Medizinisches Simulationstraining luftgestützter Bergrettungseinsätze (MedSim-BW-ZSA)

A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues

Medical simulations have led to extensive developments in emergency medicine. Apart from the growing number of applications and research efforts in patient safety, few studies have focused on modalities, research methods, and professions via a synthesis of simulation studies with a focus on non-technical skills training. Intersections between medical simulation, non-technical skills training, and emergency medicine merit a synthesis of progress over the first two decades of the 21st century. Drawing on research from the Web of Science Core Collection's Science Citation Index Expanded and Social Science Citation Index editions, results showed that medical simulations were found to be effective, practical, and highly motivating. More importantly, simulation-based education should be a teaching approach, and many simulations are utilised to substitute high-risk, rare, and complex circumstances in technical or situational simulations. (1) Publications were grouped by specific categories of non-technical skills, teamwork, communication, diagnosis, resuscitation, airway management, anaesthesia, simulation, and medical education. (2) Although mixed-method and quantitative approaches were prominent during the time period, further exploration of qualitative data would greatly contribute to the interpretation of experience. (3) High-fidelity dummy was the most suitable instrument, but the tendency of simulators without explicitly stating the vendor selection calls for a standardised training process. The literature study concludes with a ring model as the integrated framework of presently known best practices and a broad range of underexplored research areas to be investigated in detail.

Helicopter Hoist Operations in Difficult Nonalpine Terrain

OBJECTIVE

Helicopter hoist operations (HHOs) are an option for rescue in difficult- or impossible-to-access environments. At present, only a few helicopters in German helicopter emergency medical services have a hoist capability; most of them are located in the Bavarian Alps. We sought to study the demand for hoist operations in difficult terrain outside of alpine regions.

METHODS

The setting for this study was a city borough between the Rhine valley and the Black Forest (Germany). We retrospectively studied all rescue operations in difficult terrain from January 1, 2007, to July 31, 2018. The characteristics of the terrain and operational, demographic, and medical aspects were analyzed. The predictors for a prolonged response time and the total prehospital time were identified by multivariate regression analysis. In addition, a simulation study creating time intervals for the alternative rescue procedure (ground vs. hoist) was performed. Operational data for the simulation were taken from an expert survey as well as field data collection in the course of HHO training.

RESULTS

A total of 251 missions were included. Patients were predominantly male (66.7%) adults (57.5%) with traumatic lesions (75.0%); 14.1% had severe or multiple injuries, 4.7% had life-threatening medical conditions, and 4.3% were deceased. Two hundred eight patients (93%) were rescued by ground procedures. The prehospital time of HHO missions was significantly longer (104 vs. 72 minutes, P < .001). However, the simulation of all missions showed a significantly shorter prehospital time with 80 versus 91 minutes (P < .001) for rescue by HHOs. The predictors for prolonged prehospital times were a vague description of the accident site, difficult terrain, distance from the road, slope gradient, and life-threatening nontraumatic conditions of the patient.

CONCLUSION

We found a significant benefit of hoist operations regarding the total prehospital time and admission to an appropriate trauma center. Consistent dispatch procedures for HHO missions can improve patient outcomes. Adding HHO capabilities to some selected helicopter emergency medical service helicopters should be considered.

Challenges of helicopter mountain rescue missions by human external cargo: need for physicians onsite and comprehensive training

Background

Human external cargo (HEC) extrication during helicopter rescue missions is commonly used in mountain emergency medical services. Furthermore, longline or winch operations offer the opportunity to deliver professional medical care onsite. As the safety and quality of emergency medical care depends on training and experience, we aimed to investigate characteristics of mountain rescue missions with HEC.

Methods

We retrospectively reviewed all rescue missions conducted by Air Zermatt (a commercial rescue service in the high-alpine region of Switzerland) from January 2010 to September 2016.

Results

Out of 11,078 rescue missions 1137 (10%) required a HEC rescue. In 3% (n = 29) rapid sequence induction and endotracheal intubation, in 2% (n = 14) cardiopulmonary resuscitation, and in 0.4% (n = 3) a chest tube insertion had to be performed onsite prior to HEC extraction. The most common medical intervention onsite is analgesia or analgosedation, in 17% (n = 142) fentanyl or ketamine was used in doses of ≥ 0.2 mg or ≥ 50 mg, respectively.

Conclusions

As these interventions have to be performed in challenging terrain, with reduced personnel resources, and limited monitoring, our results point out the need for physicians onsite who are clinically experienced in these procedures and specially and intensively trained for the specific characteristics and challenges of HEC rescue missions.

Helicopter Emergency Medical Service Simulation Training in the Extreme: Simulation-based Training in a Mountain Weather Chamber

Mountain rescue operations often confront crews with extreme weather conditions. Extremely cold temperatures make standard treatment sometimes difficult or even impossible. It is well-known that most manual tasks, including those involved in mountain rescue operations, are slowed by extremely cold weather. To lessen and improve the decrement in performance of emergency medical treatment caused by cold-induced manual impairment and inadequate medical equipment and supplies, simulation training in a weather chamber, which can produce wind and temperatures up to -22°C, was developed. It provides a promising tool to train the management of complex multidisciplinary settings, thus reducing the occurrence of fatal human and technical errors and increasing the safety for both the patient and the mountain emergency medical service crew.

Simulation-Based Training in Mountain Helicopter Emergency Medical Service: A Multidisciplinary Team Training Concept

OBJECTIVE

Mountain helicopter rescue operations often confront crews with unique challenges in which even minor errors can result in dangerous situations. Simulation training provides a promising tool to train the management of complex multidisciplinary settings, thus reducing the occurrence of fatal errors and increasing the safety for both the patient and the helicopter emergency medical service (HEMS) crew.

METHODS

A simulation-based training, dedicated to mountain helicopter emergency medicine service, was developed and executed. We evaluated the impact of this training by the means of a pre- and posttraining self-assessment of 40 HEMS crewmembers.

RESULTS

Multidisciplinary simulation-based educational training in HEMS is feasible. There was a significant increase in self-assessed competence in safety-related items of human factors and team resource management. The highest gain of competence was demonstrated by a trend in the domain of structured decision making.

CONCLUSIONS

Interprofessional simulation-based team training could have the potential to impact patient outcomes and improve rescuer safety. Simulation trainings lead to a subjective increase of self-assuredness in the management of complex situations in a difficult working environment.