An observational study of technical and non-technical skills in advanced life support in the clinical setting.

OBJECTIVE: Technical skills (TS) and non-technical skills (NTS) are the primary elements ensuring patient safety during advanced life support (ALS) and effective crisis resource management (CRM). Both skills are needed to perform high-quality ALS, though they are traditionally practiced separately. The evidence of the association between NTS and TS in high-quality ALS performance is insufficient. Hence, we aimed to evaluate the association between the skills in real-life in-hospital ALS situations. METHODS: We video recorded real-life in-hospital ALS situations, analyzed TS and NTS demonstrated in them with an instrument measuring TS and NTS, and tested the linear association between NTS and TS using a linear mixed model. RESULTS: Among 50 real-life in-hospital ALS situations that we recorded, 20 had adequate data for analysis. NTS and TS total scores were associated with one another (slope 0.48, P < 0.001). All NTS subcategories were associated with the TS total score (slopes ranging from 0.29 to 0.39, P < 0.001). The NTS total score and TS subcategories (chest compression quality, ventilation quality, rhythm control and defibrillation quality) were associated with one another (slopes ranging from 0.37 to 0.56, P < 0.01). CONCLUSIONS: The resuscitation teams who demonstrated good NTS also performed the technical aspects of ALS better. The results suggest that NTS and TS have an association with one another in real-life in-hospital ALS situations. NTS performance had the most evident association with chest compression quality and rhythm control and defibrillation quality; these are considered the most crucial elements affecting outcomes of ALS. The findings of the study present novel information of what and why to emphasize in ALS training. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03017144.

The Finnish Forward Surgical Team Experience During EUFOR Operation RD Congo in 2006.

The army Forward Surgical Team (FST) is a mobile surgical asset designed to provide life- and limbsaving combat surgery in remote and austere terrains. Operation EUFOR RDC in Democratic Republic of the Congo (DRC) in 2006 was the first one planned and conducted solely by the European Union Forces (EUFOR). The first two European FSTs reported in the present article were established by the Finnish Defence Forces.The Finnish FSTs were deployed for 4 months in Kinshasa. Three different deployment scenarios were trained; the equipments loaded on two trucks and carried by two C-130 aircrafts, the equipments loaded on two aircraft pallets (no trucks) and carried by one C-130 aircraft, and the equipments loaded on and carried by two CH-53 helicopters. The FSTs were deployed in three tactical and four reconnaissance operations. Due to the peacekeeping nature of the Operation, the surgical medical workload was light. The total number of patients treated by FSTs was 12,5 of them being due to trauma and 7 to medical condition. All trauma cases were of noncombat origin, and only one of them was severe.The European FST concept should be developed for future missions regarding the experiences gained during the reported deployment, the main goals being the mobility and the lightness of the unit. This kind of special trauma surgical asset, designed for remote theatres, will possibly be useful also in other emergency operations taking place in non-conventional circumstances; a concept of FST could easily be deployed in short notice to various accidental and natural disasters.