Training Effectiveness and Impact on Safety, Treatment Quality, and Communication in Prehospital Emergency Care: The Prospective Longitudinal Mixed-Methods EPPTC Trial.

BACKGROUND: Emergency training is designed to improve medical care teams' knowledge, practical skills, and treatment procedures in patient care to increase patient safety. This requires effective training, but the multifactorial effects of training are difficult to measure. METHODS: We assessed the impact of emergency team training on treatment procedures and quality, processes, technical skills, and nontechnical skills in simulated trauma emergencies in a longitudinal analysis, using videos that were recorded before (t0), immediately after (t1), and 1 year after the training (t2). The training was evaluated with the validated PERFECT checklist, which includes 7 scales: primary assessment, secondary assessment, procedures, technical skills, trauma communication, nontechnical skills, and a global performance scale.The primary end point was the change from before a training intervention (t0) to 1 year after training (t2), measured by a metric point score. The second end point was the impact of the intervention from before training to after and from immediately after training to 1 year later. RESULTS: A total of 146 trainings were evaluated. In simulated traumatological emergencies, training participants showed significantly better treatment capacity after 1 year (t0: 28.8 ± 5.6 points versus t2: 59.6 ± 6.6 points, P < 0.001), with greater improvement from t0 to t1 (28.8 ± 5.6 points versus 65.1 ± 7.9 points, P < 0.001). The most significant change from t0 to t2 was seen in the primary assessment, with a mean change of 11.1 ± 5.1, followed by the scale of the procedure (6.1 ± 3.0) and nontechnical skills (6.0 ± 3.0). CONCLUSIONS: Team trainings with intensive scenario training and short theoretical inputs lead to a significant improvement in simulated care of severely injured patients, especially in identifying and intervening in life-threatening symptoms, processes, and nontechnical skills, even 1 year after the course. Positive, longitudinally positive effects were also in communication and subjective safety of prehospital health care personnel.

Quality of Documentation as a Surrogate Marker for Awareness and Training Effectiveness of PHTLS-Courses. Part of the Prospective Longitudinal Mixed-Methods EPPTC-Trial.

OBJECTIVE: Care for severely injured patients requires multidisciplinary teamwork. A decrease in the number of accident victims ultimately affects the routine and skills. PHTLS ("Pre-Hospital Trauma Life Support") courses are established two-day courses for medical and non-medical rescue service personnel, aimed at improving the pre-hospital care of trauma patients worldwide. The study aims the examination of the quality of documentation before and after PHTLS courses as a surrogate endpoint of training effectiveness and awareness. METHODS: This was a prospective pre-post intervention trial and was part of the mixed-method longitudinal EPPTC (Effect of Paramedic Training on Pre-Hospital Trauma Care) study, evaluating subjective and objective changes among participants and real patient care, as a result of PHTLS courses. The courses provide an overview of the SAMPLE approach for interrogation of anamnestic information, which is believed to be responsible for patient safety as relevant, among others, "Allergies," "Medication," and "Patient History" (AMP). The focus of the course is not the documentation. RESULTS: In total, 320 protocols were analyzed before and after the training. The PHTLS course led to a significant increase (p < 0.001) in the "AMP" information in the documentation. The subgroups analysis of "allergies" (+47.2%), "drugs" (+38.1%), and "medical history" (+27.8%) before and after the PHTLS course showed a significant increase in the information content. CONCLUSION: In summary, we showed that PHTLS training improves documentation quality, which we used as a surrogate endpoint for learning effectiveness and awareness. In this regard, we demonstrated that participants use certain parts of training in real life, thereby suggesting that the learning methods of PHTLS training are effective. These results, however, do not indicate whether patient care has changed.

Acute gastrointestinal bleeding - a new approach to clinical and endoscopic management.

Overt or occult gastrointestinal bleeding is a frequently observed condition in routine gastroenterological practice. Occult gastrointestinal bleeding is usually a purely incidental finding, based on the discovery of iron deficiency anemia in the laboratory or blood in stool (a positive Hemoccult test). However, overt bleeding accompanied by the clinical features of tarry stool, hematemesis, or hematochezia may be a life-threatening condition, calling for immediate emergency management. In contrast to traumatology, algorithms of emergency and intensive medicine are not sufficiently validated yet for acute life-threatening bleeding. The purpose of this review was to present all established and new endoscopic hemostasis techniques and to evaluate their efficacy, as well as to provide the treating endoscopist with practical advice on how he/she could incorporate these procedures into acute medical management. The recommendations are based on inspection of the study results in the recent published literature, as well as emergency medicine algorithms in traumatology.