The effectiveness of a formal curriculum in teaching mass casualty management.

OBJECTIVE: To improve knowledge, skills, and confidence in mass casualty management through design and im-plementation of a formal educational curriculum. DESIGN: Observational study using a mixed-methods formal educational training curriculum. SETTING: Rural Emergency Medical Services (EMS) system in Pennsylvania. Subjects/participants: Convenience sample of 141 licensed EMS providers. INTERVENTIONS: Formal educational curriculum using a computerized mass casualty scenario, lectures, hands-on skill stations, post-intervention participant satisfaction survey, knowledge retention at three- and six-month post curriculum. RESULTS: The formal curriculum resulted in an improvement in scene size-up, incident command system (ICS) set-up, and medical management of 12 percent, 27 percent, and 26 percent, respectively. Average scores on the written component evaluating mass casualty incident (MCI) management and knowledge of test patient triage were 84 percent and 74 percent, respectively. Knowledge recall at three- and six-month post-training was highly retained as test scores were generally unchanged from the time of the educational session. Course and instructor evaluations by participants reflected a high degree of satisfaction (scoring five on a five-point Likert scale). CONCLUSIONS: The formal curriculum was effective in improving the knowledge, skills, and confidence of mass casualty management. Although traditional educational methods tend to show decreases in long-term knowledge retention, the mixed active learning strategies used in this curriculum resulted in high level retention since short and long-term test scores were similar and unchanged over time. Additionally, this curriculum was perceived by participants as highly satisfactory toward their knowledge and skill development.

Perceptions of the osteopathic profession in New York City's Chinese Communities.

Objective: The purpose of this study was to assess knowledge of and barriers to osteopathic medicine in Chinese immigrant communities in New York City (NYC). Design: A cross-sectional study was designed in which a culturally appropriate survey in Chinese and English versions was administered anonymously to measure immigrant perceptions and knowledge of osteopathic medicine. Setting: Data collection occurred in the municipal delineations for the Chinatown neighbourhood within the New York, New York borough of Manhattan. Participants: Community members were selected using convenience sampling from high-density areas to participate. Information gathered from the survey included demographics, education level, healthcare habits and knowledge of the osteopathic profession. Results: 120 surveys were conducted with 68 males and 52 females, with an average age=40. Respondents in the age range of 18-29 years, those with fluent English-language proficiency, and participants with graduate-level education status demonstrated a higher proportion of knowledge of osteopathic manipulative medicine and osteopathic physicians (doctors of osteopathic medicine) among the study variables. Conclusion: Compared with research on the general US population, a general lack of knowledge of osteopathic medicine exists within NYC's Chinese immigrant community. Although this difference may be ascribed to linguistics and ethnosociological factors, greater outreach and education is needed in urban minority communities to make immigrants aware of all healthcare resources available during the current shortage of US primary care physicians.

Reduction in unavailable-for-response episodes in a private emergency medical services agency.

OBJECTIVE: Increased demand for emergency medical services (EMS), financial constraints, emergency department overcrowding, EMS crews kept in hospital, all result in ambulance unavailability. This study seeks to identify daily temporal patterns for unavailable-for-response episodes, impact of increasing staffing during peak periods, and evaluating the extent of reduction in unavailable-for-response episodes due to temporally precise increases in staffing during critical time periods and the resulting cost/benefit analysis. DESIGN: The authors evaluated all EMS responses during a 7-month time period and recorded all unavailable-for-response episodes. This identified clusters of unavailable-for-response episodes for which incremental staffing changes were implemented. Internal audit of cost/revenues was recorded. SETTING: Midsized private EMS agency in Northwest Pennsylvania. SUBJECTS/PARTICIPANTS: EMS Responders/Agency calls. INTERVENTIONS: Temporally precise increases in staffing during critical time periods/unavailable-for-response episodes. MAIN OUTCOME MEASURE(S): Reduction in unavailable-for-response episodes, cost effectiveness. RESULTS: Evaluating 23,833 EMS responses that occurred during the study period, staffing changes resulted in a 93 percent average reduction and 100 percent maximum reduction in unavailable-for-response episodes and were cost effective, based on evaluation of cost versus revenue, in this EMS agency. CONCLUSIONS: Identification of opportunities for system staffing improvement in a midsized EMS agency demonstrated feasibility and usability of mapping temporal patterns of unavailable-for-response episodes to substantially reduce the number of unavailable-for-response episodes and was cost effective.

Prehospital mass-casualty triage training-written versus moulage scenarios: how much do EMS providers retain?

INTRODUCTION: The aim of this study was to assess the effectiveness of written and moulage scenarios using video instruction for mass-casualty triage by evaluating skill retention at six months post intervention. METHODS: Prehospital personnel were instructed in the START method of mass-casualty triage using a video. Moulage and written testing were completed by each participant immediately after instruction and at six months post instruction. RESULTS: There was a significant decrease in performance between initial and six-month testing, indicating skill decay and loss of retention of triage skills after an extended nonuse period. There were no statistically significant differences between written and moulage testing results at either initial testing or at six months. Prior skill level did not influence test performance on the type of testing conducted or long-term retention of triage skills. CONCLUSION: These data confirm the skill deterioration associated with an infrequently used triage method. Further research to more precisely define triage criteria, as well as the ability to apply the criteria in a clinical setting and to rapidly identify patients at risk for morbidity/mortality is needed.

A usability study of users' perceptions toward a multimedia computer-assisted learning tool for neuroanatomy.

This usability study evaluated users' perceptions of a multimedia prototype for a new e-learning tool: Anatomy of the Central Nervous System: A Multimedia Course. Usability testing is a collection of formative evaluation methods that inform the developmental design of e-learning tools to maximize user acceptance, satisfaction, and adoption. Sixty-two study participants piloted the prototype and completed a usability questionnaire designed to measure two usability properties: program need and program applicability. Statistical analyses were used to test the hypothesis that the multimedia prototype was well designed and highly usable, it was perceived as: (1) highly needed across a spectrum of educational contexts, (2) highly applicable in supporting the pedagogical processes of teaching and learning neuroanatomy, and (3) was highly usable by all types of users. Three independent variables represented user differences: level of expertise (faculty vs. student), age, and gender. Analysis of the results supports the research hypotheses that the prototype was designed well for different types of users in various educational contexts and for supporting the pedagogy of neuroanatomy. In addition, the results suggest that the multimedia program will be most useful as a neuroanatomy review tool for health-professions students preparing for licensing or board exams. This study demonstrates the importance of integrating quality properties of usability with principles of human learning during the instructional design process for multimedia products.