As the ARHT moves towards purchasing a new aircraft the CEO and project manager have requested feedback regarding the clinical usability of the rear cabin interior of the two machines currently being considered. To facilitate this process the Ergonomics team and the Educational team will be working together to conduct simulation based usability testing. The feedback from this month long process will be used to help guide the decision of which new aircraft to purchase. To introduce this process and the concept of usability testing we would ask that you take the time to listen to the below podcast.

Thank you.

An Introduction to Usability Testing and Rear Cabin Design

Module three focuses on the prehospital diagnosis and management of shock and the effective use of teamwork and communication in high stress environments. We were lucky enough this month to be joined by Dr. Gareth Richards, who not only participated in the first two podcast for this module, but also provided us with an outstanding complement of critical care shock literature. The ARHT educational team would like to say a big thank you to Gareth for his help and commitment to our continued learning. We would also like to thank everyone who has helped out with this project to date.

Chapter one of this module is divided into two separate lectures. The first is a focused discussion on the diagnosis and basic management of shock in the prehospital environment. The second lecture uses a case based discussion to review the principals outlined in the first lecture. Chapter two of this module is all about trauma and will focus on the pre-hospital use of whole blood as well as the pre-hospital management of both blunt and penetrating cardiac arrest…. if the words pre-hospital thoracotomy don’t get you excited then you are reading the wrong blog!!!

Update: The educational team would like to extend a massive THANK YOU to Prof. Ian Civil, Dr. Mark Friedericksen, Dr. Tony Smith and our very own Dr. Chris Denny for joining us on our most recent trauma podcast. Bringing together experts from trauma services, the ICU, the emergency department and the pre-hospital setting produced (in our opinion) an outstanding discussion with multiple view points from all of those involved in the “chain of survival” following trauma. Only by working together from roadside to discharge can we improve the outcomes for our trauma patients.

Enjoy the podcast!

The simulations to be completed in this module are closely related to the content contained in these lectures.

Module #3 – Objectives

Module#3 – Chapter 1a – Shock-Teamwork and communication

Module #3 – Chapter 1b – Shock – Teamwork and Communication

Module #3 – Chapter 2a – Pre-hospital whole blood.

Module #3 – Chapter 2b – Damage Control Resuscitation

Module #3 – Chapter 2b – Traumatic Cardiac Arrest

Below you will find reference material to supplement the above lectures:

The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll.
Emerg Med Clin North Am. 2010 Feb;28(1):29-56

Focused assessment with sonography in trauma (FAST): should its role be reconsidered?
Postgrad Med J. 2010 May;86(1015):285-91.

Current role of emergency ultrasound of the chest.
Crit Care Med. 2011 Apr;39(4):839-45.

Lung ultrasound in the critically ill.
Ann Intensive Care. 2014 Jan 9;4(1):1.

Management of bleeding and coagulopathy following major trauma: an updated European guideline.
Crit Care. 2013 Apr 19;17(2):R76.

Bleeding and coagulopathies in critical care.
N Engl J Med. 2014 Feb 27;370(9):847-59.

Circulatory shock.
N Engl J Med. 2013 Oct 31;369(18):1726-34.

Resuscitation fluids.
N Engl J Med. 2013 Sep 26;369(13):1243-51.

Severe sepsis and septic shock.
N Engl J Med. 2013 Aug 29;369(9):840-51.

A randomized trial of protocol-based care for early septic shock.
N Engl J Med. 2014 May 1;370(18):1683-93.

Here you will find some excellent references regarding Pre-hospital thoracotomy:

I) Blogs:

https://aucklandhems.com/2012/11/13/pre-hospital-thoracotomy/

http://lifeinthefastlane.com/ed-thoracotomy-is-it-just-the-first-part-of-the-autopsy/

http://emcrit.org/podcasts/traumatic-arrest/

http://emcrit.org/podcasts/procedure-of-thoracotomy/

Click to access A_12_Weaver.pdf

II) Articles:

Click to access Thoracotomy.pdf

Click to access v022p00022.pdf

Click to access WTACriticalDecisionsResuscitativeThoracotomy.pdf

http://www.ncbi.nlm.nih.gov/pubmed/21131854

III) Videos:

Module #3 – Shock: Teamwork and Communication

Clinical and Technical Skills

Shock
1.1 Define the term shock.
1.2 Describe the cellular pathophysiology of shock.
1.3 Describe the classification of shock.
1.4 Describe the pathophysiology for each classification of shock.
1.5 List a differential diagnosis for each category of shock.
1.6 Outline a diagnostic approach to shock.
1.6 Outline the pre-hospital management priorities for each classification of shock.

Trauma
1.1 List and describe the pathophysiology of the causes of traumatic shock.
1.2 Describe the pathophysiology of coagulopathy of trauma.
1.3 Outline a diagnostic approach to traumatic shock.
1.4 Outline the pre-hospital management priorities when treating traumatic shock.
1.5 List the ARHT trigger criteria for the administration of pre-hospital whole blood.
1.6 Outline a management algorithm for the treatment of a blunt traumatic cardiac arrest.
1.7 Outline a management algorithm for the treatment of a penetrating traumatic cardiac arrest.
1.8 List the indications for pre-hospital tube thoracostomy.
1.9 List the indications for pre-hospital thoracotomy.

The clinical focus of Module 2 is centred on the diagnosis and pre-hospital management of respiratory failure. The non-technical/CRM topic for this module is leadership. Chapter one of this module reviews the management of paediatric asthma. Chapter two focuses on the differential diagnosis and management of respiratory failure – it is divided into two separate lecture focusing specifically on both adult and paediatric medicine. Chapter two also explores the pros and cons of different leadership styles and team dynamics.

The simulations to be completed in this module are closely related to the content contained in these lectures.

Module #2 – Objectives

Module #2 – Chapter 1 – Pediatric Asthma Management

Module #2 – Chapter 2a- Respiratory failure-Leadership – Adult

Module #2 – Chapter 2b – Respiratory failure-Leadership – Pediatrics

Below you will find reference material to supplement the above lectures:

Childhood asthma: a guide for pediatric emergency medicine providers.
Kline-Krammes S1, Patel NH, Robinson S.
Emerg Med Clin North Am. 2013 Aug;31(3):705-32.

Starship Clinical Guidelines – Asthma: Acute Management

More coming soon!!!!