Pediatric emergency medical care in Yerevan, Armenia: a knowledge and attitudes survey of out-of-hospital emergency physicians.

BACKGROUND: Out-of-hospital emergency care is at an early stage of development in Armenia, with the current emergency medical services (EMS) system having emergency physicians (EPs) work on ambulances along with nurses. While efforts are underway by the Ministry of Health and other organizations to reform the EMS system, little data exists on the status of pediatric emergency care (PEC) in the country. We designed this study to evaluate the knowledge and attitudes of out-of-hospital emergency physicians in pediatric rapid assessment and resuscitation, and identify areas for PEC improvement. METHODS: We distributed an anonymous, self-administered Knowledge and Attitudes survey to a convenience sample of out-of-hospital EPs in the capital, Yerevan, from August to September 2012. RESULTS: With a response rate of 80%, the majority (89.7%) of respondents failed a 10-question knowledge test (with a pre-defined passing score of ≥7) with a mean score of 4.17 ± 1.99 SD. Answers regarding the relationship between pediatric cardiac arrest and respiratory issues, compression-to-ventilation ratio in neonates, definition of hypotension, and recognition of shock were most frequently incorrect. None of the participants had attended pediatric-specific continuing medical education (CME) activities within the preceding 5 years. χ2 analysis demonstrated no statistically significant association between physician age, length of EMS experience, type of ambulance (general vs. resuscitation/critical care), or CME attendance and pass/fail status. The majority of participants agreed that PEC education in Armenia needs improvement (98%), that there is a need for pediatric-specific CME (98%), and that national out-of-hospital PEC guidelines would increase PEC safety, efficiency, and effectiveness (96%). CONCLUSIONS: Out-of-hospital emergency physicians in Yerevan, Armenia are deficient in pediatric-specific emergency assessment and resuscitation knowledge and training, but express a clear desire for improvement. There is a need to support additional PEC training and CME within the EMS system in Armenia

Social media guidelines and best practices - Recommendations from the council of residency directors (cord) social media taskforce

Social media has become a staple of everyday life among over one billion people worldwide. A social networking presence has become a hallmark of vibrant and transparent communications. It has quickly become the preferred method of communication and information sharing. It offers the ability for various entities, especially residency programs, to create an attractive internet presence and “brand� the program. Social media, while having significant potential for communication and knowledge transfer, carries with it legal, ethical, personal, and professional risks. Implementation of a social networking presence must be deliberate, transparent, and optimize potential benefits while minimizing risks. This is especially true with residency programs. The power of social media as a communication, education, and recruiting tool is undeniable. Yet the pitfalls of misuse can be disastrous, including violations in patient confidentiality, violations of privacy, and recruiting misconduct. These guidelines were developed to provide emergency medicine residency programs leadership with guidance and best practices in the appropriate use and regulation of social media, but are applicable to all residency programs that wish to establish a social media presence

How to Incorporate Global Health into Your Curriculum/Course

Objectives: 1. Understand that education on global health concepts is demanded by the student body, and how it relates to a variety of courses already taught on campus. Relevant concepts include Health \u26 Equity, Role of culture in healthcare, Healthcare delivery systems, Disaster preparedness and response, Communicable and non-communicable diseases, Women’s and children’s health, and Nutrition and mental health. 2. Understand that involvement and improvements in global health require multi-disciplinary involvement and are not limited to international work (the “local” in “glocal”) 3. Identify strategies to incorporate these global health concepts into existing coursework, especially using the upcoming Mobile Interactive Courseware Platform. 4. Identify risks/benefits associated with global health service opportunities such that they may appropriately guide and mentor students interested in such opportunities. 5. Identify strategies to help students structure their global health activities so that they are mindful of ethical issues and maximize their scholarly potential Presentation: 46 minute

Maintenance of Skill Proficiency for Emergency Skills With and Without Adjuncts Despite the Use of Level C Personal Protective Equipment

OBJECTIVE: To determine the impact of Level C personal protective equipment (PPE) on the time to perform intravenous (IV) cannulation and endotracheal intubation, both with and without the use of adjuncts. METHODS: This prospective, case-control study of emergency medicine resident physicians was designed to assess the time taken by each subject to perform endotracheal intubation using both direct laryngoscopy (DL) and video laryngoscopy (VL), as well as peripheral IV cannulation both with and without ultrasound guidance and with and without PPE. RESULTS: While median times were higher using VL as compared to DL, there was no significant difference between intubation with either DL or VL in subjects with and without Level C PPE. Similarly, no significant difference in time was found for intravenous cannulation in the PPE and no-PPE groups, both with and without ultrasound guidance. CONCLUSIONS: Existing skill proficiency was maintained despite wearing PPE and there was no advantage with the addition of adjuncts such as video-assisted laryngoscopy and ultrasound-guided intravenous cannulation. A safe and cost-effective strategy might be to conduct basic, just-in-time PPE training to enhance familiarity with donning, doffing, and mobility, and couple this with the use of personnel who have maximal proficiency in the relevant emergency skill, instead of more expensive, continuous, skills-focused PPE training

An OSCE Evaluation Tool for the Assessment of Emergency Medicine Resident Progression Performance of ACGME Patient Case and Interpersonal Communication Milestones

Audience: This curriculum is designed to provide a standardized assessment of Emergency Medicine resident performance of selected ACGME Patient Care and Interpersonal Communication Milestones in Emergency Medicine. Introduction: Since the development of the Milestones in Emergency Medicine, residency educators have found assessment of milestones in the clinical setting challenging.1 We piloted an Observed Standardized Clinical Evaluation (OSCE) based on selected milestones in Emergency Medicine. We chose to evaluate Patient Care and Interpersonal Communication milestones because we felt that these milestones are easiest to assess using an OSCE model. There is also some evidence that patient care milestones are difficult to reliably assess in the clinical setting.1 Objectives: Our goal was to create a standardized OSCE based formative assessment tool that could be deployed with minimal resource utilization. The purpose of our tool is to provide data regarding Emergency Medicine Residents’ performance in ACGME patient care milestones as they progress longitudinally through their residency. Method: The sources of multi-source feedback used in this curriculum include direct observation of the residents’ history and physical exam performed on a standardized patient, evaluation of the residents’ interpretation of visual stimuli such as EKGs and radiographs, and interaction with simulated consultants. Feedback was provided during the encounter by both faculty and the standardized patient

Effect of the Sphere Standards on the incidence of communicable and infectious diseases in a returnee camp in South Sudan

Background: The Sphere Standards are primarily focused on factors that acutely affect survival instead of guiding long-term development in displaced populations and have gained consensus in more than 200 aid organisations. However, research was not available to back up every Standard and in those cases the Standards were based on expert or consensus opinion. Therefore, research to validate or refine the Standards will be of benefit to the humanitarian community and the people they serve. Methods: A retrospective study was done at a UN High Commissioner for Refugees camp for returnees from Sudan to South Sudan before and after an intervention to introduce the Sphere Standards for water, sanitation, and hygiene (WASH). Data were collected from May 17, 2012, to July 31, 2012. The daily proportion of the camp diagnosed with a communicable or infectious disease was calculated by comparing the daily camp population to the daily counts from the camp's medical clinic. A χ2 analysis was done to compare the weekly disease proportions before and after the camp met the Sphere Standards for WASH. Findings: The camp clinic recorded 12 655 consultations. The weekly prevalences of the camp population diagnosed with diarrhoea, an upper respiratory tract infection, or a lower respiratory tract infection in the week before the camp met the Sphere Standards were 0·67%, 0·59%, and 0·34%, respectively. 2 weeks afterwards, they were 0·99%, 1·68%, and 0·57%, respectively. In the fourth week the prevalences for all three decreased (0·82%, 1·48%, and 0·39%, respectively). This pattern was statistically significant for all age groups and also for subgroup analysis on returnees younger than 5 years. Percentages for the diseases tracked ranged from 0·14% to 1·68% with p<0·05. Interpretation: Factors such as the massive influx of returnees to the camp and the introduction of local pathogens into the returnee camp population probably muted the initial effects of improved WASH on the camp. These results suggest that achievement and maintainence of the Sphere Standards will have a significant, although possibly delayed, effect on the incidence of communicable and infectious diseases during a complex humanitarian emergency. Funding: None