Current CPR guidelines recommend a chest compression depth of 5–6 cm. During an in-hospital training project using a widely adopted manikin (Resusci Anne, Laerdal Medical), integrated distance sensors consistently recorded compression depths below this target range. Further mechanical evaluation showed that a depth of 6 cm is not physically achievable with this model; the maximum displacement did not exceed 5.7 cm, even when measurements included chest components as recommended by the manufacturer. Although limited to a single, widely used manikin, these findings highlight the need to reassess calibration and mechanical design to ensure alignment with guideline-based CPR training and accurate performance feedback.
Abstract Background When accidents and disasters happen, emergent ad-hoc groups of immediate responders form to provide aid before the arrival of professional medical responders. Little is known about how immediate responders coordinate with each other over time and how that coordination affects the quality of the first aid that is provided. Emergency response is described as complex and chaotic, but methods for analyzing complexity have rarely been applied in the emergency response context. This exploratory study aims to compare recurrence quantification analysis and aggregated data analysis of coordination behaviors by immediate responders to predict performance in groups providing first aid in a simulated context. Methods Sixteen groups of three participants ( N = 48, 58% male, 40% female, and 2% preferred not to answer) were recruited from a large university and the surrounding city in southern Sweden using convenience sampling. They took part in a simulated traffic accident scenario. Of the participants, 56% had prior first aid training, including 6 emergency response professionals who were individually placed in different groups. The first aid performance of each group was rated by three subject matter experts. Only the first 10 min and 28s of each scenario was included in the analysis to allow for direct comparison of the recurrence quantification analysis results between groups. The Co-ACT framework was used to code participants’ coordinative behaviors, and the dynamics of the behaviors’ structure were calculated using a multidimensional recurrence quantification analysis. The aggregated and dynamical structures of the coordinative behaviors (i.e. behaviors of team members coordinating teamwork) were evaluated for their predictive power with regard to first aid performance ratings. Results Two groups were excluded due to incomplete data, and the analyses were conducted on the remaining 14 groups. Rate of recurrence of coordinative behaviors was found to significantly predict first aid performance ( p = .02, β = -0.57 ) while aggregated post-experimental measures of coordinative behaviors did not (Action implicit p = .37, β = -0.31 , Action explicit p = .97, β = <0.01 , Information implicit p = .99, β = 0.01 , Information explicit p = .68, β = -0.14 ). The negative effect of recurrence rate of coordinative behaviors on first aid performance suggests that other behaviors not measured in the Co-ACT analysis (e.g., task work such as chest compressions or bleeding control) had more effect on the quality of the first aid that was provided, at least in the current scenario. Conclusions The study shows the usefulness of controlled scenarios for studying complexity in provision of first aid. Additionally, the results provide initial evidence for the predictive power of recurrence rate on first aid performance in ad-hoc first aid groups. This exploratory study thus shows initial evidence of the usefulness of complexity methods to understand the emergency response context. These contributions have potential significance for both emergency response researchers and practitioners.
Nontechnical skills are essential for safe and effective performance in emergency care. Simulation-based training is widely used to develop these competencies; however, the extent to which training setting influences team performance remains uncertain. This study examined whether in situ simulation and simulation center–based simulation were associated with differences in observed nontechnical skills performance among interprofessional emergency teams in a Brazilian healthcare setting. This quantitative cross-sectional study included interprofessional healthcare professionals participating in emergency simulation training. Team performance was assessed via the Brazilian Portuguese version of the Team Emergency Assessment Measure (bp-TEAM). Sixteen teams (8 in situ and 8 simulation center-based) were video recorded and independently evaluated by seven expert raters. The participants completed a questionnaire assessing their perceptions of nontechnical skills learning and its applicability to professional practice. The content validity of the questionnaire was established through expert review. Sixteen interprofessional teams comprising 71 participants generated 112 independent bp-TEAM assessments. Interrater reliability was good (ICC = 0.798; 95
In simulation-based education, the learners are spending increasing amounts of time observing scenarios rather than being the active participant. It is known that observer roles can be less engaging and may impact the learning experience. Previous research has attempted to address this issue using live 360-degree video streaming of the simulated scenario to observers using individual headset mounted displays. These have demonstrated increased engagement and presence compared with the standard viewing approaches such as watching on a screen in a nearby room or via one-way mirrors. Unfortunately, until now, it has not been possible to scale this technology to reflect a standard simulation session (multiple learners in the same building viewing the scenario live) often due to issues with limited internet bandwidth in one location. In this paper we introduce a new technology, comprising both new software and a new configuration of hardware to enable unlimited numbers of observers to view 360 degree video-stream, live and locally (e.g. in a simulation centre). Turning their head enables them to control their individual view of the scenario. To accommodate those who would prefer not to use headset-mounted displays (e.g. due to VR sickness) the technology can operate on other devices such as tablets and laptops. This paper details the design process, new elements, final technical iteration and the technological trial. We outline the challenges involved including cost and hardware limitations and implications for practice. We present data from an evaluation pilot study to demonstrate proof-of-concept. This highlighted areas for consideration around the technology, the user experience and utility. This set up creates an innovative way for observers to interact with the scenario, allowing individual perspectives and has the potential for greater engagement. This exciting development could revolutionise the observer role and enhance their involvement in the debrief. Further research is planned to focus on the optimal use of the technology, and impact on the human factors debriefing.
Abstract Introduction The threat of intentional mass casualty incidents remains high, making healthcare response a priority. The Hartford Consensus and the THREAT protocol (Threat suppression, Hemorrhage control, Rapid Extrication to safety, Assessment by medical providers, Transport to definitive care) establish recommended actions. A key objective is training civilians as "immediate responders" for hemorrhage control. However, this emergency care training is often limited in medical schools. Francisco de Vitoria University incorporates clinical simulation, including emergency medicine content in the fifth year. This study aims to assess learning outcomes from an activity designed to familiarize students with the Hartford Consensus and THREAT protocol. Materials and methods Simulation Activity Development: Students gathered in an enclosed area. Basic principles of action during a terrorist attack were explained. A simulated attack unfolded, requiring students to escape, hide, or fight, and assist victims according to protocol. Wounded individuals were transported to a meeting point for a debriefing, followed by a final group meeting. Learning outcome assessment Students completed a questionnaire at the beginning and end of the activity, including technical and subjective questions about perceived preparedness. Statistical analysis used the Chi-square test to compare response frequencies. 112 fifth-year medical students completed the online questionnaire. Results Seventy-one pre-activity and 41 post-activity questionnaires were completed. Perceived preparedness significantly improved: initially, 66.2% felt "no" prepared, which decreased to 4.9% after the activity ( p < 0.001). Correct responses to "first thing to do in an attack" increased from 19.4% to 92.7% ( p < 0.001). Understanding "improvised means" rose from 85.9% to 100% ( p = 0.042). No statistically significant differences were observed for more technical questions like hemorrhage or cardiac arrest. Discussion Teaching through simulated environments offers undeniable learning benefits. While curriculum integration faces, simulation is a valuable tool in emergency training. Our cost-effective instructional methods proved successful, as shown by survey data. These engaging experiences facilitate knowledge acquisition. Replicating real-life conditions helps students appreciate inherent challenges. We conclude that using a simulated environment at the undergraduate level to train students as first responders in mass casualty incidents is an effective educational strategy.
