Hyperbaric medicine simulation education curriculum: CNS toxicity during Treatment Table 6 and intubated ICU patient with mucous plugging.

INTRODUCTION/BACKGROUND: The incidence of complications and number of critically ill patients in hyperbaric medicine is relatively low [1]. This poses a challenge to those tasked with educating trainees as well as maintaining the skills of staff. Hyperbaric medicine fellows may not be exposed to critical patient scenarios or complications of hyperbaric medicine during a one-year fellowship. Additional staff may be unfamiliar with these situations as well. The purpose of hyperbaric simulation curriculum is to train health care providers for rare situations. To our knowledge, this hyperbaric simulation curriculum is the first published use of simulation education in the specialty of undersea and hyperbaric medicine. MATERIALS AND METHODS: Two simulation cases have been developed that involve a patient with oxygen toxicity during hyperbaric treatment as well as an ICU patient with mucous plugging. RESULTS: Medical training simulations are an effective method of teaching content and training multiple roles in Undersea and Hyperbaric Medicine. SUMMARY/CONCLUSIONS: A hyperbaric simulation curriculum is an achievable educational initiative that is able to train multiple team members simultaneously in situations that they may not encounter on a regular basis. We believe that this could be easily exported to otherinstitutions for further education.

Non-fatal construction industry fall-related injuries treated in US emergency departments, 1998-2005.

BACKGROUND: There is a growing recognition that common occupational injury surveillance systems in the US fail to reflect true injury risk; this failure limits efforts to accurately monitor efforts to prevent work-related injuries on a national level. METHODS: Data from the National Electronic Injury Surveillance System occupational supplement (NEISS-Work) were used to describe fall-related injuries treated in US emergency departments among workers in the construction industry (1998-2005). These data do not require workers' compensation as the payer in order to be classified as work-related. RESULTS: Based on NEISS-Work estimates, a total of 555,700 (95% confidence interval (CI): 390,700-720,800) non-fatal work-related injuries among workers in the construction industry were the result of a fall, resulting in an annual rate of 70 (95% CI: 49-91) per 10,000 full-time equivalents. Younger workers had higher rates of falls, whereas older workers were more likely to suffer serious injuries. The majority of the injuries (70%) were precipitated by falls to a lower level from roofs, ladders, and scaffolding. CONCLUSIONS: The patterns of fall-related injuries identified in these data are consistent with other reports. In contrast to the declining rates of falls requiring days away from work reported through the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses, construction industry fall-related injury rates estimated through NEISS-Work remained unchanged from 1998 to 2005 providing another perspective on this serious cause of morbidity in the construction industry.

COVID-19 educational innovation: Hybrid in-person and virtual simulation for emergency medicine trainees.

The COVID-19 pandemic has dramatically affected medical education. Emergency medicine (EM) requires excellence in multiple core competencies, including leadership, teamwork, and communication skills as well as procedural experience. To meet these objectives, we developed a hybrid simulation model that accommodated a reduced number of learners in our simulation center to allow for physical distancing, seamlessly integrated with an online integrated experience for remote learners. All learners participated or watched one adult and one pediatric simulation case. Fourteen residents participated in live simulation, while six residents and six medical students comprised the remote group. At the end of each case, the live feed was ended, and separate debriefings were conducted by different EM faculty, in person and online (via Zoom). An electronic survey was then sent to participants to rate the effectiveness of the intervention; 23 survey responses were collected: 52.2% (12) from the live session and 47.2% (11) from the virtual session. Survey results demonstrated that the online simulation observation and debriefing had the same, if not better, satisfaction than in-person simulation sessions and debriefings. Due to its success, this new method of hybrid simulation will be our plan for the foreseeable future, at least until COVID-19 abates.

Nonfatal construction industry-related injuries treated in hospital emergency departments in the United States, 1998-2005.

BACKGROUND: This study documented the burden of nonfatal construction industry work-related injuries treated in hospital emergency departments in the United States (US) from 1998 through 2005 and described injured worker demographics and injury characteristics. METHODS: Data from the National Electronic Injury Surveillance System work-related injury supplement (NEISS-Work) were used to identify and describe construction industry-related injuries. Rates were estimated using data from the Current Population Survey. RESULTS: An estimated 3,216,800 (95% CI 2,241,400-4,192,200) construction industry-related injuries were seen in US emergency departments during the 8-year period; this represented an injury rate of 410/10,000 full-time equivalents and suggests that there are a greater number of construction injuries than reported through the Bureau of Labor Statistics' Survey of Occupational Injuries and Illnesses (BLS SOII). Common characteristics included diagnoses of laceration, sprain/strain, and contusion/abrasion; events of contact with an object/equipment, bodily reaction/exertion, and falls; and sources of injury of parts/materials; structures/surfaces; and tools/instruments/equipment. The upper extremities were most often affected. CONCLUSIONS: These data highlight the high burden of nonfatal construction industry-related injuries. The limitations of national occupational injury data sources inherent in relying on OSHA logs highlight the utility of NEISS-Work data in occupational injury research. While data captured from emergency departments are not immune to factors that influence whether a worker or an employer reports an injury as work-related or files a workers' compensation claim, emergency department data as collected through NEISS-Work do not rely on employer involvement in order to be classified as work-related.

Nonfatal tool- or equipment-related injuries treated in US emergency departments among workers in the construction industry, 1998-2005.

BACKGROUND: Individuals in the construction industry are exposed to a variety of tools and pieces of equipment as they work. METHODS: Data from the National Institute for Occupational Safety and Health (NIOSH) occupational supplement to the National Electronic Injury Surveillance System (NEISS-Work) were used to characterize tool- and equipment-related injuries among workers in the construction industry that were treated in US emergency departments between 1998 and 2005. Based on a national stratified probability sample of US hospitals with 24 hr emergency services, NEISS-Work allows calculation of national injury estimates. RESULTS: Over the 8-year period between 1998 and 2005, we estimated 786,900 (95% CI 546,600-1,027,200) ED-treated tool- or equipment-related injuries identified by the primary or secondary source of injury code. These injuries accounted for a quarter of all ED-treated construction industry injuries. Although over 100 different tools or pieces of equipment were responsible for these injuries, seven were responsible for over 65% of the injury burden: ladders, nail guns, power saws, hammers, knives, power drills, and welding tools in decreasing order. CONCLUSIONS: Current injury estimates and their severity, marked by the proportion of cases that were not released after ED treatment, indicate interventions are particularly needed to prevent injuries associated with use of ladders as well as nail guns and power saws. Attention should focus on design and guarding to more efficiently prevent these injuries rather than simply calling for the training of workers in how to safely use a dangerous tool or piece of equipment.

Non-fatal contact injuries among workers in the construction industry treated in U.S. emergency departments, 1998-2005.

PROBLEM: The National Occupational Research Agenda (NORA) for the construction industry calls for efforts to identify areas where guidance and regulation are needed to adequately prevent traumatic injuries resulting from a worker coming into contact with objects or equipment. METHOD: This descriptive study of work-related contact injuries in the construction industry that were treated in emergency departments (EDs) between 1998 and 2005 utilized records of work injuries captured through a national probability-based sample of U.S. hospitals with 24-hour ED services. RESULTS: Contact injuries accounted for 54% of all construction ED-treated injuries. Hospitalizations were most common for injuries from contact with discharged nails from pneumatic nail guns, with hand held power saws, and fixed saws. Some injuries were proportionally more serious and sometimes involved multiple workers including trenching injuries and those resulting from collapse of buildings under construction, walls, roofs, and scaffolding. DISCUSSION AND IMPACT: Given that nail gun use is limited primarily to wood frame construction, efforts are needed to control frequent serious injuries associated with these tools. Enforcement of existing trenching regulations is also needed.