scholarly journals Comparing Training Techniques in Chemical Disaster Preparedness

2019 ◽  
Vol 34 (s1) ◽  
pp. s109-s109
Author(s):  
Richard Salway ◽  
Trenika Williams ◽  
Camilo Londono ◽  
Bonnie Arquilla
Keyword(s):  
Emergency Medicine ◽  
Emergency Preparedness ◽  
Disaster Preparedness ◽  
Error Rates ◽  
Evaluation Tool ◽  
Self Evaluation ◽  
Significant Difference ◽  
Group B ◽  
Demonstration Video ◽  
Training Modalities

Introduction:Currently, there are no universally accepted personal protective equipment (PPE) training guidelines for Emergency Medicine physicians, though many hospitals offer training through a brief didactic presentation. Physicians’ response to hazmat events requires PPE utilization to ensure the safety of victims, facilities, and providers; providing effective and accessible training is crucial. In the event of a real disaster, time constraints may not allow a brief in-person presentation and an accessible video training may be the only resource available.Aim:To assess the effectiveness of video versus in-person training of 20 Emergency Medicine Residents in Level C PPE donning and doffing (chemical-resistant coverall, butyl gloves, boots, and an air-purifying respirator).Methods:A prospective observational study was performed with 20 Emergency Medicine residents as part of Emergency Preparedness training. Residents were divided into two groups, with Group A viewing a demonstration video developed by the emergency preparedness team, and Group B receiving in-person training by a Hazmat Team Member. Evaluators assessed critical tasks of donning and doffing PPE utilizing a prepared evaluation tool. At the drill’s conclusion, all participants completed a self-evaluation to determine their confidence in their respective trainings.Results:Both video and in-person training modalities showed significant improvement in participants’ confidence in doffing and donning a PPE suit (p>0.05). However, no statistically significant difference was seen between training modalities in the performance of donning or doffing (p>0.05).Discussion:Video and in-person training are equally effective in preparing residents for donning and doffing Level C PPE, with similar error rates in both modalities. Future trainings should focus on decreasing the overall rate of breaches across all training modalities.

Comparing Training Techniques in Personal Protective Equipment Use

2020 ◽  
Vol 35 (4) ◽  
pp. 364-371 ◽  
Author(s):  
Richard J. Salway ◽  
Trenika Williams ◽  
Camilo Londono ◽  
Patricia Roblin ◽  
Kristi Koenig ◽  
...  
Keyword(s):  
Sample Size ◽  
Personal Protective Equipment ◽  
Emergency Preparedness ◽  
Null Hypothesis ◽  
Small Sample ◽  
Protective Equipment ◽  
Video Training ◽  
Significant Difference ◽  
Demonstration Video ◽  
Training Modalities

AbstractIntroduction:Physicians’ management of hazardous material (HAZMAT) incidents requires personal protective equipment (PPE) utilization to ensure the safety of victims, facilities, and providers; therefore, providing effective and accessible training in its use is crucial. While an emphasis has been placed on the importance of PPE, there is debate about the most effective training methods. Circumstances may not allow for a traditional in-person demonstration; an accessible video training may provide a useful alternative.Hypothesis:Video training of Emergency Medicine (EM) residents in the donning and doffing of Level C PPE is more effective than in-person training.Null Hypothesis:Video training of EM residents in the donning and doffing of Level C PPE is equally effective compared with in-person training.Methods:A randomized, controlled pilot trial was performed with 20 EM residents as part of their annual Emergency Preparedness training. Residents were divided into four groups, with Group 1 and Group 2 viewing a demonstration video developed by the Emergency Preparedness Team (EPT) and Group 3 and Group 4 receiving the standard in-person demonstration training by an EPT member. The groups then separately performed a donning and doffing simulation while blinded evaluators assessed critical tasks utilizing a prepared evaluation tool. At the drill’s conclusion, all participants also completed a self-evaluation survey about their subjective interpretations of their respective trainings.Results:Both video and in-person training modalities showed significant overall improvement in participants’ confidence in doffing and donning PPE equipment (P <.05). However, no statistically significant difference was found in the number of failed critical tasks in donning or doffing between the training modalities (P >.05). Based on these results, the null hypothesis cannot be rejected. However, these results were limited by the small sample size and the study was not sufficiently powered to show a difference between training modalities.Conclusion:In this pilot study, video and in-person training were equally effective in training for donning and doffing Level C PPE, with similar error rates in both modalities. Further research into this subject with an appropriately powered study is warranted to determine whether this equivalence persists using a larger sample size.

35 Wound Improvement Project: Improving Skill Sustainment and Confidence

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S24-S25
Author(s):  
Sarah K Shingleton ◽  
Alexandra J Helms ◽  
Leopoldo C Cancio ◽  
Monica L Abbott ◽  
Corey A Miner
Keyword(s):  
Wound Care ◽  
Care Quality ◽  
Nurse Specialist ◽  
Positive Trend ◽  
Evaluation Tool ◽  
Improvement Project ◽  
Self Evaluation ◽  
Burn Center ◽  
Significant Difference ◽  
Student’S T

Abstract Introduction New burn intensive care unit (BICU) nurses in the Burn Center complete an evidence-based preceptorship to include standardized wound care education that is reinforced throughout preceptorship. A gap in skill sustainment was identified; factors include lack of a formal sustainment program, inconsistent reinforcement of wound care skills and a perceived decrease in pride in wound care. The purposes of this project are to 1) develop and implement a wound care skill sustainment program 2) re-establish confidence in wound care and 3) improve the quality of wound care delivered in the BICU. Methods A Wound Improvement Project (WIP) committee was formed FEB 2018 consisting 8 BICU nurses; the BICU Nurse Manager and Wound Clinical Nurse Specialist serve as consultants. WIP developed several learning modules and is now developing a wound skill sustainment program and evaluation tool based on the Burn Nurse Competency Initiative (BNCI) standards. BICU staff complete an anonymous survey about wound care confidence every 6 months. WIP mentors and evaluates competency through direct observation during 3 assigned shifts with each BICU nurse. Wound care documentation is audited monthly and a wound care quality audit tool is being developed. Descriptive statistics, student’s T-test, and ANOVA were used. Results The confidence survey was given in Spring 2018 (n=52), Winter 2019 (n=33) and Summer 2019 (n=64); each question showed significant improvement. Notably “how confident would you be doing a full body wound care by yourself with some help turning” improved from 4.12 (±1.17) to 4.64 (±0.65, p=.01). 24 BICU staff have been evaluated with 40 pending completion. No significant difference was found in skill competency between the 3 WIP assigned shifts; however self-evaluation for “how comfortable/confident do you feel advocating for a different type of wound care treatment for your patient” improved from 6.1 (±2.2) to 7.5 (±1.9, p&lt; .0001). Average wound documentation scores improved from 85% in FEB 2018 to 99% in FEB 2019. Conclusions Wound care confidence and documentation have improved since initiation of WIP. Targeted education, bedside tools and workshops have all contributed. There is a positive trend (not significant) towards improved skill competency this is likely due to tool modifications and the small number of staff evaluated to date. Staff feedback has been positive with most staff finding WIP helpful. The long-term goal is to expand WIP to all areas of the Burn Center. Applicability of Research to Practice BNCI standards are a framework for skill sustainment and progression of staff from competent towards proficient and expert. Development and evaluation of nurse-led sustainment programs are needed across the burn community.

scholarly journals Anterior Shoulder Dislocation Reduction Managed Either with Midazolam or Propofol in Combination with Fentanyl

2014 ◽  
Vol 21 (6) ◽  
pp. 346-353 ◽  
Author(s):  
T Cimilli Ozturk ◽  
O Guneysel ◽  
H Akoglu
Keyword(s):  
Emergency Medicine ◽  
Prospective Trial ◽  
Vital Signs ◽  
Respiratory Compromise ◽  
Intravenous Fentanyl ◽  
Orthopaedic Surgeons ◽  
Dislocation Reduction ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objective Procedural Sedation and Analgesia is used in managing emergency painful procedures. The aim of this study is to compare the effects of propofol and midazolam on haemodynamic parameters when used in combination with fentanyl in isolated anterior shoulder dislocations and to measure the patient and physician satisfactions. Methods The study is a randomised single blind prospective trial. All procedural sedations were performed by emergency medicine specialists and the shoulder reductions were performed by orthopaedic surgeons. Two groups were defined. Group A received intravenous fentanyl and midazolam and Group B received intravenous fentanyl and propofol. The orthopaedic surgeons were not informed about the drugs. The emergency medicine specialist observed the patients. The patients and the orthopaedic surgeons were asked for a satisfaction scoring. Results Midazolam group consisted of 37 patients and propofol group consisted of 38 patients. Both groups were similar in demographic characteristics and pre-procedural vital signs. There was only one statistically significant difference at one time and it was the 5th minutes SpO2 levels between groups. There were statistically significant changes in the measurements of vital parameters in both groups when compared with the baseline levels. However none of them was clinically important. In midazolam and propofol group, 10.8% and 10.5% respectively had respiratory compromise. Patient and physician satisfactions were similar in both groups. Conclusions Midazolam and propofol are both relatively safe drugs using in combination with fentanyl in anterior shoulder dislocations. Patients and physicians can be highly satisfied with the two groups of drugs. (Hong Kong j.emerg.med. 2014;21:346-353)

scholarly journals The Incidence and Frequency of Various Causes of Angioedema in Emergency Medicine

2018 ◽  
Vol 47 (1) ◽  
pp. 11
Author(s):  
Ljerka Karadža-Lapić ◽  
Tamara Pikivaca ◽  
Petra Pervan ◽  
Josipa Jović Zlatović ◽  
Sanja Delin ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Case Reports ◽  
Subsequent Treatment ◽  
Chi Square ◽  
Significant Difference ◽  
Causative Agents ◽  
Life Threatening ◽  
Group A ◽  
Group B ◽  
Insect Bites

<p><strong>Objective. </strong>Angioedema (AE) is a potentially life-threatening event. We investigated the etiology of AE, with the emphasis on bradykinininduced angioedema treatment in emergency medicine.</p><p><strong>Methods. </strong>The retrospective study included 237 patients with AE, who were examined and treated in two hospitals (group A and B) in Croatia from 2009 to 2016. The location and duration of AE, data about chronic diseases and treatment, potential causative agents (food, drugs, insect bites and chemicals), physical examination data and the subsequent treatment were analyzed.</p><p><strong>Results. </strong>There was no statistical difference regarding age or comorbidities but there was a statistically significant difference in etiology between the groups (Chi-square, P=0.03). Renin-angiotensin-aldosterone system (RAAS) blocker induced AE was the main cause of emergency attendance in group A (37.5%) and among the leading causes in group B (18.8%). Bradykinin-induced AE (hereditary angioedema (HAE) and RAAS-AE) were the leading causes in a total of 75 (31.5%) patients. RAAS-AE was treated with glucocorticoids and antihistamines. HAE attacks in both groups (2/7 patients, 1.5/6%) were treated with specific therapy. Other causes of AE in groups A/B were insect bites (15/23 patients, 13.5/20%), use of antibiotics/analgetics (11/17 patients, 9/15%), gastroesophageal reflux disease (10/11 patients, 8/9%), neoplasms (5/6 patients, 4/5%) and idiopatic (32/31 patients, 26.5/26%). 21% of patients were hospitalized.</p><p><strong>Conclusion. </strong>Bradykinin-mediated AE was the main cause of emergency attendance associated with AE. Advances in the treatment of HAE, with case reports of patients with RAAS-AE treated with C1 esterase inhibitor concentrate or bradykinin receptor antagonist, may prove to be a new, reliable and efficacious therapy option.</p>

THE ROLE OF EDUCATION ON DISASTER PREPAREDNESS CASE STUDY OF 2012 INDIAN OCEAN EARTHQUAKES ON THAILAND’S

2018 ◽  
Author(s):  
Raya Muttarak ◽  
Wiraporn Pothisiri
Keyword(s):  
Indian Ocean ◽  
Emergency Preparedness ◽  
Disaster Preparedness ◽  
Formal Education ◽  
Disaster Experience ◽  
Individual Household ◽  
The Indian Ocean ◽  
The Individual

In this paper we investigate how well residents of the Andaman coast in Phang Nga province, Thailand, are prepared for earthquakes and tsunami. It is hypothesized that formal education can promote disaster preparedness because education enhances individual cognitive and learning skills, as well as access to information. A survey was conducted of 557 households in the areas that received tsunami warnings following the Indian Ocean earthquakes on 11 April 2012. Interviews were carried out during the period of numerous aftershocks, which put residents in the region on high alert. The respondents were asked what emergency preparedness measures they had taken following the 11 April earthquakes. Using the partial proportional odds model, the paper investigates determinants of personal disaster preparedness measured as the number of preparedness actions taken. Controlling for village effects, we find that formal education, measured at the individual, household, and community levels, has a positive relationship with taking preparedness measures. For the survey group without past disaster experience, the education level of household members is positively related to disaster preparedness. The findings also show that disaster related training is most effective for individuals with high educational attainment. Furthermore, living in a community with a higher proportion of women who have at least a secondary education increases the likelihood of disaster preparedness. In conclusion, we found that formal education can increase disaster preparedness and reduce vulnerability to natural hazards.

Comparative Study to Evaluate the Surface Detail Reproduction of Dental Stone after Immersion in Various Different Disinfectant Solutions, Under Stereomicroscope 10 X Magnification –An In-Vitro Study

2017 ◽  
Vol 9 (3) ◽  
Author(s):  
Rathika Rai ◽  
M. A. Easwaran ◽  
K. T. Dhivya
Keyword(s):  
Sodium Hypochlorite ◽  
In Vitro Study ◽  
Control Group ◽  
Immersion Method ◽  
Significant Difference ◽  
Surface Irregularities ◽  
Disinfectant Solution ◽  
Surface Detail ◽  
Group B

Aim: To evaluate the surface detail reproduction of dental stone this is immersed in different disinfectant solution and studied under stereomicroscope. Methodology: Total number of 30 specimens of dental stone (Type III) were made with measurements of 1.5cm diameter and 1cm height .This samples are divided in to 3 groups group A,B,C. were A is immersed in Distilled water which was taken as control group ;B is immersed in 2% Glutaraldehyde and C is immersed in 5%sodium hypochlorite. Each specimen were immersed in the disinfectant solution for 15 minutes and dried under room temperature for 24 hrs. After 24 hrs each specimens are studied under stereomicroscope for surface details. Result: The results showed no significant difference in the surface irregularities and porosities for a group 1 and group 2 except group 3 which showed significant increase in the porosities, surface irregularities and erosions after disinfection with 5% NaHOCl by immersion method. Conclusion: The surface detail reproduction capacity of die stone was adversely affected when 5% Sodium hypochlorite was used as disinfectant solution when compare d to control group and 2% Glutaraldehyde

DeVega versus ring annuloplasty in severe functional tricuspid insufficiency and their impact on the right ventricle

2019 ◽  
Vol 1 (4) ◽  
pp. 133-139
Author(s):  
Yasser Hamdy ◽  
Mohammed Mahmoud Mostafa ◽  
Ahmed Elminshawy
Keyword(s):  
Right Ventricular ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Early Postoperative Period ◽  
Tricuspid Valve Repair ◽  
Ring Annuloplasty ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
The Right

Background: Functional tricuspid valve regurgitation secondary to left-sided valve disease is common. DeVega repair is simple, but residual regurgitation with subsequent impairment of the right ventricular function is a concern. This study aims to compare tricuspid valve repair using DeVega vs. ring annuloplasty and their impact on the right ventricle in the early postoperative period and after six months. Methods: This is a prospective cohort study of 51 patients with rheumatic heart disease who underwent tricuspid valve repair for secondary severe tricuspid regurgitation. Patients were divided into two groups: group A; DeVega repair (n=34) and group B; ring annuloplasty repair (n=17). Patients were assessed clinically and by echocardiography before discharge and after six months for the degree of tricuspid regurgitation, right ventricular diameter and tricuspid annular plane systolic excursion (TAPSE). Results: Preoperative echocardiographic assessment showed no difference in left ventricular end-systolic diameter, end-diastolic diameter, ejection fraction and right ventricular diameter, however; group A had significantly better preoperative right ventricular function measured by TAPSE (1.96 ± 0.27 vs1.75 ± 0.31 cm; p=0.02). Group B had significantly longer cardiopulmonary bypass time (127.65 ± 13.56 vs. 111.74 ± 18.74 minutes; p= 0.003) and ischemic time (99.06 ± 11.80 vs. 87.15 ± 16.01 minutes; p= 0.009). Pre-discharge, there was no statistically significant difference in the degree of tricuspid regurgitation, but the right ventricular diameter was significantly lower in group B (2.66 ± 0.41 and 2.40 ± 0.48 cm; p=0.049). After six months of follow up, the degree of tricuspid regurgitation (p= 0.029) and the right ventricular diameter were significantly lower in the ring annuloplasty group (2.56 ± 0.39 and 2.29 ± 0.44 cm; p=0.029). Although there was a statistically significant difference in preoperative TAPSE, this difference disappeared after six months. Conclusion: Both DeVega and ring annuloplasty techniques were effective in the early postoperative period, ring annuloplasty was associated with lesser residual regurgitation and better right ventricular remodeling in severe functional tricuspid regurgitation than DeVega procedure after 6-months of follow up.

Effect of short-term use of oral contraceptive pills on intraocular pressure

2020 ◽  
Vol 35 (3) ◽  
Author(s):  
Tayyaba Gul Malik ◽  
Hina Nadeem ◽  
Eiman Ayesha ◽  
Rabail Alam
Keyword(s):  
Oral Contraceptive ◽  
Childbearing Age ◽  
Short Term ◽  
Oral Contraceptive Pills ◽  
Contraceptive Pills ◽  
Time Period ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Short Time

Objective: To study the effect of short-term use of oral contraceptive pills on intra-ocular pressures of women of childbearing age.   Methods: It was a comparative observational study, conducted at Arif memorial teaching hospital and Allied hospital Faisalabad for a period of six months. Hundred female subjects were divided into two groups of 50 each. Group A, included females, who had been taking oral contraceptive pills (OCP) for more than 6 months and less than 36 months. Group B, included 50 age-matched controls, who had never used OCP. Ophthalmic and systemic history was taken. Careful Slit lamp examination was performed and intraocular pressures (IOP) were measured using Goldman Applanation tonometer. Fundus examination was done to rule out any posterior segment disease. After collection of data, we analyzed and compared the intra ocular pressures between the two groups by using ANOVA in SPSS version 21.   Results: Average duration of using OCP was 14.9 months. There was no significant difference of Cup to Disc ratios between the two groups (p= 0.109). However, significant difference was noted between the IOP of OCP group and controls. (p=0.000). Conclusion: OCP significantly increase IOP even when used for short time period.

Comparative Clinical study of Jatyadi Taila and Jatyadi Ghrita in the management of Dushta Vrana

2018 ◽  
Vol 3 (3) ◽  
Author(s):  
Rajendra Joshi ◽  
N. B. Mashetti ◽  
Rakesh Kumar Gujar
Keyword(s):  
Clinical Study ◽  
Burning Sensation ◽  
Normal Process ◽  
Surgical Practice ◽  
Local Factors ◽  
Significant Difference ◽  
Comparative Clinical Study ◽  
Group A ◽  
Contaminated Wound ◽  
Group B

Dushta Vrana is a common and frequently encountered problem faced in surgical practice. The presence of Dushta Vrana worsens the condition of the patient with different complications and may become fatal. Local factors on wound like slough, infection and foreign body, affect the normal process of healing. A healthy wound in a normal body heals earlier with a minimum scar as compared to a contaminated wound. Therefore in this study all the efforts are made to make a Dushta Vrana into a Shuddha Vrana. Once the Vrana becomes Shuddha, Ropana of the Vrana will start. The objective of the study was to evaluate the clinical efficacy of Jatyadi Taila and Jatyadi Ghrita in Dushta Vrana. Clinically diagnosed 60 Patients of Dushta Vrana were randomly divided into two groups, each consisting of 30 Patients. Group A were treated with the Jatyadi Taila and Group B was treated by Jatyadi Ghrita. The results observed was based on the relief obtained on the subjective and objective parameters taken for consideration for this study viz, size of ulcer, discharge, smell, pain, burning sensation, itching and granulation were found significant (P Lass Than 0.05). On the basis of assessment criteria and overall result of treatment, the patients of Jatyadi Taila group showed better results when compared to Jatyadi Ghrita group. Even though statistically there is no much significant difference between the two groups, but by seeing the effect on individual parameters (subjective and objective) and over all response, Jatyadi Taila seems to be effective when compared to Jatyadi Ghrita. It is having more Ropana qualities when compared to Shodhana.

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