'How to stop a nosebleed': a combined objective and subjective assessment of YouTube videos on first-aid management of epistaxis.

OBJECTIVE: A previous study in 2016 found that the quality of YouTube videos on epistaxis first-aid management was highly variable. This study aimed to reassess the accuracy and patient understandability of such YouTube videos. METHOD: YouTube was searched using the phrase 'How to stop a nosebleed'. The highest 50 ranking videos, based on relevance, were screened. Each video was assessed objectively using a standardised 'advice score', and subjectively using a video understandability and actionability checklist, the Patient Education Materials Assessment Tool for Audiovisual Materials ('PEMAT-A/V'). RESULTS: The mean advice score was 4.1 out of 8. The mean (standard deviation) understandability and actionability scores were 76 per cent (17 per cent) and 89 per cent (18 per cent), respectively. There was a strong positive correlation between the actionability scores and the advice scores (ρ = 0.634; p < 0.001), and between the actionability scores and the understandability scores (ρ = 0.519; p = 0.002). CONCLUSION: YouTube videos are providing increasingly relevant advice for patients seeking healthcare information. YouTube is proposed as a useful medium for teaching epistaxis management to patients and community practitioners.

[Trauma assessment and first aid in the confined spaces after major natural disasters].

Major natural disasters seriously threaten human life and health. After earthquakes and other catastrophes, survivors are often trapped in the confined spaces caused by the collapse of ground and buildings, with relative separation from the outside world, restricted access, complex environment, and oncoming or ongoing unsafety, leading to the rescue extremely difficult. In order to save lives and improve the outcome more efficiently in the confined spaces after natural disasters, it is very important to standardize and reasonably apply the trauma assessment and first aid workflow. This study focuses on trauma assessment and first aid. From the aspects of trauma assessment, vital signs stabilization, hemostasis and bandaging, post-trauma anti-infection, and the transportation of patients, a trauma first aid work process suitable for a small space of a major natural disaster is formed, It is helpful to realize the immediate and efficient treatment of trauma in the confined spaces after natural catastrophes, to reduce the rate of death and disability and improve the outcome of patients.

Assessing bystander first aid: development and validation of a First Aid Quality Assessment (FAQA) tool.

BACKGROUND: Injuries are one of the leading causes of death worldwide. Bystanders at the scene can perform first aid measures before the arrival of health services. The quality of first aid measures likely affects patient outcome. However, scientific evidence on its effect on patient outcome is limited. To properly assess bystander first aid quality, measure effect, and facilitate improvement, validated assessment tools are needed. The purpose of this study was to develop and validate a First Aid Quality Assessment (FAQA) tool. The FAQA tool focuses on first aid measures for injured patients based on the ABC-principle, as assessed by ambulance personnel arriving on scene. METHODS: In phase 1, we drafted an initial version of the FAQA tool for assessment of airway management, control of external bleeding, recovery position and hypothermia prevention. A group of ambulance personnel aided presentation and wording of the tool. In phase 2 we made eight virtual reality (VR) films, each presenting an injury scenario where bystander performed first aid. In phase 3, an expert group discussed until consensus on how the FAQA tool should rate each scenario. Followingly, 19 respondents, all ambulance personnel, rated the eight films with the FAQA tool. We assessed concurrent validity and inter-rater agreement by visual inspection and Kendall's coefficient of concordance. RESULTS: FAQA-scores by the expert group concurred with ± 1 of the median of the respondents on all first aid measures for all eight films except one case, where a deviation of 2 was seen. The inter-rater agreement was "very good" for three first aid measures, "good" for one, and "moderate" for the scoring of overall quality on first aid measures. CONCLUSION: Our findings show that it is feasible and acceptable for ambulance personnel to collect information on bystander first aid with the FAQA tool and will be of importance for future research on bystander first aid for injured patients.

Observed behaviours and suicide assessment language post-Mental Health First Aid training in Australia and the United States: a mixed methods study using discourse analysis.

BACKGROUND: Mental Health First Aid (MHFA) training teaches participants how to respond to mental health crises, including suicide. Little is known about the impact of training on participants' observed MHFA behaviours. This exploratory study aimed to compare MHFA-trained Australian and US student pharmacists' performance and suicide assessment language during simulated patient role-play (SPRP) assessments. METHODS: Student pharmacists (n = 265) completed MHFA training and participated (n = 81) in SPRPs with simulated patients (SP) who were people with lived experience of mental illness. Each SPRP was marked by three raters (student, tutor and SP). One-way ANOVA, chi-squared tests and independent samples t-tests were used to compare scores and pass/fail rates, where appropriate. Transcribed audio-recordings of suicide assessments underwent discourse analysis. A chi-squared test was conducted to investigate the differences in how suicide assessment language was coded across six discursive frames ('confident'/'timid', 'empathetic'/'apathetic', and 'direct'/'indirect'). RESULTS: Three raters assessed 81 SPRPs, resulting in quantitative analysis of 243 rubrics. There were no significant differences between student pharmacists' mean scores and pass/fail rates across countries. Overall, both cohorts across Australia and the US performed better during the mania scenario, with a low failure rate of 13.9 and 19.0%, respectively. Most students in both countries passed their SPRP assessment; however, 27.8% did not assess for suicide or used indirect language during suicide assessment, despite completing MHFA training. Australian student pharmacists demonstrated, more direct language (76.9% versus 67.9%) and empathy (42.3% versus 32.1%) but less confidence (57.7% versus 60.7%) compared to US student pharmacists, during their suicide assessment; however, these differences were not statistically significant. CONCLUSIONS: Findings indicate most MHFA-trained student pharmacists from Australia and the US can provide MHFA during SPRPs, as well as assess for suicide directly, empathetically and confidently. This exploratory study demonstrates the importance of practicing skills post-training and the need for further research exploring participants' hesitance to assess for suicide, despite training completion.

Assessment of the Knowledge Level of First Aid among Medical Students in Work Environment.

First aid is one of the most important life-saving skills a health provider specifically or anybody generally must have. It can be defined as the first treatment one provides at the site of the accident to the injured person until full medical treatment is available. In some emergency situations, simple first aid can make a life-or-death difference. Aim. This study is designed to evaluate the knowledge of first aid among medical students at KSAU-HS in Riyadh, Saudi Arabia. Methods. The cross-sectional study is conducted in KSAU-HS, Riyadh, about the knowledge of first aid among medical students. A self-administered structured questionnaire is used for the purpose of data collection. The main variables are as follows: to compare the knowledge of first aid between male and female medical students, among different years of study, and identify the percentage that have knowledge of first aid. Results. Out of 326 students, 10 students (3.1%) scored excellent, 99 (30.4%) good, 136 (41.7%) average, 75 (23%) poor, and 6 (1.8%) very poor. Conclusion. The level of knowledge improved with the advancement in years, but this was not sufficient, and more training should be given to all medical students on first aid.

Assessment of Knowledge, Emotion, and Attitude Levels of Kindergarten and Elementary School Teachers on the Disaster Management and Pediatric First Aid.

OBJECTIVES: This study's aim is to assess the disaster management and pediatric first aid-related knowledge, emotion, and attitude levels of of kindergarten and elementary school teachers, as the professionals that are first to provide interventions in the case of a disaster to children ages 0-8, who are considered to be among the vulnerable groups in the context of a disaster. METHODS: A total of 119 teachers working in the kindergarten and elementary schools located in the Gümüshane province of Turkey were included in the study and were asked to fill in a questionnaire that comprises 3 sections. Data collection tools included a sociodemographic questionnaire, teachers' disaster management knowledge levels, and teachers' pediatric first-aid knowledge, emotion, and attitude levels. RESULTS: Analysis of the scores obtained by the teachers from the questionnaire revealed that the teachers, who participated in the study, had a high level of disaster management knowledge and a moderate-to-high level of pediatric first aid knowledge. CONCLUSIONS: It is suggested as a result of this study that the disaster risks and injuries or losses of life associated with disasters that may occur at schools may be reduced with disaster management and first-aid interventions.

Mental Health First Aid training and assessment in Australian medical, nursing and pharmacy curricula: a national perspective using content analysis.

BACKGROUND: Suicide is among the leading causes of death among people aged 15 to 29 worldwide. Healthcare professionals interact with people at risk of suicide regularly, yet mental health and crisis first aid training is lacking in curricula. Mental Health First Aid (MHFA) training teaches crucial communication and crisis first aid skills and is increasingly recognised as integral to healthcare education. This study aimed to explore the extent of, as well as barriers and enablers to MHFA training delivery and assessment in Australian medical, nursing and pharmacy curricula. METHODS: All accredited Australian medical, nursing and pharmacy program providers were identified through Australian Health Practitioner Regulation Agency and National Boards websites and invited to participate in a semi-structured interview. A purpose-designed interview guide explored if and how MHFA training was delivered and assessed in curricula, as well as perceptions of and barriers and enablers to MHFA training. Interview recordings were transcribed verbatim, allowing for deductive content analysis to compare MHFA training provision across programs. RESULTS: Of 75 invited program providers, 36 (48%; 13 medical, 13 nursing and 10 pharmacy) participated, of which 15 representatives (42%; six medical, two nursing and six pharmacy) reported providing MHFA training to students. Differences in mandating training, year level of students completing training, type of training delivered and source of MHFA instructors were identified. Barriers to MHFA implementation included perceived adequacy of existing curricula, lack of funding and time, while facilitators included perceived benefit and availability of funding. CONCLUSION: MHFA training is provided to more than one third of medical, nursing and pharmacy students in Australia. Increased funding may facilitate the integration of MHFA as a minimum standard of mental health training for future healthcare professionals. Further research exploring the effectiveness of MHFA in improving behaviours and its impact on patient outcomes is warranted. TRIAL REGISTRATION: This study was approved by the University of Sydney Human Research Ethics Committee [Project number: 2020/087].

The needs and opportunities of older laypeople to acquire first aid skills.

We aimed to determine the needs and opportunities of older lay people to obtain first aid skills. We determined the level of theoretical knowledge of performing first aid with a structured questionnaire, performed on the sample of 842 adult inhabitants of Slovenia. The method of sampling was balanced by using a system of sampling weights in order to correct deviations in the structure of the sample to the level of the population structure. We also checked their attitude regarding the renewal of first aid knowledge. The level of self-assessment of first aid knowledge and actual theoretical knowledge of proper first aid measures typically decreased with age. The percentage of those who had attended first aid courses at any time was statistically significantly lower among respondents over the age of 60; 38% of elderly respondents thought they needed to renew their first aid knowledge, and 44% would attend a suitable first aid course. None of the 29 European Red Cross and Red Crescent Societies member states that responded have a developed a formally adopted first aid program to train the elderly. A tailored first aid training program for the elderly could be one of the many steps that should be taken to ensure adequate health care for the elderly population.

Non-resuscitative first aid training and assessment for junior secondary school students: A pre-post study.

ABSTRACT: School-based first aid interventions can contribute to the number of adults trained in first aid in the community over time but few studies have examined the effectiveness of teaching non-resuscitative first aid on knowledge, attitudes and skills. Currently, there is no consensus on the optimal content and duration of first aid training for junior secondary students. The aim of this study was to evaluated the effectiveness of a 2.5 hour introductory non-resuscitative first aid course for junior secondary students.This prospective, single-centre, pre-post study included 140 students (11-13 years old). Students completed a questionnaire on first aid knowledge, attitude towards first aid and self-confidence to perform first aid before and after a training session. Six emergency medicine physicians taught practical first aid skills training. A game-based formative assessment was undertaken where the instructors assessed small teams of students' role-playing injured classmates and first aid responders (and vice-versa) treating abrasions, ankle sprain, choking and a scald injury.Few students had prior first aid training (14%). After adjusting for student's age, sex, prior first aid training and format delivery, the course was associated with increased mean knowledge score (pre-training 53%, post-training 88%; mean difference [MD] 35%, 95% CI: 32% to 38%), positive attitudes and more confidence in performing first aid after training (all P < .001). All teams showed a good level of competency in treating simulated injuries with first aid kits.This brief non-resuscitative first aid course was associated with noticeable and valuable changes in knowledge score and self-confidence level in performing first aid. The game-based formative assessment facilitated a positive learning environment for skill competency evaluation.

Assessment of knowledge, attitude and practice on first aid management of choking and associated factors among kindergarten teachers in Addis Ababa governmental schools, Addis Ababa, Ethiopia. A cross-sectional institution-based study.

BACKGROUND: Choking refers to a blockage of upper airways by food or other objects resulting in interruption of breathing. It is a medical emergency that needs immediate action by anyone near by the victim to save life. Chocking is a major cause of illness and death in the pediatric population under the age of 5 years. Children at this age spent more time in their school and are at high risk during their feeding and playing. Immediate provision of first aid in response to choking by a preschool teacher will help to decrease the risk of developing life-threatening complications, length of hospital stays, the cost of treatment, and death. METHODS: Institutional-based cross-sectional study design was applied to the study area using pretested, structured, and self-administered questionnaires. The collected data were analyzed using SPSS version 25. Multiple logistic regression analysis was used to identify factors associated with Knowledge, attitude, and practice of kindergarten teachers towards first aid management of choking. RESULTS: A total of 224 Kindergarten teachers were involved in the study with a response rate of 95%. Only eighty-three (37%) of them were knowledgeable and 97 (43.3%) have faced a choked child in the school compound. Of these, only 42 (43.2%) had provided first aid to the victim. Most of the respondents 95.1% had a positive attitude towards choking first aid and 57.1% of them agreed that choking needs immediate management. Multiple logistic regression analysis showed that Kindergarten teachers with the previous first aid training were 2.9 times more knowledgeable than those kindergarten teachers without previous first aid training (AOR: 2.902, 95% CI: 1.612, 5.227). CONCLUSIONS: The level of knowledge and skills for providing first aid for choking children among kindergarten teachers is low. There is a need for urgent intervention to train teachers regarding the provision of first aid for choking children.

Epistaxis first-aid management: a needs assessment among healthcare providers.

PURPOSE: To perform a needs assessment of epistaxis first-aid measures practiced by family physicians and Emergency Department (ED) staff in London, Ontario, Canada. METHODS: Paper-based multiple-choice questionnaires were distributed to participants. Participant recruitment was conducted in two parts: 1) 28 Emergency Medicine (EM) attending physicians, 21 resident physicians training in the ED, and 26 ED nurses were surveyed while on duty in the ED; 2) 27 family physicians providing walk-in or urgent care and attending a continuing medical education (CME) event were also surveyed. Respondents were asked to identify where to apply compression to the nose and how patients should be positioned during acute epistaxis. RESULTS: Regarding where to apply compression, 19% of family physicians, 43% of EM physicians, 24% of residents, and 8% of ED nurses responded correctly. Regarding positioning, all groups responded similarly with 54-62% responding correctly. Twenty-one percent of emergency physicians, 19% of residents, 11% of family physicians, and 4% of nurses responded correctly to both questions. CONCLUSIONS: Most family physicians, EM attending physicians, ED nurses, and residents could not correctly identify basic first-aid measures for acute epistaxis. This study identifies an area where knowledge is lacking and the potential for improvement in patient management and education.

Evaluation of the Aboriginal and Torres Strait Islander Mental Health First Aid Program.

OBJECTIVE: This study reports findings from an uncontrolled evaluation of a course designed to educate participants in how to recognise and respond to mental health problems until professional help is received. METHODS: Utilising a mixed methods design, participants in 21 different courses, delivered across two Australian states, were invited to complete pre-, post-, and follow-up surveys and provide qualitative feedback on their training experiences. RESULTS: Participants reported feeling more confident in their capacity to respond appropriately to a person presenting with a mental health need and believed they would be more likely to provide assistance. Satisfaction was attributed to the skills and sensitivities of instructors who had lived experience of mental health concerns in Aboriginal and Torres Strait Islander communities. CONCLUSION: This course holds promise in improving mental health literacy in relation to Aboriginal and Torres Strait Islander mental health. Implications for public health: Few courses are available that address issues relating to the social and emotional wellbeing of Aboriginal and Torres Strait Islander People. This study illustrates how community engagement with primary health and specialist mental health services might be strengthened.

The Bolivian trauma patient's experience: A qualitative needs assessment.

BACKGROUND: Despite a significant burden of injury-related deaths, the Plurinational State of Bolivia (Bolivia), a lower- middle-income country in South America, lacks a formalized trauma system. This study sought to examine Bolivian trauma care from the patient perspective in order to determine barriers to care and targets for improvement. METHODS: Investigators conducted 15 semi-structured interviews with trauma patients admitted at four hospitals in Santa Cruz de la Sierra, Bolivia in June and July of 2016. Interviews were transcribed, translated, and analyzed through content and discourse analysis to identify key themes and perceptions of trauma care. RESULTS: Participants primarily presented with orthopedic injuries due to road traffic incidents and falls. Only one participant reported receiving first aid from a layperson at the scene of injury. Of the 15 participants, 12 did not know any number to contact emergency medical services (EMS). Participants expressed negative views of EMS as well as concerns for slow response times and inadequate personnel and training. Two thirds of participants were initially brought to a hospital without adequate resources to care for their injuries. Participants generally expressed positive views regarding healthcare workers involved in their hospital-based medical care. CONCLUSIONS: This region of Bolivia has a disorganized, underutilized, and distrusted trauma system. In order to increase survival, interventions should focus on improving prehospital trauma care. Potential interventions include the implementation of layperson trauma first responder courses, the establishment of a medical emergency hotline, the unification of EMS, the implementation of basic training requirements for EMS personnel, and public education campaigns to increase trust in EMS.

Venomous snakebites: Rapid action saves lives-A multifaceted community education programme increases awareness about snakes and snakebites among the rural population of Tamil Nadu, India.

The lack of public awareness surrounding the dangers of snakebite envenomation (SBE) is one of the most critical factors contributing to SBE-induced complications, and subsequently exacerbating the number of deaths and disabilities resulting from SBE. In this study, we deployed a multifaceted community education programme to educate students, healthcare professionals and members of the public in rural areas of Tamil Nadu, India about the dangers of SBE, appropriate first aid measures and the 'do's and don'ts' following a snakebite. An assessment of prior knowledge within these communities identified several misconceptions concerning snakes and SBE. Using a combination of direct engagement (estimated to reach over 200,000 people), information leaflets (200,000 distributed), posters, video documentaries, media and social media (>2.8 million engagements), over the course of one year (January to December 2019) we reached over 3 million people in rural Tamil Nadu (around 8% of population). Evaluation of community-based assemblies indicated that at least 90% of attendees were able to recall the key messages at the end of the events, and at least 85% were able to recall the key messages even after 12 months. Due to high demand, a one-day symposium was organised to provide clinical knowledge and training on SBE to 250 healthcare professionals in rural Tamil Nadu. Notably, an assessment of patient data (291 victims) collected from a snakebite referral hospital over the same 12-month period (2019) indicated that arrival time at hospital following a snakebite was significantly faster and the effective first aid measures were administered to patients who were aware of our activities compared to those that were not. Overall, our approach provides a framework on how to educate rural communities about the dangers of SBE and thereby, mitigate delayed SBE treatment leading to an overall reduction in SBE-induced mortality, morbidity, treatment costs and other socio-economic ramifications.

Risk Management in First Aid for Acute Drug Intoxication.

Drug abuse (cannabis, cocaine, opiates, and synthetic drugs) is an increasing phenomenon, especially in the younger population, thus leading to more cases of intoxication requiring evaluation in the emergency department and subsequent hospitalization. In 2017, 34.2% of students reported having used an illegal psychoactive substance in their lifetime, while 26% reported having done so over the past year. We made a review about the effectiveness of the role of the temporary observation unit in the emergency department to improve management of acute drugs intoxication. We checked medical literature from the last 10 years (2009-2019). The following electronic databases were systematically searched: MEDLINE-PubMed, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials. Then, a systematic review was carried out according to the Preferred Reporting Items for Systematic Review standards. Intoxicated patients usually display a favorable medical course, few diagnostic and therapeutic interventions, a short stay in the hospital, and, when hospitalization is needed, semi-intensive therapy is a feasible solution; therefore, intoxicated patients are ideal candidates for a temporary observation unit. The emergency department is very important to manage intoxicated patients; however, the hospitalization of these patients is often not necessary.

Evaluating the effectiveness of the PA Foundation's Mental Health Outreach fellowship.

OBJECTIVES: Mental Health First Aid (MHFA) is designed to help the general public acquire the knowledge and skills needed to respond to a person in a mental health emergency and offer support to someone in emotional distress. Through the PA Foundation's Mental Health Outreach Fellowship, 16 physician assistants (PAs) were selected to become MHFA instructors and teach the course to members of their local communities over 1 year. METHODS: MHFA course evaluations, completed by course participants, were reviewed to determine the effectiveness of the PA fellows as instructors. RESULTS: The fellows' mean evaluation instructor presentation score was 4.82 and the mean course content score was 4.75. The national mean for instructor presentation was 4.72 for presentation and 4.66 for course content. The maximum possible score in each category was a 5. CONCLUSIONS: The PAs selected for the Mental Health Outreach Fellowship were effective MHFA instructors. Benefits to having a PA serve as the instructor include positively affecting communities by increasing the public's mental health literacy, reducing the stigma associated with mental illness, increasing visibility and promotion of the PA profession, and enhancement of a PA's individual career through education and service.

Repeated and adaptive multidisciplinary assessment of a patient with acute pulmonary embolism and recurrent cardiac arrests.

High-risk pulmonary embolism (PE) is a life-threatening condition that must be recognised and treated rapidly. The importance of correct risk stratification to guide therapeutic decisions has prompted the introduction of multidisciplinary PE response teams (PERTs). The recommended first-line treatment for high-risk PE is intravenous thrombolysis. Alternatives to consider if thrombolysis has insufficient effect or may cause significant haemorrhagic complications include catheter-directed intervention (CDI) and surgical thrombectomy. For patients in deep shock or cardiac arrest, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can be instituted for cardiopulmonary rescue and support during CDI, thrombectomy or pharmacological treatment. We present a complex case of high-risk PE that illustrates the importance of an early PERT conference and repeated decision-making when the initial therapy fails. After a trial of thrombolysis with insufficient effect, VA-ECMO was used to reverse circulatory and respiratory collapse in a patient with PE and recurrent episodes of cardiac arrest.

Recent trends and variations in general practitioners' involvement in accident care in Switzerland: an analysis of claims data.

BACKGROUND: As in other countries, there is concern and some fragmentary evidence that GPs' central role in the Swiss healthcare system as the primary provider of care might be changing or even be in decline. Our study gives a systematic account of GPs' involvement in accident care from 2008 to 2016 and identifies changes in GPs' involvement in this typical field of primary care: how frequently GPs were involved along the care pathway, to what extent they figured as initial care provider, and what their role in the care pathway was. METHODS: Using a claims dataset from the largest Swiss accident insurer with two million accident cases, we constructed individual care pathways, i.e., when and from which providers patients received care. We calculated probabilities for the involvement of various care provider groups, for initial care provision, and for the role of GPs in patients' care pathways, adjusted for injury and patient characteristics using multinomial regression. RESULTS: In 2014, GPs were involved in 70% of all accident cases requiring outpatient care but no inpatient stay, and provided initial care in 56%. While involvement stayed at about the same level for accidents occurring from 2008 to 2014, the share of accidents where GPs provided initial care decreased by 4 percentage points. The share of cases where GPs acted as sole care provider decreased by 7 percentage points down to 44%. At the same time, accident cases involving care from an ED at any point in time increased from 38 to 46% and the share receiving initial care from an ED from 30 to 35 percentage points - apparently substituting for the declining involvement of GPs in initial care. GPs' involvement in accident care is higher in rural compared to urban regions, among elderly compared to younger patients, and among Swiss compared to non-Swiss citizens. CONCLUSIONS: GPs play a key role in accident care with considerable variation depending on region and patient profile. From 2008 to 2014, there is a remarkable decline in GPs' provision of initial care after an accident. This is a strong indication that the GPs' role in the Swiss healthcare system is changing.

An Assessment of the Utility of the Youth Mental Health First Aid Training: Effectiveness, Satisfaction, and Universality.

Youth Mental Health First Aid (YMHFA) is a training program developed to educate child-serving professionals on how to properly identify and respond to mental health needs among children and adolescents. The current study tested the utility of the training by examining the effectiveness, satisfaction, and universality across child-serving occupations. Data collected from 893 child-serving professionals was used to compare training effectiveness and training experiences across four different occupational settings (child welfare, education, support services, and the justice system). Using a pretest/posttest survey design, strong support for the effectiveness of YMHFA (i.e. knowledge, confidence, preparedness, and intentions to intervene), satisfaction with the training program, and universality of effectiveness and satisfaction across the occupational groups was found. Results highlight the utility of YMHFA across different sectors of child-serving agencies and support its sustainability.