Evaluation of a New Virtual Reality Concept Teaching K-Wire Drilling With Force Feedback Simulated Haptic in Orthopedic Skills Training.

PURPOSE: Surgical simulations are becoming increasingly relevant in musculoskeletal training. They provide the opportunity to develop surgical skills in a controlled environment while reducing the risks for patients. For K-wire internal fixation in musculoskeletal surgery, a force feedback virtual reality (VR) simulator was developed. The aim of this study was to evaluate training results using this technology and compare the results with that of standard teaching on cadavers. METHODS: Twenty participants attending an AO Trauma Course during 2020 were randomly allocated in 2 groups. On day 1, group A was trained by senior surgeons using a cadaver and group B was trained by the VR simulator for K-wire insertion in the distal radius. On day 2, all participants performed K-wire insertion on the cadaver model, without assistance, to validate the training effect. RESULTS: On a surgical skills test, group B performed better than group A. In group B, the entry point of the first K-wire was closer to the targeted styloid process of the radius, and the protrusion of the K-wires into soft tissue was less than that in group A. CONCLUSIONS: Training with the VR simulator for K-wire insertion resulted in better surgical skills than training by a surgeon and cadaver model. CLINICAL RELEVANCE: Training with the VR simulator provides the opportunity to improve and refine surgical skills without the risk of harming patients. It offers easier access, unlimited repetitions, and is more cost-effective compared with training sessions with cadavers.

[Telemedicine in the emergency room-An extension with potential? : Results of a recent survey]. / Telemedizin im Schockraum ­ eine Ergänzung mit Potenzial : Ergebnisse einer aktuellen Umfrage.

Critically injured patients pose great challenges for medical personnel in emergency room treatment. How can such a high workload due to a lack of personnel be reduced? Telemedicine can offer solutions here. With the help of external medical expertise, diagnoses and treatment processes are already significantly accelerated and optimized in other specialist areas. This possibility should now also be introduced into the care of critical trauma surgery patients. In this article, current emergency room treatment is reflected, problems are shown and future-oriented solutions are suggested.

[Teleradiology in the TraumaNetwork DGU®]. / Teleradiologie im TraumaNetzwerk DGU®.

Digital exchange of images and diagnostic findings has become more and more popular in German hospitals in recent years. Solutions such as the TKmed telecooperation platform, which was developed on behalf of the German Trauma Society (DGU), have meanwhile also become established in the clinical routine of trauma surgery and can be very useful in cases of emergency relocation, for requesting second opinions, in questions with respect to the severely injured type procedure (SAV) and other applications. A fast, secure and privacy-conform exchange of treatment and imaging data can be beneficial, particularly in the care of severely injured patients. This article provides an overview of the development and use of teleradiology tools in trauma networks across Germany.

Orthopaedics and Trauma Surgery in Germany in 2023 - Will We Have Sufficient Doctors in the Future? / Orthopädie und Unfallchirurgie 2023 ­ haben wir genug Nachwuchs?

There has been a growing shortage of physicians in Germany in recent years. In this study, we analyse the situation facing orthopaedic hospitals and trauma centres.Between 22 November and 5 December 2022, a web-based questionnaire was sent out by the Academy of the German Trauma Society (AUC) and by the Society of Leading Orthopaedic and Trauma Surgeons (VLOU).The questionnaire was answered by 185 heads of department. Of the responses, 20% came from university hospitals or major trauma centres, and a third from regional or local clinics. More than half of the hospital departments (55%) had a median of 2.7 vacant doctor positions. Among those hospitals, 47% had a vacant position for a consultant, 33% for a board-certified specialist, and 89% for a junior doctor. Within the university hospitals, only one third had vacant doctor positions. The responding heads of department gave negative feedback regarding the number of applications, the qualifications of young doctors, and their motivation for scientific work (in university hospitals).More than half of the responding hospitals had vacant doctor positions. If we are to counteract the growing shortage of doctors in orthopaedics and trauma surgery, the number of clinical doctors in general and the working conditions in hospitals have to be improved. Teaching hospitals should try to improve the training of medical students with a view to inspiring greater motivation to work in orthopaedics and trauma surgery.

[Simulation in surgery]. / Simulation in der Chirurgie.

In order to achieve a qualitatively high-grade standard of operations and follow-up monitoring of operations as well as a trouble-free communication in interprofessional teams and an overall high level of safety in the treatment of patients, simulation techniques are increasingly being implemented even in surgery. This article gives an overview of these aspects. Attention should be paid to the fact that simulation should always only be a part of a didactic concept that must be strictly flanked by learning targets and control of the learning targets and also by definition can only approximate to the real situation.

Education and training as a key enabler of successful patient care in mass-casualty terrorist incidents.

BACKGROUND AND PURPOSE: The increase in terrorist attacks with sometimes devastating numbers of victims has become a reality in Europe and has led to a fundamental change in thinking and a reorientation in many fields including health policy. The purpose of this original work was to improve the preparedness of hospitals and to provide recommendations for training. MATERIAL AND METHODS: We conducted a retrospective literature search based on the Global Terrorism Database (GTD) for the period 2000 to 2017. Using defined search strategies, we were able to identify 203 articles. We grouped relevant findings into main categories with 47 statements and recommendations on education and training. In addition, we included data from a prospective questionnaire-based survey on this topic that we conducted at the 3rd Emergency Conference of the German Trauma Society (DGU) in 2019. RESULTS: Our systematic review identified recurrent statements and recommendations. A key recommendation was that regular training should take place on scenarios that should be as realistic as possible and should include all hospital staff. Military expertise and competence in the management of gunshot and blast injuries should be integrated. In addition, medical leaders from German hospitals considered current surgical education and training to be insufficient for preparing junior surgeons to manage patients who have sustained severe injuries by terrorist events. CONCLUSION: A number of recommendations and lessons learned on education and training were repeatedly identified. They should be included in hospital preparations for mass-casualty terrorist incidents. There appear to be deficits in current surgical training which may be offset by establishing courses and exercises.

Evaluation of the decision-making process within the table-top exercise of the Terror and Disaster Surgical Care (TDSC®) course.

PURPOSE: The threat of terror is omnipresent in Europe and the number of attacks worldwide is increasing. The target of attacks in Europe is usually the civilian population. Incalculable dangerous situations at the scene of the event and severe injury patterns such as complex gunshot and explosion injuries with a high number of highly life-threatening people present rescue forces, emergency physicians and subsequently hospitals with medical, organizational as well as tactical and strategic challenges. The Terror and Disaster Surgical Care (TDSC®) course trains clinical decision-makers to meet these challenges of a TerrorMASCAL in the first 24-48 h. METHODS: A table-top exercise was developed for the TDSC® course as a decision training tool, which was prospectively evaluated in six courses. The evaluation took place in 3 courses of the version 1.0, in 3 courses in the further developed version 2.0 to different target values like, e.g., the accuracy of the in-hospital triage. Furthermore, 16 TDSC® course instructors were evaluated. RESULTS: For the evaluation, n = 360 patient charts for version 1.0 and n = 369 for version 2.0 could be evaluated. Overall, the table-top exercise was found to be suitable for training of internal clinical decision makers. Version 2.0 was also able to depict the action and decision-making paths in a stable and valid manner compared to the previous version 1.0. The evaluation of the instructors also confirmed the further value and improvement of version 2.0. CONCLUSION: With this prospective study, the table-top exercise of the TDSC® course was tested for decision stability and consistency of the participants' decision paths. This could be proven for the selected target variables, it further showed an improvement of the training situation. A further development of the table-top exercise, in particular also using digital modules, will allow a further optimization. http://www.bundeswehrkrankenhaus-ulm.de.

[Safety aspects, emergency preparedness and hazard prevention in hospitals concerning mass casualty incidents (MCI)/terror-related MCI : Prospects on future challenges based on survey results from the 3rd emergency conference of the DGU]. / Sicherheitsaspekte und Vorbereitung zur Notfallvorsorge und Gefahrenabwehr in Kliniken bei MANV/TerrorMANV : Ausblick auf zukünftige Herausforderungen anhand von Umfrageergebnissen zur 3. Notfallkonferenz der DGU.

BACKGROUND: Worldwide terrorist activities since "9/11" and subsequently also in the European region have led to a rethinking in the context of the evaluation of critical infrastructure in Germany, also with respect to security at and in hospitals. OBJECTIVE: This publication deals with the evaluation of existing concepts on topics such as "alerting", "security", "communication" and "preparation" in the aforementioned context. MATERIAL AND METHODS: Based on a literature review as well as a survey among participants of the 3rd emergency conference of the DGU (German Society for Trauma Surgery), this topic and the currently existing situation are further analyzed and presented. RESULTS: The data obtained illustrate that while the majority of hospitals have a hospital alert and response planning, the frequency of updates and intrahospital communication to increase awareness show significant variation. Furthermore, the results illustrate a heterogeneity of the existing intrahospital alerting concepts as well as a lack of security concepts and cooperation with security and guard services. Furthermore, it is evident that the topic of a possible CBRN (chemical, biological, radiological, nuclear) threat is not yet adequately perceived or implemented in the risk analysis. DISCUSSION: The latent threat of terrorist activities appears to have led German hospitals to address the issue of hospital alarm and response planning in their assessment as critical infrastructure and to have implemented this for the most part; however, the subordinated areas and the consequences that can be derived from alarm planning do not yet show the necessary stringency to ultimately ensure adequate responses in these special scenarios with respect to security in and at German hospitals.

Evaluation of the Terror and Disaster Surgical Care course.

BACKGROUND: Mass-casualty terrorist incidents are a medical and organisational challenge for every hospital. The Terror and Disaster Surgical Care (TDSC®) course was developed because such incidents are associated with special injury patterns, escalating situations, and surges of casualties and haemodynamically unstable patients requiring treatment and can overwhelm the resources of hospitals. MATERIALS AND METHODS: The course currently lasts two-and-a -half days and is designed for 18-21 experienced surgeons, anaesthetists and clinical emergency physicians (who form groups of three for the tabletop simulation game). From 2017 to 2019, a total of 20 courses with 437 participants were conducted. The data in this study were collected from these 437 participants. RESULTS: Most of the participants were male (82%); 64% of participants specialised in a major field of surgery (general surgery, visceral surgery, vascular surgery, trauma surgery and orthopaedics). At the time of the course, most participants (86%) were department heads, senior physicians or specialists. The tabletop simulation game, which was specifically developed for the course, as well as the presentations were rated good to very good. The result of the overall course evaluation, which included aspects such as organisation, professionalism, content and teaching, was on average 1.34 and thus very good. DISCUSSION: The TDSC course complements already established courses and provides training in tactical surgical care after hospital admission. The TDSC course integrates and builds on elements of individualised trauma care such as the primary survey and the extended focused assessment with sonography in trauma (eFAST). This underlines again that it complements and does not replace other course formats. We can conclude that the presentations and the tabletop simulation game were well suited to the target group and that the participants were able to increase their knowledge of this complex subject.

Terror and disaster surgical care: training experienced trauma surgeons in decision making for a MASCAL situation with a tabletop simulation game.

BACKGROUND: Mass-casualty incidents, especially in connection with a terrorist attack, can quickly overwhelm the capacities of receiving hospitals. After a mass-casualty terrorist incident, patients often arrive at hospitals in an uncoordinated manner on account of the chaotic situation. Many patients leave the incident site and refer themselves to hospitals independently. Hospital decision makers must, therefore, be able to make quick decisions on diagnostic procedures and treatment for every individual patient and, at the same time, take into consideration available resources. They require decision criteria and aids to properly manage such scenarios. MATERIALS AND METHODS: As part of the preparation of the Terror and Disaster Surgical Care (TDSC®) course, we developed a tabletop simulation game based on a comprehensive and structured review of the literature, the opinions of renowned experts, and the results of specialised conferences. This tabletop simulation game is played four times during each TDSC® course. RESULTS: Our analysis involved 264 of 465 course-participants from 2017 to 2019 and showed that the overall evaluation was very good and that participants grew more positive about the tabletop simulation game during the course. The tabletop simulation game received an average rating of 1.53 (1 = very good, 6 = insufficient). This rating remained consistently high over 19 courses. DISCUSSION: Hospital decision makers must respond to mass-casualty terrorist situations in a defined tactical and strategic approach. Rapid decisions must be made that take into account the special situation and available capacities and resources to maximise the number of survivors even though individual patients may have a poorer functional outcome. As part of the TDSC® course, the tabletop simulation game teaches high-level decision-making algorithms and prepares key hospital personnel for such situations.

Analysis of Digital Documentation Speed and Sequence Using Digital Paper and Pen Technology During the Refugee Crisis in Europe: Content Analysis.

BACKGROUND: The Syria crisis has forced more than 4 million people to leave their homeland. As a result, in 2016, an overwhelming number of refugees reached Germany. In response to this, it was of utmost importance to set up refugee camps and to provide humanitarian aid, but a health surveillance system was also implemented in order to obtain rapid information about emerging diseases. OBJECTIVE: The present study describes the effects of using digital paper and pen (DPP) technology on the speed, sequence, and behavior of epidemiological documentation in a refugee camp. METHODS: DPP technology was used to examine documentation speed, sequence, and behavior. The data log of the digital pens used to fill in the documentation was analyzed, and each pen stroke in a field was recorded using a timestamp. Documentation time was the difference between first and last stroke on the paper, which includes clinical examination and translation. RESULTS: For three months, 495 data sets were recorded. After corrections had been made, 421 data sets were considered valid and subjected to further analysis. The median documentation time was 41:41 min (interquartile range 29:54 min; mean 45:02 min; SD 22:28 min). The documentation of vital signs ended up having the strongest effect on the overall time of documentation. Furthermore, filling in the free-text field clinical findings or therapy or measures required the most time (mean 16:49 min; SD 20:32 min). Analysis of the documentation sequence revealed that the final step of coding the diagnosis was a time-consuming step that took place once the form had been completed. CONCLUSIONS: We concluded that medical documentation using DPP technology leads to both an increase in documentation speed and data quality through the compliance of the data recorders who regard the tool to be convenient in everyday routine. Further analysis of more data sets will allow optimization of the documentation form used. Thus, DPP technology is an effective tool for the medical documentation process in refugee camps.

Advancing Towards a CDA-Based Trauma Registry Data Submission.

This poster presents an assessment to which extent the data submission to one of the largest trauma registries worldwide can be structured compliant to the clincial document architecture (CDA) and semantically annotated. Overall, complete annotation was achieved for 75% of the items, for the remaining ones annotation failed due to missing codes or concepts for individual items or values of value sets.