Reflections and interdisciplinary perceptions of pharmacy learners on an international medical brigade.

BACKGROUND AND PURPOSE: The Mountain Area Health Education Center, Inc. and Shoulder to Shoulder have partnered on medical brigades in rural Honduras since 2005, with pharmacy learner participation beginning in 2007. This study assesses the value of this experience to pharmacy learners and their contribution to a brigade's success. EDUCATIONAL ACTIVITY AND SETTING: Pharmacy learners and faculty, family medicine residents and faculty physicians, student volunteers, and other health care professionals participate in two-week medical brigades each February and August. Since 2011, brigades have been based out of Camasca, a small town in rural, southwest Honduras. February brigade teams conduct home visits, while August brigades consist primarily of mobile clinics. In both situations, the pharmacy team prepares, dispenses, and counsels on medications. Participants from three trips were surveyed. FINDINGS: All pharmacy learners agreed the brigade contributed to improvements in their skills and competence as pharmacists. Brigade members agreed that pharmacy learners made valuable contributions, particularly in counseling patients, maintaining an organized workflow, and assisting in activities outside of pharmacy services. All respondents agreed that pharmacy learners were necessary to a trip's success. SUMMARY: These international medical brigades were impactful educational experiences for pharmacy learners. Brigade participants viewed pharmacy learners as essential team members.

Cardiac arrest patients rarely receive chest compressions before ambulance arrival despite the availability of pre-arrival CPR instructions.

OBJECTIVES: To determine the proportion of out-of-hospital cardiac arrest (OOHCA) patients who received chest compressions, before EMS arrival, from bystanders who called the EMS emergency telephone number (9-1-1) at dispatch centers that provided telephone CPR instructions and to describe barriers to following instructions. METHODS: A retrospective case series was conducted in 2004 at three dispatch centers all of which provided sequential airway, breathing and chest compression pre-arrival instructions. All calls for which the call-taker established that the patient was in OOHCA were identified, and the recorded interaction was reviewed using a structured data collection tool. Data included whether the caller performed compressions, the sequence of instructions, whether there were barriers to performing CPR and characteristics of the caller, call taker and patient. Descriptive statistics were used to evaluate the data. RESULTS: 343 calls were reviewed. 3 were excluded because it was unclear whether compressions were provided. 172 calls were not eligible for pre-arrival instructions (e.g. obviously dead, already receiving CPR). Of the 168 calls eligible for CPR instructions, chest compressions were actually given to 25 patients (15%, 95% confidence interval 10-21%) before EMS arrival. Leading reasons for not following CPR instructions included: caller disconnected phone before directions were complete (19%), caller's refusal (18%), emotional state of the caller (14%), inability to listen to telephone instructions and care for patient at the same time (13%) and physical limitations of the caller (8%). Failure to complete airway and breathing steps prevented 8% of callers from providing compressions. CONCLUSIONS: Few 9-1-1 callers provided chest compressions following telephone CPR instructions that included airway and breathing steps. The majority of callers were unwilling or emotionally or physically unable to follow the instructions.