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2 Critical Care Innovations

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Learning how to stop external hemorrhage during a medical simulation using cadavers - a randomized trial.

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Przychodzeń B. , Cudna J. , Panasiuk I. , Leszczyński P.

2024

tom 7

nr 4

32-42

INTRODUCTION: Patients suffering from trauma are at risk of death from uncontrolled external bleeding, therefore witnesses to the incident and emergency medical services should promptly implement appropriate procedures, which requires prior training. The purpose of this study is to comparatively analyze the didactic effectiveness resulting from the use of cadavers – human-based unfixed preparations, and training devices, during practice-based teaching of medical students on how to stop external hemorrhage. MATERIALS AND METHODS: Fifty-four medical students participated in the study. At the initial stage, training was provided including procedures for stopping external hemorrhages using hand maneuvers, tourniquets, and hemostatic dressings. Randomization was performed by selecting a study group (procedures performed on human unfixed specimens) and a control group (procedures performed on a training model). During the practical test, the time to perform the procedure until the hemorrhage was effectively stopped was evaluated. The students were also asked to perform a self-assessment of their skills, as well as to indicate their level of satisfaction with the training. Statistical analysis allowed to obtain correlations of variables, taking age, sex, height, body mass and hand sizes of the subjects into account. RESULTS: The study group consisted of 35 women (64.81%) and 19 men (35.19%). Intergroup comparisons confirmed the absence of significant differences between groups in Mann-Whitney U tests for unrelated variables for the criterion of sex (p=0.403), age (p=0.081), height (p=0.472), body mass (p=0.883), hand width (p=0.653) and hand length (p=0.355). Group A performed the procedures on training models, while Group B performed the procedures on appropriately prepared cadavers. Direct manual compression was performed in an average of 2.85 seconds (group A) and 5.23 seconds (group B), wound packing in an average of 42.48 seconds (group A) and 50.97 seconds (group B), passing a tourniquet fastened into a loop in an average of 27.66 seconds (group A) and 26.01 seconds (group B), and an unfastened tourniquet over bleeding site in an average of 27.70 seconds (group A) and 29.14 seconds (group B). The manual wound compression procedure was performed significantly longer on the cadaver (p=0.005) than on the training model. The level of satisfaction and self-assessment after the training increased comparably in both groups. CONCLUSIONS: Unfixed human-body-based preparations constitute an important part of medical student education. Simulations of external hemorrhage stopping allowed noticing prolonged procedure performance time in the case of cadaver-based exercises, especially regarding the procedure for manual wound compression. The results suggest that selected rescue procedures are more difficult to perform on human specimens, compared to training models, therefore cadaver-based training may prove more effective

WSTĘP: Pacjenci cierpiący na urazy są narażeni na śmierć z powodu niekontrolowanego krwawienia zewnętrznego, dlatego świadkowie zdarzenia i służby ratunkowe powinny niezwłocznie wdrożyć odpowiednie procedury, co wymaga wcześniejszego przeszkolenia. Celem tego badania jest porównawcza analiza skuteczności dydaktycznej wynikającej z wykorzystania zwłok – nieutrwalonych preparatów ludzkich i urządzeń szkoleniowych podczas praktycznego nauczania studentów medycyny, jak zatamować krwotok zewnętrzny. MATERIAŁY I METODY: W badaniu wzięło udział pięćdziesięciu czterech studentów kierunków medycznych. Na etapie początkowym przeprowadzono szkolenie obejmujące procedury zatrzymywania krwotoków zewnętrznych za pomocą manewrów ręcznych, opasek uciskowych i opatrunków hemostatycznych. Randomizacja została przeprowadzona poprzez wybranie grupy badawczej (procedury wykonywane na nieutrwalonych próbkach ludzkich) i grupy kontrolnej (procedury wykonywane na modelu szkoleniowym). Podczas testu praktycznego oceniono czas wykonania procedury do momentu skutecznego zatrzymania krwotoku. Studenci zostali również poproszeni o dokonanie samooceny swoich umiejętności, a także o wskazanie poziomu zadowolenia z treningu. Analiza statystyczna pozwoliła na uzyskanie korelacji zmiennych, uwzględniających wiek, płeć, wzrost, masę ciała i rozmiary dłoni badanych. WYNIKI: Grupę badaną stanowiło 35 kobiet (64,81%) i 19 mężczyzn (35,19%). Porównania międzygrupowe potwierdziły brak istotnych różnic między grupami w testach U Manna-Whitneya dla zmiennych niezależnych dla kryterium płci (p=0,403), wieku (p=0,081), wzrostu (p=0,472), masy ciała (p=0,883), szerokości dłoni (p=0,653) i długości dłoni (p=0,355). Grupa A wykonywała zabiegi na modelach treningowych, natomiast Grupa B wykonywała zabiegi na odpowiednio przygotowanych zwłokach. Bezpośredni ucisk ręczny wykonywano średnio przez 2,85 sekundy (grupa A) i 5,23 sekundy (grupa B), tamponowanie rany średnio przez 42,48 sekundy (grupa A) i 50,97 sekundy (grupa B), przeciąganie opaski uciskowej zapiętej w pętlę średnio przez 27,66 sekundy (grupa A) i 26,01 sekundy (grupa B), a niezapiętej opaski uciskowej nad miejscem krwawienia średnio przez 27,70 sekundy (grupa A) i 29,14 sekundy (grupa B). Procedura ucisku ręcznego rany była wykonywana istotnie dłużej na zwłokach (p = 0,005) niż na modelu szkoleniowym. Poziom satysfakcji i samooceny po szkoleniu wzrósł porównywalnie w obu grupach. WNIOSKI: Nieutrwalone preparaty na bazie ciała ludzkiego stanowią ważną część kształcenia studentów medycyny. Symulacje zatrzymania krwotoku zewnętrznego pozwoliły zauważyć wydłużony czas wykonywania procedury w przypadku ćwiczeń na zwłokach, zwłaszcza w odniesieniu do procedury ręcznego uciskania rany. Wyniki sugerują, że wybrane procedury ratunkowe są trudniejsze do wykonania na próbkach ludzkich w porównaniu z modelami treningowymi, dlatego też trening na zwłokach może okazać się skuteczniejszy.

Social reactions to emergencies and illnesses: identifying the validity of EMS calls

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Bakalarski P. , Jędral K. , Przychodzeń B. , Leszczyński P.

Critical Care Innovations

2023

tom 6

nr 4

48-57

INTRODUCTION: Poland’s healthcare systems is based on insurance and universal and equal access. The first component of the system is primary healthcare. At night and on holidays, the medical help can be obtained by means of After Hours Medical Services. Private paid visits can also be arranged. In emergencies, and cases of risk to health or life, emergency medical team can be called at 112 or 999, or a patient can go to the hospital emergency department (ED) on their own. There are also pharmacies where selected over-the-counter medicines can be bought. MATERIALS AND METHODS: The study was conducted in the first quarter of 2023 using a proprietary questionnaire with 5 sociodemographic questions and 20 case descriptions for which the participants indicated the type of medical help which they would use. The expert panel prepared a set of cases (accidents and illnesses), taking into account patient’s age and gender, time of day and working days and holidays when the incident occurred. The group of participants was selected using the snowball sampling method. The results were subjected to statistical analysis using nonparametric tests, the Spearman’s rho test and the Wilcoxon test. The used significance level was p<0.05. RESULTS: The study comprised 233 participants (166 females and 66 males). The mean age was 25 years (SD ± 9.50). A significant correlation was showed between the decision made and the gender in case of stroke occurring on a weekday (p=0.042); stroke symptoms on a holiday (p=0.024); head injury in a child (p=0,024); chest pain in an adult (p=0.009), and also the place of residence in case of an infection in a child (p=0.008). The decision was also influenced by education in case of chest pain in an adult (p=0.048); stroke (p=0.046) and sudden weakness (p=0.009). Also performing a medical profession correlated with the decision in case of arterial hypertension (p=0.028) and chest pain (p=0.010) in adults. The type of day (working/holiday) and the time of day were also analysed, revealing statistical differences depending on the type and time of day for infection in a child (p<0.000 in each comparison); working day and holiday for abdominal pain (p=0.000), stroke (p=0.023), diarrhea (p<0.000) and weakness (p<0.000), and also depending on the time of day in arterial hypertension (p<0.000); however, no differences were found in case of chest pain depending on the time of day(p=0.073). CONCLUSIONS: Emergency medical teams are called both in urgent cases, such as stroke or chest pain, and also in cases that do not require an immediate responses, such as diarrhea or weakness. Solutions need to be sought which would provide information what healthcare system units should be used in specific situations. The EMTs are called more often during the day on weekdays than at night or on holidays. The ambulance service responds most often in emergency cases such as convulsions, stroke or chest pain, but a significant number of calls is related to cases of weakness or arterial hypertension where the medical help should be sought in other healthcare units.