Evaluation of stress induced by high-fidelity simulation among anesthesiology and emergency residents: impact of oral debriefing versus video assisted.

AIM: To describe the level of stress in emergency medicine and anesthesia residents during high fidelity simulation sessions and to evaluate the effect of video-assisted debriefing versus no-video assisted debriefing on stress level. METHODS: Prospective randomized study. INCLUSION: emergency medicine and anesthesia residents consenting. Stress was assessed, before and after the training session, by: Blood Pressure (BP), Heart Rate (HR), Simple Numerical Scale (SNS), Scale trait anxiety inventory-YA (STAI-YA). Heart Rate and SNS were measured after debriefing. Residents were randomized into two groups according to the debriefing modality. The design of the simulation session was evaluated by the Simulation design scale (SDS). RESULTS: Thirty-six residents were included. We observed significant increase in the mean HR and mean Systolic BP before briefing and after the scenario respectively from 83.8±9.97 cpm to 101.3±17.84 cpm (p <0.001) and from 112.2±8.3 mmHg to 149.6±16.8 (p <0.001). Mean SNS and mean STAY-YA increased before the briefing and after the scenario respectively from 5±2.11 to 6±1.52 (p=0.004) and from 40±6.6 to 57.8±12.3 (p=0.01). HR and SNS decreased significantly after debriefing regardless of modality. The mean SDS was 84.53±5.8. After scenario, we found significant negative correlation between HR and time needed to initiate symptomatic treatment (r = - 0.449, p = 0.019). CONCLUSION: Learning by simulation of critical situations is associated with significant stress which decreased after debriefing.

Observatory of elderly people cared in pre-hospital.

INTRODUCTION: Emergency medical services (EMS) supports an increasing number of elderly patients. AIM: To evaluate outcome and autonomy of patients aged 65 and older who  managed in the prehospital theater. METHODS: We conducted a prospective observational multicenter study over one year (October 2015 -September 2016). We included patients aged 65 or older managed in the pre hospital setting. We studied: demographic criteria, pre-hospital care, severity (IGSA score and GCS), baseline and 3-month autonomy was assessed using the Katz score. Multivariate analysis was performed to identify predictive factors of mortality at 24 hours. RESULTS: we included 385 patients. Average age was 81 ± 8 years and sex ratio was equal to 1.08. Thirty eight (10%) patients were in cardiac arrest at the arrival of EMS team and 50% of them were resuscitated without recuperation. The IGSA score was 7 [5-10] on the initial examination versus 6  [4-7] on the arrival at the hospital (p<0.01). Baseline autonomy was 2 [0-6] versus 3 [0-6] at 3 months with p = 0.02. Ninety four patients (33%) regained their  baseline autonomy after the acute episode. At 24 hours the mortality rate was 9% (n=32). In multivariate analysis, the independent predictor factor of  mortality was GCS <8 with an adjusted OR=9,22 ;95%CI[3,44-24,70] ; p<0.001. CONCLUSION: Except out of hospital cardiac arrest, the survival of elderly subjects managed by EMS teams was encouraging. In the medium term, one-third of them regained their autonomy after the acute episode. These elements suggest successful integration into the emergency system.