Trauma team training at a "high-risk, low-incidence" hospital.

INTRODUCTION: Trauma is the leading cause of death in younger people in the Western world. It is of great importance that smaller trauma centres with "high-risk, low-incidence" trauma resuscitations maintain high standards in trauma resuscitation, as severely injured patients are occasionally treated. We aimed to evaluate the effect of implementing trauma team training (TTT). Additionally, we investigated the incidence of severe traumas using the Injury Severity Score (ISS). METHODS: Data on process times were collected in a three-month period before and after implementation of TTT at the Regional Hospital Randers, Denmark. Process times from arrival of the patient in the trauma room until chest X-ray, trauma CT, CT description and transfer were registered. ISS was calculated as trauma severity. RESULTS: A total of 43 trauma patients were registered. ISS values were not significantly different between the two cohorts. 5/43 (12%) had an ISS > 15 as an expression of severe traumas. A tendency to reduced process times was found, but results were not statistically significant. CONCLUSIONS: Despite limitations in this study, our results point towards a reduced process time after the implementation of TTT. At an organisational level, TTT can draw attention to challenges, inappropriate local procedures and allocation of material and staff in order to improve trauma resuscitations. Only 12% of patients had an ISS > 15, emphasising the need to simulate trauma resuscitations using TTT. FUNDING: none. TRIAL REGISTRATION: The study was registered with the Danish Data Protection Agency.

CE: Assessing a Child's Pain.

: Effective pain assessment is a necessary component of successful pain management and the pursuit of optimal health outcomes for patients of all ages. In the case of children, accurate pain assessment is particularly important, because children exposed to prolonged or repeated acute pain, including procedural pain, are at elevated risk for such adverse outcomes as subsequent medical traumatic stress, more intense response to subsequent pain, and development of chronic pain.As with adults, a child's self-report of pain is considered the most accurate and reliable measure of pain. But the assessment of pain in children is challenging, because presentation is influenced by developmental factors, and children's responses to certain features of pain assessment tools are unlike those commonly observed in adults.The authors describe the three types of assessment used to measure pain intensity in children and the tools developed to address the unique needs of children that employ each. Such tools take into account the child's age as well as special circumstances or conditions, such as ventilation requirements, cognitive impairment, and developmental delay. The authors also discuss the importance of proxy pain reporting by the parent or caregiver and how nurses can improve communication between the child, caregiver, and health care providers, thereby promoting favorable patient outcomes.

Unannounced vs announced in situ simulation of emergency teams: Feasibility and staff perception of stress and learning.

BACKGROUND: Simulation-based medical education, often used for teaching teamwork, can be conducted in different settings: off-site (simulation centers or other settings away from clinical units) or in situ (real clinical environment), where the latter can be either announced or unannounced. Simulation in general, but especially unannounced in situ simulation, has been described as stressful and stress can affect learning. The aim of this study was to evaluate feasibility and the perception of learning and stress. METHODS: Sixteen standardized in situ simulations were planned in an emergency department on eight predetermined dates, with one unannounced and one announced simulation per day. Authentic ad hoc teams were formed based on the on-call staff and included doctors, nurses, radiographers, biochemist, porters, and secretaries. Data were collected using questionnaires and the State-Trait Anxiety Inventory. RESULTS: Eleven of the 16 in situ simulations were completed. Self-perceived learning was "good" or "very good" for 27/47 (57%) participants and 33/50 (66%) in unannounced vs announced in situ simulation (P = 0.33). Two of 47 (4%) in unannounced in situ simulation "agreed or partly agreed" that in situ simulation was stressful or unpleasant vs 12/50 (24%) in announced in situ simulation (P = 0.06). CONCLUSION: No significant difference was found between unannounced and announced in situ simulation among emergency department staff according to self-perceived learning and self-perceived stress. This is relevant for the future planning of simulation when considering what is to be achieved from implementing different designs for simulation-based medical education.