Chemical, biological, radiological, and nuclear (CBRN) incidents are a major challenge for emergency medical services and the involved hospitals, especially if decontamination needs to be performed nearby or even within the hospital campus. The University Hospital Wuerzburg has developed a comprehensive and alternative CBRN response plan. The focus of this study was to proof the practicability of the concept, the duration of the decontamination process, and the temperature management.The entire decontamination area can be deployed 24/7 by the hospitals technical staff. Fire and rescue services are responsible for the decontamination process itself. This study was designed as full-scale exercise with 30 participants.The decontamination area was ready for operation within 30 minutes. The decontamination of the four simulated patients took 5.5 ± 0.6 minutes (mean ± SD). At the end of the decontamination process, the temperature of the undressed upper body of the training patients was 27.25 ± 1°C (81.05 ± 2°F) (mean ± SD) and the water in the shower was about 35°C (95°F).The presented concept is comprehensive and simple for a best possible care during CBRN incidents at hospitals. It ensures wet decontamination by Special Forces, while the technical requirements are created by the hospital.
Cognitive aids - artefacts that support a user in the completion of a task at the time - have raised great interest to support healthcare staff during medical emergencies. However, the mechanisms of how cognitive aids support or affect staff remain understudied. We describe the iterative development of a tablet-based cognitive aid application to support in-hospital resuscitation team leaders. We report a summative evaluation of two different versions of the application. Finally, we outline the limitations of current explanations of how cognitive aids work and suggest an approach based on embodied cognition. We discuss how cognitive aids alter the task of the team leader (distributed cognition), the importance of the present team situation (socially situated), and the result of the interaction between mind and environment (sensorimotor coupling). Understanding and considering the implications of introducing cognitive aids may help to increase acceptance and effectiveness of cognitive aids and eventually improve patient safety.
Precise and complete documentation of in-hospital cardiopulmonary resuscitations is important but data quality can be poor. In the present study, we investigated the effect of a tablet-based application for real-time resuscitation documentation used by the emergency team leader on documentation quality and clinical performance of the emergency team.Senior anaesthesiologists either used the tablet-based application during the simulated resuscitation for documentation and also used the application for the final documentation or conducted the full documentation at the end of the scenario using the local hospital information system. The latter procedure represents the current local documentation method. All scenarios were video recorded. To assess the documentation, we compared the precision of intervention delivery times, documentation completeness, and final documentation time. To assess clinical performance, we compared adherence to guidelines for defibrillation and adrenaline administration, the no-flow fraction, and the time to first defibrillation.The results showed significant benefits for the tablet-based application compared to the hospital information system for precision of the intervention delivery times, the final documentation time, and the no-flow fraction. We observed no differences between the groups for documentation completeness, adherence to guidelines for defibrillation and adrenaline administration, and the time to first defibrillation.In the presented study, we observed that a tablet-based application can improve documentation data quality. Furthermore, we demonstrated that a well-designed application can be used in real-time by a member of the emergency team with possible beneficial effects on clinical performance.The present evaluation confirms the advantage of tablet-based documentation tools and also shows that the application can be used by an active member of an emergency team without compromising clinical performance.
Abstract Background: Mechanical ventilation in helicopter emergency medical service (HEMS) environments is a procedure which carries a significant risk of complications. Limited data on the quality and performance of mechanical ventilation in HEMS are available in the literature. Method: We conducted an international survey to evaluate mechanical ventilation infrastructure in HEMS and collect data of transported ventilated patients. From June 20-22, 2019, the participating HEMS bases were asked to provide data via a web-based platform. Results: Fifty-three HEMS bases responded. Respondents were from Germany, Denmark, United Kingdom, Luxembourg, Austria and Switzerland. Of the HEMS bases, all medical team leaders were physicians, mainly anesthesiologists (79%), the majority were board certified (92.5%) and trained in intensive care medicine (89%) and had a median (range) experience in HEMS of 9 (0-25) years. HEMS may provide a high level of expertise in mechanical ventilation whereas the majority of ventilators are able to provide pressure controlled ventilation and continuous positive airway pressure modes (77%). Data of 30 ventilated patients with a median (range) age of 54 (21-100) years and 53% male gender were analyzed. Conclusion: In this pilot study, the management of ventilated HEMS-patients was not associated with ventilation related serious adverse events. Individual circumstances of patients, training of medical crew and different technical and environmental resources are likely to influence management. Further studies involving ventilated patients are necessary to assess safety and process quality of mechanical ventilation in HEMS.
