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Objective:To understand the cognition and training status of basic life support among medical staff in Linfen, Shanxi Province, and to provide reference for the development of targeted training strategies and programs.Methods:A questionnaire survey was conducted among medical staff in 12 county hospitals in Linfen, Shanxi Province by convenience sampling method. The survey included the general characteristics of departments and medical staff, previous basic life support training assessment and cognitive status.Results:A total of 839 medical staff were included, 756 (90.1%) completed the survey, 183 (24.2%) were doctors and 573 (75.8%) were nurses. Most personnel lacked awareness of environmental safety, emergency response system start-up, adequate compression, airway management, and electrical defibrillation.Conclusions:The cognitive status of basic life support of medical staff in Linfen county is not optimistic. It is necessary to construct an applicable precision training course and retraining assessment system to improve the cognitive level and practical operation ability.
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Cardiopulmonary resuscitation is an important part of standardized residency training. There are certain flaws in the various commonly used training and assessment mode. In the exploration of the new mode, "step-by-step" training helps to learn skills step by step. "Low intensity and high frequency" training not only focuses on key points and difficulties, and lightens the burden of the teachers and residents, but also can improve the training effect through repeated reinforcement. Combining different training methods organically to establish a "diversified" training mode can make full use of the advantages of different methods and make up for each other's shortcomings. In addition, the "veto power" should be introduced into the assessment. Scenario simulation with role play may be an effective way to train teamwork ability, but it still needs further exploration.
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Objective:At present, the postgraduate education of emergency medicine in China mainly relies on the internal medicine system and lacks specialty pertinence. The purpose of this study is to establish a compulsory curriculum system for professional postgraduates of emergency medicine.Methods:Modified Delphi method was used to subscribe questionnaires to experts, and the contents were mainly about medical education management and research of emergency in the affiliated teaching hospitals of Peking University. Microsoft Excel 2016 was used for double entry of questionnaire contents, and SPSS 22.0 software was used for statistics.Results:The panel was consisted of 14 experts in total and two rounds of Delphi questionnaires were completed. The response rate of the two rounds were both 100%. The authority coefficient of experts was > 0.9 and the average score of each evaluation index was 4.07-5.00 points. The coefficient of variation of each index was 0-0.22 and the Kendall coefficient of concordance was 0.07-0.10.Conclusion:As a result, a comprehensive emergency professional postgraduate curriculum system has been established.
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Objective:To investigate the current situation of telephone cardiopulmonary resuscitation (T-CPR) in China, and analyze the reasons for the low implementation rate of T-CPR.Methods:This was a multicenter cross-sectional survey. Twenty cities were selected from six geographical regions of China by convenient sampling method. Anonymous online electronic questionnaires were sent to emergency medical service staffs in each city. All respondents were divided into the routine T-CPR group and control group. Student's t test and Chi-square test were used to analyze the difference between groups. Multivariate logistic regression was used to analyze the influencing factors of T-CPR. Results:⑴A total of 1 191 questionnaires were collected. 80.94% of respondents knew T-CPR. Nine hundred and sixty respondents, who knew T-CPR and completed the questionnaires, were included in the study, and were divided into the routine T-CPR group ( n=401) and control group ( n=559). Nine hundred and thirty-nine (97.81%) responders believed that T-CPR should be implemented for cardiac arrest patients that could be confirmed by telephone.⑵Four hundred and one (41.77%) responders routinely implemented T-CPR. Among them, 237 (24.68%) responders always did and 164 (17.08%) responders often did. ⑶Multivariate logistic regression analysis showed that male ( OR=1.787, 95% CI: 1.235-2.587, P=0.002), age ( OR=1.025, 95% CI: 1.004-1.047, P=0.020), clinical medicine background ( OR=2.926, 95% CI: 1.387-6.171, P =0.005), dispatcher ( OR=5.305, 95% CI: 3.463-8.126, P<0.01), using medical priority dispatch system (MPDS) system ( OR=1.941, 95% CI: 1.418-2.656, P<0.01), and T-CPR policy or procedure ( OR=3.879, 95% CI: 2.652-5.674, P<0.01) were favorable factors for T-CPR. ⑷The top three reasons for implementing T-CPR in the routine T-CPR group were that they had received T-CPR training (67.08%), believed that T-CPR could improve survival rate (63.59%), and had standard T-CPR process (63.09%). The top three reasons for not implementing T-CPR in the control group were that worrying about bystander compliance (42.04%), worrying about the quality of bystander cardiopulmonary resuscitation (CPR) (38.28%), and worrying about medical dispute (36.14%). Conclusions:The awareness and implementation of T-CPR among emergency medical service staffs need to be improved. The implementation of T-CPR depend on telephone dispatchers with clinical medicine background, clear T-CPR policy, standardized operation procedure, and professional assistant tools. To improve the public's awareness of cardiac arrest and cardiopulmonary resuscitation, and to improve the supporting legal system are also conducive to the implementation of T-CPR.
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Objective@#To propose the concept of a novel regional control and prevention (RCP) system for the outbreak of COVID-19 infectious disease, design an emergency epidemic prevention information system based on the existing network architecture and information system in the region, and a remote intelligent medical consultation and remote office platform, research and develop the technology of risk assessment and early warning for people in the region, and improve the regions’prevention and control ability facing emergency of major infectious diseases.@*Methods@#Taking colleges, affiliated (teaching) hospitals, and cloud applications as typical RCP regional units, the existing local area network interaction methods between the cloud and universities and affiliated (teaching) hospitals are established to realize remote work in the network environment, remote medical imaging, psychological and ethical consultation and interaction; applying multi-agent propagation model based on complex network, combining Global Positioning System (GPS), Radio Frequency Identification (RFID), and electronic fence technology, to realize the risk classification and early warning of units and personnel in the area.@*Results@#In the RCP, a system architecture combining campus network, affiliated (teaching) hospital intranet, and the Internet is used. Dynamic connection is made using distributed technology and cloud storage. The data buffer mechanism of the intermediary database in the network realized telemedicine consultation and telecommuting. Relying on the platform, multi-agent propagation model based on complex network and cellular automaton model are used to realize the score and early warning of population exposure risk in the region by using GPS, RFID and electronic fence technology.@*Conclusions@#In the epidemic phase of major infectious diseases, the construction of RCP can improve the response speed of wartime epidemic prevention, provide reasonable data-based warnings and risk ratings, and reduce the exposure risk of susceptible people. The design and development of RCP is a systematic project that needs to combine regional structural and functional characteristics, and the foundation of the early informatization work in the region and the level of the emergency development team determine the development progress, maintenance, and actual application effects. It is recommended to establish a peacetime and wartime combined RCP mode and incorporate it into the government's disease control system to improve the national and regional level of prevention and control of major infectious diseases.
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Objectives To investigate the cognition of dispatcher-initiated telephone cardiopulmonary resuscitation (TCPR) among emergency medical system(EMS) personnel and compare the cognition of TCPR among EMS personnel in different economic status,and to understand the current situation of TCPR cognition of EMS personnel in China.Methods This study is a multicenter crosssectional survey.The method of multi-level convenient sampling was adopted,and the test reliability and split half reliability of the questionnaire was tested.Questionnaire survey and data collection were conducted from December 2018 to June 2019.The ethical approval number is M2018264.SPSS 20.0 was used for analysis.x2 test was used to analyze the differences between groups.Results A total of 1191 electronic questionnaires were collected.Of them,80.94％ respondents knew TCPR,97.82％ respondents thought that TCPR should be implemented in cardiac arrest,36.62％ respondents thought that bystander cardiopulmonary resuscitation quality monitoring was needed in TCPR,and TCPR training courses were set up in the emergency department which recruited 25.83％ respondents.Emergency personnel in developed areas had a better understanding of the criteria for judging patients' breathlessness (11.69％ vs 7.89％,P=0.048),of TCPR need ncluding guidance of chest compression (92.45％ vs 87.49％,P=0.012) and of bystander cardiopulmonary resuscitation (BCPR) quality monitoring including the frequency of artificial respiration (84.42％ vs 74.87％,P=0.029) than those in underdeveloped areas,but there was no significant difference in other indicators (P＞0.05).Conclusions TCPR knowledge of EMS personnel in China is unsatisfactory.Further training is needed to improve their understanding of the criteria for judging cardiac arrest in out-of-hospital cardiac arrest patients via telephone,TCPR content and bystander cardiopulmonary resuscitation quality monitoring.There is difference in TCPR knowledge between the EMS personnel in developed and undeveloped areas in China.
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Objective:To propose the concept of a novel regional control and prevention (RCP) system for the outbreak of COVID-19 infectious disease, design an emergency epidemic prevention information system based on the existing network architecture and information system in the region, and a remote intelligent medical consultation and remote office platform, research and develop the technology of risk assessment and early warning for people in the region, and improve the regions’prevention and control ability facing emergency of major infectious diseases.Methods:Taking colleges, affiliated (teaching) hospitals, and cloud applications as typical RCP regional units, the existing local area network interaction methods between the cloud and universities and affiliated (teaching) hospitals are established to realize remote work in the network environment, remote medical imaging, psychological and ethical consultation and interaction; applying multi-agent propagation model based on complex network, combining Global Positioning System (GPS), Radio Frequency Identification (RFID), and electronic fence technology, to realize the risk classification and early warning of units and personnel in the area.Results:In the RCP, a system architecture combining campus network, affiliated (teaching) hospital intranet, and the Internet is used. Dynamic connection is made using distributed technology and cloud storage. The data buffer mechanism of the intermediary database in the network realized telemedicine consultation and telecommuting. Relying on the platform, multi-agent propagation model based on complex network and cellular automaton model are used to realize the score and early warning of population exposure risk in the region by using GPS, RFID and electronic fence technology.Conclusions:In the epidemic phase of major infectious diseases, the construction of RCP can improve the response speed of wartime epidemic prevention, provide reasonable data-based warnings and risk ratings, and reduce the exposure risk of susceptible people. The design and development of RCP is a systematic project that needs to combine regional structural and functional characteristics, and the foundation of the early informatization work in the region and the level of the emergency development team determine the development progress, maintenance, and actual application effects. It is recommended to establish a peacetime and wartime combined RCP mode and incorporate it into the government's disease control system to improve the national and regional level of prevention and control of major infectious diseases.
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The standard training of emergency residents is still in its early phase. Computer-based simulation teaching overcomes the drawbacks of traditional teaching mode, because of its high reducibility, simple operation , repeatability , low risks and feasibility for standardized assessment , which is the development trend of emergency medicine teaching. But at present, there are many deficiencies in the application and research of simulation teaching, including low popularity, low level of application, neglect of Teachers' training , research lagged behind , etc . In the future , these aspects should be continuously improved , including popularizing the understanding of computer simulation teaching and attaching importance to teachers' training and research work, so that simulation teaching procedures could meet the needs of modern medical development and practical clinical work.
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Objective To explore the influence of medical care reform on crowded emergency department in the tertiary hospital.Methods The 8 April 2017 was considered as turning point when Beijing began to implement medical care reform.The research subgroups consisted of pre-medical reform group,intra-medical reform group and post-medical reform group,according to the date 20 days before the medical reform,20 days after the medical reform and 21-40 days after the medical reform.During this period,The NEDOCS scores(The National Emergency Department Overcrowding Scale) were calculated at 10:00,14:00,18:00 in the Emergency Department of Peking University Third Hospital every day,the mean of which assessed the degree of crowding.The key indicators in the NEDOCS scoring formula were compared to find the reasons for the change of emergency crowding.All statistical analyses were performed using SPSS version 25.0.Continuous data presented as means ± standard deviation (normal distribution),analyzed by t-tests or median ± quartile(abnormal distribution),analyzed by Mann-Whitney U test.Results The NEDOCS scores in the intra-medical reform group were statistically higher than that in the pre-medical reform group (401.69 vs 339.68,P＜0.05).The NEDOCS scores in the post-medical reform group were higher than that in the pre-medical reform group,but the difference was not statistically significant (380.83 vs 339.68,P＞0.05).The number of ventilated patients (Rn) significantly increased after the reform (P＜0.05).Conclusions The degree of emergency department crowding in the tertiary hospital has increased after the Beijing medical care reform in 2017.The increase in the number of critically ill patients may be the reason for the increased overcrowding in the emergency department.
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It has been 10 years since the residency training in China has been gradually implemented and standardized. Orientation is playing an important role in the transition from medical students to residents in a new work environment to ensure medical safety. The daily work of the emergency room is characterized by high intensity, fast pace and high risk. Orientation is even more important here. This article compared the similarities and differences between orientation program of emergency medicine in China and the United States, it was found that the orientation programs in the United States usually lasted for a longer time, the training was various in forms and the contents were more comprehensive. A multi-dimensional evaluation was designed for orientation also. It is worth summarizing and drawing lessons to provide reference for improving the orientation of emergency residents in China.
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The emergency management training for general practitioners during job-transfer training is an important part of clinical teaching.At present,there are many problems in emergency management teaching,such as teaching contents are extensive but the class hours are limited,traditional teaching cannot meet students' needs for studying and lack of practice for emergency management skills,leading to poor teaching effects.In the teaching of emergency management of general practitioners during job-transfer training,we cultivated emergency management ability by elaborating teaching content,strengthening their clinical thinking of emergency management,carrying out a variety of training models,enhancing skill training,and stressing the evaluation of performance and so on.
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The emergency management training for general practitioners during job-transfer training is an important part of clinical teaching. At present, there are many problems in emergency management teaching, such as teaching contents are extensive but the class hours are limited, traditional teaching cannot meet students' needs for studying and lack of practice for emergency management skills, leading to poor teaching effects. In the teaching of emergency management of general practitioners during job-transfer training, we cultivated emergency management ability by elaborating teaching content, strengthening their clinical thinking of emergency management, carrying out a variety of training models, enhancing skill training, and stressing the evaluation of performance and so on.
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Now the visiting physicians are usually trained without effective supervision and guidance mechanism.Since 2017,the Emergency Department of Peking University Third Hospital has adopted the training model under tutor system for visiting physicians.Tutors and visiting physicians are matched 1∶1.Personalized training program is made by tutors and visiting physicians depending on the level of the hospital where visiting physicians practice in,educational background,clinical experience,length and the goal of study.The training plan is refined according to the timeline in order to facilitate the tutor and training physician's own precise management.Since implementation of this training model,the visiting physicians say they are more efficient to complete the training program and learned more than before.The teaching ability of tutors has further been enhanced.
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Objective To explore the multiple disciplinary model of emergent extracorporeal membrane oxygenation (ECMO) for cardiac arrest (CA) patients.Methods A retrospective investigation was done to analyze the general material,multiple disciplinary corporations,the complication and its treatment of patients who underwent emergent ECMO for non-surgery CA from January 2016 to August 2017.Results Three patients were all men with mean age 45.3 ± 20.3 years.Their mean cardiopulmonary resuscitation duration was 34 ± 10 min,and 2 patients returned to spontaneous circulation,yet hemodynamics instability.2 patients discharged with cerebral performance category 1-2,however the third died.3 cannulation of femoral artery and venous were all operated by cardiac surgery using surgical exposure via open cutdown.Mean duration of CA to ECMO pump-on was 132 ±93 min,while the mean duration of ECMO was 3 858 ± 1 092min.The implementation and maintenance of ECMO needed collaboration of emergent physicians,cardiovascular medicine and surgeon,anesthetists,nurses and so on.At the same time,incision site oozing blood,platelet counting decreasing,coagulopathy and other complications would occur,which needed interventional vascular surgeon and blood bank to participate in.Conclusions Emergent ECMO for CA patients need corporations of prehospital emergent medical system,emergent physicians,cardiovascular physicians and surgeons,anesthetists,perfusionists,blood bank and so on.Establishing coordination and cooperation model of multiple disciplinary quick response team with emergency department as the guide is the important guarantee for emergent department developing emergent extracorporeal resuscitation.
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Tracheal intubation is one of the most important emergency techniques, and it is a key and difficult point in advanced life support training for cardiopulmonary resuscitation. Our treatment is trying to combine standard video with visual laryngoscopes for tracheal intubation teaching. Firstly, the students watch the standard video. Then, the teacher shows how to perform a tracheal intubation by visual laryngo-scope. Finally, the students practice the intubation process on the simulation device. In this way, the teach-ing process is more intuitive, easier to be mastered, more normalized and repeatable. This method is worth to be promoted.
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The article analyzed the problems in Emergency Medicine and illuminated the character-istics of the teaching model based on micro-course , and pointed out that the introduction of the micro course into the emergency training was the inevitable trend of the development of teaching. Combined with the real case of emergency training, the article described the micro teaching structure and implementation plan in detail, namely with the WeChat public number as the platform for teaching, setting up the curricu-lum according to the differences of the training staff, setting up the interactive communication area, taking into account the basic theory and expanding the study, to achieve the repeatability, individuation, interac-tivity and convenience of the teaching.
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Objective To evaluate the status of implementation of the chain of survival and the gap between the guideline's recommendations and clinical practice as well as to analyze the factors influencing the prognosis of cardiac arrest (CA) patients.Methods A retrospective analysis of CA in adult patients admitted to Emergency Department of Peking University Third Hospital from January 2012 to December 2013 was carried out.The epidemiology,clinical features,implementations of the chain of survival and outcome were compared between out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients,with regard to the analysis of the predictors for survival and neurological outcome.Results A total of 414 patients with 69.8％ male and average age of (61.7 ± 18.0) years were divided into two groups,OHCA group (n =190) and IHCA group (n =224).Cardiogenic cause was found in 30％ of CA patients.There were 27.5％ patients with restoration of spontaneous circulation (ROSC),8.2％ patients discharged in survival and 3.1％ patients with good neurologic outcome (CPC =1 and 2).There were higher proportion of medical responders arriving to CA patients within 5 minutes after onset (99.1％ vs.10.5％,P ＜0.01),bystander carrying out cardiopulmonary resuscitation (100％ vs.15.3％,P ＜0.01),CPR initiated in 5 minutes (98.7％ vs.11.1％,P ＜ 0.01),defibrillation performed in 5 minutes (87.5％ vs.12.5％,P ＜ 0.01) in IHCA group compared with OHCA.There were no statistical differences in epinephrine administration and epinephrine dose,and targeted temperature management between two groups.There were higher proportion of ROSC (37.1％ vs.16.3％,P ＜ 0.05),higher percentage of survivals discharged (31.0％ vs.22.6％,P =0.002) and good neurologic outcome with CPC =1 or 2 (48.1％ vs.0.0％,P =0.029) in IHCA group compared with OHCA.Location of CA occurred and initial arrhythmia rectifiable with defibrillation treatment after ROSC were the favorable predictors for assessing the percentages of ROSC and survivals discharged.In contrast,male and age over 65 years were the unfavorable predictors of ROSC.Conclusions Improvement in outcome of victims with CA is required in every link of the chain of survival,especially in prehospital rescue act,bystander carrying out CPR,defibrillation,and therapeutic hypothermia in unconscious patients after resuscitation.The effective implementation of chain of survival concept can improve the prognosis of CA patients.
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Objective To explore the relationship between content of fine particulate matter (PM2.5) in atmospheric and the number of emergency room (ER) visits with acute coronary syndrome (ACS).Methods Daily data of ER visits to Peking University Third Hospital for ACS was collected from December 1st,2013 to November 30th,2014.All patients were resident population of Haidian District,Beijing.The daily meteorological data and contents of air pollutants in Beijing were also collected in the same time period.Generalized Additive Model (GAM) was fitted to estimate the association between the ambient PM2.5 and the ER visits for ACS,under controlling for time trends,holiday effect,day of week effect and weather conditions.Results The annual average amount of PM2.5 was 85.44 μg/m3 over the study period.There were 619 cases with ACS as ER visits.PM2.5 was positive related with PM10,NO2 and SO2.The corresponding correlation coefficients were 0.87,0.48 and 0.67,respectively (P ＜ 0.05).But PM2.5 was negative related with mean temperature (r =-0.04,P ＜ 0.05).In the polluted model,there was positive association between PM2.5 and ER visits with ACS.When each increament in PM2.2 with 10 μg/m3,the relative risk strength of ER visits with ACS was 1.019 (95％ CI:1.000-1.038).PM2.5 concentrations had a delayed effect on the onset of ACS occurred on the next day.This lagged 1 day phenomenon showed the most significant influence of PM2.5 on ER visits for ACS.Conclusions The ambient concentrations of PM2.5 are positively associated with ER visits for ACS.And there is a lag effect.
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Taking a national continuing education program with hand in hand mode as an example, the advantages and disadvantages of hand in hand mode and traditional mode are com-pared. Hand in hand mode realizes a door-to-door teaching, and the curriculum is more targeted. Moreover, the time and physical power of trainees are saved, so the training effect is better. The na-tional continuing medical education program withhand in hand is worthy of promotion in the teach-ing practice.
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Objective To explore the clinical risk factors of ventilator-associated fungal pneumonia (VAFP) in emergency intensive care unit.Methods One hundred and ninety-seven consecutive patients with 121 males and 76 females,aged from 17 to 98 years met the criteria of ventilator-associated pneumonia in emergency intensive care unit admitted from July 2009 to June 2014,were retrospectively evaluated.Those with mechanical ventilation less than 48 hours or treatment discontinued were excluded.Patients were divided into VAFP group and ventilator-associated non-fungal pneumonia group according to the results of fungal culture and microscopy.Univariate analysis was used to find out preliminary risk factors for VAFP,and then the ultimate independent risk factors were determined with multivariate stepwise logistic regression analysis.Results The occurrence of VAFP was 32.0 ％ (63 cases) out of 197 patients with ventilatorassociated pneumonia.In those 63 patients,there were 71 species found from fungus culture.Candida albicans counted for 33 (46.5％),Candida glabrata for 11 (15.5％),other Candida Albicans for 26 (36.6％).The preliminary univariate analysis showed that 19 factors were statistically significant,while multivariate stepwise logistic regression analysis revealed that acute physiology and chronic health evaluation Ⅱ score≥ 22,radiotherapy or chemotherapy,mechanical ventilation ≥14.11 days,use of antibiotics ≥14 days,use of glucocorticoid and other immuno-suppressants were independent predictors of VAFP,and the adjusted odds ratios with 95％ confidential intervals were 4.133 (2.831-6.033),2.977 (1.942-4.564),2.305 (1.439-3.736),1.988 (1.441-2.741),1.528 (1.337-1.746),respectively.Conclusion Higher APACHE Ⅱ score,radiotherapy or chemotherapy,prolonged use of mechanical ventilation,prolonged use of antibiotics,use of glucocorticoid and immunosuppressants are independent risk factors of VAFP.The incidence rate of VAFP may be reduced by improving patients' overall clinical setting,shortening the duration of mechanical ventilation and employment of antibiotics,and more strict guidelines to the application of glucocorticoid and immunosuppressants.