Accidental Hypothermia in a Swiss Alpine Trauma Centre-Not an Alpine Problem.

BACKGROUND Research in accidental hypothermia focuses on trauma patients, patients exposed to cold environments or patients after drowning but rarely on hypothermia in combination with intoxications or on medical or neurological issues. The aim of this retrospective single-centre cohort study was to define the aetiologies, severity and relative incidences of accidental hypothermia, methods of measuring temperature and in-hospital mortality. METHODS The study included patients ≥18 years with a documented body temperature ≤35 °C who were admitted to the emergency department (ED) of the University Hospital in Bern between 2000 and 2019. RESULTS 439 cases were included, corresponding to 0.32 per 1000 ED visits. Median age was 55 years (IQR 39-70). A total of 167 patients (38.0%) were female. Furthermore, 63.3% of the patients suffered from mild, 24.8% from moderate and 11.9% from severe hypothermia. Exposure as a single cause for accidental hypothermia accounted for 12 cases. The majority were combinations of hypothermia with trauma (32.6%), medical conditions (34.2%), neurological conditions (5.2%), intoxications (20.3%) or drowning (12.0%). Overall mortality was 22.3% and depended on the underlying causes, severity of hypothermia, age and sex

Data and methods to calculate cut-off values for serum potassium and core temperature at hospital admission for extracorporeal rewarming of avalanche victims in cardiac arrest.

The data and estimation methods presented in this article are associated with the research article, "Cut-off values of serum potassium and core temperature at hospital admission for extracorporeal rewarming of avalanche victims in cardiac arrest: a retrospective multi-centre study" [1]. In this article we estimate recommended cut-off values for in-hospital triage with respect to extracorporeal rewarming. With only 6 survivors of 103 patients collected over a period of 20 years the ability to estimate reliable threshold values is limited. In addition, because the number of avalanche victims is also limited, a significantly larger dataset is unlikely to be obtained. We have therefore adapted two non-parametric estimation methods (bootstrapping and exact binomial distribution) to our specific needs and performed a simulations to confirm validity and reliability

Interprofessional and interdisciplinary simulation-based training leads to safe sedation procedures in the emergency department

BACKGROUND Sedation is a procedure required for many interventions in the Emergency department (ED) such as reductions, surgical procedures or cardioversions. However, especially under emergency conditions with high risk patients and rapidly changing interdisciplinary and interprofessional teams, the procedure caries important risks. It is thus vital but difficult to implement a standard operating procedure for sedation procedures in any ED. Reports on both, implementation strategies as well as their success are currently lacking. This study describes the development, implementation and clinical evaluation of an interprofessional and interdisciplinary simulation-based sedation training concept. METHODS All physicians and nurses with specialised training in emergency medicine at the Berne University Department of Emergency Medicine participated in a mandatory interdisciplinary and interprofessional simulation-based sedation training. The curriculum consisted of an individual self-learning module, an airway skill training course, three simulation-based team training cases, and a final practical learning course in the operating theatre. Before and after each training session, self-efficacy, awareness of emergency procedures, knowledge of sedation medication and crisis resource management were assessed with a questionnaire. Changes in these measures were compared via paired tests, separately for groups formed based on experience and profession. To assess the clinical effect of training, we collected patient and team satisfaction as well as duration and complications for all sedations in the ED within the year after implementation. We further compared time to beginning of procedure, time for duration of procedure and time until discharge after implementation with the one year period before the implementation. Cohen's d was calculated as effect size for all statistically significant tests. RESULTS Fifty staff members (26 nurses and 24 physicians) participated in the training. In all subgroups, there is a significant increase in self-efficacy and knowledge with high effect size (d z  = 1.8). The learning is independent of profession and experience level. In the clinical evaluation after implementation, we found no major complications among the sedations performed. Time to procedure significantly improved after the introduction of the training (d = 0.88). DISCUSSION Learning is independent of previous working experience and equally effective in raising the self-efficacy and knowledge in all professional groups. Clinical outcome evaluation confirms the concepts safety and feasibility. CONCLUSION An interprofessional and interdisciplinary simulation-based sedation training is an efficient way to implement a conscious sedation concept in an ED

Kompetenzbasierte Lehre - die Reform der ärztlichen Weiterbildung in der Schweiz

Objective: Medical training in Switzerland is currently undergoing change. The postgraduate education curricula of all medical specialties are being converted to competency-based medical education (CBME). Entrustable Professional Activities (EPA) are used to assess competencies. EPAs describe specific professional tasks that are assigned to postgraduate trainees once they have achieved sufficient competencies.Methodology and results: The article describes how the didactic building blocks are joined to create competency-based teaching and how the implementation takes place.The project is described using the Kern cycle. The first two steps, problem identification and targeted needs assessment, are presented in the project description section, the other four steps in the results. Concrete details are given using examples from the cardiology curriculum.Conclusion: The conversion of medical training in Switzerland to competency-based teaching is an important step that is urgently needed but complex. The long-term plan of the Swiss Institute for Postgraduate and Continuing Medical Education (SIWF) consists not only of structural steps but also cultural change. The first two years of the conversion were successful. In collaboration with the specialist societies, postgraduate curricula are being converted to EPA-based learning objectives, the didactic training for postgraduate teaching staff adapted accordingly and feedback from learners is continuously gathered. The implementation process has begun. Additional data will be collected as the project proceeds. Using experience already gained internationally and by specialist societies which have already taken this step as benchmarks is critical for other specialties and training centres that are still to follow.Zielsetzung: Die ärztliche Weiterbildung der Schweiz ist derzeit im Wandel: Die Weiterbildungscurricula aller medizinischen Fachgebiete werden auf eine kompetenzbasierte Lehre (Competency-Based Medical Education, CBME) umgestellt. Zur Bewertung der Kompetenzen werden Entrustable Professional Activities (EPA) verwendet. EPAs beschreiben spezifische berufliche Aufgaben, die den Weiterzubildenden nach Erreichen ausreichender Kompetenzen übertragen werden.Methodik und Ergebnisse: Der Artikel stellt dar, wie die didaktischen Bausteine sich zu einer kompetenzbasierten Lehre zusammenfügen sollen und wie die Implementierung vonstattengeht.Das Projekt wird anhand des Kern-Zyklus beschrieben. Die ersten beiden Schritte "Problem Identification" und "Targeted needs Assessment" werden im Abschnitt der Projektbeschreibung vorgestellt, die weiteren vier Schritte in den Ergebnissen. Konkrete Details beschreiben wir anhand der Beispiele aus dem Curriculum der Kardiologie.Schlussfolgerung: Die Umstellung der ärztlichen Weiterbildung der Schweiz hin zu einer kompetenzbasierten Lehre ist ein wichtiger Schritt, der dringend notwendig aber komplex ist. Der langfristige Plan des Schweizerischen Instituts für ärztliche Weiter- und Fortbildung (SIWF) umfasst nicht nur strukturelle Schritte, sondern auch einen kulturellen Wandel. Die ersten zwei Jahre der Umstellung verliefen positiv: In Zusammenarbeit mit den Fachgesellschaften werden Weiterbildungscurricula auf EPA-basierte Lernziele umgestellt, die didaktische Schulung der Weiterbildenden entsprechend angepasst und kontinuierlich das Feedback der Lernenden eingeholt. Der Implementierungsprozess hat begonnen. Weitere Daten werden im Verlauf erhoben. Die Orientierung an internationalen Erfahrungen und an den Fachgesellschaften, die den Schritt bereits gewagt haben, bietet eine wichtige Hilfe für die Fachgesellschaften und Weiterbildungsstätten, die noch folgen werden

Medical aspects of the Gorkha earthquake 2015: disaster preparedness and response

This chapter includes exemplary accounts from two medical doctors pertaining to the situation in the capital and in remote valleys. Within both accounts, the authors describe their personal experience, beginning with the first few hours post the initial quake. These experiences are firsthand accounts, ranging from uncoordinated medical aid in a governmental hospital in Kathmandu and a mountain hospital in Lukla to the ad hoc rescue chain in the Khumbu valley for those victims coming predominantly from Everest Base Camp. Unfortunately, the threat of future earthquakes and other natural hazard events in Nepal cannot be diminished. Therefore, in order to better manage any future mass casualty event, it is clear that there is a pressing need for further development of medical and rescue training services for both existing practitioners in the capital and those individuals based in rural Nepal. Moreover, the development of an international, coordinative body with rapid response time and specialist skill base must be discussed and deployed effectively in the case of any future national emergency

Initiative zur Implementierung von Planetary Health in die ärztliche Fort- und Weiterbildung in der Schweiz

The Swiss Medical Association FMH drew up the strategy "Planetary health - Strategy on the courses of action on climate change for the medical profession in Switzerland" in collaboration with the Swiss Institute for Medical Education SIME, the umbrella organisations and students. On 7 October 2021, the strategy was approved by the Swiss Medical Chamber with a budget of over CHF 380,000 (approx Euro 365,000). The first step in implementation involved setting up an advisory group which will tackle the concrete implementation of the strategy. This article provides an insight into the current state of work on the project with a focus on the measures in the areas of postgraduate medical training and continuing medical education. It is a work in progress.Die Verbindung der Schweizer Ärztinnen und Ärzte FMH hat die Strategie "Planetary Health - Strategie zu den Handlungsmöglichkeiten der Ärzteschaft in der Schweiz zum Klimawandel" in Zusammenarbeit mit dem Schweizerischen Institut für ärztliche Weiter- und Fortbildung SIWF, den Dachverbänden und den Studierenden verfasst. Am 7. Oktober 2021 wurde die Strategie von der Ärztekammer der FMH mit einem Budget über ca. 380'000 CHF (ca. 365'000 Euro) verabschiedet. Als erster Schritt zur Umsetzung wurde eine Begleitgruppe ins Leben gerufen, die nun die konkrete Umsetzung der Strategie in Angriff nehmen wird. Der vorliegende Artikel gibt einen Einblick in den aktuellen Stand der Projektarbeit mit dem Fokus auf Maßnahmen im Bereich der ärztlichen Weiter- und Fortbildung. Er soll als "work in progress" verstanden werden

Konzeption, Entwicklung und Umsetzung eines nationalen Programms zur Förderung von CBME in der medizinischen Weiterbildung in der Schweiz

Background: Competency Based Medical Education (CBME) is a global movement in graduate medical training but implementation on a national scale is challenging. One crucial element of fostering CBME is to establish faculty development. We report the design of a national program, the process of implementation, and the results of the first two years.Methods: Following Kern's cycle of curriculum development, a group of medical education experts designed a training program covering the basic skills for teaching in clinical settings. In addition, we outlined a qualification pathway for future educators in the program.Results: The program was built upon 1-day-workshops with the topics: "clinical teaching", "feedback and assessment", "clinical leadership", "supporting trainees in difficulties". More than 30 workshops were delivered in two language regions to more than 500 clinical teachers. The median rating whether participants' expectations were met was 9 (of 10 points, IQR 8-9). The qualification pathway for future educators in the program included a nomination, a 2.5-day introductory workshop, shadowing of workshops, and stepwise acquisition of workshop parts as an educator candidate.Discussion: This faculty development program was well attended and well-received. Using Kern's established model for the design process including an extensive needs assessment helped to serve the goals of the program. Developing future educators for expanding this program proved resource intensive.Conclusion: Implementing a national faculty development program was successful based on a rigorous design process, a highly motivated expert team, and learning content tailored to the needs of the audience. Effects on the implementation of CBME still need to be evaluated.Hintergrund: Kompetenzbasierte medizinische Weiterbildung (Competency Based Medical Education, CBME) ist derzeit eine weltweite Entwicklung, wobei die Umsetzung auf nationaler Ebene herausfordernd ist. Entscheidende Bedeutung hat dabei die angemessene didaktische Qualifizierung von klinischen Supervisor*innen (Oberärztinnen und Oberärzten). In diesem Beitrag stellen wir ein entsprechendes nationales Programm vor ("Teach-the-teacher"-Training), hinsichtlich Konzeption, Umsetzung und Ergebnissen der ersten beiden Jahre.Methoden: Basierend auf dem Kern'schen Zyklus für Curriculumentwicklung entwicklte eine Expertengruppe ein Traingsprogramm für grundlegende didaktische Kompetenzen in der klinischen Weiterbildung. Ausserdem wurde ein Qualifizierungsprozess für zukünftige Instruktor*innen innerhalb dieses Programms definiert.Ergebnisse: Das Programm umfasste 1-Tages-Workshops mit den Themen: "Unterrichten im klinischen Alltag", "Feedback und Assessment", "Teamarbeit und Leadership", "Unterstützung von Assisstenzärzt*innen mit Schwierigkeiten". In zwei Sprachregionen wurden über 30 Workshops für mehr als 500 klinische Weiterbildende abgehalten. Die Teilnehmer*innen bewerteten, "ob ihre Erwartungen erfüllt wurden", mit im Median 9 Punkten (von maximal 10, IQR 8-9). Der Qualifizierungsprozess für künftige Instuktor*innen im Programm wurde festgelegt über die Stufen der Nominierung, eines 2,5-tägigen Einführungsworkshops, Hospitationen im Progamm und der schrittweisen Übernahme von Workshopteilen als Kandidat*in.Diskussion: Das "Teach-the-teacher"-Programm wurde gut angenommen. Das Kern'sche Modell erwies sich als geeignetes Verfahren für die Entwicklung. Die Qualifzierung künftiger Instrutor*innen für das Programm war hingegen ressourcenintensiv.Schlussfolgerung: Wir konnten ein nationales "Teach-the-teacher"-Programm für superviderende Oberärzte und Oberärztinnen erfolgreich etablieren. Erfolgsfaktoren waren ein stringenter Planungsprozesses, zielgruppengerechte Lerninhalte und -ziele, sowie ein hoch motiviertes Expertenteam bei der Entwicklung. Allerdings sind die Effekte auf die Umsetzung von CBME noch offen und müssen zukünftig evaluiert werden

Wilderness Mass Casualty Incident (MCI): rescue chain after avalanche at Everest Base Camp (EBC) in 2015

The Nepal Earthquake of 2015 killed over 8000 people and injured over 20,000 in Nepal. Moments after the earthquake, an avalanche of falling ice came down from above Everest Base Camp (EBC). The air blast created by the avalanche flattened the middle part of EBC, killing 15 people and injuring at least 70. The casualties were initially triaged and treated at EBC and then evacuated by air to Kathmandu for definitive care. There were intermediate stops at the villages of Pheriche and Lukla during which the casualties were offloaded, retriaged, treated, and loaded again for further transport. Most of the authors of this article helped to provide primary disaster relief at EBC, Pheriche, or Lukla immediately after the earthquake. We describe the process by which an ad hoc rescue chain evacuated the casualties. We discuss challenges, both medical and nonmedical, what went well, and lessons learned. We make recommendations for disaster planning in the Khumbu (Everest) region, an isolated high altitude roadless area of Nepal

Wilderness Mass Casualty Incident (MCI): rescue chain after avalanche at Everest Base Camp (EBC) in 2015

The Nepal Earthquake of 2015 killed over 8000 people and injured over 20,000 in Nepal. Moments after the earthquake, an avalanche of falling ice came down from above Everest Base Camp (EBC). The air blast created by the avalanche flattened the middle part of EBC, killing 15 people and injuring at least 70. The casualties were initially triaged and treated at EBC and then evacuated by air to Kathmandu for definitive care. There were intermediate stops at the villages of Pheriche and Lukla during which the casualties were offloaded, retriaged, treated, and loaded again for further transport. Most of the authors of this article helped to provide primary disaster relief at EBC, Pheriche, or Lukla immediately after the earthquake. We describe the process by which an ad hoc rescue chain evacuated the casualties. We discuss challenges, both medical and nonmedical, what went well, and lessons learned. We make recommendations for disaster planning in the Khumbu (Everest) region, an isolated high altitude roadless area of Nepal