The preparation, delivery and outcome of COVID-19 pandemic training program among the Emergency Healthcare Frontliners (EHFs): the Malaysian teaching hospital experience

One of the strategies in strengthening the healthcare providers in mitigating the impact of COVID-19 pandemic is through training. Safety and disease unfamiliarity with COVID-19 was the main reason for developing this dedicated specialized training modules in order to address the issue. The training modules were developed based on three strategies that are learning from experience, design suitable dedicated module and identify weakness and vulnerability. The training modules created were donning-doffing of Personal Protective Equipment (PPE), airway management and cardiopulmonary resuscitation of suspected COVID-19 patients which were delivered through immersive life simulation technique. A total of 178 Emergency Healthcare Frontliners (EHFs) were trained. Each module was guided with a checklist that the participants found to be very useful. None of the participants reported developing symptoms of infection after undergoing the face-to-face simulation training even after two weeks of post-training periods. Seven important steps were found to be crucial that contributed to these findings which included room space, participants number per group, COVID-19 screening, taking of temperature, hand sanitization, PPE, and equipment sanitization before and after training. Hands-on training with guided-checklist was found to be very useful to the EHFs in managing an unfamiliar situation of COVID-19. In time-constraint-resource-limited conditions, training modules should be focused on addressing the pressing problem at hand. In conducting a face-to-face training, precautionary safety measures should be strictly adhered to prevent the spread of the disease

Diagnosing pediatric intussusception through bedside ultrasound by novice emergency department sonographers: a case report

Intussusception is a common cause of gastrointestinal emergency in the paediatric population and it is usually diagnosed through Barium enema radiography or ultrasound. The skill of using an ultrasound by a minimally trained medical officer in diagnosing this cases in the Emergency Department are very helpful and expedite the management. We present the case of a 7-month-old girl who presented to Emergency Department (ED) with the chief complaint of passing blood in stool. Clinically she was dehydrated, irritable and in compensated shock. There was generalised tenderness per abdomen but it was soft and not distended. There was no palpable mass and bowel sound normal. Immmediate fluid resuscitated commenced. Bedside abdominal ultrasound performed by ED medical officer showed a 1.8 cm x 2.5 cm mass of alternating hypo-echoic and hyper-echoic rings at the right lower quadrant, consistent with the ‘target’ sign of intussusception. Supine plain abdominal X-ray did not reveal any abnormality. The ultrasound finding of intussusception was later confirmed by the radiologist. She underwent immediate hydrostatic reduction and was discharged well

Traumatic small bowel injury : a diagnosis challenge

Traumatic small bowel injury is rare complication following a blunt abdominaltrauma. We encountered a case of small bowel injury following a motor vehicle accident that was initially missed during the first presentation due to unremarkable findings in examination. Patient re-presented five days later with bowel ischaemia and was managed accordingly. It is a challenge in diagnosing the injury due to its vague presentation. The usage of Focused Assessment with Sonography for Trauma (FAST) scan as a screening tool in Emergency Department to pick up intra-abdominal injury do have limitations especially in diagnosing small bowel perforation post blunt abdominal trauma. The early phase of small bowel injury post blunt abdominal trauma rarely produces significant free fluid during the FAST scan. It is paramount for the emergency doctors to have a high level of suspicion in high risk cases to provide early supportive treatment and early referral to surgical team. If left undiagnosed bowel ischaemia may lead to catastrophic complication affecting the patient’s morbidity and mortality. In conclusion, each case should be managed and risk stratify individually. Computed tomography abdomen is found to be more superior in detecting bowel injuries, hence, and investigation of choice compared to bedside ultrasonograpy in cases with high level of suspicaion

Paramedics’ perception on video assisted learning method in learning emergency skills

Information technology use in healthcare education has become a popular medium of instruction. One of the medium of instruction is video assisted learning (VAL). The use of VAL as an instructioemergency skills is not new. However, there are lack of studies on the perception of using this method in learning emergency skills. This qualitative study involved four focused discussion groups following a VAL instruction on emergency skills. A total of 20 paramedics were divided into four groups. They were involved in a focussed discussion after a VAL instruction session. Findings reveal that the paramedics perceived three major themes which were categorized as : i) advantages of video as teaching tool, ii) barrier in using video as a teaching tool; and iii) suggestions on using video as teaching tool. The findings indicate that the paramedics perceived VAL as a potential tool for learning emergency skills. However, they suggested the language of instruction should be in their mother tongue for better understanding. This implies that using English language has disadvantage in technology enhanced learning for better understanding

Doing less is better : challenges in complex polytrauma management - case report

Damage control resuscitation, characterized by hemostatic resuscitation with blood products, rapid arrest of bleeding and when possible, permissive hypotension with restricted fluid load form a structured approach in managing a polytrauma patient. When complicated with traumatic rhabdomyolysis however, permissive hypotension strategy may cause more harm resulting in subsequent ischaemicreperfusion injury and acute kidney injury. We present a case involving a 20-yearold man who was rolled over by a lorry and sustained an open unstable pelvic fracture with vascular injury and left lower limb ischaemia. Permissive hypotension strategy was pursued for 4 hours prior to bleeding control in OT. This was followed by protracted surgery of 6 hours. Coagulopathy, acute kidney injury and rhabdomyolysis ensued in the post-operative period and patient succumbed to his injury on Day 3 post-trauma. Challenges and pitfalls in managing a complex polytrauma patient and recent evidences on damage control resuscitation is discussed

Simulation in healthcare in the realm of Education 4.0

The advent of Education 4.0, in parallel with Industrial Revolution (IR) 4.0, has translated into an evolution in healthcare education. Simultaneously, as a result of concerns in doctors’ competency and patient safety, simulation shot into center-stage in the field of healthcare education. Generally, there are five modalities in healthcare education, namely role-play (verbal), standardized patient, part-task trainer, computer or screen-based simulation, and electronic patients including virtual reality. Dissecting the nine principles of Education 4.0, this article reviews the relevance and role of the five different modalities of simulation in easing healthcare education into the mold of Education 4.0

Challenges in embracing virtual reality from healthcare professional’s perspective: a qualitative study

Virtual reality (VR) in healthcare is relatively new concept and the views of healthcare professionals (HCPs) on its potential should be studied. We set out to investigate the perception of HCPs concerning VR’s feasibility and utility in healthcare. An exploratory qualitative study was conducted among HCPs in a medical teaching institution in the Klang Valley, Malaysia from March until July 2021. Focus group discussions were held using semi-structured questions consisting of four categories i.e., utility, training, development and resources and obstacles were developed deductively prior to the study. They were analysed using thematic coding. The data were presented in the form of categories, themes and quotes. Seven doctors, four allied health professionals and four science officers were among the fifteen respondents. A total of 16 themes were derived out of the four categories which were usage, purpose, new modality, individual experience, patient safety, trainer trainer safety, training standardisation, logistic, interactivity, cost to consumers, potentiality, management support, limitation, funding, lack of expertise, and mindset ignorance. Apart from safety concerns, high VR technology costs were expected to become more affordable in the future. Cybersickness was also of a concern. This study demonstrated that VR was feasible in healthcare education and practice if several critical factors were considered, including increased funding, a more favourable mindset, increased visibility, awareness of available resources and increased collaboration between technical and subject matter experts. As VR acts as simulation, VR ensures trainee's, teacher's and patient's safety while allowing more flexible training in a variety of clinical scenarios

Influence of simulation in Malaysian healthcare education and research (ISIM-HERE): a two-decade experience

The use of simulation as a teaching methodology in medical institutions has been in Malaysia for over two decades. This study aimed to evaluate the current scenarios of simulation impact and utilization in Malaysian academic healthcare institutions (AHIs). We conducted a population-based survey on all AHIs in Malaysia including public and private. We performed an online survey followed by a face-to-face interview evaluating the number of institutions that used simulation, duration of experience, purpose, funding, users’ category and healthcare domain, research activities, dedicated-trained staff and the challenges faced. Out of 75 healthcare institutions approached, 38 agreed to participate in this study. Twenty-two (57.9%) were public hospitals while 16 (42.1%) were private institutions. Thirty-five (92.1%) out of 38 institutions used simulation as a teaching method. The majority (15, 42.9%) had less than five years’ experience, and about a third (11, 31.4%) used simulation for teaching, training and performance assessment. Nurses (30, 26.1%) were the main users followed by physicians and paramedic (19, 16.5% each respectively). In-hospital and procedural group were the top two domains of utilizers. Almost three quarters (25, 71.4%) have dedicated support staff to manage the centre. Funding was mainly from internal institutional support mechanisms. Seven different categories of challenges were identified, the biggest being financial support. In summary, even though healthcare simulation has been in Malaysia for the past two decades but the most substantial impact happened over the last five years. Utilization was mainly for teaching, training, and performance assessment with minimal use in research

Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: An observational study

Background: This study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance. Methods: This was a planned sub-study of a prospective, interrupted time series cohort study conducted at three time points in 2014 and which included consecutive adult patients presenting to the ED with dyspnoea as a main symptom. For this sub-study, additional inclusion criteria were presentation to an ED in Australia or New Zealand and transport by ambulance. The primary outcomes of interest are the epidemiology and outcome of these patients. Analysis was by descriptive statistics and comparisons of proportions. Results: One thousand seven patients met inclusion criteria. Median age was 74 years (IQR 61-68) and 46.1 % were male. There was a high rate of co-morbidity and chronic medication use. The most common ED diagnoses were lower respiratory tract infection (including pneumonia, 22.7 %), cardiac failure (20.5%) and exacerbation of chronic obstructive pulmonary disease (19.7 %). ED disposition was hospital admission (including ICU) for 76.4 %, ICU admission for 5.6 % and death in ED in 0.9 %. Overall in-hospital mortality among admitted patients was 6.5 %. Discussion: Patients transported by ambulance with shortness of breath make up a significant proportion of ambulance caseload and have high comorbidity and high hospital admission rate. In this study, >60 % were accounted for by patients with heart failure, lower respiratory tract infection or COPD, but there were a wide range of diagnoses. This has implications for service planning, models of care and paramedic training. Conclusion: This study shows that patients transported to hospital by ambulance with shortness of breath are a complex and seriously ill group with a broad range of diagnoses. Understanding the characteristics of these patients, the range of diagnoses and their outcome can help inform training and planning of services

Leptospirosis with Pulseless Electrical Activity (PEA) cardiac arrest in multiple comorbid patient

Leptospirosis is one of the endemic diseases in Malaysia. It has a broad spectrum of clinical manifestation ranging from mild illness to life-threatening illness. We report a case of 56-year-old male with multiple comorbidities, who came with history of fever, cough, abdominal pain, vomiting and diarrhea for two days. He presented to the Emergency Department (ED) unresponsive with pulseless electrical activity (PEA). He was resuscitated and achieved return of spontaneous circulation (ROSC) shortly after it. It was complicated with hyperosmolar hyperglycemic state (HHS), oliguric acute kidney injury and non-ST elevation myocardial infarction (NSTEMI). He was then admitted to intensive care unit (ICU) and treated with IV Ceftriaxone 2 g daily for 4 days then was changed to IV Ceftazidime 2 g twice per day for 1 week because of ventilator acquired pneumonia (VAP). His condition improved and was discharge home well after 18 days of admission