A Simulation-based Randomized Controlled Study of Factors Influencing Chest Compression Depth.

Introduction: Current resuscitation guidelines emphasize a systems approach with a strong emphasis on quality cardiopulmonary resuscitation (CPR). Despite the American Heart Association (AHA) emphasis on quality CPR for over 10 years, resuscitation teams do not consistently meet recommended CPR standards. The objective is to assess the impact on chest compression depth of factors including bed height, step stool utilization, position of the rescuer's arms and shoulders relative to the point of chest compression, and rescuer characteristics including height, weight, and gender.

Effect of a backboard on compression depth during cardiac arrest in the ED: a simulation study.

Research Purpose: We evaluated the impact of a backboard on chest compression depth during cardiac arrest practice sessions conducted using a high-fidelity mannequin on a standard emergency department stretcher.

Methods: Forty-three health care trainees completed cardiac resuscitation simulations requiring 2 minutes of uninterrupted chest compressions. Twenty-one were randomly allocated to the intervention group in which a backboard was concealed by placement between the stretcher mattress and a top sheet and, 22 were allocated to the control group in which no backboard was placed.

Gearing up for milestones in surgery: Will simulation play a role?

Background: The Consortium of American College of Surgeons-Accredited Education Institutes was created to promote patient safety through the use of simulation, develop new education and technologies, identify best practices, and encourage research and collaboration.

Methods: During the 7th Annual Meeting of the Consortium, leaders from a variety of specialties discussed how simulation is playing a role in the assessment of resident performance within the context of the Milestones of the Accreditation Council for Graduate Medical Education as part of the Next Accreditation System.

Conclusion: This report presents experiences from several viewpoints and supports the utility of simulation for this purpose.

Simulation in medical student education: survey of clerkship directors in emergency medicine.

Introduction: The objective of this study is to identify (1) the current role of simulation in medical student emergency medicine (EM) education; (2) the challenges to initiating and sustaining simulation-based programs; and (3) educational advances to meet these challenges.

Methods: We solicited members of the Clerkship Directors in Emergency Medicine (CDEM) e-mail list to complete a Web-based survey addressing the use of simulation in both EM clerkships and preclinical EM curricula. Survey elements addressed the nature of the undergraduate EM clerkship and utilization of simulation, types of technology, and barriers to increased use in each setting.

Simulation in emergency medicine training.

Simulation provides a range of educational tools that have increasingly been incorporated into emergency medicine (EM) curricula. Standardized patients and some partial task trainers, such as intubation heads, have been used for decades. More recently, a growing number of computer-screen simulations, high-fidelity mannequins, and virtual-reality simulators have expanded the number of procedures and conditions, which can be effectively simulated.

Improved fourth-year medical student clinical decision-making performance as a resuscitation team leader after a simulation-based curriculum.

Objective: To determine the impact of simulation-based instruction on student performance in the role of emergency department resuscitation team leader.

Methods: A randomized, single-blinded, controlled study using an intention to treat analysis. Eighty-three fourth-year medical students enrolled in an emergency medicine clerkship were randomly allocated to two groups differing only by instructional format.

Improved medical student satisfaction and test performance with a simulation-based emergency medicine curriculum: a randomized controlled trial.

Study Objective: We determine the effect of a simulation-based curriculum on fourth-year medical student test performance and satisfaction during an emergency medicine clerkship.

Methods: This was a randomized controlled study using a crossover design for curriculum format and an anonymous end-of-rotation satisfaction survey. Students were randomized into 2 groups.

Medical malpractice: utilization of layered simulation for resident education.

Objectives: The authors present a novel approach to the use of simulation in medical education with a two-event layered simulation. A patient care simulation with an adverse outcome was followed by a simulated deposition.

Methods: Senior residents in an academic emergency medicine (EM) program were solicited as simulation research volunteers.

Ability of regional hospitals to meet projected avian flu pandemic surge capacity requirements.

Introduction: Hospital surge capacity is a crucial part of community disaster preparedness planning, which focuses on the requirements for additional beds, equipment, personnel, and special capabilities. The scope and urgency of these requirements must be balanced with a practical approach addressing cost and space concerns. Renewed concerns for infectious disease threats, particularly from a potential avian flu pandemic perspective, have emphasized the need to be prepared for a prolonged surge that could last six to eight weeks.

Utilization and effectiveness of an emergency department initiated smoking cessation program.

OBJECTIVE: To determine which method of intervention will best assist ED patients who smoke and are interested in quitting. METHODS: This was a prospective, controlled randomized survey of patients seen at a military ED with an annual census of approximately 30,000. All patients 18 years old or older who were medically stable and who admitted to smoking were eligible.

Female exposure to high G: echocardiographic evaluation for chronic changes in cardiac function.

Background: Significant changes in cardiac preload and afterload are generated by a number of factors present during the operation of high performance aircraft. These include high levels of +Gz, positive pressure breathing and anti-G straining maneuvers. Centrifuge subjects are exposed to these same factors in doses that are comparable to their operational counterparts.

Serum dopamine beta hydroxylase and maltreatment in psychiatrically hospitalized boys.

Fifty boys, hospitalized on a school-age and an adolescent unit in an intermediate length psychiatric hospital, were studied while off psychoactive medication to determine how serum dopamine beta hydroxylase (DBH) activity varies with different childhood maltreatment experiences. Childhood maltreatment was categorized according to onset (before 36 months old, between 36-72 months old and over 72 months old). Childhood maltreatment groups were compared with a group of psychiatrically hospitalized boys who had neither been abused nor neglected.

Improving the quality of emergency medicine rotation/clerkship evaluations.

The process of evaluating the performance of medical students and/or residents during emergency medicine clinical rotations is constrained by several potential shortcomings. These constraints can limit the quality of the information provided to the student/resident, as well as that provided to the sponsoring institution. During the course of an academic year at United States Air Force Medical Center, Wright-Patterson, a number of medical students, interns, and residents rotate through the emergency department.

Automated external defibrillator training and skills maintenance in Air Force emergency medical services systems.

In April 1989, we initiated a test program to evaluate the use of semi-automated external defibrillators in five United States Air Force Medical Treatment Facilities. The objectives of the study were 2-fold. First, the feasibility of conducting a uniform training program in a number of geographically separated basic life support emergency medical services (EMS) systems was assessed.

Low dopamine-beta-hydroxylase: a biological sequela of abuse and neglect?

Twenty-one psychiatrically hospitalized boys were studied while off psychoactive medication to determine if conduct disorder, solitary type, and abuse or neglect experiences correlated with low levels of dopamine-beta-hydroxylase (DBH) activity. Preliminary results supported earlier findings that undersocialized types of conduct disorder in boys were correlated with low DBH activity. Possible or definite neglect or abuse before 36 months of age was correlated with low DBH activity.

Airway management: a new look at old models.

Two methods for modifying standard orotracheal intubation models, in order to teach and practice special airway management skills, are described. Using these quick and inexpensive manipulations, an intubation manikin can be modified for use as a teaching model for standard nasotracheal intubation techniques as well as both orotracheal and nasotracheal intubation with a lighted stylet.

New concepts in triage.

The triage process is a valid concept in the initial approach to multiple casualties. Triage tags are, in theory, a reasonable adjunct to the process, but have proved to be a failure in practice. Based on the historical perspective and on the authors' experience with approximately 180 mass casualty drills and incidents, it is recommended that the "daily routine doctrine" be applied and that conventional, color-coded triage tags be replaced by a process of "geographical triage.

Stroma-free methemoglobin solution: an effective antidote for acute cyanide poisoning.

Several aspects of stroma-free methemoglobin solution (SFMS) as a cyanide antidote were investigated using a rat model. Stroma-free methemoglobin solution was more than 90% effective against multiples of the LD90 of cyanide up to and including four times the LD90 and approximately 50% effective against multiples up to and including eight times the LD90. Highly concentrated solutions of SFMS (33 g/dl) did not differ significantly from less concentrated solutions of SFMS (16 g/dl) when compared on the basis of efficacy.

Comparison of nitrite treatment and stroma-free methemoglobin solution as antidotes for cyanide poisoning in a rat model.

The standard nitrite/thiosulfate regimen for cyanide poisoning was tested in our rat model. By modifying the treatment regimen and the nitrite solution an effective antidote against an LD90 of cyanide could be produced. However, this treatment was effective against two times the LD90 only when administered ten minutes prior to cyanide injection.

Morbidity of Hurricane Frederic.

On September 12, 1979, Hurricane Frederic struck the Gulf Coasts of Mississippi and Alabama. A retrospective review of emergency department logs for a three-week period surrounding the storm was conducted to determine the amount and type of back up needed for an emergency department to cope with the results of such a disaster. There was a significant increase in the number of patients presenting to the emergency department for at least two weeks after the storm, with the greatest demand being for professionals skilled in outpatient trauma management.

Stroma-free methemoglobin solution as an antidote for cyanide poisoning: a preliminary study.

Effective treatment of cyanide poisoning requires rapid diagnosis, good supportive treatment and the use of a specific antidote. The currently available antidotes offer demonstrated efficacy along with significant potential adverse side effects. We have investigated an alternate approach to antidote therapy for cyanide poisoning by using Stroma-Free Methemoglobin Solution ( SFMS ).

Mechanical bull injuries: the empty saddle syndrome.

We reviewed the cases of 30 patients presenting to the emergency department over a four-month period with a total of 31 injuries suffered while riding a mechanical bull. The majority of injuries were sprains and contusions. The most severe injuries included seven fractures, one dislocation, and one fracture-dislocation.