FAMILY Medicine.

This is a reflective piece about a family who I cared for during my first year of residency.

Emergency physician risk of occupational mortality: A scoping review.

BACKGROUND: Occupational hazards for emergency physicians are widely known, but the risk of work-related mortality is not clear. The COVID-19 pandemic generated new concerns about the risk of occupational mortality, particularly in the setting of inadequate personal protective equipment. The perception of increased risk generated ethical concerns regarding emergency physicians' duty to treat and employers' duty to protect their employees. We performed this scoping review to define prepandemic emergency physician occupational mortality. METHODS: We performed a scoping review of peer-reviewed publications from PubMed, EMBASE, and Cochrane databases in September 2020. RESULTS: Of the 747 unique articles identified in the 3 databases, 1 article met inclusion criteria and was included in the final analysis. CONCLUSION: The baseline risk of occupational mortality for emergency physicians is not established in the scientific literature. Further study is needed to quantify risk, as this information would be useful to shape policy and ethical considerations.

The FAST VIP (First Aid for Severe Trauma "Virtual" in-Person) Educational Study.

INTRODUCTION: Trauma is the leading cause of death for young Americans. Increased school violence, combined with an emphasis on early hemorrhage control, has boosted demand to treat injuries in schools. Meanwhile, coronavirus disease 2019 (COVID-19) has made educating the public about trauma more difficult. A federally funded high school education program in development, called First Aid for Severe Trauma™ (FAST™), will teach students to aid the severely injured. The program will be offered in instructor-led, web-based, and blended formats. We created a program to prepare high school teachers to become FAST instructors via "virtual" in-person (VIP) instruction. We used a webinar followed by VIP skills practice, using supplies shipped to participants' homes. To our knowledge, no prior studies have evaluated this type of mass, widely distributed, VIP education. METHODS: This study is a prospective, single-arm, educational cohort study. We enrolled a convenience sample of all high school teachers attending FAST sessions at the Health Occupations Students of America-Future Health Professionals International Leadership Conference. Half of the participants were randomized to complete the Stop the Bleed Education Assessment Tool (SBEAT) prior to the webinar, and the other completed it afterward; SBEAT is a validated tool to measure learning of bleeding competencies. We then performed 76 VIP video-training sessions from June-August 2020. The FAST instructors assessed each participant's ability to apply a tourniquet and direct pressure individually, then provided interactive group skills training, and finally re-evaluated each participant's performance post-training. RESULTS: A total of 190 (96%) participants successfully applied a tourniquet after VIP training, compared to 136 (68%) prior to training (P < 0.001). Participants significantly improved their ability to apply direct pressure: 116 (56%) pre-assessment vs 204 (100%) post-assessment (P < 0.001). The mean score for the SBEAT increased significantly from pre-training to post-training: 2.09 with a standard deviation (SD) of 0.97 to 2.55 post-training with a SD of 0.72 (P < 0.001). CONCLUSION: This study suggests that a webinar combined with VIP training is effective for teaching tourniquet and direct-pressure application skills, as well as life-threatening bleeding knowledge. VIP education may be useful for creating resuscitative medicine instructors from distributed locations, and to reach learners who cannot attend classroom-based instruction.