Quality Training in Prehospital Trauma Care

This talk from the 2014 London Trauma Conference covered how the training of clinicians in prehospital & retrieval medicine needs to focus on performance rather than just knowledge. Simulation is the key, and to allow time for this traditional lectures can substituted by online learning material prior to attending induction training.

Simulation aims to train teams to achieve mission success. Team members need to be able to manage themselves, the environment, and other people. Various methods can be employed to train and test these areas.

Here are the references used to prepare the talk.

Flipped Classroom / Online learning

Prober CG, Heath C. Lecture halls without lectures–a proposal for medical education. N Engl J Med. 2012 May 3;366(18):1657–9.

Cognitive biases snd debiasing

Croskerry P. From mindless to mindful practice–cognitive bias and clinical decision making. N Engl J Med. 2013 Jun 27;368(26):2445–8

Croskerry P, Singhal G, Mamede S. Cognitive debiasing 1: origins of bias and theory of debiasing. BMJ Quality & Safety. 2013 Sep 18;22(Suppl 2):ii58–ii64.

Croskerry P, Singhal G, Mamede S. Cognitive debiasing 2: impediments to and strategies for change. BMJ Quality & Safety. 2013 Sep 18;22(Suppl 2):ii65–ii72. .

Imagery & Visualisation

Moppett I, Sevdalis N. II. From pilots to Olympians: enhancing performance in anaesthesia through mental practice. Br J Anaesth. 2013 Jan 14;110(2):169–72.

Sanders CW, Sadoski M, van Walsum K, Bramson R, Wiprud R, Fossum TW. Learning basic surgical skills with mental imagery: using the simulation centre in the mind. Medical Education. 2008 Apr 23;42(6):607–12.

Situation Awareness & Cognitive Stop Points

Norris EM, Lockey AS. Human factors in resuscitation teaching. Resuscitation 2012 Apr 1;83(4):423–7.

Controlling the Environment / Establishing Workspace

Campeau AG. The Space-Control Theory of Paramedic Scene-Management. Symbolic Interaction 2008 Jun 21;31(3):285–302

Leadership and Communication

Hunziker S, Tschan F, Semmer NK, Howell MD, Marsch S. Human factors in resuscitation: Lessons learned from simulator studies. J Emerg Trauma Shock. 2010;3(4):389 

Brindley PG, Reynolds SF. Improving verbal communication in critical care medicine. Journal of Critical Care. 2011 Apr;26(2):155–9

Training

Excellent review article covering many of the concepts discussed: Petrosoniak A, Hicks CM. Beyond crisis resource management. Current Opinion in Anaesthesiology. 2013 Dec;26(6):699–706

Distractors: Krage R, Tjon Soei Len L, Schober P, Kolenbrander M, van Groeningen D, Loer SA, et al. Does individual experience affect performance during cardiopulmonary resuscitation with additional external distractors? Anaesthesia. 2014 Jun 2;69(9):983–9

Fidelity: Hochmitz I, Yuviler-Gavish N. Physical Fidelity Versus Cognitive Fidelity Training in Procedural Skills Acquisition. Human Factors: The Journal of the Human Factors and Ergonomics Society. 2011 Sep 16;53(5):489–501

Salas E, Wilson KA, Burke CS, Bowers CA. Myths About Crew Resource Management Training. Ergonomics in Design: The Quarterly of Human Factors Applications. 2002 Oct 1;10(4):20–4

Team cognitive readiness: Fiore SM, Ross KG, Jentsch F. A Team Cognitive Readiness Framework for Small-Unit Training. Journal of Cognitive Engineering and Decision Making. 2012 Aug 9;6(3):325–49

Perturbation, cross training: Gorman JC, Cooke NJ, Amazeen PG. Training Adaptive Teams. Human Factors: The Journal of the Human Factors and Ergonomics Society. 2010 Sep 14;52(2):295–307

Guided error training: Marshall S, Flanagan B. Simulation-based education for building clinical teams. J Emerg Trauma Shock. 2010;3(4):360

Stress exposure training: Driskell JE, Johnston JH, Salas E. Does Stress Training Generalize to Novel Settings? Human Factors: The Journal of the Human Factors and Ergonomics Society. 2001 Jan 1;43(1):99–110

DeMaria S Jr, Bryson EO, Mooney TJ, Silverstein JH, Reich DL, Bodian C, et al. Adding emotional stressors to training in simulated cardiopulmonary arrest enhances participant performance. Medical Education. 2010 Sep 30;44(10):1006–15

Assessment

Von Wyl, Zuercher M, Amsler F, Walter B, Ummenhofer W. Technical and non-technical skills can be reliably assessed during paramedic simulation training. Acta Anaesthesiol Scand. 2009 Jan;53(1):121-7

Flowerdew L, Brown R, Vincent C, Woloshynowych M. Development and Validation of a Tool to Assess Emergency Physicians’ Nontechnical Skills. Ann Emerg Med. 2012 May;59(5):376–385

Sydney HEMS Prehospital & Retrieval Medicine Simulation Assessment Tool (PHARMSAT)