Education in emergency response to trauma is a global health priority . Mortality rates are nearly twice as high in patients with trauma in low-income as compared to high-income countries . With uncontrolled bleeding as the number one cause of death from trauma, tourniquet application has been the focus of training programs, like the “Stop the Bleed” campaign in the United States . Although understanding how to apply a tourniquet is a life-saving intervention, use of a windlass tourniquet may not be intuitive . The windlass tourniquet in its simplest form is the “stick-and-rope.” Winding the stick in the tourniquet creates a mechanical advantage for providing compression. Simulation of the windlass technique can be used to teach management of uncontrolled bleeding. Here we describe a low-cost simulation model that combines low- and high-fidelity techniques to train healthcare personnel on windlass tourniquet application.
In many parts of the world, emergency medicine is just beginning to emerge as a specialty. In Pakistan, for example, it was introduced as recently as 2012. Hands-on training in the management of critically-ill medical and trauma patients is imperative for adequate preparation of board-certified emergency physicians, but accurate simulation can be hard to come by in developing nations. There are very few training programs and dedicated centers for healthcare professionals, and even fewer that have simulation . High-tech simulation equipment is often cost-prohibitive; a mobile, low-tech simulation lab could potentially address the need for advanced training in resuscitation for emergency physicians training in under-resourced hospitals.
According to the National Health And Nutrition Examination Survey, approximately 630,000 adults in the United States have cirrhosis of the liver, 69% of which are reportedly unaware of having liver disease. A diagnostic paracentesis is a simple procedure for identifying spontaneous bacterial peritonitis in cirrhotic patients with ascites. A just-in-time training (JITT) model incorporating low-fidelity equipment readily available in the ED can facilitate procedural teaching of the diagnostic paracentesis.(more…)
IDEA Series | “Saving Society” Podcast Series Teaches Residents Reflective Practice Through Debriefing
Emergency physicians (EPs) experience professional burnout more than 3 times that of the average physician.1 In a recent study, the prevalence of burnout among emergency medicine residents was found to be an astounding 76.1%, suggesting that burnout begins as early as residency training.2 The emotional impact of witnessing suffering and death and the high-stakes, stressful environment of the ED likely contribute to burnout among trainees.
One potential protective factor against burnout is the strategic use of debriefing to mitigate work-related stress. Debriefing involves taking the opportunity to discuss and reflect upon a recent experience with a group of peers who share an understanding of the experience’s context. Debriefing can create a space for peers to provide mentorship, support and feedback to each other, thereby reducing work-related stress.3,4
Burnout is a well-known syndrome characterized by poor self-care, dehumanization, exhaustion, and reduced effectiveness. The study of wellness and resilience among emergency medicine (EM) providers and trainees has recently blossomed, largely as a consequence of recent tragedies of physician suicide, provider distress, and an increased awareness the impact burnout has on both personal and professional domains. While there are ongoing discussions on practices to best address burnout, methods have focused on promoting resilience, mindfulness, and provider engagement.1
Cricothyroidotomy is an emergency life-saving procedure that involves surgical placement of a tube through the cricothyroid membrane in order to establish a patent airway for oxygenation and ventilation. The indications for this procedure are when traditional means, such as orotracheal or nasotracheal intubation, are contraindicated or have failed during attempts to establish an emergency airway.1,2 It is a critical skill for emergency physicians but the declining rate of this procedure has resulted in decreased exposure during training.3,4
Emergency Medicine (EM) residents are expected to be familiar with and competent in performing a wide number of procedures, including rare ones such as performing an escharotomy in a patient with severe burns. Unfortunately, there is a paucity of readily available simulation models to facilitate practice of this rare yet potentially life-saving skill.