ABSTRACT
In this first report of rabies in Equatorial Guinea, problems accompanying the application of the Milwaukee Protocol are described. With its apparent success, and despite a subsequent death from complications of malnutrition, we sound a note of optimism that canine as well as bat rabies may be treatable.
Subject(s)
Amantadine/therapeutic use , Anesthetics, Dissociative/therapeutic use , Ketamine/therapeutic use , Midazolam/therapeutic use , Rabies/drug therapy , Ribavirin/therapeutic use , Ubiquinone/analogs & derivatives , Animals , Antiviral Agents/therapeutic use , Child, Preschool , Combined Modality Therapy , Dogs , Drug Therapy, Combination , Equatorial Guinea , Fatal Outcome , Humans , Male , Rabies/diagnosis , Rabies virus/isolation & purification , Treatment Outcome , Ubiquinone/therapeutic useABSTRACT
BACKGROUND: Cardiopulmonary resuscitation (CPR) is a sudden emergency procedure that requires a rapid and efficient response, and personnel trained in lifesaving procedures. Regular practice and training are necessary to improve resuscitation skills and reduce anxiety among the staff. Western Galilee Hospital has developed simulator programs for surprise CPR training exercises in all hospital departments and units. This study assessed the efficacy of surprise drills. METHODS: Advanced cardiac life-support instructors performed 131 surprise drills between 2003 and 2005, using a computerized simulation mannequin (SIM 4000). Nine criteria were measured and scored in the drill: reaction time, CPR according to ABC principles, calling for doctor, CPR knowledge, CPR skills, resuscitation management, staff work, resuscitation chart, and defibrillator management. Drills were evaluated, discussed, and compared with previous drills from the same department and from other departments. RESULTS: A gradual improvement was observed in the results of the drills held through 2003-2005, more significantly in the medical departments than in the surgical departments and outpatient clinics. The average score in 2005 was 77.2% (P=0.001), compared with 74% (P=0.012) in 2004 and 59% (P<0.001) in 2003. Major improved criteria were calling for doctor, staff work, CPR knowledge, and defibrillator (P<0.05). CONCLUSION: It is our belief that surprise resuscitation drills constitute an effective tool to improve performance in case of a real emergency resuscitation, both on a departmental and a general hospital level.
Subject(s)
Cardiopulmonary Resuscitation/education , Personnel, Hospital/education , Program Development , Quality of Health Care , Advanced Cardiac Life Support/education , Clinical Competence , Computer Simulation , Electric Countershock , Emergency Treatment , Humans , Inservice Training , Israel , Models, Educational , Time FactorsABSTRACT
BACKGROUND: Saving life demands only two hands and some basic knowledge. A qualified person can open airways, resuscitate, massage a heart and call for help. A person with cardio-pulmonary resuscitation (CPR) training can sustain an ailing person's heart and brain for a short time. However, knowledge of CPR guidelines and skills is not enough; medical and nursing practitioners must practice and train regularly to hone those skills. Western Galilee Hospital has developed simulator programs for surprise CPR training exercises in all hospital departments and units. OBJECTIVE: To use surprise drills in order to improve the quality of resuscitation and CPR methods. MATERIALS AND METHODS: ACLS (Advanced cardiac life support) instructors use a computerized simulation mannequin (SIM 4000). Two to three surprise drills are conducted in the hospital each week. At the end of each drill, a final report is given to the department head and a staff meeting is held to discuss the drill results. Between the years 2003-2005, 131 drills were carried out in 30 different departments of Western Galilee Hospital. Nine criteria are measured and scored in the drill: reaction time, ABC principles, calling the doctor, CPR knowledge, CPR skills, resuscitation management, staff work, resuscitation chart, and defibrillator management. Drills are compared with previous drills performed in the same department, and with drills conducted in other departments. Data is analyzed using Anova, Kruskal-Wallis, independent t-test and Spearman correlation coefficient test. RESULTS: Improvement was found in the results of the drills held from 2003-2005, mainly in the medical departments as compared with the surgical departments and ambulatory clinics. The average score in 2005 was 77.2 (p = 0.001), compared with 74 (p = 0.012) in 2004, and 59 (p < 0.001) in 2003. Improved criteria included: calling the doctor, staff work, CPR knowledge, and defibrillator (p < 0.05). CONCLUSIONS: It is our belief that surprise resuscitation drills are the key to improve functioning during actual emergency resuscitation, both on a departmental and a general hospital level.