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07/12/2018

Zone de confort: En sortir pour progresser ?

Biological Response to Stress During Battlefield Trauma Training: Live Tissue Versus High-Fidelity Patient Simulator.

 
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Le recours à la simulation permet la création d'un stress physiologique considéré comme propice à l'amélioration de la performance. Il semblerait que le changement de modalités d'entraînement soit le plus générateur de stress. Ce document suggère la pertinence de mise en situation des équipes médicales dans un bloc opératoire d'une part pour la maîtrise en conditions réelles de certaines pratiques médicales mais aussi pour une sortie de leur zone de confort d'entraînement habituel. 
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INTRODUCTION:

Tactical Combat Casualty Care (TCCC) training imposes psychophysiological stress on medics. It is unclear whether these stress levels vary with the training modalities selected. It is also unclear how stress levels could have an impact on medical performance and skill uptake.

MATERIALS AND METHODS:

We conducted a pilot study to compare the effects of live tissue (LT) with a high-fidelity patient simulator (SIM) on the level of stress elicited, performance, and skill uptake during battlefield trauma training course in an operating room (OR) and in a simulated battlefield scenario (field). In the report, we studied the effects of training modalities and their changes on stress levels by measuring different biomarkers (salivary amylase, plasma catecholamines, and neuropeptide Y) at various time points during the trauma training course.

RESULTS:

We found that the training resulted in significant psychophysiological stress as indicated by elevated levels of various biomarkers relative to baseline immediately after both OR and field assessment (p < 0.05). Compared with pre-OR levels, the LT training in the OR resulted in significant increases in the plasma levels of epinephrine, norepinephrine, and neuropeptide (p = 0.013, 0.023, 0.004, respectively), whereas the SIM training in the OR resulted in significant increases in the plasma levels of norepinephrine and neuropeptide (p = 0.003 and 0.008). Compared with pre-field levels, we found significant increases in plasma epinephrine concentration in the SIM group (p = 0.016), plasma norepinephrine concentration in the LT group (p = 0.015), and plasma neuropeptide Y concentration in both LT (p = 0.006) and SIM groups (p = 0.029). No differences in the changes of biomarker levels were found between LT and SIM groups in the OR and field. Compared with pre-field levels, the testing on the same modality as that in the OR in the simulated battlefield resulted in significant increases in norepinephrine and neuropeptide levels (p = 0.013 and 0.015), whereas the testing on different modalities resulted in significant increases in amylase, epinephrine, and neuropeptide levels (p = 0.016, 0.05, 0.018, respectively). There was a significantly larger increase in plasma norepinephrine concentration (p = 0.031) and a trend toward a greater increase in the salivary amylase level (p = 0.052) when the field testing involved a different modality than the OR compared with when OR and field testing involved the same modality. Although most of the biomarkers returned to baseline levels after 24 h, plasma norepinephrine levels remained significantly higher regardless of whether field testing occurred on the same or different modality compared with OR (p = 0.040 and 0.002).

CONCLUSION:

TCCC training led to significant increase in psychophysiological stress, as indicated by elevated levels of various biomarkers. The training modalities did not result in any differences in stress levels, whereas the switch in training modalities appeared to elicit greater stress as evidenced by changes in specific biomarkers (amylase and norepinephrine). A comparative study with a larger sample size is warranted.

16/09/2018

Airway, pour être au RDV: S'entraîner

A Continuous Quality Improvement Airway Program Results in Sustained Increases in Intubation Success.

 

INTRODUCTION:

Airway management is a critical skill for air medical providers, including the use of rapid sequence intubation (RSI) medications. Mediocre success rates and a high incidence of complications has challenged air medical providers to improve training and performance improvement efforts to improve clinical performance.

OBJECTIVES:

The aim of this research was to describe the experience with a novel, integrated advanced airway management program across a large air medical company and explore the impact of the program on improvement in RSI success.

METHODS:

The Helicopter Advanced Resuscitation Training (HeART) program was implemented across 160 bases in 2015. The HeART program includes a novel conceptual framework based on thorough understanding of physiology, critical thinking using a novel algorithm, difficult airway predictive tools, training in the optimal use of specific airway techniques and devices, and integrated performance improvement efforts to address opportunities for improvement. The C-MAC video/direct laryngoscope and high-fidelity human patient simulation laboratories were implemented during the study period. Chi-square test for trend was used to evaluate for improvements in airway management and RSI success (overall intubation success, first-attempt success, first-attempt success without desaturation) over the 25-month study period following HeART implementation.

RESULTS:

A total of 5,132 patients underwent RSI during the study period. Improvements in first-attempt intubation success (85% to 95%, p < 0.01) and first-attempt success without desaturation (84% to 94%, p < 0.01) were observed. Overall intubation success increased from 95% to 99% over the study period, but the trend was not statistically significant (p = 0.311).

Quality Intubation.jpeg

CONCLUSIONS:

An integrated advanced airway management program was successful in improving RSI intubation performance in a large air medical company.

| Tags : airway

08/09/2018

Le TCCC dans la vraie vie

Survey of Casualty Evacuation Missions Conducted by the 160th Special Operations Aviation Regiment During the Afghanistan Conflict.

 
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Une vision des techniques mises en oeuvre en préhospitalier par des équipes américaines en afghanistan. Les pratiques gestuelles mies en oeuvre sur le terrain et en cours d'évacuation sont décrites. Ces dernières doivent être maîtrisées, ce qui est un vrai challenge en terme de formation et d'implication des équipes
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BACKGROUND:

Historically, documentation of prehospital combat casualty care has been relatively nonexistent. Without documentation, performance improvement of prehospital care and evacuation through data collection, consolidation, and scientific analyses cannot be adequately accomplished. During recent conflicts, prehospital documentation has received increased attention for point-of-injury care as well as for care provided en route on medical evacuation platforms. However, documentation on casualty evacuation (CASEVAC) platforms is still lacking. Thus, a CASEVAC dataset was developed and maintained by the 160th Special Operations Aviation Regiment (SOAR), a nonmedical, rotary-wing aviation unit, to evaluate and review CASEVAC missions conducted by their organization.

METHODS:

A retrospective review and descriptive analysis were performed on data from all documented CASEVAC missions conducted in Afghanistan by the 160th SOAR from January 2008 to May 2015. Documentation of care was originally performed in a narrative after-action review (AAR) format. Unclassified, nonpersonally identifiable data were extracted and transferred from these AARs into a database for detailed analysis. Data points included demographics, flight time, provider number and type, injury and outcome details, and medical interventions provided by ground forces and CASEVAC personnel.

RESULTS:

There were 227 patients transported during 129 CASEVAC missions conducted by the 160th SOAR. Three patients had unavailable data, four had unknown injuries or illnesses, and eight were military working dogs. Remaining were 207 trauma casualties (96%) and five medical patients (2%). The mean and median times of flight from the injury scene to hospital arrival were less than 20 minutes. Of trauma casualties, most were male US and coalition forces (n = 178; 86%). From this population, injuries to the extremities (n = 139; 67%) were seen most commonly. The primary mechanisms of injury were gunshot wound (n = 89; 43%) and blast injury (n = 82; 40%). The survival rate was 85% (n = 176) for those who incurred trauma. Of those who did not survive, most died before reaching surgical care (26 of 31; 84%).

CONCLUSION:

Performance improvement efforts directed toward prehospital combat casualty care can ameliorate survival on the battlefield. Because documentation of care is essential for conducting performance improvement, medical and nonmedical units must dedicate time and efforts accordingly. Capturing and analyzing data from combat missions can help refine tactics, techniques, and procedures and more accurately define wartime personnel, training, and equipment requirements. This study is an example of how performance improvement can be initiated by a nonmedical unit conducting CASEVAC missions.

21/12/2017

Préparateur sportif et trauma sévère: Une évidence !

What surgeons can learn from athletes: mental practice in sports and surgery

Cocks M et Al. J Surg Educ. 2014 Mar-Apr;71(2):262-9

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Usez des outils de préparation mentale et les blessés s'en porteront mieux. Mais pour cela il faut une méthode que l'on peut trouver auprès de certains préparateurs sportifs 
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BACKGROUND:

Mental practice has been successfully applied in professional sports for skills acquisition and performance enhancement. The goals of this review are to describe the literature on mental practice within sport psychology and surgery and to explore how the specific principles of mental practice can be applied to the improvement of surgical performance-both in novice and expert surgeons.

METHOD:

The authors reviewed the sports psychology, education, and surgery literatures through Medline, PubMed, PsycINFO, and Embase.

RESULTS:

In sports, mental practice is a valuable tool for optimizing existing motor skill sets once core competencies have been mastered. These techniques have been shown to be more advantageous when used by elite athletes. Within surgery, mental practice studies have focused on skill acquisition among novices with little study of how expert surgeons use it to optimize surgical preparation.

CONCLUSIONS:

We propose that performance optimization and skills acquisition should be viewed as 2 separate domains of mentalpractice. Further understanding of this phenomenon has implications for changing how we teach and train not only novice surgeons but also how experienced surgeons continue to maintain their skills, acquire new ones, and excel in surgery.

| Tags : top

10/11/2017

Formation des personnels des FS: Réflexions OTAN

Un peu ancien

NATO SOF Training.png

Clic sur l'image pour accéder au document

21/10/2017

Serious game ? Peut-être mais pas sûr

Serious game training improves performance in combat life-saving interventions.
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Un travail très intéressant mais dont le titre n'est pas  en adéquation avec les conclusions qui ne démontre pas d'avantage évident au recours d'un serious-game pour la formation au SC1. Peut être est il nécessaire d'intégrer une démarche analogue à celle proposée ici 
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AIM:

In modern warfare, almost 25% of combat-related deaths are considered preventable if life-saving interventions are performed. Therefore, Tactical Combat Casualty Care (TCCC) training for soldiers is a major challenge. In 2014, the French Military Medical Service supported the development of 3D-SC1®, a serious game designed for the French TCCC program, entitled Sauvetage au Combat de niveau 1 (SC1). Our study aimed to evaluate the impact on performance of additional training with 3D-SC1®.

MATERIAL AND METHODS:

The study assessed the performance of soldiers randomly assigned to one of two groups, before (measure 1) and after (measure 2) receiving additional training. This training involved either 3D-SC1® (Intervention group), or a DVD (Control group). The principal measure was the individual performance (on a 16-point scale), assessed by two investigators during a hands-on simulation. First, the mean performance score was compared between the two measures for Intervention and Control groups using a two-tailed paired t-test. Second, a multivariable linear regression was used to determine the difference in the impacts of 3D-SC1® and DVD training, and the order of presentation of the two scenarios, on the mean change from baseline in performance scores.

RESULTS AND DISCUSSION:

A total of 96 subjects were evaluated: seven could not be followed-up, while 50 were randomly allocated to the Intervention group, and 39 to the Control group. Between measure 1 and measure 2, the mean (SD) performance score increased from 9.9 (3.13) to 14.1 (1.23), and from 9.4 (2.97) to 12.5 (1.83), for the Intervention group and Control group, respectively (p<0.0001). The adjusted mean difference in performance scores between 3D-SC1® and DVD training was 1.1 (95% confidence interval -0.3, 2.5) (p=0.14). Overall, the study found that supplementing SC1 training with either 3D-SC1® or DVD improved performance, assessed by a hands-on simulation. However, our analysis did not find a statistically significant difference between the effects of these two training tools. 3D-SC1® could be an efficient and pedagogical tool to train soldiers in life-saving interventions. In the current context of terrorist threat, a specifically-adapted version of 3D-SC1®may be a cost-effective and engaging way to train a large civilian public.

09/08/2017

Un grimé comme assistant pédagogique

Conveying practical clinical skills with the help of teaching associates-a randomised trial with focus on the long term learning retention

Hoefer SH et Al. BMC Med Educ. 2017; 17: 65.

 

BACKGROUND:

Ensuring that all medical students achieve adequate clinical skills remains a challenge, yet the correct performance of clinical skills is critical for all fields of medicine. This study analyzes the influence of receiving feedback by teaching associates in the context of achieving and maintaining a level of expertise in complex head and skull examination.

METHODS:

All third year students at a German university who completed the obligatory surgical skills lab training and surgical clerkship participated in this study. The students were randomized into two groups.

CONTROL GROUP:

lessons by an instructor and peer-based practical skills training. Intervention group: training by teaching associates who are examined as simulation patients and provided direct feedback on student performance. Their competency in short- and long-term competence (directly after intervention and at 4 months after the training) of head and skull examination was measured. Statistical analyses were performed using SPSS Statistics version 19 (IBM, Armonk, USA). Parametric and non-parametric test methods were applied. As a measurement of correlation, Pearson correlations and correlations via Kendall's-Tau-b were calculated and Cohen's d effect size was calculated.

RESULTS:

A total of 181 students were included (90 intervention, 91 control). Out of those 181 students 81 agreed to be videotaped (32 in the control group and 49 in the TA group) and examined at time point 1. At both time points, the intervention group performed the examination significantly better (time point 1, p = <.001; time point 2 (rater 1 p = .009, rater 2 p = .015), than the control group. The effect size (Cohens d) was up to 1.422.

CONCLUSIONS:

The use of teaching associates for teaching complex practical skills is effective for short- and long-term retention. We anticipate the method could be easily translated to nearly every patient-based clinical skill, particularly with regards to a competence-based education of future doctors.

17/02/2017

Visualisation mentale: Mieux que l'ATLS

Mental practice: a simple tool to enhance team-based trauma resuscitation.

Lorello GR et Al CJEM. 2016 Mar;18(2):136-42. doi: 10.1017/cem.2015.4. Epub 2015 Apr 10.

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l'ATLS (Advanced trauma life support) est souvent présenté comme la panacée en matière de prise en charge du traumatisé. Il n'est pas inintéressant d'avoir une analyse très critique de ce type de formation dont le but originel était d'apporter, en 2 jours et demi, des connaissances de base à des équipes peu formées à la pris en charge de traumatisés sévères. Aussi doit on considérer qu'elle a été d'un apport fondamental dans les pays ne disposant pas de réseaux avancés. Si le contenu structuré et le recours à des ateliers pratiques apparaît attrayant , le contenu médical est régulièrement non conforme aux bonnes pratiques et les enseignants souvent non experts du sujet (1, 2). Il a pu être proposé de traduire l'acronyme ATLS par "Archaic Trauma Life Support"(3). Le travail proposé confirme bien les limites de cette formation qui ne parait plus adapté au contexte actuel pour des professionnels de l'affaire (4). Quand on s'adresse à des étudiants avancés dans leur cursus de formation, la préparation d'un exercice de simulation en équipe par l'imagerie mentale est plus efficace. 

L'ATLS demeure néanmoins un bon moyen d'appréhender pour les novices les bases fondamentales de la prise en charge des traumatisés. Ce n'est pas le seul et il existe d'autres approches notamment le DIU de traumatisés sévères (5) ou l'European Trauma Course (6), dernier donnant un grande place à la simulation.

INTRODUCTION:

Effective trauma resuscitation requires the coordinated efforts of an interdisciplinary team. Mental practice (MP) is defined as the mental rehearsal of activity in the absence of gross muscular movements and has been demonstrated to enhance acquiring technical and procedural skills. The role of MP to promote nontechnical, team-based skills for trauma has yet to be investigated.

METHODS:

We randomized anaesthesiology, emergency medicine, and surgery residents to two-member teams randomly assigned to either an MP or control group. The MP group engaged in 20 minutes of MP, and the control group received 20 minutes of Advanced Trauma Life Support (ATLS) training. All teams then participated in a high-fidelity simulated adult trauma resuscitation and received debriefing on communication, leadership, and teamwork. Two blinded raters independently scored video recordings of the simulated resuscitations using the Mayo High Performance Teamwork Scale (MHPTS), a validated team-based behavioural rating scale. The Mann-Whitney U-test was used to assess for between-group differences.

RESULTS:

Seventy-eight residents provided informed written consent and were recruited. The MP group outperformed the control group with significant effect on teamwork behaviour as assessed using the MHPTS: r=0.67, p<0.01.

CONCLUSIONS:

MP leads to improvement in team-based skills compared to traditional simulation-based trauma instruction. We feel that MP may be a useful and inexpensive tool for improving nontechnical skills instruction effectiveness for team-based trauma care.

 

 

| Tags : top

03/12/2016

Voies aériennes: Objectifs de formation CHIFFRE

A n'en pas douter: Il faut un minimum de pratique pour pouvoir prétendre jouer un rôle. Le caractère obligatoire de quotas de geste est en route.

R26.jpg

Clic sur l'image pour accéder à la RFE

 

12/09/2016

L'hôpital de proximité: Insuffisant ?

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

Schauer SG et Al. J Spec Oper Med. 2015 Winter;15(4):67-70

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Lire également cet éditorial qui pointe l'insuffisance de l'exercice en hôpital de proximité avec le rôle important que peut jouer la simulation. Les auteurs proposent un  maintien longitudinal des compétences avec des minima en termes de pratiques gestuelles avant projection. 

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BACKGROUND:

Emergency medicine physicians (EPs) are often placed in far-forward, isolated areas in theater. Maintenance of their emergency intervention skills is vital to okeep the medical forces deployment ready. The US Army suggests that working at a Military Treatment Facility (MTF) is sufficient t keep emergency procedural skills at a deployment-ready level. We sought to compare the volume of emergency procedures that providers reported necessary to maintain their skills with the number available in the MTF setting.

METHODS:

EPs were surveyed to quantify the number of procedures they reported they would need to perform yearly to stay deployment-ready. We obtained procedure data for their duty stations and compared the procedure volume with the survey responses to determine if working at an MTF is sufficient to keep providers' skills deployment ready.

RESULTS:

The reported necessary average numbers per year were as follows: tube thoracostomy (5.9), intubation (11.4), cricothyrotomy (4.2), lumbar puncture (5.2), central line (10.0), focused assessment with sonography for trauma (FAST) (21.3), reductions (10.6), splints (10.5), and sedations (11.7). None of the procedure volumes at MTFs met provider requirements with the exception of FAST examinations at the only trauma center.

Emergency Physician.jpg

CONCLUSIONS:

This suggests the garrison clinical environment is inadequate for maintaining procedure skills. Further research is needed to determine modalities that will provide adequate training volume.

01/09/2016

Pensez, efficace et peu couteux

Cognitive skills analysis, kinesiology, and mental imagery in the acquisition of surgical skills

Bathalon S. et Al. J Otolaryngol. 2005 Oct;34(5):328-32.

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Un moyen simple pour améliorer sa performance 

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GOAL:

Isolate and evaluate the impact of mental imagery on the acquisition of an emergency surgical technique.

METHOD:

We studied 44 first-year medical students performing a cricothyrotomy on a mannequin to determine the impact of teaching usingmental imagery (MI) and/or kinesiology (KG) compared to the standard Advandec Trauma Life Support (ATLS) approach. Students were randomly assigned to one of three groups: MI and KG, KG alone or control (ATLS). Two weeks after the one-hour teaching session, they were evaluated with an OSCE testing the performance of the different steps of the technique, the time required and its fluidity.

RESULTS:

Total results (maximum: 25 marks) are as follows: KG + MI = 20.3 +/- 1.5 ; KG = 19.3 +/- 2.9 ; ATLS = 18.2 +/- 2.5. The only statistically significant difference for total results was in the use of MI and KG compared to the control group. Kinesiology alone or with mental imageryimproved the fluidity of the performance.

CONCLUSION:

Many factors influence the acquisition of a surgical technique. This study showed that acquisition and performance of an emergency procedure (cricothyrotomy) was improved when mental imagery and kinesiology were combined to teach it.

| Tags : airway, top

04/08/2016

Le cône d'apprentissage de Dale: Quèsaco ?

J'entends et j'oublie,

Je vois et je me souviens,

Je fais et je comprends

cone-de-dale2.png

30/01/2016

Coniotomie: Modèle porcin

A porcine model for teaching surgical cricothyridootomy

Netto FA et Al. Rev Col Bras Cir. 2015 Jun;42(3):193-6

 

0100-6991-rcbc-42-03-00193-gf01.jpg

Le matériel nécessaire

0100-6991-rcbc-42-03-00193-gf02.jpg

Le montage

0100-6991-rcbc-42-03-00193-gf03.jpg

Un gant fixé derrière la peau va simuler la membrane

0100-6991-rcbc-42-03-00193-gf04.jpg

Le simulateur prêt à l'emploi.

 

| Tags : coniotomie

17/12/2015

Tourniquet:Oui, mais bien posé= Serrer FORT

Evaluation of rapid training in ultrasound guided tourniquet application skills

Jaffer U. et Al. International Journal of Surgery 10 (2012) 563-567 

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Il existe actuellement un engouement justifié pour l'emploi du tourniquet comme moyen d'hémostase. Néanmoins il est important de rappeler que la pose d'un garrot a pour objectif l'arrêt d'un saignement important le plus souvent d'origine artérielle. Ils se doivent donc d'être serrés fort. Le travail proposé rappelle que la formation à la pose d'un garrôt n'est pas simplement sa manipulation mais qu'elle doit porter de manière spécifique sur les critères d'arrêt du saignement. En effet dans un modèle classique d'instruction de pose sur patient sain, les critères d'arrêt du serrage ne correspondent pas à ceux nécessaires en réel. Dans le travail proposé la pose à l'aveugle d'un garrot ne permet d'obtenir l'arrêt du saignement que dans moins  d'1/4 à 1/5 des cas. Un enseignement donc à conduire par ceux qui en ont une pratique avancée. L'apport de simulateurs de saignement objectif comme celui du TOMMAN est certainement très intéressant. 

Pour info: Fiche memento Garrot tactique

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Tourniquet application has been widely accepted to improve survival for major limb trauma. Colour duplex ultrasound (US) can be used as a non-invasive method of confirming cessation of arterial flow. Participants with no or limited experience of ultrasound were taught to apply the Tourniquet with ultrasound guidance. Following this, participants were tested in effective tourniquet application: Blind and with ultrasound guidance. US guidance improved abolition of limb perfusion from 22 to 93 per cent in upper limb; from 25 to 100 per cent in lower limb (p ¼ 0.0027 and <0.0001).
         1-s2.0-S1743919112007686-gr7.jpg 1-s2.0-S1743919112007686-gr5.jpg

                                     Membre Sup                                                                          Membre inf

No significant difference was found in application time for the lower limb; less time was taken for application with US guidance in the upper limb 8.1 (7.1, 8.6) vs 4.5 s (4.0, 5.3; median (IQR)), p ¼ 0.002. Tourniquet ultrasound skills are rapidly acquired by novice operators. Accuracy improves with ultrasound guidance, this may have a role in improving survival.

 

 

30/10/2015

Echographie: De l'expérience SVP

Does physician experience influence the interpretability of focused echocardiography images performed by a pocket device?

Bobbia X et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2015) 23:52

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Il existe un très grand engouement concernant l'emploi d'échographe dit de poche. Cet article appelle a être plus circonspect. Sil il s'agit bien de faire rentrer l'échographie dans la pratique quotidienne, encore faut il que cela soit assorti d'une qualification réelle.

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Introduction: The use of focused cardiac ultrasound (FoCUS) in a prehospital setting is recommended. Pocket ultrasound devices (PUDs) appear to be well suited to prehospital FoCUS. The main aim of our study was to evaluate the interpretability of echocardiography performed in a prehospital setting using a PUD based on the experience of the emergency physician (EP).

Methods: This was a monocentric prospective observational study. We defined experienced emergency physicians (EEPs) and novice emergency physicians (NEPs) as echocardiographers if they had performed 50 echocardiographies since their initial university training (theoretical training and at least 25 echocardiographies performed with a mentor). Each patient undergoing prehospital echocardiography with a PUD was included. Four diagnostic items based on FoCUS were analyzed: pericardial effusions (PE), right ventricular dilation (RVD), qualitative left ventricular function assessment (LVEF), and inferior vena cava compliance (IVCC). Two independent experts blindly evaluated the interpretability of each item by examining recorded video loops. If their opinions were divided, then a third expert concluded.

Results: Fourteen EPs participated: eight (57 %) EEPs and six (43 %) NEPs. Eighty-five patients were included: 34 (40 %) had an echocardiography by an NEP and 51 (60 %) by an EEP. The mean number of interpretable items by echocardiography was three [1; 4]; one [0; 2.25] in the NEP group, four [3; 4] in EEP (p < .01). The patient position was also associated with interpretable items: supine three [2; 4], “45°” three [1; 4], sitting two [1; 4] (p = .02). In multivariate analysis, only EP experience was associated with the number of interpretable items (p = .02). Interpretability by NEPs and EEPs was: 56 % vs. 96 % for LVF, 29 % vs. 98 % for PE, 26 % vs. 92 % for RVD, and 21 % vs. 67 % for IVCC (p < .01 for all).

ECHO.jpg

 

Conclusion: FoCUS with PUD in prehospital conditions was possible for EEPs, It is difficult and the diagnostic yield is poor for NEPs.

 

| Tags : échographie

01/09/2015

Grimage ou mannequins ? Les 2 svp !

A comparison of live tissue training and high-fidelity patient simulator: A pilot study in battlefield trauma training

Savage EC et Al.  J Trauma Acute Care Surg. 2015;00: 00_00[Epub ahead of print].

 

BACKGROUND:

Trauma procedural and management skills are often learned on live tissue. However, there is increasing pressure to use simulators because their fidelity improves and as ethical concerns increase. We randomized military medical technicians (medics) to training on either simulators or live tissue to learn combat casualty care skills to determine if the choice of modality was associated with differences in skill uptake.

METHODS:

Twenty medics were randomized to trauma training using either simulators or live tissue. Medics were trained to perform five combat casualty care tasks (surgical airway, needle decompression, tourniquet application, wound packing, and intraosseous line insertion). We measured skill uptake using a structured assessment tool. The medics also completed exit questionnaires and interviews to determine which modality they preferred.

RESULTS:

We found no difference between groups trained with live tissue versus simulators in how they completed each combat casualty care skill. However, we did find that the modality of assessment affected the assessment score. Finally, we found that medics preferred trauma training on live tissue because of the fidelity of tissue handling in live tissue models. However, they also felt that training on simulators also provided additional training value.

CONCLUSION:

We found no difference in performance between medics trained on simulators versus live tissue models. Even so, medics preferred live tissue training over simulation. However, more studies are required, and future studies need to address the measurement bias of measuring outcomes in the same model on which the study participants are trained.

19/08/2015

Simuler en haute fidélité: Pas si sûr !

A Comparison of Teaching Modalities and Fidelity of Simulation Levels in Teaching Resuscitation Scenarios

Adams AJ et Al.  J Surg Ed 2015, 72:778-785

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Il existe un très grand engouement pour le recours à la simulation haute fidélité, ce qui n'est pas sans impact financier. Un mannequin sophistiqué serait le gage d'une meilleure qualité de formation. Il semble que les bases scientifiques de ces démarches ne sont pas aussi solides que cela du moins pour les novices. Cet article a le mérite de montrer que l'on peut parfaitement conduire une formation de qualité avec des moyens plus conventionnels. 

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Introduction

The purpose of our study was to examine the ability of novices to learn selected aspects of Advanced Cardiac Life Support (ACLS) in training conditions that did not incorporate simulation compared to those that contained low- and high-fidelity simulation activities. We sought to determine at what level additional educational opportunities and simulation fidelity become superfluous with respect to learning outcomes.

Methods

Totally 39 medical students and physician assistant students were randomly assigned to 4 training conditions: control (lecture only), video-based didactic instruction, low-, and high-fidelity simulation activities. Participants were assessed using a baseline written pretest of ACLS knowledge. Following this, all participants received a lecture outlining ACLS science and algorithm interpretation. Participants were then trained in specific aspects of ACLS according to their assigned instructional condition. After training, each participant was assessed via a Megacode performance examination and a written posttest.

Results

All groups performed significantly better on the written posttest compared with the pretest (p < 0.001); however, no groups outperformed any other groups. On the Megacode performance test, the video-based, low-, and high-fidelity groups performed significantly better than the control group (p = 0.028, p < 0.001, p = 0.019). Equivalence testing revealed that the high-fidelity simulation condition was statistically equivalent to the video-based and low-fidelity simulation conditions.

Simulation.jpg

Conclusion

Video-based and simulation-based training is associated with better learning outcomes when compared with traditional didactic lectures only. Video-based, low-fidelity, and high-fidelity simulation training yield equivalent outcomes, which may indicate that high-fidelity simulation is superfluous for the novice trainee.

01/08/2015

Simulation préhospitalière: Etat des lieux

Mapping the use of simulation in prehospital care - a literature review

Abelsson et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2014, 22:22

  

BACKGROUND:

High energy trauma is rare and, as a result, training of prehospital care providers often takes place during the real situation, with the patient as the object for the learning process. Such training could instead be carried out in the context of simulation, out of danger for both patients and personnel. The aim of this study was to provide an overview of the development and foci of research on simulation in prehospital care practice.

METHODS:

An integrative literature review were used. Articles based on quantitative as well as qualitative research methods were included, resulting in a comprehensive overview of existing published research. For published articles to be included in the review, the focus of the article had to be prehospital care providers, in prehospital settings. Furthermore, included articles must target interventions that were carried out in a simulation context.

RESULTS:

The volume of published research is distributed between 1984- 2012 and across the regions North America, Europe, Oceania, Asia and Middle East. The simulation methods used were manikins, films, images or paper, live actors, animals and virtual reality. The staff categories focused upon were paramedics, emergency medical technicians (EMTs), medical doctors (MDs), nurse and fire fighters. The main topics of published research on simulation with prehospital care providers included: Intubation, Trauma care, Cardiac Pulmonary Resuscitation (CPR), Ventilation and Triage.

CONCLUSION:

Simulation were described as a positive training and education method for prehospital medical staff. It provides opportunities to train assessment, treatment and implementation of procedures and devices under realistic conditions. It is crucial that the staff are familiar with and trained on the identified topics, i.e., intubation, trauma care, CPR, ventilation and triage, which all, to a very large degree, constitute prehospital care. Simulation plays an integral role in this. The current state of prehospital care, which this review reveals, includes inadequate skills of prehospital staff regarding ventilation and CPR, on both children and adults, the lack of skills in paediatric resuscitation and the lack of knowledge in assessing and managing burns victims. These circumstances suggest critical areas for further training and research, at both local and global levels.

| Tags : simulateurs

16/07/2015

S'entraîner pour son assurance personnelle : Combien ?

Training Modalities and Self-Confidence Building in ALS Providers

Ilia S et Al. . Mil Med. 2012 Aug;177(8):901-6.

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Un document important qui aborde l'impact de la confiance en soi obtenu par l'entraînement. Plusieurs techniques d'entraînement doivent être associée: Simulation et monde réel. Le recours au modèle animal n'apparaît pas significatif. Des plateaux à partir desquels il faut opter pour une autre méthode sont identifiés: Pour l'intubation 30 sur mannequin et 25 en réel, 40 pour l'exsufflation sur mannequin et 3 en réel et 10 pose de KTIO sur simulateur.

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OBJECTIVE:

Physicians and paramedics in the Israel Defense Forces are trained to perform advanced medical procedures using standardized training modalities, such as manikins. We studied the association of experience using these training modalities with self-reported confidence in procedure performance.

METHODS:

Providers were sent a questionnaire regarding their experience with and self-confidence levels for performing endotracheal intubation, cricothyroidotomy, needle chest decompression, tube thoracostomy, and intraosseous infusion.

RESULTS:

Provider level (physician or paramedic) and gender were associated with reported self-confidence levels. Manikin and supervised and unsupervised patient experience exhibited positive associations with self-confidence, but (animal) model experience did not. For many procedure-training modality pairs, we identified a plateau level above which additional experience was minimally associated with an increase in self-confidence.

training Modalities IDF.jpg

CONCLUSIONS:

Among military advanced life support providers, self-confidence levels in procedure performance are positively associated with experience gained from manikins and supervised and unsupervised patient application. We were not able to demonstrate a clear benefit of an animal model in increasing self-confidence. A plateau was generally identified, indicating decreased benefit from the use of a particular training modality for a particular procedure. Modifying training regimens in light of these findings may help maximize the self-confidence of advanced life support providers more efficiently. 

14/06/2015

Transfert de compétences: Oui si organisé !

Amélioration de l'offre des soins obstétricaux par la délégation des tâches en milieu africain Exemple de l'hôpital du district sanitaire de Bogodogo à Ouagadougou, Burkina Faso

Ouédraogo CM et Al. Médecine et Santé Tropicales 2015 ; 00 : 1-5

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La performance du sauvetage au combat tient à un transfert de compétences et savoir faire choisis et pour lesquels des personnels ont été spécifiquement formés. Ainsi la médicalisation de l'avant doit elle être comprise non pas la présence du médecin à l'avant mais la présence de savoir faire. Ce besoin déborde largement le contexte militaire et est bien connu dans les pays où l'infrastructure médicale n'est pas aussi développée qu'en métropole. Le document présenté exprime toute la puissance de ces transferts quand ils sont organisés et bien maîtrisés. 

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Objectif : délégation de la pratique des interventions obstétricales majeures à des infirmiers spécialisés en chirurgie à l’hôpital de district de Bogodogo, Burkina Faso.

Méthode: Etude descriptive, analytique et non expérimentale comparant les prestations de gynécologues-obstétriciens et des infirmiers spécialisés en chirurgie pour des interventions obstétricales majeures. La collecte des données a été réalisée de février à octobre 2013 dans le service de gynécologie obstétrique de l’hôpital du district de Bogodogo. Ont été incluses dans l’étude les femmes qui ont bénéficié d’une intervention obstétricale majeure (IOM) en urgence, par un gynécologue obstétricien ou par un infirmier spécialisé en chirurgie. La collecte des données a été réalisée de février à octobre 2013 dans le service de gynécologie obstétrique de l’hôpital de district de Bogodogo, à l’aide d’une fiche (questionnaire) individuelle. Les données ont été saisies grâce au logiciel EPIDATA, version 3.1, et analysées par SPSS, version 22. Le test de Khi2 a permis la comparaison des proportions et celui de Student la comparaison des moyennes. Le seuil de significativité retenu était de 5%.

Résultats : Au cours de la période d’étude, nous avons colligé 601 cas d’interventions obstétricales majeures dont 65,4% réalisés par les gynécologues obstétriciens. L’âge moyen des femmes était de 26,7 ans. La césarienne était l’intervention obstétricale majeure la plus pratiquée avec fréquence de 90% suivi de la laparotomie avec une fréquence de 7,7%. Dans les cas de césarienne, la technique de Misgav-Ladach a été utilisée respectivement dans 86,5% et 95,3% par les gynécologues obstétriciens et les infirmiers spécialisés en chirurgie.

Délégation IOM.jpg

Conclusion : La délégation de tâches en chirurgie obstétricale est effective à l’hôpital du district de Bogodogo et sans risque selon les résultats de cette étude. Son extension au niveau national permettrait de combler le déficit en ressources humaines hautement qualifiées pour réaliser les IOM dans les hôpitaux de district des régions rurales