Objective This study aimed to introduce a novel negative pressure aerosol box (Carrycure Isolator) and to test its efficiency and limitations, with the hope of suggesting improvements and further directions.
Methods A novel aerosol box (Carrycure Isolator) was invented. A single-center, randomized, crossover simulation study of 28 emergency medicine physicians was designed. Three trials of each participant using an intubation manikin were conducted, including intubation without the aerosol box (trial A), intubation with the aerosol box (trial B), and intubation with the aerosol box after familiarization (trial C). The primary endpoint was the time to intubation. The secondary endpoints were first-attempt success, number of attempts, percentage of glottic opening score, and Cormack-Lehane view. Collected data were statistically analyzed for their significance.
Results The median times to intubation of trials A, B, and C were 30.5 (interquartile range [IQR], 28.0–40.0 seconds), 59.0 (IQR, 50.0–75.5 seconds), and 34.0 seconds (IQR, 30.5–47.0 seconds), respectively. Post hoc analysis showed that the time to intubation in trial B was significantly longer than that in trial A (P<0.05), while that the time to intubation in trial C was significantly shorter than that in trial B (P<0.05). Results concerning secondary endpoints showed similar patterns. Participants reported performing intubation with Carrycure Isolator to be relatively difficult, necessitating significant arm movement and view restrictions while increasing their time to intubation.
Conclusion Physicians took a longer time to intubate a manikin using the Carrycure Isolator, a novel negative pressure aerosol box. However, the time was improved after a period of familiarization.
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Objective Since onsite education is difficult due to the COVID-19 pandemic, official development assistance (ODA) projects have implemented online training of trainers (ToT) for emergency medical experts and staff. This study aims to share and discuss the ToT experience and its results in Uzbekistan.
Methods We trained emergency medical advanced course instructors through online ToT among emergency medical service experts in Uzbekistan as a part of an ODA project. After the ToT, instructors were selected based on written tests, video monitoring of practice, and simulation performance. They operated the emergency medical course including lectures, practices, and simulations for 5 days. We tested the trainees through written tests before and after the course. They were surveyed regarding the course contents, its relevance, and their satisfaction with the course.
Results Six instructors were selected after the online ToT program. They educated 68 emergency medical workers through the three training courses. The total score of the pretest was 129.2±34.8, and the posttest score was 170.8±31.2, which was significantly higher (P<0.05). The satisfaction calculated by adding the values of survey items for this curriculum was 28.0 (interquartile range, 26.0–30.0), and there was no statistical difference regarding trainee satisfaction between the three courses (P=0.148).
Conclusion Instructors trained by online ToT programs could provide an in-person emergency medical advanced course.
Objective Optimal training methods remain controversial for rarely performed emergency procedures. Previous research has failed to demonstrate the superiority or inferiority of live anesthetized animal models (LAA) as compared to other modalities. Most of the data on LAA use comes from military contexts; less information is available for civilian emergency medicine (EM) training. We sought to characterize the prevalence of LAA use among civilian EM residency programs and reasons for its use or discontinuation.
Methods Survey study of program directors of EM residency programs accredited by the Accreditation Council for Graduate Medical Education. A 16-item questionnaire was electronically delivered to program directors, including program region, current and historical use of LAA, and attitudes regarding the optimal procedural training modalities.
Results Of 179 survey recipients, 83 completed the survey (46.4%). Twelve programs (14.3%) currently use LAA, and 17 programs (20.5%) report previous LAA use. Reasons for discontinuing LAA use included ethical concerns, financial and logistical limitations, political pressures, and feeling that there were superior or equivalent alternative models available. Programs that currently use LAA were more likely to rank LAA as being the most preferable training modality while programs that do not currently use LAA were more likely to rank human cadavers as the most preferable modality.
Conclusion Despite a lack of data showing educational outcomes-driven differences between LAA and alternative training models, LAA use is declining among civilian EM residencies. Despite this, disagreement exists among programs that do and do not use LAA regarding the most optimal procedural training.
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Objective This study aimed to evaluate how BLS courses affect primary school students’ knowledge, attitudes, and life support skills; investigate how medical students’ knowledge and competence in teaching BLS can improve by serving as instructors.
Methods This experimental study was conducted in a rural primary school. First-year medical students conducted a BLS course for grade 4 and 5 primary school students with a 6–7:1 ratio of trainees-to-trainer. All trainers had completed a BLS course before the course. This 3.5-hour simulation-based course covered chest compressions and automated external defibrillator use. The pre- and post-course assessments included multiple choice questions toward BLS, practical skills test, and attitude test. For medical students, evaluation was conducted by attitude test, both pre- and post-teaching.
Results The mean pre- and post-test scores increased from 5.74±0.10 to 9.43±0.13 (P<0.01). The increase in the scores was the same for both the students and the teachers (3.05±0.60 vs. 3.68±0.16, P=0.33). After the course, more than 90% of the students could perform all the procedures involved in BLS and automated external defibrillation. Medical students showed an improved understanding of CPR and confidence in performing and teaching CPR (both, P<0.01).
Conclusion Primary school students can learn how to perform BLS through simulation-based learning. Simulation-based training can improve their attitude and provide them with knowledge and crucial skill sets, improving their confidence in performing BLS. Furthermore, teachers’ attitudes and confidence toward CPR improved after teaching CPR.
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Objective Cardiopulmonary resuscitation (CPR) education with a feedback device is known to result in better CPR skills compared to one without the feedback device. However, its long-term benefits have not been established. The purpose of this study was to evaluate the long-term CPR skill retention after training using real-time visual manikins in comparison to that of non-feedback manikins.
Methods We recruited 120 general university students who were randomly divided into the real-time feedback group (RTFG) and the non-feedback group. Of them, 95 (RTFG, 48; non-feedback group, 47) attended basic life support and automated external defibrillation training for 1 hour. For comparison of retention of CPR skills, the two groups were evaluated based on 2-minute chest compression performed immediately after training and at 3, 6, and 9 months. The CPR parameters between the two groups were also compared using a generalized linear model.
Results At immediately after training, the performance of RTFG was better in terms of average chest compression depth (51.9±1.1 vs. 45.5±1.1, p<0.001) and a higher percentage of adequate chest compression depth (51.0±4.1 vs. 26.9±4.2, p<0.001). This significant difference was maintained until 6 months after training, but there was no difference at 9 months after training. However, there was no significant difference in the chest compression rate and the correct hand position at any time point.
Conclusion CPR training with a real-time visual feedback manikin improved skill acquisition in chest compression depth, but only until 6 months after the training. It could be a more effective educational method for basic life support training in laypersons.
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Objective This study aimed to evaluate the efficacy of i-gel blind intubation (IGI) as a rescue device for definitive airway management in ground intubation for pre-hospital trauma patients.
Methods A prospective randomized crossover study was conducted with 18 paramedics to examine intubation performance of two blind intubation techniques through a supraglottic airway devices (IGI and laryngeal mask airway Fastrach), compared with use of a Macintosh laryngoscope (MCL). Each intubation was conducted at two levels of patient positions (ground- and stretcher-level). Primary outcomes were the intubation time and the success rate for intubation.
Results The intubation time (sec) of each intubation technique was not significantly different between the two positions. In both patient positions, the intubation time of IGI was shortest among the three intubation techniques (17.9±5.2 at the ground-level and 16.9±3.8 at the stretcher-level). In the analysis of cumulative success rate and intubation time, IGI was the fastest to reach 100% success among the three intubation techniques regardless of patient position (all P<0.017). The success of intubation was only affected by the intubation technique, and IGI achieved more success than MCL (odds ratio, 3.6; 95% confidence interval, 1.1 to 11.6; P=0.03).
Conclusion The patient position did not affect intubation performance. Additionally, the intubation time with blind intubation through supraglottic airway devices, especially with IGI, was significantly shorter than that with MCL.
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Objective Tube thoracostomy (TT) is a commonly performed intensive care procedure. Simulator training may be a good alternative method for TT training, compared with conventional methods such as apprenticeship and animal skills laboratory. However, there is insufficient evidence supporting use of a simulator. The aim of this study is to determine whether training with medical simulator is associated with faster TT process, compared to conventional training without simulator.
Methods This is a simulation study. Eligible participants were emergency medicine residents with very few (≤3 times) TT experience. Participants were randomized to two groups: the conventional training group, and the simulator training group. While the simulator training group used the simulator to train TT, the conventional training group watched the instructor performing TT on a cadaver. After training, all participants performed a TT on a cadaver. The performance quality was measured as correct placement and time delay. Subjects were graded if they had difficulty on process.
Results Estimated median procedure time was 228 seconds in the conventional training group and 75 seconds in the simulator training group, with statistical significance (P=0.040). The difficulty grading did not show any significant difference among groups (overall performance scale, 2 vs. 3; P=0.094).
Conclusion Tube thoracostomy training with a medical simulator, when compared to no simulator training, is associated with a significantly faster procedure, when performed on a human cadaver.
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