challenge. SEE champions collaborative collegiate-level modeling and simulation by providing a venue for students to work in highly dispersed inter-university teams to design, develop, test, and execute simulated missions associated with space exploration. Participating teams gain valuable knowledge, skills, and increased employability by working closely with industry professionals, NASA, and faculty advisors. This presentation gives and overview of the SEE and the upcoming 2018 SEE event.

Conceptualizing Interprofessional Teams as Multi-Team Systems-Implications for Assessment and Training.

PubMed

West, Courtney; Landry, Karen; Graham, Anna; Graham, Lori; Cianciolo, Anna T; Kalet, Adina; Rosen, Michael; Sherman, Deborah Witt

2015-01-01

SGEA 2015 CONFERENCE ABSTRACT (EDITED). Evaluating Interprofessional Teamwork During a Large-Scale Simulation. Courtney West, Karen Landry, Anna Graham, and Lori Graham. CONSTRUCT: This study investigated the multidimensional measurement of interprofessional (IPE) teamwork as part of large-scale simulation training. Healthcare team function has a direct impact on patient safety and quality of care. However, IPE team training has not been the norm. Recognizing the importance of developing team-based collaborative care, our College of Nursing implemented an IPE simulation activity called Disaster Day and invited other professions to participate. The exercise consists of two sessions: one in the morning and another in the afternoon. The disaster scenario is announced just prior to each session, which consists of team building, a 90-minute simulation, and debriefing. Approximately 300 Nursing, Medicine, Pharmacy, Emergency Medical Technicians, and Radiology students and over 500 standardized and volunteer patients participated in the Disaster Day event. To improve student learning outcomes, we created 3 competency-based instruments to evaluate collaborative practice in multidimensional fashion during this exercise. A 20-item IPE Team Observation Instrument designed to assess interprofessional team's attainment of Interprofessional Education Collaborative (IPEC) competencies was completed by 20 faculty and staff observing the Disaster Day simulation. One hundred sixty-six standardized patients completed a 10-item Standardized Patient IPE Team Evaluation Instrument developed from the IPEC competencies and adapted items from the 2014 Henry et al. PIVOT Questionnaire. This instrument assessed the standardized or volunteer patient's perception of the team's collaborative performance. A 29-item IPE Team's Perception of Collaborative Care Questionnaire, also created from the IPEC competencies and divided into 5 categories of Values/Ethics, Roles and Responsibilities, Communication, Teamwork, and Self-Evaluation, was completed by 188 students including 99 from Nursing, 43 from Medicine, 6 from Pharmacy, and 40 participants who belonged to more than one component, were students at another institution, or did not indicate their institution. The team instrument was designed to assess each team member's perception of how well the team and him- or herself met the competencies. Five of the items on the team perceptions questionnaire mirrored items on the standardized patient evaluation: demonstrated leadership practices that led to effective teamwork, discussed care and decisions about that care with patient, described roles and responsibilities clearly, worked well together to coordinate care, and good/effective communication. Internal consistency reliability of the IPE Team Observation Instrument was 0.80. In 18 of the 20 items, more than 50% of observers indicated the item was demonstrated. Of those, 6 of the items were observed by 50% to 75% of the observers, and the remaining 12 were observed by more than 80% of the observers. Internal consistency reliability of the IPE Team's Perception of Collaborative Care Instrument was 0.95. The mean response score-1 (strongly disagree) to 4 (strongly agree)-was calculated for each section of the instrument. The overall mean score was 3.57 (SD = .11). Internal consistency reliability of the Standardized Patient IPE Team Evaluation Instrument was 0.87. The overall mean score was 3.28 (SD = .17). The ratings for the 5 items shared by the standardized patient and team perception instruments were compared using independent sample t tests. Statistically significant differences (p < .05) were present in each case, with the students rating themselves higher on average than the standardized patients did (mean differences between 0.2 and 0.6 on a scale of 1-4). Multidimensional, competency-based instruments appear to provide a robust view of IPE teamwork; however, challenges remain. Due to the large scale of the simulation exercise, observation-based assessment did not function as well as self- and standardized patient-based assessment. To promote greater variation in observer assessments during future Disaster Day simulations, we plan to adjust the rating scale from "not observed," "observed," and "not applicable" to a 4-point scale and reexamine interrater reliability.

Lead us not into tanktation: a simulation modelling approach to gain insights into incentives for sporting teams to tank.

PubMed

Tuck, Geoffrey N; Whitten, Athol R

2013-01-01

Annual draft systems are the principal method used by teams in major sporting leagues to recruit amateur players. These draft systems frequently take one of three forms: a lottery style draft, a weighted draft, or a reverse-order draft. Reverse-order drafts can create incentives for teams to deliberately under-perform, or tank, due to the perceived gain from obtaining quality players at higher draft picks. This paper uses a dynamic simulation model that captures the key components of a win-maximising sporting league, including the amateur player draft, draft choice error, player productivity, and between-team competition, to explore how competitive balance and incentives to under-perform vary according to league characteristics. We find reverse-order drafts can lead to some teams cycling between success and failure and to other teams being stuck in mid-ranking positions for extended periods of time. We also find that an incentive for teams to tank exists, but that this incentive decreases (i) as uncertainty in the ability to determine quality players in the draft increases, (ii) as the number of teams in the league reduces, (iii) as team size decreases, and (iv) as the number of teams adopting a tanking strategy increases. Simulation models can be used to explore complex stochastic dynamic systems such as sports leagues, where managers face difficult decisions regarding the structure of their league and the desire to maintain competitive balance.

Lead Us Not into Tanktation: A Simulation Modelling Approach to Gain Insights into Incentives for Sporting Teams to Tank

PubMed Central

Tuck, Geoffrey N.; Whitten, Athol R.

2013-01-01

Annual draft systems are the principal method used by teams in major sporting leagues to recruit amateur players. These draft systems frequently take one of three forms: a lottery style draft, a weighted draft, or a reverse-order draft. Reverse-order drafts can create incentives for teams to deliberately under-perform, or tank, due to the perceived gain from obtaining quality players at higher draft picks. This paper uses a dynamic simulation model that captures the key components of a win-maximising sporting league, including the amateur player draft, draft choice error, player productivity, and between-team competition, to explore how competitive balance and incentives to under-perform vary according to league characteristics. We find reverse-order drafts can lead to some teams cycling between success and failure and to other teams being stuck in mid-ranking positions for extended periods of time. We also find that an incentive for teams to tank exists, but that this incentive decreases (i) as uncertainty in the ability to determine quality players in the draft increases, (ii) as the number of teams in the league reduces, (iii) as team size decreases, and (iv) as the number of teams adopting a tanking strategy increases. Simulation models can be used to explore complex stochastic dynamic systems such as sports leagues, where managers face difficult decisions regarding the structure of their league and the desire to maintain competitive balance. PMID:24312243

Teaching communication and supporting autonomy with a team-based operative simulator.

PubMed

Cook, Mackenzie R; Deal, Shanley B; Scott, Jessica M; Moren, Alexis M; Kiraly, Laszlo N

2016-09-01

Changing residency structure emphasizes the need for formal instruction on team leadership and intraoperative teaching skills. A high fidelity, multi-learner surgical simulation may offer opportunities for senior learners (SLs) to learn these skills while teaching technical skills to junior learners (JLs). We designed and optimized a low-cost inguinal hernia model that paired JLs and SLs as an operative team. This was tested in 3 pilot simulations. Participants' feedback was analyzed using qualitative methods. JL feedback to SLs included the themes "guiding and instructing" and "allowing autonomy." Senior Learner feedback to JLs focused on "mechanics," "knowledge," and "perspective/flow." Both groups focused on "communication" and "professionalism." A multi-learner simulation can successfully meet the technical learning needs of JLs and the teaching and communication learning needs of SLs. This model of resident-driven simulation may illustrate future opportunities for operative simulation. Copyright © 2016 Elsevier Inc. All rights reserved.

Waterborne Disease Case Investigation: Public Health Nursing Simulation.

PubMed

Alexander, Gina K; Canclini, Sharon B; Fripp, Jon; Fripp, William

2017-01-01

The lack of safe drinking water is a significant public health threat worldwide. Registered nurses assess the physical environment, including the quality of the water supply, and apply environmental health knowledge to reduce environmental exposures. The purpose of this research brief is to describe a waterborne disease simulation for students enrolled in a public health nursing (PHN) course. A total of 157 undergraduate students completed the simulation in teams, using the SBAR (Situation-Background-Assessment-Recommendation) reporting tool. Simulation evaluation consisted of content analysis of the SBAR tools and debriefing notes. Student teams completed the simulation and articulated the implications for PHN practice. Student teams discussed assessment findings and primarily recommended four nursing interventions: health teaching focused on water, sanitation, and hygiene; community organizing; collaboration; and advocacy to ensure a safe water supply. With advanced planning and collaboration with partners, waterborne disease simulation may enhance PHN education. [J Nurs Educ. 2017;56(1):39-42.]. Copyright 2017, SLACK Incorporated.

Effect of a simulation-based workshop on multidisplinary teamwork of newborn emergencies: an intervention study.

PubMed

Rovamo, Liisa; Nurmi, Elisa; Mattila, Minna-Maria; Suominen, Pertti; Silvennoinen, Minna

2015-11-12

Video analyses of real-life newborn resuscitations have shown that Neonatal Resuscitation Program (NRP) guidelines are followed in fewer than 50% of cases. Multidisciplinary simulation is used as a first-rate tool for the improvement of teamwork among health professionals. In the study we evaluated the impact of the crisis resource management (CRM) and anesthesia non-technical skills instruction on teamwork during simulated newborn emergencies. Ninety-nine participants of two delivery units (17 pediatricians, 16 anesthesiologists, 14 obstetricians, 31 midwives, and 21 neonatal nurses) were divided to an intervention group (I-group, 9 teams) and a control group (C-group, 6 teams). The I-group attended a CRM and ANTS instruction before the first scenario. After each scenario the I-group performed either self- or peer-assessment depending on whether they had acted or observed in the scenario. All the teams participated in two and observed another two scenarios. All the scenarios were video-recorded and scored by three experts with Team Emergency Assessment Measure (TEAM). SPSS software and nlme package were used for the statistical analyses. The total TEAM scores of the first scenario between the I- and C-group did not differ from each other. Neither there was an increase in the TEAM scoring between the first and second scenario between the groups. The CRM instruction did not improve the I-group's teamwork performance. Unfortunately the teams were not comparable because the teams had been allowed to self-select their members in the study design. The total TEAM scores varied a lot between the teams. Mixed-model linear regression revealed that the background of the team leader had an impact on differences of the total teamwork scores (D = 6.50, p = 0.039). When an anesthesia consultant was the team leader the mean teamwork improved by 6.41 points in comparison to specialists of other disciplines (p = 0.043). The instruction of non-technical skills before simulation training did not enhance the acquisition of teamwork skills of the intervention groups over the corresponding set of skills of the control groups. The teams led by an anesthesiologist scored the best. Experience of team leaders improved teamwork over the CRM instruction.

Can focused trauma education initiatives reduce mortality or improve resource utilization in a low-resource setting?

PubMed

Petroze, Robin T; Byiringiro, Jean Claude; Ntakiyiruta, Georges; Briggs, Susan M; Deckelbaum, Dan L; Razek, Tarek; Riviello, Robert; Kyamanywa, Patrick; Reid, Jennifer; Sawyer, Robert G; Calland, J Forrest

2015-04-01

Over 90% of injury deaths occur in low-income countries. Evaluating the impact of focused trauma courses in these settings is challenging. We hypothesized that implementation of a focused trauma education initiative in a low-income country would result in measurable differences in injury-related outcomes and resource utilization. Two 3-day trauma education courses were conducted in the Rwandan capital over a one-month period (October-November, 2011). An ATLS provider demonstration course was delivered to 24 faculty surgeons and 15 Rwandan trauma nurse auditors, and a Canadian Network for International Surgery Trauma Team Training (TTT) course was delivered to 25 faculty, residents, and nurses. Trauma registry data over the 6 months prior to the courses were compared to the 6 months afterward with emergency department (ED) mortality as the primary endpoint. Secondary endpoints included radiology utilization and early procedural interventions. Univariate analyses were conducted using χ(2) and Fisher's exact test. A total of 798 and 575 patients were prospectively studied during the pre-intervention and post-intervention periods, respectively. Overall mortality of injured patients decreased after education implementation from 8.8 to 6.3%, but was not statistically significant (p = 0.09). Patients with an initial Glasgow Coma Score (GCS) of 3-8 had the highest injury-related mortality, which significantly decreased from 58.5% (n = 55) to 37.1% (n = 23), (p = 0.009, OR 0.42, 95% CI 0.22-0.81). There was no statistical difference in the rates of early intubation, cervical collar use, imaging studies, or transfusion in the overall cohort or the head injury subset. When further stratified by GCS, patients with an initial GCS of 3-5 in the post-intervention period had higher utilization of head CT scans and chest X-rays. The mortality of severely injured patients decreased after initiation of focused trauma education courses, but no significant increase in resource utilization was observed. The explanation may be complex and multi-factorial. Long-term multidisciplinary efforts that pair training with changes in resources and mentorship may be needed to produce broad and lasting changes in the overall care system.

Computer-based simulation training to improve learning outcomes in mannequin-based simulation exercises.

PubMed

Curtin, Lindsay B; Finn, Laura A; Czosnowski, Quinn A; Whitman, Craig B; Cawley, Michael J

2011-08-10

To assess the impact of computer-based simulation on the achievement of student learning outcomes during mannequin-based simulation. Participants were randomly assigned to rapid response teams of 5-6 students and then teams were randomly assigned to either a group that completed either computer-based or mannequin-based simulation cases first. In both simulations, students used their critical thinking skills and selected interventions independent of facilitator input. A predetermined rubric was used to record and assess students' performance in the mannequin-based simulations. Feedback and student performance scores were generated by the software in the computer-based simulations. More of the teams in the group that completed the computer-based simulation before completing the mannequin-based simulation achieved the primary outcome for the exercise, which was survival of the simulated patient (41.2% vs. 5.6%). The majority of students (>90%) recommended the continuation of simulation exercises in the course. Students in both groups felt the computer-based simulation should be completed prior to the mannequin-based simulation. The use of computer-based simulation prior to mannequin-based simulation improved the achievement of learning goals and outcomes. In addition to improving participants' skills, completing the computer-based simulation first may improve participants' confidence during the more real-life setting achieved in the mannequin-based simulation.

Lean Participative Process Improvement: Outcomes and Obstacles in Trauma Orthopaedics

PubMed Central

New, Steve; Hadi, Mohammed; Pickering, Sharon; Robertson, Eleanor; Morgan, Lauren; Griffin, Damian; Collins, Gary; Rivero-Arias, Oliver; Catchpole, Ken; McCulloch, Peter

2016-01-01

Objectives To examine the effectiveness of a “systems” approach using Lean methodology to improve surgical care, as part of a programme of studies investigating possible synergy between improvement approaches. Setting A controlled before-after study using the orthopaedic trauma theatre of a UK Trust hospital as the active site and an elective orthopaedic theatre in the same Trust as control. Participants All staff involved in surgical procedures in both theatres. Interventions A one-day “lean” training course delivered by an experienced specialist team was followed by support and assistance in developing a 6 month improvement project. Clinical staff selected the subjects for improvement and designed the improvements. Outcome Measures We compared technical and non-technical team performance in theatre using WHO checklist compliance evaluation, “glitch count” and Oxford NOTECHS II in a sample of directly observed operations, and patient outcome (length of stay, complications and readmissions) for all patients. We collected observational data for 3 months and clinical data for 6 months before and after the intervention period. We compared changes in measures using 2-way analysis of variance. Results We studied 576 cases before and 465 after intervention, observing the operation in 38 and 41 cases respectively. We found no significant changes in team performance or patient outcome measures. The intervention theatre staff focused their efforts on improving first patient arrival time, which improved by 20 minutes after intervention. Conclusions This version of “lean” system improvement did not improve measured safety processes or outcomes. The study highlighted an important tension between promoting staff ownership and providing direction, which needs to be managed in “lean” projects. Space and time for staff to conduct improvement activities are important for success. PMID:27124012

A cross-sectional study of knife injuries at a London major trauma centre

PubMed Central

Sutherland, E; Glucksman, E; Tunnicliff, M; Keep, JW

2014-01-01

INTRODUCTION No national recording systems for knife injuries exist in the UK. Understanding the true size and nature of the problem of knife injuries is the first stage in reducing the burden of this injury. The aim of this study was to survey every knife injury seen in a single inner city emergency department (ED) over a one-year period. METHODS A cross-sectional observational study was performed of all patients attending with a knife injury to the ED of a London major trauma centre in 2011. Demographic characteristics, patterns of injury, morbidity and mortality data were collected. RESULTS A total of 938 knife injuries were identified from 127,191 attendances (0.77% of all visits) with a case fatality rate of 0.53%. A quarter (24%) of the major trauma team’s caseload was for knife injuries. Overall, 44% of injuries were selfreported as assaults, 49% as accidents and 8% as deliberate self-harm. The highest age specific incident rate occurred in the 16–24 year age category (263/100,000). Multiple injuries were seen in 19% of cases, of which only 81% were recorded as assaults. The mean length of stay for those admitted to hospital was 3.04 days. Intrathoracic injury was seen in 26% of cases of chest trauma and 24% of abdominal injuries had a second additional chest injury. CONCLUSIONS Violent intentional injuries are a significant contributory factor to the workload of the major trauma team at this centre. This paper contributes to a more comprehensive understanding of the nature of these injuries seen in the ED. PMID:24417825

Prehospital Blood Product Resuscitation for Trauma: A Systematic Review

PubMed Central

Smith, Iain M.; James, Robert H.; Dretzke, Janine; Midwinter, Mark J.

2016-01-01

ABSTRACT Introduction: Administration of high ratios of plasma to packed red blood cells is a routine practice for in-hospital trauma resuscitation. Military and civilian emergency teams are increasingly carrying prehospital blood products (PHBP) for trauma resuscitation. This study systematically reviewed the clinical literature to determine the extent to which the available evidence supports this practice. Methods: Bibliographic databases and other sources were searched to July 2015 using keywords and index terms related to the intervention, setting, and condition. Standard systematic review methodology aimed at minimizing bias was used for study selection, data extraction, and quality assessment (protocol registration PROSPERO: CRD42014013794). Synthesis was mainly narrative with random effects model meta-analysis limited to mortality outcomes. Results: No prospective comparative or randomized studies were identified. Sixteen case series and 11 comparative studies were included in the review. Seven studies included mixed populations of trauma and non-trauma patients. Twenty-five of 27 studies provided only very low quality evidence. No association between PHBP and survival was found (OR for mortality: 1.29, 95% CI: 0.84–1.96, P = 0.24). A single study showed improved survival in the first 24 h. No consistent physiological or biochemical benefit was identified, nor was there evidence of reduced in-hospital transfusion requirements. Transfusion reactions were rare, suggesting the short-term safety of PHBP administration. Conclusions: While PHBP resuscitation appears logical, the clinical literature is limited, provides only poor quality evidence, and does not demonstrate improved outcomes. No conclusions as to efficacy can be drawn. The results of randomized controlled trials are awaited. PMID:26825635

Prognosis and treatment of pancreaticoduodenal traumatic injuries: which factors are predictors of outcome?

PubMed

Antonacci, Nicola; Di Saverio, Salomone; Ciaroni, Valentina; Biscardi, Andrea; Giugni, Aimone; Cancellieri, Francesco; Coniglio, Carlo; Cavallo, Piergiorgio; Giorgini, Eleonora; Baldoni, Franco; Gordini, Giovanni; Tugnoli, Gregorio

2011-03-01

Abdominal trauma rarely causes injuries involving the duodenum and pancreas. Associated injuries occur in 46% of all pancreatic injuries. The morbidity and mortality of pancreaticoduodenal injuries remain high. The present study is a retrospective review of our experience from 1989 to 2008 in the surgical treatment of traumatic pancreaticoduodenal injuries. Mortality, morbidity, prognostic factors, and the value of surgical techniques were analyzed. In our level I Trauma Center, between 1989 and 2008, 55 patients had a pancreaticoduodenal injury. In 68.5% of cases pancreatic injuries were found, 20.4% had duodenal injury, and 11.1% suffered combined pancreaticoduodenal injuries; 85.3% of the patients had blunt abdominal trauma, while 14.9% had penetrating injuries. We treated 78.1% of the patients with external drainage and/or simple suture; distal pancreatectomy was performed in 9% of cases and duodenal resection with anastomosis (3.7%) and diversion procedures (3.7%) were performed in an equal number of patients. Age, American Association for the Surgery of Trauma (AAST) grade, organ involved, hemodynamic status, intraoperative cardiac arrest, and operative time remained strongly predictive of mortality on multivariate analysis. The AAST grade represented, on multivariate analysis, the only independent prognostic factor predictive of overall morbidity. In the past decade we have used feeding jejunostomy more frequently, with a reduction of mortality and operating time, due also to a better approach from a dedicated trauma team. Optimal management and better outcome of pancreaticoduodenal injuries seem to be associated with shorter operative time, and with simple and fast damage control surgery (DCS), in contrast to definitive surgical procedures.

Ketamine Patient Controlled Analgesia for Acute Pain in Trauma Patients: A Randomized, Active Comparator Controlled, Blinded, Pilot Trial

DTIC Science & Technology

2017-01-11

patient- controlled analgesia per the primary treating team. Four subjects in the ketamine group and one subject in the hydromorphone group withdrew...occurred more frequently in the ketamine group , although this was not statistically significant (40% vs. 0%, P=0.090). Ketamine patient- controlled ...breakthrough IV morphine equivalents between groups . 4.0 RESULTS 4.1 Participants Due to unanticipated barriers to enrollment, including a

Emergency Blood Transfusions in Combat Theaters and Impact on HIV Testing Policy

DTIC Science & Technology

2008-06-02

or sickle cell traits, an approximate 8.6% misidentification of blood type is thought to have occurred, further indicating the importance of thorough...Military Medicine. 149:55-62. o. Spinella PC, Perkins JG, Gathwohl KW et al. (2007) Risks Associated with Fresh Whole Blood and Red Blood Cell ...administering trauma care in theater, tested packed red blood cells (PRBC) are the only blood component therapy available to the Forward Surgical Team

Artiss Symposium 2014: Psychiatry and Pain Management

DTIC Science & Technology

2014-01-01

1983 to spur military psychiatry residents to con - duct high quality research. This award still exists today and was presented at the conclusion of...important to understand, in con - text, what it means to take care of severe trauma over great distances with the team of people that impact on the...perception and how it affects the psyche are extremely important. There is a post- con - cussive syndrome called chronic traumatic encephalopathy (CTE

Transporting Patients with Lethal Contagious Infections

DTIC Science & Technology

2002-04-01

will be analyzed. If the patient requires a BSL-4 patient care room, he or she must be transported to the US Army Medical Research Institute of...consists of a physician, a registered nurse, and 4 to 6 medics who can manage one patient (Figure 2). The team can provide emer- gency care, such as airway...CLINICAL DECISIONS Section Editor: Colleen Swartz, RN, MSN, CCRN Transporting Patients with Lethal Contagious Infections Q If a trauma patient is

Defense AT and L. Volume 38, Number 4

DTIC Science & Technology

2009-06-01

accuracy at extended ranges. Today, Afghanistan- and Iraq-bound medics get realistic training on a Florida-based company’s Mini-Combat Trauma Patient ...school basketball team and drone on about how we miss 100 percent of the shots we don’t take. Fine. They may be right; failure might be good for us...be developed (or procured) that exhibits high inherent reliability and maintainability plus ad- vanced self- diagnostics . Do the ICD and Gate 1

[Prevention of psychological disorders after a road accident].

PubMed

Nicolas, Florian; Delahaye, Aline

2018-02-01

A psychological intervention programme, set up within a trauma centre, revealed common factors contributing to the emotional upheaval felt by road accident victims. These factors are linked to the event itself, its medical management, the quality of family support and the patient's history. Early psychotherapy, the awareness of the nursing teams and the involvement of the families are the key elements ensuring coherent and effective prevention. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Teamwork and patient safety in dynamic domains of healthcare: a review of the literature.

PubMed

Manser, T

2009-02-01

This review examines current research on teamwork in highly dynamic domains of healthcare such as operating rooms, intensive care, emergency medicine, or trauma and resuscitation teams with a focus on aspects relevant to the quality and safety of patient care. Evidence from three main areas of research supports the relationship between teamwork and patient safety: (1) Studies investigating the factors contributing to critical incidents and adverse events have shown that teamwork plays an important role in the causation and prevention of adverse events. (2) Research focusing on healthcare providers' perceptions of teamwork demonstrated that (a) staff's perceptions of teamwork and attitudes toward safety-relevant team behavior were related to the quality and safety of patient care and (b) perceptions of teamwork and leadership style are associated with staff well-being, which may impact clinician' ability to provide safe patient care. (3) Observational studies on teamwork behaviors related to high clinical performance have identified patterns of communication, coordination, and leadership that support effective teamwork. In recent years, research using diverse methodological approaches has led to significant progress in team research in healthcare. The challenge for future research is to further develop and validate instruments for team performance assessment and to develop sound theoretical models of team performance in dynamic medical domains integrating evidence from all three areas of team research identified in this review. This will help to improve team training efforts and aid the design of clinical work systems supporting effective teamwork and safe patient care.

Managing the negatives of experience in physician teams.

PubMed

Hoff, Timothy

2010-01-01

Experience is a key shaper of thought and action in the health care workplace and a fundamental component of management and professional policies dealing with improving quality of care. Physicians rely on experience to structure social interaction, to determine authority relations, and to resist organizational encroachments on their work and autonomy. However, an overreliance on experience within physician teams may paradoxically undermine learning, participation, and entrepreneurship, affecting organizational performance. Approximately 100 hours of direct observation of normal workdays for physician teams (n = 17 physicians) in two different work settings in a single academic medical center located in the Northeastern part of the United States. Qualitative data were collected from physician teams in the medical intensive care unit and trauma/general surgery settings. Data were transcribed and computer analyzed through an interactive process of open coding, theoretical sampling, and pattern recognition that proceeded longitudinally. Three particular experience-based schemas were identified that physician teams used to structure social relations and perform work. These schemas involved using experience as a commodity, trump card, and liberator. Each of these schemas consisted of strongly held norms, beliefs, and values that produced team dynamics with the potential for undermining learning, participation, and entrepreneurship in the group. Organizations may move to mitigate the negative impact of an overreliance on experience among physicians by promoting bureaucratic forms of control that enable physicians to engage learning, participation, and entrepreneurship in their work while not usurping existing and difficult-to-change cultural drivers of team behavior.

The effects of the Omagh bomb on adolescent mental health: a school-based study.

PubMed

Duffy, Michael; McDermott, Maura; Percy, Andrew; Ehlers, Anke; Clark, David M; Fitzgerald, Michael; Moriarty, John

2015-02-06

The main objective of this study was to assess psychiatric morbidity among adolescents following the Omagh car bombing in Northern Ireland in 1998. Data was collected within schools from adolescents aged between 14 and 18 years via a self-completion booklet comprised of established predictors of PTSD; type of exposure, initial emotional response, long-term adverse physical problems, predictors derived from Ehlers and Clark's (2000) cognitive model, a PTSD symptoms measure (PDS) and the General Health Questionnaire (GHQ). Those with more direct physical exposure were significantly more likely to meet caseness on the GHQ and the PDS. The combined pre and peri trauma risk factors highlighted in previous meta-analyses accounted for 20% of the variance in PDS scores but the amount of variance accounted for increased to 56% when the variables highlighted in Ehlers and Clark's cognitive model for PTSD were added. High rates of chronic PTSD were observed in adolescents exposed to the bombing. Whilst increased exposure was associated with increased psychiatric morbidity, the best predictors of PTSD were specific aspects of the trauma ('seeing someone you think is dying'), what you are thinking during the event ('think you are going to die') and the cognitive mechanisms employed after the trauma. As these variables are in principle amenable to treatment the results have implications for teams planning treatment interventions after future traumas.

Medical Simulation for Trauma Management.

DTIC Science & Technology

1997-10-01

the inferior mesenteric vein and identify the aorta. Indications for surgical exploration of major trauma (McAninch and Carroll (1989...aorta. (5) Vascular control is obtained by clamping the renal vein and artery at their origins from the vena cava and the aorta, (mistake possible...as if they are being miniaturized and injected into the heart’s left atrium . Their mission, in Page 21 order to save the patient, is to maneuver

Do great teams think alike? An examination of team mental models and their impact on team performance.

PubMed

Gardner, Aimee K; Scott, Daniel J; AbdelFattah, Kareem R

2017-05-01

Team mental models represent the shared understanding of team members within their relevant environment. Thus, team mental models should have a substantial impact on a team's ability to engage in purposeful and coordinated action. We sought to examine the impact of shared team mental models on team performance and to investigate if team mental models increase over time as teams continue to work together. New surgery interns were assigned randomly to 1 of 10 teams. Each team participated in one unique simulation every day for 5 days, each followed by video-based debriefing with a facilitator. Participants also completed independently a concept similarity tool validated previously in nonmedical team literature to assess team mental models. All performances were video recorded and evaluated with a scenario-specific team performance tool by a single, blinded junior surgeon under an institutional review board-approved protocol. Changes in performance and team mental models over time were assessed with paired samples t tests. Regression analysis was used to examine the extent to which team mental models predicted team performance. Thirty interns (age 27; 77% men) participated in the training program. Percentage of items achieved (x¯ ± SD) on the performance evaluation was 39 ± 20, 51 ± 14, 22 ± 17, 63 ± 14, and 77 ± 25 for Days 1-5, respectively. Team mental models were 30 ± 5, 28 ± 6, 27 ± 8, 26 ± 7, and 25 ± 6 for Days 1-5 respectively, such that larger values corresponded to greater differences in team mental models. Paired sample t tests indicated that both average performance and team mental models similarity improved from the first to last day (P < .01, P < .05, respectively). Additionally, regression analyses indicated that team mental models predicted team performance on Days 2-5 (all P < .05) but not on the first day of simulations. These results demonstrate that greater sharing of team mental models among the teams leads to better team performance. Additionally, the increase in team mental models over time suggests that engaging in team-based simulation may catalyze the process by which surgery teams are able to develop shared knowledge. Copyright © 2016 Elsevier Inc. All rights reserved.

Simulation in the Executive Suite: Lessons Learned for Building Patient Safety Leadership.

PubMed

Rosen, Michael A; Goeschel, Christine A; Che, Xin-Xuan; Fawole, Joseph Oluyinka; Rees, Dianne; Curran, Rosemary; Gelinas, Lillee; Martin, Jessica N; Kosel, Keith C; Pronovost, Peter J; Weaver, Sallie J

2015-12-01

Simulation is a powerful learning tool for building individual and team competencies of frontline health care providers with demonstrable impact on performance. This article examines the impact of simulation in building strategic leadership competencies for patient safety and quality among executive leaders in health care organizations. We designed, implemented, and evaluated a simulation as part of a larger safety leadership network meeting for executive leaders. This simulation targeted knowledge competencies of governance priority, culture of continuous improvement, and internal transparency and feedback. Eight teams of leaders in health care organizations-a total of 55 participants-participated in a 4-hour session. Each team performed collectively as a new chief executive officer (CEO) tasked with a goal of rescuing a hospital with a failing safety record. Teams worked on a modifiable simulation board reflecting the current dysfunctional organizational structure of the simulated hospital. They assessed and redesigned accountability structures based on information acquired in encounter sessions with confederates playing the role of internal staff and external consultants. Data were analyzed, and results are presented as qualitative themes arising from the simulation exercise, participant reaction data, and performance during the simulation. Key findings include high degrees of variability in solutions developed for the dysfunctional hospital system and generally positive learner reactions to the simulation experience. This study illustrates the potential value of simulation as a mechanism for learning and strategy development for executive leaders grappling with patient safety issues. Future research should explore the cognitive or functional fidelity of organizational simulations and the use of custom scenarios for strategic planning.

The “Resus:Station”: The use of clinical simulations in a randomised crossover study to evaluate a novel resuscitation trolley☆

PubMed Central

Walker, Susanna T.; Brett, Stephen J.; McKay, Anthony; Aggarwal, Rajesh; Vincent, Charles

2012-01-01

Background and aim Inadequately designed equipment has been implicated in poor efficiency and critical incidents associated with resuscitation. A novel resuscitation trolley (Resus:Station) was designed and evaluated for impact on team efficiency, user opinion, and teamwork, compared with the standard trolley, in simulated cardiac arrest scenarios. Methods Fifteen experienced cardiac arrest teams were recruited (45 participants). Teams performed recorded resuscitation simulations using new and conventional trolleys, with order of use randomised. After each simulation, efficiency (“time to drugs”, un-locatable equipment, unnecessary drawer opening) and team performance (OSCAR) were assessed from the video recordings and participants were asked to complete questionnaires scoring various aspects of the trolley on a Likert scale. Results Time to locate the drugs was significantly faster (p = 0.001) when using the Resus:Station (mean 5.19 s (SD 3.34)) than when using the standard trolley (26.81 s (SD16.05)). There were no reports of missing equipment when using the Resus:Station. However, during four of the fifteen study sessions using the standard trolley participants were unable to find equipment, with an average of 6.75 unnecessary drawer openings per simulation. User feedback results clearly indicated a highly significant preference for the newly designed Resus:Station for all aspects. Teams performed equally well for all dimensions of team performance using both trolleys, despite it being their first exposure to the Resus:Station. Conclusion We conclude that in this simulated environment, the new design of trolley is safe to use, and has the potential to improve efficiency at a resuscitation attempt. PMID:22796405

Factors affecting team leadership skills and their relationship with quality of cardiopulmonary resuscitation.

PubMed

Yeung, Joyce H Y; Ong, G J; Davies, Robin P; Gao, Fang; Perkins, Gavin D

2012-09-01

This study aims to explore the relationship between team-leadership skills and quality of cardiopulmonary resuscitation in an adult cardiac-arrest simulation. Factors affecting team-leadership skills were also assessed. Forty advanced life-support providers leading a cardiac arrest team in a standardized cardiac-arrest simulation were videotaped. Background data were collected, including age (in yrs), sex, whether they had received any leadership training in the past, whether they were part of a professional group, the most recent advanced life-support course (in months) they had undergone, advanced life-support instructor/provider status, and whether they had led in any cardiac arrest situation in the preceding 6 months. Participants were scored using the Cardiac Arrest Simulation test score and Leadership Behavior Description Questionnaire for leadership skills. Process-focused quality of cardiopulmonary resuscitation data were collected directly from manikin and video recordings. Primary outcomes were complex technical skills (measured as Cardiac Arrest Simulation test score, preshock pause, and hands-off ratio). Secondary outcomes were simple technical skills (chest-compression rate, depth, and ventilation rate). Univariate linear regressions were performed to examine how leadership skills affect quality of cardiopulmonary resuscitation and bivariate correlations elicited factors affecting team-leadership skills.Teams led by leaders with the best leadership skills performed higher quality cardiopulmonary resuscitation with better technical performance (R = 0.75, p < .001), shorter preshock pauses (R = 0.18, p < .001), with lower total hands-off ratio (R = 0.24, p = .01), and shorter time to first shock (R = 0.14, p = .02). Leadership skills were not significantly associated with more simple technical skills such as chest-compression rate, depth, and ventilation rate. Prior training in team leader skills was independently associated with better leadership behavior. There is an association between team leadership skills and cardiac arrest simulation test score, preshock pause, and hands off ratio. Developing leadership skills should be considered an integral part of resuscitation training.

Operationalizing Healthcare Simulation Psychological Safety: A Descriptive Analysis of an Intervention.

PubMed

Henricksen, Jared W; Altenburg, Catherine; Reeder, Ron W

2017-10-01

Despite efforts to prepare a psychologically safe environment, simulation participants are occasionally psychologically distressed. Instructing simulation educators about participant psychological risks and having a participant psychological distress action plan available to simulation educators may assist them as they seek to keep all participants psychologically safe. A Simulation Participant Psychological Safety Algorithm was designed to aid simulation educators as they debrief simulation participants perceived to have psychological distress and categorize these events as mild (level 1), moderate (level 2), or severe (level 3). A prebrief dedicated to creating a psychologically safe learning environment was held constant. The algorithm was used for 18 months in an active pediatric simulation program. Data collected included level of participant psychological distress as perceived and categorized by the simulation team using the algorithm, type of simulation that participants went through, who debriefed, and timing of when psychological distress was perceived to occur during the simulation session. The Kruskal-Wallis test was used to evaluate the relationship between events and simulation type, events and simulation educator team who debriefed, and timing of event during the simulation session. A total of 3900 participants went through 399 simulation sessions between August 1, 2014, and January 26, 2016. Thirty-four (<1%) simulation participants from 27 sessions (7%) were perceived to have an event. One participant was perceived to have a severe (level 3) psychological distress event. Events occurred more commonly in high-intensity simulations, with novice learners and with specific educator teams. Simulation type and simulation educator team were associated with occurrence of events (P < 0.001). There was no association between event timing and event level. Severe psychological distress as categorized by simulation personnel using the Simulation Participant Psychological Safety Algorithm is rare, with mild and moderate events being more common. The algorithm was used to teach simulation educators how to assist a participant who may be psychologically distressed and document perceived event severity.

Introducing a Short Measure of Shared Servant Leadership Impacting Team Performance through Team Behavioral Integration

PubMed Central

Sousa, Milton; Van Dierendonck, Dirk

2016-01-01

The research reported in this paper was designed to study the influence of shared servant leadership on team performance through the mediating effect of team behavioral integration, while validating a new short measure of shared servant leadership. A round-robin approach was used to collect data in two similar studies. Study 1 included 244 undergraduate students in 61 teams following an intense HRM business simulation of 2 weeks. The following year, study 2 included 288 students in 72 teams involved in the same simulation. The most important findings were that (1) shared servant leadership was a strong determinant of team behavioral integration, (2) information exchange worked as the main mediating process between shared servant leadership and team performance, and (3) the essence of servant leadership can be captured on the key dimensions of empowerment, humility, stewardship and accountability, allowing for a new promising shortened four-dimensional measure of shared servant leadership. PMID:26779104

Military medical modeling and simulation in the 21st century.

PubMed

Moses, G; Magee, J H; Bauer, J J; Leitch, R

2001-01-01

As we enter the 21st century, military medicine struggles with critical issues. One of the most important issues is how to train medical personnel in peace for the realities of war. In April, 1998, The General Accounting Office (GAO) reported, "Military medical personnel have almost no chance during peacetime to practice battlefield trauma care skills. As a result, physicians both within and outside the Department of Defense (DOD) believe that military medical personnel are not prepared to provide trauma care to the severely injured soldiers in wartime. With some of today's training methods disappearing, the challenge of providing both initial; and sustainment training for almost 100,000 military medical personnel is becoming insurmountable. The "training gap" is huge and impediments to training are mounting. For example, restrictions on animal use are increasing and the cost of conducting live mass casualty exercises is prohibitive. Many medical simulation visionaries believe that four categories of medical simulation are emerging to address these challenges. These categories include PC-based multimedia, digital mannequins, virtual workbenches, and total immersion virtual reality (TIVR). The use of simulation training can provide a risk = free realistic learning environment for the spectrum of medical skills training, from buddy-aid to trauma surgery procedures. This will, in turn, enhance limited hands on training opportunities and revolutionize the way we train in peace to deliver medicine in war. High-fidelity modeling will permit manufacturers to prototype new devices before manufacture. Also, engineers will be able to test a device for themselves in a variety of simulated anatomical representations, permitting them to "practice medicine".

Virtual reality: emerging role of simulation training in vascular access.

PubMed

Davidson, Ingemar J A; Lok, Charmaine; Dolmatch, Bart; Gallieni, Maurizio; Nolen, Billy; Pittiruti, Mauro; Ross, John; Slakey, Douglas

2012-11-01

Evolving new technologies in vascular access mandate increased attention to patient safety; an often overlooked yet valuable training tool is simulation. For the end-stage renal disease patient, simulation tools are effective for all aspects of creating access for peritoneal dialysis and hemodialysis. Based on aviation principles, known as crew resource management, we place equal emphasis on team training as individual training to improve interactions between team members and systems, cumulating in improved safety. Simulation allows for environmental control and standardized procedures, letting the trainee practice and correct mistakes without harm to patients, compared with traditional patient-based training. Vascular access simulators range from suture devices, to pressurized tunneled conduits for needle cannulation, to computer-based interventional simulators. Simulation training includes simulated case learning, root cause analysis of adverse outcomes, and continual update and refinement of concepts. Implementation of effective human to complex systems interaction in end-stage renal disease patients involves a change in institutional culture. Three concepts discussed in this article are as follows: (1) the need for user-friendly systems and technology to enhance performance, (2) the necessity for members to both train and work together as a team, and (3) the team assigned to use the system must test and practice it to a proficient level before safely using the system on patients. Copyright © 2012 Elsevier Inc. All rights reserved.

[The role of multi-disciplinary team in the surgical area--at present and in future].

PubMed

Tomita, Michiko; Sakamoto, Suga

2010-07-01

This article describes four particular tasks of nursing profession and identifies the contribution of nurses within a multi-professional team in the surgical area. The four tasks involve; triage nursing in Emergency Room; allocation of surgical beds; provision of patients' information on a course of surgical treatment prior to hospital admission; and participation in Diagnosis Related Group (DRG). Being responsible for each of these tasks, the nurses play a significant role as mediators between patients and health professionals as well as between the health professionals in order to respond to their patients' needs. This contributes to alleviation of suffering through the diagnosis and surgical treatment, leading to the best ways to recover from major trauma the patients had. In recent years, expanding nursing responsibilities for decision-making in patients' care has been in discussion. However, it is clear that with certain levels of education and practice, nursing profession is able to fill the important roles within the multi-professional team in the surgical area.

Technology evaluation, assessment, modeling, and simulation: the TEAMS capability

NASA Astrophysics Data System (ADS)

Holland, Orgal T.; Stiegler, Robert L.

1998-08-01

The United States Marine Corps' Technology Evaluation, Assessment, Modeling and Simulation (TEAMS) capability, located at the Naval Surface Warfare Center in Dahlgren Virginia, provides an environment for detailed test, evaluation, and assessment of live and simulated sensor and sensor-to-shooter systems for the joint warfare community. Frequent use of modeling and simulation allows for cost effective testing, bench-marking, and evaluation of various levels of sensors and sensor-to-shooter engagements. Interconnectivity to live, instrumented equipment operating in real battle space environments and to remote modeling and simulation facilities participating in advanced distributed simulations (ADS) exercises is available to support a wide- range of situational assessment requirements. TEAMS provides a valuable resource for a variety of users. Engineers, analysts, and other technology developers can use TEAMS to evaluate, assess and analyze tactical relevant phenomenological data on tactical situations. Expeditionary warfare and USMC concept developers can use the facility to support and execute advanced warfighting experiments (AWE) to better assess operational maneuver from the sea (OMFTS) concepts, doctrines, and technology developments. Developers can use the facility to support sensor system hardware, software and algorithm development as well as combat development, acquisition, and engineering processes. Test and evaluation specialists can use the facility to plan, assess, and augment their processes. This paper presents an overview of the TEAMS capability and focuses specifically on the technical challenges associated with the integration of live sensor hardware into a synthetic environment and how those challenges are being met. Existing sensors, recent experiments and facility specifications are featured.

Laying the Foundation for Successful Team Performance Trajectories: The Roles of Team Charters and Performance Strategies

ERIC Educational Resources Information Center

Mathieu, John E.; Rapp, Tammy L.

2009-01-01

This study examined the influences of team charters and performance strategies on the performance trajectories of 32 teams of master's of business administration students competing in a business strategy simulation over time. The authors extended existing theory on team development by demonstrating that devoting time to laying a foundation for…

Next Generation Simulation Framework for Robotic and Human Space Missions

NASA Technical Reports Server (NTRS)

Cameron, Jonathan M.; Balaram, J.; Jain, Abhinandan; Kuo, Calvin; Lim, Christopher; Myint, Steven

2012-01-01

The Dartslab team at NASA's Jet Propulsion Laboratory (JPL) has a long history of developing physics-based simulations based on the Darts/Dshell simulation framework that have been used to simulate many planetary robotic missions, such as the Cassini spacecraft and the rovers that are currently driving on Mars. Recent collaboration efforts between the Dartslab team at JPL and the Mission Operations Directorate (MOD) at NASA Johnson Space Center (JSC) have led to significant enhancements to the Dartslab DSENDS (Dynamics Simulator for Entry, Descent and Surface landing) software framework. The new version of DSENDS is now being used for new planetary mission simulations at JPL. JSC is using DSENDS as the foundation for a suite of software known as COMPASS (Core Operations, Mission Planning, and Analysis Spacecraft Simulation) that is the basis for their new human space mission simulations and analysis. In this paper, we will describe the collaborative process with the JPL Dartslab and the JSC MOD team that resulted in the redesign and enhancement of the DSENDS software. We will outline the improvements in DSENDS that simplify creation of new high-fidelity robotic/spacecraft simulations. We will illustrate how DSENDS simulations are assembled and show results from several mission simulations.

High-reliability emergency response teams in the hospital: improving quality and safety using in situ simulation training.

PubMed

Wheeler, Derek S; Geis, Gary; Mack, Elizabeth H; LeMaster, Tom; Patterson, Mary D

2013-06-01

In situ simulation training is a team-based training technique conducted on actual patient care units using equipment and resources from that unit, and involving actual members of the healthcare team. We describe our experience with in situ simulation training in a major children's medical centre. In situ simulations were conducted using standardised scenarios approximately twice per month on inpatient hospital units on a rotating basis. Simulations were scheduled so that each unit participated in at least two in situ simulations per year. Simulations were conducted on a revolving schedule alternating on the day and night shifts and were unannounced. Scenarios were preselected to maximise the educational experience, and frequently involved clinical deterioration to cardiopulmonary arrest. We performed 64 of the scheduled 112 (57%) in situ simulations on all shifts and all units over 21 months. We identified 134 latent safety threats and knowledge gaps during these in situ simulations, which we categorised as medication, equipment, and/or resource/system threats. Identification of these errors resulted in modification of systems to reduce the risk of error. In situ simulations also provided a method to reinforce teamwork behaviours, such as the use of assertive statements, role clarity, performance of frequent updating, development of a shared mental model, performance of independent double checks of high-risk medicines, and overcoming authority gradients between team members. Participants stated that the training programme was effective and did not disrupt patient care. In situ simulations can identify latent safety threats, identify knowledge gaps, and reinforce teamwork behaviours when used as part of an organisation-wide safety programme.

Planning to fail: mission design for modular repairable robot teams

NASA Technical Reports Server (NTRS)

Stancliff, Stephen B.; Dolan, John B.; Trebi-Ollennu, Ashitey

2005-01-01

This paper presents a method using stochastic simulation to evaluate the reliability of robot teams consisting of modular robots. For an example planetary exploration mission we use this method to compare the performance of a repairable robot team with spare modules versus nonrepairable robot teams.

Team Training and Institutional Protocols to Prevent Shoulder Dystocia Complications.

PubMed

Smith, Samuel

2016-12-01

Shoulder dystocia is an obstetrical emergency that may result in significant neonatal complications. It requires rapid recognition and a coordinated response. Standardization of care, teamwork and communication, and clinical simulation are the key components of patient safety programs in obstetrics. Simulation-based team training and institutional protocols for the management of shoulder dystocia are emerging as integral components of many labor and delivery safety initiatives because of their impact on technical skills and team performance.

Clinical efficiency in a simulated emergency and relationship to team behaviours: a multisite cross-sectional study.

PubMed

Siassakos, D; Bristowe, K; Draycott, T J; Angouri, J; Hambly, H; Winter, C; Crofts, J F; Hunt, L P; Fox, R

2011-04-01

To identify specific aspects of teamworking associated with greater clinical efficiency in simulated obstetric emergencies. Cross-sectional secondary analysis of video recordings from the Simulation & Fire-drill Evaluation (SaFE) randomised controlled trial. Six secondary and tertiary maternity units. A total of 114 randomly selected healthcare professionals, in 19 teams of six members. Two independent assessors, a clinician and a language communication specialist identified specific teamwork behaviours using a grid derived from the safety literature. Relationship between teamwork behaviours and the time to administration of magnesium sulfate, a validated measure of clinical efficiency, was calculated. More efficient teams were likely to (1) have stated (recognised and verbally declared) the emergency (eclampsia) earlier (Kendall's rank correlation coefficient τ(b) = -0.53, 95% CI from -0.74 to -0.32, P=0.004); and (2) have managed the critical task using closed-loop communication (task clearly and loudly delegated, accepted, executed and completion acknowledged) (τ(b) = 0.46, 95% CI 0.17-0.74, P=0.022). Teams that administered magnesium sulfate within the allocated time (10 minutes) had significantly fewer exits from the labour room compared with teams who did not: a median of three (IQR 2-5) versus six exits (IQR 5-6) (P=0.03, Mann-Whitney U-test). Using administration of an essential drug as a valid surrogate of team efficiency and patient outcome after a simulated emergency, we found that more efficient teams were more likely to exhibit certain team behaviours relating to better handover and task allocation. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

A rater training protocol to assess team performance.

PubMed

Eppich, Walter; Nannicelli, Anna P; Seivert, Nicholas P; Sohn, Min-Woong; Rozenfeld, Ranna; Woods, Donna M; Holl, Jane L

2015-01-01

Simulation-based methodologies are increasingly used to assess teamwork and communication skills and provide team training. Formative feedback regarding team performance is an essential component. While effective use of simulation for assessment or training requires accurate rating of team performance, examples of rater-training programs in health care are scarce. We describe our rater training program and report interrater reliability during phases of training and independent rating. We selected an assessment tool shown to yield valid and reliable results and developed a rater training protocol with an accompanying rater training handbook. The rater training program was modeled after previously described high-stakes assessments in the setting of 3 facilitated training sessions. Adjacent agreement was used to measure interrater reliability between raters. Nine raters with a background in health care and/or patient safety evaluated team performance of 42 in-situ simulations using post-hoc video review. Adjacent agreement increased from the second training session (83.6%) to the third training session (85.6%) when evaluating the same video segments. Adjacent agreement for the rating of overall team performance was 78.3%, which was added for the third training session. Adjacent agreement was 97% 4 weeks posttraining and 90.6% at the end of independent rating of all simulation videos. Rater training is an important element in team performance assessment, and providing examples of rater training programs is essential. Articulating key rating anchors promotes adequate interrater reliability. In addition, using adjacent agreement as a measure allows differentiation between high- and low-performing teams on video review. © 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

The n-by-T Target Discharge Strategy for Inpatient Units.

PubMed

Parikh, Pratik J; Ballester, Nicholas; Ramsey, Kylie; Kong, Nan; Pook, Nancy

2017-07-01

Ineffective inpatient discharge planning often causes discharge delays and upstream boarding. While an optimal discharge strategy that works across all units at a hospital is likely difficult to identify and implement, a strategy that provides a reasonable target to the discharge team appears feasible. We used observational and retrospective data from an inpatient trauma unit at a Level 2 trauma center in the Midwest US. Our proposed novel n-by-T strategy-discharge n patients by the Tth hour-was evaluated using a validated simulation model. Outcome measures included 2 measures: time-based (mean discharge completion and upstream boarding times) and capacity-based (increase in annual inpatient and upstream bed hours). Data from the pilot implementation of a 2-by-12 strategy at the unit was obtained and analyzed. The model suggested that the 1-by-T and 2-by-T strategies could advance the mean completion times by over 1.38 and 2.72 h, respectively (for 10 AM ≤ T ≤ noon, occupancy rate = 85%); the corresponding mean boarding time reductions were nearly 11% and 15%. These strategies could increase the availability of annual inpatient and upstream bed hours by at least 2,469 and 500, respectively. At 100% occupancy rate, the hospital-favored 2-by-12 strategy reduced the mean boarding time by 26.1%. A pilot implementation of the 2-by-12 strategy at the unit corroborated with the model findings: a 1.98-h advancement in completion times (P<0.0001) and a 14.5% reduction in boarding times (P = 0.027). Target discharge strategies, such as the n-by-T, can help substantially reduce discharge lateness and upstream boarding, especially during high unit occupancy. To sustain implementation, necessary commitment from the unit staff and physicians is vital, and may require some training.

Simulation-based team training improved the self-assessed ability of physicians, nurses and midwives to perform neonatal resuscitation.

PubMed

Malmström, B; Nohlert, E; Ewald, U; Widarsson, M

2017-08-01

The use of simulation-based team training in neonatal resuscitation has increased in Sweden during the last decade, but no formal evaluation of this training method has been performed. This study evaluated the effect of simulation-based team training on the self-assessed ability of personnel to perform neonatal resuscitation. We evaluated a full-day simulation-based team training course in neonatal resuscitation, by administering a questionnaire to 110 physicians, nurses and midwives before and after the training period. The questionnaire focused on four important domains: communication, leadership, confidence and technical skills. The study was carried out in Sweden from 2005 to 2007. The response rate was 84%. Improvements in the participants' self-assessed ability to perform neonatal resuscitation were seen in all four domains after training (p < 0.001). Professionally inexperienced personnel showed a significant improvement in the technical skills domain compared to experienced personnel (p = 0.001). No differences were seen between professions or time since training in any of the four domains. Personnel with less previous experience with neonatal resuscitation showed improved confidence (p = 0.007) and technical skills (p = 0.003). A full-day course on simulation-based team training with video-supported debriefing improved the participants' self-assessed ability to perform neonatal resuscitation. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.