Simulations have become an indispensable part of modern teaching. They provide a safe environment for learning and perfecting complex clinical skills without endangering patients. This article highlights the current possibilities and advantages of simulation in anesthesiology, intensive care medicine, emergency medicine, and pain medicine and shows how these technologies can revolutionize medical education.

Modern patient simulation and CRM (crisis resource management) are very often mentioned in the same context. In this article, we will classify the parallel developments of the last 60 years and the introduction of CRM in healthcare concept over 30 years ago and to examine them from different perspectives. CRM has more dimensions than most people realize. This toolbox deals with the description and optimization of human factors in the context of the healthcare system. Since the human factors and the effects on the quality of treatment can be addressed very well in the context of simulation training, they play a natural role in many simulation training courses.

Zusammenfassung Hintergrund Bei Massenanfällen von Verletzten (MANV) besteht oft ein Missverhältnis zwischen dem Behandlungsbedarf und den verfügbaren Ressourcen. Verschiedene Sichtungssysteme werden präklinisch verwendet, darunter der „tactical Simple Triage and Rapid Treatment“(tacSTART)-Algorithmus, der speziell für Bedrohungslagen entwickelt wurde. Ziel der Arbeit Die Studie untersuchte, ob der tacSTART-Algorithmus von zivilen und militärischen Rettungskräften ohne vorherige Erfahrung mit Sichtungsalgorithmen wirksam genutzt werden kann. Das Weltwirtschaftsforum (WEF) 2020 bot ein optimales Umfeld für diese Untersuchung. Material und Methoden Die Studie wurde während des WEF in Davos durchgeführt und umfasste nichtärztliches und ärztliches Personal von zivilen und militärischen Rettungsdiensten. Die Teilnehmenden erhielten eine Einführung in den tacSTART-Algorithmus und führten insgesamt 2000 Vorsichtungen an Schauspielpatientinnen und -patienten sowie Patientenkarten durch. Ein Online-Fragebogen diente zur Datenerfassung, welche statistisch ausgewertet wurde. Ergebnisse Die Studienergebnisse zeigten, dass der tacSTART-Algorithmus eine hohe Übereinstimmung mit der wahren Vorsichtung erzielte (91,7 %). Es gab keine signifikanten Unterschiede zwischen zivilen und militärischen Rettungskräften. Die Selbsteinschätzung der Teilnehmenden und die Bewertung des Algorithmus waren positiv. Diskussion Die Studienergebnisse unterstützen die Effektivität des tacSTART-Algorithmus als Instrument zur Vorsichtung in MANV-Szenarien. Die Ergebnisse betonen seine Anwendbarkeit für verschiedene Fachkräftegruppen. Die Studie trägt dazu bei, das Verständnis für Sichtungsalgorithmen in Großschadenslagen zu erweitern und die Patientenversorgung zu verbessern. Graphic abstract

Background Digitalization in disaster medicine holds significant potential to accelerate rescue operations and ultimately save lives. Mass casualty incidents demand rapid and accurate information management to coordinate effective responses. Currently, first responders manually record triage results on patient cards, and brief information is communicated to the command post via radio communication. Although this process is widely used in practice, it involves several time-consuming and error-prone tasks. To address these issues, we designed, implemented, and evaluated an app-based mobile triage system. This system allows users to document responder details, triage categories, injury patterns, GPS locations, and other important information, which can then be transmitted automatically to the incident commanders. Objective This study aims to design and evaluate an app-based mobile system as a triage and coordination tool for emergency and disaster medicine, comparing its effectiveness with the conventional paper-based system. Methods A total of 38 emergency medicine personnel participated in a within-subject experimental study, completing 2 triage sessions with 30 patient cards each: one session using the app-based mobile system and the other using the paper-based tool. The accuracy of the triages and the time taken for each session were measured. Additionally, we implemented the User Experience Questionnaire along with other items to assess participants’ subjective ratings of the 2 triage tools. Results Our 2 (triage tool) × 2 (tool order) mixed multivariate analysis of variance revealed a significant main effect for the triage tool (P<.001). Post hoc analyses indicated that participants were significantly faster (P<.001) and more accurate (P=.005) in assigning patients to the correct triage category when using the app-based mobile system compared with the paper-based tool. Additionally, analyses showed significantly better subjective ratings for the app-based mobile system compared with the paper-based tool, in terms of both school grading (P<.001) and across all 6 scales of the User Experience Questionnaire (all P<.001). Of the 38 participants, 36 (95%) preferred the app-based mobile system. There was no significant main effect for tool order (P=.24) or session order (P=.06) in our model. Conclusions Our findings demonstrate that the app-based mobile system not only matches the performance of the conventional paper-based tool but may even surpass it in terms of efficiency and usability. This advancement could further enhance the potential of digitalization to optimize processes in disaster medicine, ultimately leading to the possibility of saving more lives.

Zusammenfassung Hintergrund Bei Massenanfällen von Verletzten (MANV) besteht oft ein Missverhältnis zwischen dem Behandlungsbedarf und den verfügbaren Ressourcen. Verschiedene Sichtungssysteme werden präklinisch verwendet, darunter der „tactical Simple Triage and Rapid Treatment“(tacSTART)-Algorithmus, der speziell für Bedrohungslagen entwickelt wurde. Ziel der Arbeit Die Studie untersuchte, ob der tacSTART-Algorithmus von zivilen und militärischen Rettungskräften ohne vorherige Erfahrung mit Sichtungsalgorithmen wirksam genutzt werden kann. Das Weltwirtschaftsforum (WEF) 2020 bot ein optimales Umfeld für diese Untersuchung. Material und Methoden Die Studie wurde während des WEF in Davos durchgeführt und umfasste nichtärztliches und ärztliches Personal von zivilen und militärischen Rettungsdiensten. Die Teilnehmenden erhielten eine Einführung in den tacSTART-Algorithmus und führten insgesamt 2000 Vorsichtungen an Schauspielpatientinnen und -patienten sowie Patientenkarten durch. Ein Online-Fragebogen diente zur Datenerfassung, welche statistisch ausgewertet wurde. Ergebnisse Die Studienergebnisse zeigten, dass der tacSTART-Algorithmus eine hohe Übereinstimmung mit der wahren Vorsichtung erzielte (91,7 %). Es gab keine signifikanten Unterschiede zwischen zivilen und militärischen Rettungskräften. Die Selbsteinschätzung der Teilnehmenden und die Bewertung des Algorithmus waren positiv. Diskussion Die Studienergebnisse unterstützen die Effektivität des tacSTART-Algorithmus als Instrument zur Vorsichtung in MANV-Szenarien. Die Ergebnisse betonen seine Anwendbarkeit für verschiedene Fachkräftegruppen. Die Studie trägt dazu bei, das Verständnis für Sichtungsalgorithmen in Großschadenslagen zu erweitern und die Patientenversorgung zu verbessern. Graphic abstract

Background: Disaster medicine is a component of the German medical education since 2003. However, studies have shown some inconsistencies within the implementation of the national curriculum, and limits with the number of students trained over the years. Facing the SARS-CoV-2 pandemic and other disasters, it became much more important to train medical students in disaster medicine on a coordinated basis. Methods: The University Clinic for Anaesthesiology and Intensive Care Medicine in Tübingen, Germany, expanded the existing curriculum of undergraduate disaster medicine training with fundamentals of humanitarian medicine, integrating the experience with distance learning, interactive teaching and simulation sessions. Survey tools were used to assess participants’ previous experiences and interest in the field of disaster medicine, to compare the self-reported degree of knowledge before and after training, and the programme’s quality evaluation. A mandatory pre- and post-test of knowledge was also administered to evaluate learner outcomes. The prospective and cross-sectional study evaluates the pilot course Disaster Medicine and Humanitarian Assistance carried out for third-, fourth- and fifth- year medical students over five semesters during the period between 2018 and 2020. Results: Data was collected from 107 students over five training sessions. Out of a sample of 82 students, the subjective perception of knowledge increased after the course (t [81] = 24.426, p < .001), alongside with the interest in engaging in the field of disaster medicine (t[81 ] = 7.031, p < .001). 102 students entered the mandatory knowledge assessment, with the rate of correct answers passing from 73.27% in the pre-test to 95.23% in the post-test ( t [101] = 18.939, p < .001). The 93.46% of the medical students ( N = 100) graded the training received with an excellent overall score (1.01 out of 6). Discussion: The study indicates a significant increase in students’ understanding of disaster medicine through the use of both subjective and objective measures, as well as an increase interest in the field of disaster and humanitarian medicine. The educational programme appears to address the deficiencies documented in previous studies, and possible adaptation with virtual reality approaches could expand access to a larger audience. Conclusion: The programme offers an effective and comprehensive tool to address the urgent need of quality education for medical students, suggesting integrated strategies to implement disaster medicine training.

Abstract Background Disaster medicine is a component of the German medical education since 2003. Nevertheless, studies have shown some inconsistencies within the implementation of the national curriculum, and limits in the number of students trained over the years. Recently, the SARS-CoV-2 pandemic and other disasters have called attention to the importance of training medical students in disaster medicine on a coordinated basis. The aim of this study is to present and evaluate the disaster medicine and humanitarian assistance course, which was developed in the University of Tübingen, Germany. Methods The University Clinic for Anesthesiology and Intensive Care Medicine in Tübingen expanded the existing curriculum of undergraduate disaster medicine training with fundamentals of humanitarian medicine, integrating distance learning, interactive teaching and simulation sessions in a 40 h course for third-, fourth- and fifth- year medical students. This prospective and cross-sectional study evaluates the Disaster Medicine and Humanitarian Assistance course carried out over five semesters during the period between 2018 and 2020. Three survey tools were used to assess participants’ previous experiences and interest in the field of disaster medicine, to compare the subjective and objective level of knowledge before and after training, and to evaluate the course quality. Results The total number of medical students attending the five courses was n = 102 of which n = 60 females (59%) and n = 42 males (41%). One hundred two students entered the mandatory knowledge assessment, with the rate of correct answers passing from 73.27% in the pre-test to 95.23% in the post-test (t [101] = 18.939, p < .001, d = 1.88). To determine the subjective perception of knowledge data were collected from 107 observations. Twenty-five did not complete the both questionnaires. Out of a remaining sample of 82 observations, the subjective perception of knowledge increased after the course (t [81] = 24.426, p < .001, d = 2.69), alongside with the interest in engaging in the field of disaster medicine (t [81] = 7.031, p < .001, d = .78). The 93.46% of the medical students (n = 100) graded the training received with an excellent overall score (1.01 out of 6). Conclusion The study indicates a significant increase in students’ understanding of disaster medicine using both subjective and objective measurements, as well as an increase interest in the field of disaster medicine and humanitarian assistance. Whereas former studies showed insufficient objective knowledge regarding disaster medical practices as well as subjective insecurities about their skills and knowledge to deal with disaster scenarios, the presented course seems to overcome these deficiencies preparing future physicians with the fundamentals of analysis and response to disasters. The development and successful implementation of this course is a first step towards fulfilling disaster medicine education requirements, appearing to address the deficiencies documented in previous studies. A possible adaptation with virtual reality approaches could expand access to a larger audience. Further effort must be made to develop also international training programs, which should be a mandatory component of medical schools’ curricula.

In pandemic times, medical staff is becoming a key resource in fighting the infection. To achieve the best medical care, relevant techniques and procedures have to be taught to medical staff to reduce the risk of infection. COVID patients often need mechanical ventilation due to progredient respiratory insufficiency, so an endotracheal intubation becomes a critical procedure in managing these patients. This procedure has an increased risk of infection due to aerosol formation and working with an unsecured airway. Patient safety should not be neglected, and complications like hypoxaemia and aspiration should be avoided. At the same time, personal protection from infection is of utmost importance becuase human resources in a pandemic crisis must be preserved. This video shows the procedure of endotracheal intubation while taking personal infection protection into account.

AbstractIntroduction:A standardized team-training program for healthcare professionals in obstetric units was developed based on an analysis of common causes for adverse events found in claims registries. The interdisciplinary and inter-professional training concept included both technical and non-technical skill training. Evaluation of the program was carried out in hospitals with respect to the immediate personal learning of participants and also regarding changes in safety culture.Methods:Trainings in n=7 hospitals including n=270 participants was evaluated using questionnaires. These were administered at four points in time to staff from participating obstetric units: (1) 10 days ahead of the training (n=308), (2) on training day before (n=239), (3) right after training (n=248), and (4) 6 months after (n=188) the intervention. Questionnaires included several questions for technical and non-technical skills and the Hospital Survey on Patient Safety (HSOPS).Results:Strong effects were found in the participants’ perception of their own competence regarding technical skills and handling of emergencies. Small effects could be observed in the scales of the HSOPS questionnaire. Most effects differed depending on professional groups and hospitals.Conclusions:Integrated technical and team management training can raise employees’ confidence with complex emergency management skills and processes. Some indications for improvements on the patient safety culture level were detected. Furthermore, differences between professional groups and hospitals were found, indicating the need for more research on contributing factors for patient safety and for the success of crew resource management (CRM) trainings.

Usability studies often use methods focused on product parameters. Test designs are processed in laboratories and evaluation is commonly performed by expert opinions. For validation studies we want to point out the importance of field studies and user and system oriented evaluation. For this purpose we want to present the methodological approach iFlow (information flow) as multiple assessment technique for usability issues in real or quasi-real (simulated) situations. The idea of iFlow is to assess input and output workload via video and audio recordings combined with subjective and objective measurement techniques of workload. In this contribution the iFlow method and an evaluative study in anesthesiology are presented. The added value to already existing methods and approaches is considered in the sensitivity of iFlow to identify situations of overload in a descriptive way. For design interventions it would be helpful to consult the iFlow chart to deduct cause and effect relations.

The areas of application of modern patient simulators are becoming more widely. Many different medical areas are using simulation in many different ways, e.g. basic education, advanced training, research and even performance assessment [1][2]. One of them is research on human factors, human limitations and medical ergonomics [3].Moreover, the methodology of simulation based trainings and the environment of modern simulation centres provides a perfect playground to introduce new medical devices to healthcare practitioners.

The anesthesia workplace can be regarded as a complex human-machine-system (HMS). In this information-intensive "cockpit" the operator has to handle several devices. Not only visual but also auditory cues have to be integrated in the action-control-loop. It ' s obvious that in some stressful and complex situations, a perceptual and cognitive overloading of the anesthetist could occur and therefor inhibit an efficient and save interaction. The design of the interfaces and the form of information presentation has a significant impact on these aspects.The contribution presents the possibilities of the new methodical approach "iFlow Analysis" (information-flow) to observe cognitive ergonomics and informatory load in such HMS. In our exemplary observation we used an eyetracking-system to evaluate the user interactions in a simulated scenario and in a field (thyroidectomy and exploratory laparotomy) situation. All incoming visual and auditory signals were observed during the procedure of anesthetic guidance. The interactions have been integrated in the so called iFlow Chart to evaluate the density of information presentation. In addition informatory load has been measured by the dynamic changes of pupil size.

Realistic simulation training is on its way to spread all over healthcare [1]. For example, in Denmark simulation training is compulsory for all anaesthesiologists and nurse anaesthetists, in Germany the Anaesthesia Society DGAI promoted the establishment of simulators in all medical schools. Also the goals for using simulators become more widespread in terms of basic education, advanced training, research and even performance assessment [2]. There are many different areas of using modern patient simulators [3]. One of them is research on human factors and human limitations. One special focus of this research can be product usability and ergonomics. This research and the knowledge about human limitations can have an effect on future development to design safer devices [4]. The experience and the methodology in analysing medical cases combined with modern manikin based simulators and the infrastructure of modern simulation labs can provide a perfect test bed for innovative product development.

In recent years web applications have evolved from pure data-centric towards complex process-based applications that involve multiple users, organizations and systems. Web applications in the area of healthcare have been particularly affected by this evolution. New process-oriented technologies like business process management systems were used for the development of such web applications. They facilitate the implementation of the processes by providing tools for the process design, execution, administration and integration and guarantee performance and scalability. However, most web applications are implemented conventionally and therefore, cannot take advantage from these new technologies. What they are lacking is a methodology for converting conventionally implemented, intrinsically process-oriented web applications to process-oriented platforms. In the following article, a methodology is introduced that shows how web applications may be re-engineered towards process-oriented platforms. Furthermore, the relevance of this methodology to solve the challenges arising in a concrete web application in the area of healthcare, specifically incident reporting in hospitals, is outlined.

This article addresses the necessary steps in the design of simulation-based instructional systems. A model for designing instructional systems is presented which stipulates that the outcome metrics be defined before the simulation system is designed. This ensures integration of educational objectives and measures of competency into the design and development process. The article ends with a challenge to simulator users and instructors: become involved in the integrated system design process by the daily collection of standardized data and working with the simulation engineers throughout the design process.

This article addresses the necessary steps in the design of simulation-based instructional systems. A model for designing instructional systems is presented which stipulates that the outcome metrics be defined before the simulation system is designed. This ensures integration of educational objectives and measures of competency into the design and development process. The article ends with a challenge to simulator users and instructors: become involved in the integrated system design process by the daily collection of standardized data and working with the simulation engineers throughout the design process.

Background: More than any other teams, air rescue teams are challenged with incidents in not standardized settings, faced with dynamic decision making processes and interaction with other teamsIdea/concept: Giving teams the chance to watch themselves on video, how they handle a critical patient, how they act concerning leadership and followership, how they communicate between each other is unique regarding selfreflective learning aspects. Trainees who are not active in the simulator have the unique chance to watch their colleagues and focus on HF and CRM principles as well as medical guidelines and logistic aspects.Methods/implementation: Since 2003 over 2000 trainees, all professional air rescue teams were trained in full size simulation setting with live transmission and video-based debriefings by special trained CRM instructors.Results from 987 completed and analyzed questionnaires.Discussion: Regarding the short period of training – time, it is encouraging how professionals rate the role of debriefings. More over that even very experienced teams think that they have learned something new.Conclusion: The results show a high impact on subjective learning and improving patient safety, even in highly experienced team members. Regularly repeated simulation based team training with video-feedback and applying CRM should be part of all routine training programmes for all prehospital emergency teams. The additional use of data from incident reporting systems could further close the loop from report, react and train the causes of the reported incidents. Patient safety is a systems issue – simulation team training and incident reporting are an important indispensable part of it. Background: More than any other teams, air rescue teams are challenged with incidents in not standardized settings, faced with dynamic decision making processes and interaction with other teams Idea/concept: Giving teams the chance to watch themselves on video, how they handle a critical patient, how they act concerning leadership and followership, how they communicate between each other is unique regarding selfreflective learning aspects. Trainees who are not active in the simulator have the unique chance to watch their colleagues and focus on HF and CRM principles as well as medical guidelines and logistic aspects. Methods/implementation: Since 2003 over 2000 trainees, all professional air rescue teams were trained in full size simulation setting with live transmission and video-based debriefings by special trained CRM instructors. Results from 987 completed and analyzed questionnaires. Discussion: Regarding the short period of training – time, it is encouraging how professionals rate the role of debriefings. More over that even very experienced teams think that they have learned something new. Conclusion: The results show a high impact on subjective learning and improving patient safety, even in highly experienced team members. Regularly repeated simulation based team training with video-feedback and applying CRM should be part of all routine training programmes for all prehospital emergency teams. The additional use of data from incident reporting systems could further close the loop from report, react and train the causes of the reported incidents. Patient safety is a systems issue – simulation team training and incident reporting are an important indispensable part of it.