Disaster day: a simulation-based competition for educating emergency medicine residents and medical students on disaster medicine.

BACKGROUND: Disaster medicine is a growing field within the specialty of emergency medicine, but educational training typically focuses on hospital drills or other educational strategies, such as didactics, simulation, or tabletop exercises. With the success of gamification in other medical education applications, we sought to investigate if a novel gamified curricular innovation would lead to improved test performance and confidence in the ability to manage a real mass casualty incident (MCI). METHODS: This was a prospective observational study of medical students and emergency medicine residents who participated in a 4-h simulation-based competition consisting of 4 unique stations. Each station had learning objectives associated with the content taught. Learners completed a pre-event survey, followed by participation in the competitive gamification event, and subsequently completed a post-event survey. Differences between pre- and post-event responses were matched and analyzed using paired and unpaired t tests for medical knowledge assessments, the Mann-Whitney U test for perceptions of confidence in the ability to manage an MCI event, and descriptive statistics provided on perceptions of the effectiveness of this educational strategy. RESULTS: We analyzed data from 49 learners with matched (and unmatched) pre- and post-event survey responses. There was a statistically significant increase in medical knowledge assessment scores in both unmatched group means and available matched data (47 to 69%, p < 0.01, and 50 to 69%, p < 0.05). Self-reported confidence in the ability to handle an MCI scenario also significantly increased (p < 0.01). Finally, 100% of respondents indicated they "agreed" or "strongly agreed" that the event was an effective education tool for disaster preparedness and training. CONCLUSIONS: In this study, we found that learners perceived a novel gamification event as an effective educational tool, which led to improved learner knowledge and self-reported confidence in the ability to manage a real MCI.

Identification of depression in an inner-city population using a simple screen.

OBJECTIVES: The purpose of this study was to compare a brief screening tool with physicians' usual practice in detecting depressive symptoms in patients presenting with somatic complaints to an inner-city emergency department. Depression is a major cause of morbidity and mortality in the United States. Underprivileged patients who rely on emergency departments for primary care remain at risk for undetected depression. METHODS: This prospective observational study included all patients older than 18 years presenting to an urgent care clinic staffed by emergency physicians in an urban public hospital during an eight-week period. Clinically unstable patients and those with a chief complaint of depression were excluded. After consenting, patients completed a previously validated two-question screening tool for depression. Patients identified as having depressive symptoms were referred to social workers for evaluation for possible psychiatric intervention. RESULTS: Of the 226 patients enrolled, 55% (124/226; 95% confidence interval [CI] = 48% to 61%) screened positive for depressive symptoms. Physicians identified 14% (31/226; 95% CI = 10% to 19%) as having depressive symptoms. The kappa value was 0.22 (95% CI = 0.14 to 0.29). All patients but one identified as positive by the physicians screened positive on the screening tool. Patients who screened positive were referred to social workers. The physicians failed to identify 19 of the patients who needed further psychiatric care. CONCLUSIONS: Depressive symptoms are common among patients in urgent care settings with somatic complaints. A simple screening tool identified more patients for further evaluation than does physicians' usual practice.

Increased blood lead levels in severe smoke inhalation.

Lead-containing paint is common in structures built before 1977. Heated lead in burning paint can be aerosolized and absorbed directly into the bloodstream through the lungs. Acute lead intoxication has been reported in this setting. The objective of this study was to determine if victims of severe smoke inhalation secondary to closed-space fires have clinically important elevated blood lead levels. A case-control study, with a 2:1 ratio of cases to controls, was matched for age and sex. Cases were drawn from a prospective convenience sample of intubated victims of closed-space fires presenting to the ED of an urban tertiary burn center. Cases had blood lead levels obtained 24 hours postexposure. Matched control subjects had blood lead levels obtained during ED evaluation for a complaint unrelated to smoke inhalation. The difference between mean lead levels for cases and control subjects was expressed with a 95% confidence interval (CI). Among 22 cases, the mean lead level was 6.64 mug/dL (standard deviation [SD], 4.14 mug/dL). Among the 44 matched control subjects, mean lead level was 2.89 mug/dL (SD, 1.65 mug/dL). The mean difference between cases and control subjects was 3.75 mug/dL (95% confidence interval, 1.86-5.64). Although severe smoke inhalation is associated with a more than 2-fold statistically significant increase in blood lead levels, there is no evidence to suggest that these elevations are clinically important.