Who's Who in the Trauma Bay? Association between Wearing of Identification Jackets and Trauma Teamwork Performance: A Simulation Study.

Introduction: Trauma is the leading cause of under-45 mortality worldwide, and the leading cause of years of life lost. To manage the severe trauma patients, trauma teams require both improved technical and nontechnical skills, such as communication, leadership, teamwork, and team resource management. The objective of this study was to measure the impact of the identification of trauma team members on teamwork performance. The hypothesis was that wearing identification jackets was associated with better teamwork performance. Methods: The study was conducted from 2015 to 2019 at the Percy Army Training Hospital, a trauma center in the Ile-de-France region. In 2016, the protocol for receiving severe trauma patients was modified, including the obligation to wear identification jackets. Thus, each member of the trauma team wore a jacket identifying his or her function. This study was carried out by analyzing videos of medical simulation sessions during the reception of trauma patients in the trauma bay. The study compared the teamwork performance before 2016, a period with no identification jackets wearing, with the teamwork performance after 2016, a period with identification jackets wearing. The Team Emergency Assessment Measure (TEAM)Scale was used. This TEAM scale is a benchmark measure of teamwork performance, particularly adapted to the context of trauma. Results: A total of 48 participants were included in the study. Six videos of medical simulation sessions "arrival of severe trauma patients" were analyzed and divided into two groups. A first group of three videos with no identification jackets wearing was the GROUP ID(-). A second group of three videos with identification jackets wearing was the GROUP ID(+). An 11-item TEAM scale was used to rate each video for a total of 33 scores per group. The distribution of the median scores for the GROUP ID(+) was significantly different from the distribution of the median scores for the GROUP ID(-) (P = 0.001). These results were consistent with those of other single-center studies conducted in operating theaters and in emergency departments, where clearly identifying the roles of each member of the medical teams was associated with less communication errors. The main limits of this study were its single-center nature and a limited data sample. Conclusion: In this single-center simulation study, wearing identification jackets was associated with an improvement in the trauma team performance TEAM scores. Further studies are needed to confirm these results but they already encourage the consideration of nontechnical skills in the management of severe trauma patients.

Role of emotional competence in residents' simulated emergency care performance: a mixed-methods study.

OBJECTIVE: Emergency situations can generate negative affect in medical personnel, which can negatively impact on the quality of care. Several studies have demonstrated a positive influence of emotional competence (EC) on negative affect. The goal of this study was to test the effect of EC level on simulated emergency care situation in medical residents. METHODS: The sample included 21 medical residents caring for a simulated seriously wounded person whose condition suddenly deteriorated. Medical performance was scored by expert medical doctors (MDs). EC level and affective states were evaluated with self-assessment questionnaires. Finally, the origin of the negative affect experienced by the residents was identified through individual interviews. RESULTS: Higher EC levels were found to be associated with better medical performance and a lower intensity of negative affect. The latter two variables were found to correlate negatively. The main source of negative affect for residents was the inability to establish a diagnosis, regardless of their EC level and their medical performance. CONCLUSIONS: The results suggest that residents who have a high EC level are better able to manage negative affect, so that they are better able to put their medical knowledge to work and explore alternative diagnoses. Emotional-management training for residents who, as new MDs, have limited experience may be beneficial to complement simulation exercises. Additional studies should be considered to better define the links between the affect experienced by MDs and their thought processes during establishment of a diagnosis.

A simulator-based study of in-flight auscultation.

INTRODUCTION: The use of a stethoscope is essential to the delivery of continuous, supportive en route care during aeromedical evacuations. We compared the capability of 2 stethoscopes (electronic, Litmann 3000; conventional, Litmann Cardiology III) at detecting pathologic heart and lung sounds, aboard a C135, a medical transport aircraft. METHODS: Sounds were mimicked using a mannequin-based simulator SimMan. Five practitioners examined the mannequin during a fly, with a variety of abnormalities as follows: crackles, wheezing, right and left lung silence, as well as systolic, diastolic, and Austin-Flint murmur. The comparison for diagnosis assessed (correct or wrong) between using the electronic and conventional stethoscopes were performed as a McNemar test. RESULTS: A total of 70 evaluations were performed. For cardiac sounds, diagnosis was right in 0/15 and 4/15 auscultations, respectively, with conventional and electronic stethoscopes (McNemar test, P = 0.13). For lung sounds, right diagnosis was found with conventional stethoscope in 10/20 auscultations versus 18/20 with electronic stethoscope (P = 0.013). CONCLUSIONS: Flight practitioners involved in aeromedical evacuation on C135 plane are more able to practice lung auscultation on a mannequin with this amplified stethoscope than with the traditional one. No benefit was found for heart sounds.

Vertebromedullary wound with ureteral fistula.

We report a case of associated vertebromedullary and ureteral lesions in a severely injured patient, a victim of a gunshot aggression in Africa. Urine extended from the ureteral fistula through the third lumbar vertebral body, blended with cerebrospinal fluid from the dural attrition, and flowed very slowly through the dorsal exit ballistic hole. This is to our knowledge the first such case described in the literature. Uro-computed tomography scan finally made the diagnosis of ureteral fistula after two neurosurgical procedures determined that initially presumed dural persistent fistula needed to be closed.

A case of rhabdomyolysis with fatal outcome after a treatment with levofloxacin.

Fluoroquinolones are known to cause rhabdomyolysis. Levofloxacin is a recent fluoroquinolone and its muscular toxicity is not well documented. We describe the case of a 77-year-old female patient, who presented with an acute rhabdomyolysis after treatment with levofloxacin. She had a background of serious cardio-pulmonary disease. She received an oral ambulatory treatment with levofloxacin for pulmonary infection. After 6 days, she presented with severe rhabdomyolysis, resulting in complete anuria with hyperkalaemia, complicated with acute liver cytolysis and respiratory failure. The treatment was a daily repeated haemodialysis. She presented with a fatal myocardial infarction 13 days after admission. The medical history inclines us to strongly suspect levofloxacin as the cause of this severe adverse drug reaction. We also reviewed 27 other suspect cases reported in the database provided by the World Health Organization Collaborating Centre for Drug Monitoring (Uppsala, Sweden). We conclude that rhabdomyolysis can be a rare, severe adverse effect of levofloxacin, as well as the other fluoroquinolones.