Attributes of leadership skill development in high-performance pre-hospital medical teams: results of an international multi-service prospective study.

BACKGROUNDS: Team leadership skills of physicians working in high-performing medical teams are directly related to outcome. It is currently unclear how these skills can best be developed. Therefore, in this multi-national cross-sectional prospective study, we explored the development of these skills in relation to physician-, organization- and training characteristics of Helicopter Emergency Medicine Service (HEMS) physicians from services in Europe, the United States of America and Australia. METHODS: Physicians were asked to complete a survey regarding their HEMS service, training, and background as well as a full Leader Behavior Description Questionnaire (LBDQ). Primary outcomes were the 12 leadership subdomain scores as described in the LBDQ. Secondary outcome measures were the association of LBDQ subdomain scores with specific physician-, organization- or training characteristics and self-reported ways to improve leadership skills in HEMS physicians. RESULTS: In total, 120 HEMS physicians completed the questionnaire. Overall, leadership LBDQ subdomain scores were high (10 out of 12 subdomains exceeded 70% of the maximum score). Whereas physician characteristics such as experience or base-specialty were unrelated to leadership qualities, both organization- and training characteristics were important determinants of leadership skill development. Attention to leadership skills during service induction, ongoing leadership training, having standards in place to ensure (regular) scenario training and holding structured mission debriefs each correlated with multiple LBDQ subdomain scores. CONCLUSIONS: Ongoing training of leadership skills should be stimulated and facilitated by organizations as it contributes to higher levels of proficiency, which may translate into a positive effect on patient outcomes. TRIAL REGISTRATION: Not applicable.

Red line the red line: Optimizing emergency medicine physicians and surgeons collaborative roles on trauma teams.

ABSTRACT: It has long been the standard for surgical and EM teams to both be present upon patient arrival and work together for the sickest trauma patients, yielding improved outcomes. It is important to dismantle divisive perceptions, confront system constraints, and promote new strategies that optimize the engagement of trauma team members. The focus should be on the patient, whose injury care starts with prevention and extends seamlessly through prehospital, hospital and rehabilitation.The authors address several myths that impact collaborative teamwork among emergency medicine physician and surgeons.Leaders, especially at GME sites, need to foster collaborative relationships, rather than adversarial. The red line mentality is a divisive construct that should be dismantled.

Virtual urgent care is here to stay: driving toward safe, equitable, and sustainable integration within emergency medicine.

BACKGROUND: Virtual care in Canada rapidly expanded during the COVID-19 pandemic in a low-rules environment in response to pressing needs for ongoing access to care amid public health restrictions. Emergency medicine specialists now face the challenge of advising on which virtual urgent care services ought to remain as part of comprehensive emergency care. Consideration must be given to safe, quality, and appropriate care as well as issues of equitable access, public demand, and sustainability (financial and otherwise). The aim of this project was to summarize current literature and expert opinion and formulate recommendations on the path forward for virtual care in emergency medicine. METHODS: We formed a working group of emergency medicine physicians from across Canada working in a variety of practice settings. The virtual care working group conducted a scoping review of the literature and met monthly to discuss themes and develop recommendations. The final recommendations were circulated to stakeholders for input and subsequently presented at the 2023 Canadian Association of Emergency Physicians (CAEP) Academic Symposium for discussion, feedback, and refinement. RESULTS: The working group developed and reached unanimity on nine recommendations addressing the themes of system design, equity and accessibility, quality and patient safety, education and curriculum, financial models, and sustainability of virtual urgent care services in Canada. CONCLUSION: Virtual urgent care has become an established service in the Canadian health care system. Emergency medicine specialists are uniquely suited to provide leadership and guidance on the optimal delivery of these services to enhance and complement emergency care in Canada.

RéSUMé: CONTEXTE: Les soins virtuels au Canada ont rapidement pris de l'ampleur pendant la pandémie de COVID-19 dans un environnement où les règles sont peu strictes, en réponse aux besoins urgents d'accès continu aux soins dans un contexte de restrictions en santé publique. Les spécialistes de la médecine d'urgence sont maintenant confrontés au défi de conseiller sur les services de soins d'urgence virtuels qui devraient rester dans le cadre des soins d'urgence complets. Il faut tenir compte des soins sécuritaires, de qualité et appropriés, ainsi que des questions d'accès équitable, de la demande publique et de la durabilité (financière et autre). L'objectif de ce projet était de résumer la littérature actuelle et l'opinion d'experts et de formuler des recommandations sur la voie à suivre pour les soins virtuels en médecine d'urgence. MéTHODES: Nous avons formé un groupe de travail composé de médecins urgentistes de partout au Canada qui travaillent dans divers milieux de pratique. Le groupe de travail sur les soins virtuels a effectué un examen de la portée de la documentation et s'est réuni chaque mois pour discuter des thèmes et formuler des recommandations. Les recommandations finales ont été distribuées aux intervenants pour obtenir leurs commentaires, puis présentées au symposium universitaire 2023 de l'Association canadienne des médecins d'urgence (ACMU) pour discussion, rétroaction et perfectionnement. RéSULTATS: Le groupe de travail a élaboré et atteint l'unanimité sur neuf recommandations portant sur les thèmes de la conception du système, de l'équité et de l'accessibilité, de la qualité et de la sécurité des patients, de l'éducation et des programmes, des modèles financiers et de la viabilité des services virtuels de soins d'urgence au Canada. CONCLUSION : Les soins d'urgence virtuels sont devenus un service établi dans le système de santé canadien. Les spécialistes en médecine d'urgence sont particulièrement bien placés pour fournir un leadership et des conseils sur la prestation optimale de ces services afin d'améliorer et de compléter les soins d'urgence au Canada.

Demora en tiempo de respuestas a codigos amarillos en un servicio de emergencias médicas de la ciudad de Córdoba

Este estudio investiga las causas de demora en los tiempos de respuesta a códigos amarillos en un servicio privado de emergencias médicas de la ciudad de Córdoba, que cuenta con afiliados directos y por convenios, estos últimos representan un 70% del total. Los nivel de prestaciones son diferenciados por códigos según riesgo de vida y/o por tiempo de respuesta en: Verde (consultas o demora hasta 3 horas), Amarillos (urgencias o demora hasta 20 minutos), Rojos (emergencias o demora hasta 12 minutos) Azul (traslados, sin demora establecida)...

Summary: This study investuigates the causes of delay in response times to yellow code in a private emergency medical service of the city of Córdoba, which has direct and affiliate agreements, the latter account for 70% of the total. Performance levels are differentiated by codes as life-threatening and/ or response time: Green (queries or delay up to 3 hours), Yellow (emergency or delay up to 20 minutes), Reds (emergencies or delay up to 12 minutes) blue (trasfers, established without delay)...

Gestão em terapia intensiva: conceitos e inovações / Management in intensive care: concepts and innovations

JUSTIFICATIVA E OBJETIVOS: Atualmente, várias propostas são feitas com o objetivo de resolver ou pelo menos, controlar o grande problema da gestão na área da saúde: reduzir ou conter custos ao mesmo tempo em que a melhoria contínua da qualidade é promovida. A Unidade de Terapia Intensiva (UTI) é um dos setores mais importantes do hospital, local onde mudanças são essenciais. A procura por modelos em que medicina baseada em evidênciase utilização de rotinas e protocolos em UTI convivam como conceito de gestão ocorre em velocidade nunca vista antes. Cabe ao líder da UTI, tornar o setor modelo de unidade de negócios,preocupando-se com aspectos financeiros, segurança, qualidade, educação e inovação no atendimento ao cliente interno e externo. CONTEÚDO: Revisão da literatura incluindo modelos estudados e aplicados em outras áreas de conhecimento humano, bem como a proposta inovadora da utilização do instrumento Product Lifecycle Management (PLM) como opção de implementação de serviços médicos em UTI. CONCLUSÃO: O conhecimento de conceitos fundamentais e aplicação de modelos de gestão que priorizam a redução de margem de erro, segurança e aplicação da medicina baseada em evidência para o paciente crítico, podem estar relacionados a melhor utilização de recursos em Medicina Intensiva, colaborando na solução do dilema da área da saúde, manter qualidade e conter ou reduzir custos.

BACKGROUND AND OBJECTIVES: As each day passes, various proposals are made to resolve or at least control the major problem of health care: to reduce or contain costs at the same time as continuous quality improvement is promoted. One of the most important sectors of a hospital, where changes are essential,is the Intensive Care Unit (ICU). The search for models in which evidence-based medicine and the use of routines and protocols in ICU mingle with the concept of management occurs at a rate never seen before. It is for the leader of ICU, making the sector a business model unit, concerned with financial aspects, safety, quality, education and innovation in customer service. CONTENTS: Review of literature including models studied and applied in other areas of human knowledge and a innovative approach,using the tool Product Lifecycle Management (PLM), asan option for implementation of medical services in Intensive Care Units. CONCLUSION: Knowledge of fundamental concepts and application of management models that emphasize the reduction of error, security and implementation of evidence-based medicine for the critically ill patient, may be related to better utilization of resources in intensive care, collaborating in the solution of health care dilemma, maintain quality and contain or reduce costs.

Inclusión de médicos en la atención prehospitalaria: ¿existe evidencia científica? / Inclusion of physicians in prehospital care: is there scientific evidence?

Un creciente número de países han decidido incluir médicos en sus sistemas de atención prehospitalaria, tanto para la atención de emergencias fuera del hospital, como para traslados interhospitalarios de pacientes críticos. Nuestro objetivo es revisar la evidencia científica que los ha llevado a tomar esta decisión. La evidencia muestra mayormente que la inclusión de médicos en los equipos de atención prehospitalaria: disminuye la morbimortalidad del paciente crítico, descongestiona los servicios de urgencias, permite concentrar las unidades de pacientes críticos, mejora las condiciones de traslado de pacientes complejos, optimiza el manejo de incidentes con múltiples víctimas y desastres, mejora los resultados de la intubación endotraqueal, permite la realización de maniobras invasivas prehospitalarias en pacientes traumatizados graves seleccionados, entre otros beneficios. Por todas estas razones, creemos que la evidencia científica demuestra que la inclusión de médicos en la atención prehospitalaria es beneficiosa en emergencias con pacientes graves (especialmente cuando el tiempo de traslado es prolongado) y en traslados interhospitalarios de pacientes críticos inestables. Estos equipos deberían implementarse en Chile para reforzar y articular las redes públicas de urgencias y unidades de pacientes críticos.

A growing number of countries have decided to include physicians in prehospital care systems, both for emergency care outside the hospital and for interhospital transfer of critically ill patients. Our goal is to review the scientific evidence that has led them to take this decision. Medicalized prehospital teams increases survival of critically ill patients, clears up emergency departments, concentrates critical care units, improves interhospital critical care transfer, improves multiple casualty incidents and disaster management, allowes prehospital endotracheal intubation and finally allowes prehospital invasive procedures in severely injured patients. Supported on scientific evidence, we believe that the inclusion of physicians in prehospital care is beneficial. These teams should be promptly created in Chile to strength emergency departments and critical care networks.

Qualidade em terapia intensiva / Intensive care unit quality

JUSTIFICATIVA E OBJETIVOS: A Unidade de Terapia Intensiva é um setor de alta complexidade no ambiente hospitalar. A monitoração da qualidade de serviços prestados torna-se a cada dia fundamental para segurança do paciente crítico. O objetivo deste estudo foi realizar uma revisão de conceitos e práticas úteis na melhoria contínua do atendimento do paciente grave. CONTEÚDO: Revisão de literatura sobre qualidade e segurança em Medicina Intensiva, incluindo modelos de outras áreas de conhecimento agora aplicados na gestão de uma Unidade de Terapia Intensiva. CONCLUSÃO: A utilização de conceitos e práticas que envolvem análise de processos e desfechos é fundamentalno processo de melhoria contínua e na segurança do atendimento do paciente crítico. Modelos vindos de áreas como administração e engenharia de produção podem ser adaptados em Medicina Intensiva, facilitando fluxos internos e equilibrando uma boa prática médica com controle adequado de custos.

Peculiaridades da pesquisa clínica em medicina de urgência e emergência: aspectos éticos e organizacionais / Peculiarities of clinical research in urgency and emergency medicine: ethical and organizational aspects

Justificativa e objetivos: Estudos clínicos em Medicina de urgência e emergência apresentam algumas peculiaridades em relação aos demais estudos, que por vezes dificultam sua condução, de acordo com princípios éticos e aspectos organizacionais. O objetivo deste estudo foi descrever as peculiaridades da pesquisa clínica em Medicina de urgência e emergência, para que o estudo clínico seja desenvolvido de acordo com as normas éticas, bem como discutir aspectos organizacionais de um centro de pesquisa nesta área. Conteúdo: Conforme as resoluções e normatizações nacionais e internacionais permitem-se a inclusão de sujeitos de pesquisa incapazes de fornecer consentimento informado prévio e sem possibilidade de contato com um representante legal e/ou familiar, somente quando esta for uma característica necessária para a população da pesquisa e após aprovação do Comitê de Ética em pesquisa, devendo a equipe e o centro de pesquisa organizado e adaptado a estas necessidades. Conclusão: A condução de estudos clínicos em medicina de urgência e emergência requer uma equipe qualificada e experiente a assuntos referentes à pesquisa clínica e uma estrutura física adequada. Apresenta peculiaridades, particularmente na abordagem do paciente e termo de consentimento livre e esclarecido, porém isto não isenta a aprovação de um Comitê de Ética em Pesquisa para os devidos procedimentos.

Background and objectives: Clinical trials in urgency and emergency medicine have some peculiarities in relation to other studies, thus hindering the conduct in accordance with ethical principles and organizational aspects. This article aims to describe the peculiarities of clinical research in urgency and emergency medicine for the clinical study is developed in accordance with ethical standards, and also discusses the aspects of a research center organization in this area. Contents: According to national and international laws It is possible the inclusion of subjects incapable of providing informed consent and without prior opportunity to contact a legal representative and/or family, only when it is a necessary feature for the population of the survey and only after the Ethical Committee approval, with the team and the research center are adapted to these needs. Conclusion: The conduct of clinical studies in urgency and emergency medicine and rescue team requires a qualified and experienced in the clinical research and an appropriate physical structure. Presents peculiarities with regard to the approach end of the patient and informed consent, but is not dispense for approval of the independent ethics committee.

The evolution of emergency medicine in Jamaica / La evolución de la medicina de emergencia en Jamaica

Emergency Medicine in Jamaica has evolved rapidly over the past 20 years and has gained recognition as a specialty. A residency training programme has been established, trademark life support courses are now available, moves to develop areas of sub-specialization have begun and an emergency medicine association has been formed. There has been an increase in the diagnostic modalities in the main teaching institution, the University Hospital of the West Indies (UHWI). There is an urgent need for improvements in pre-hospital care. This will require the development of an efficient Emergency Medical Service (EMS). More emphasis and attention is required on disaster medicine, toxicology and trauma. Increased training of emergency physicians and nurses, advances in academia and research, and greater advocacy by local emergency physicians will further advance the specialty.

La medicina de emergencia en Jamaica ha evolucionado rápidamente en el curso de los últimos 20 años, y ha ganado reconocimiento como especialidad. Se ha establecido un programa de entrenamiento de residencia, y existen en la actualidad cursos comerciales en soporte de vida, se han iniciado movimientos para desarrollar áreas de sub-especialización, y se ha creado una asociación de medicina de emergencia. Ha habido un aumento en las modalidades de diagnóstico en la principal institución docente - el Hospital Universitario de West Indies (UHWI). Existe una necesidad urgente de lograr mejoras en el cuidado pre-hospitalario. Esto requerirá el desarrollo de Servicios Médicos de Emergencia (SME) eficientes. Se requiere más énfasis y atención a la medicina de desastre, toxicología y trauma. El aumento de entrenamiento de médicos y enfermeras de emergencia, los avances en la academia y la investigación, y una mayor defensa de los médicos de emergencia local, contribuirán al ulterior progreso de la especialidad.

A organização do atendimento às urgências e trauma / Emergency and trauma system organization

A organização dos sistemas de urgência e trauma tem sido extensivamente discutida no mundo. Diversos modelos têm sido propostos principalmente pelos países desenvolvidos. Embora exista um consenso com relação à necessidade e os grandes benefícios trazidos pela organização dos sistemas de urgência e trauma, ainda não existem evidências quanto às upremacia de um único modelo. Sumariamente as principais diferenças são baseadas na participação ou não dos médicos no atendimento pré-hospitalar e na existência ou não de uma especialidade médica em emergências na linha de frente dos hospitais. No Brasil, embora nos últimos anos o Ministério da Saúde tenha investido no desenvolvimento de um modelo nacional, o setor de urgência ainda carece de definições, maiores investimentos e envolvimento dos órgãos formadores no setor de saúde.

Trauma and emergency system organization has been extensively discussed world wide in the last years. Different models have been proposed, mainly in developed countries. Although there is no doubt about the benef its of organizing an emergency and trauma system, there is no evidence to sustain one best model. In summary, main differences among the models are medical activity in the pre-hospital field and the recognition of an emergency medical speciality in the hospital’s emergency rooms. In Brazil, nevertheless the current Health Minister policies focused in the development of a national emergency system, the emergency sector needs better statements, investments and commitment of health care formation institutions.