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\"What is the relationship between education and natural disasters? Can education play a role in ameliorating and mitigating them, preparing people in how to respond, and even helping to prevent them? If so, how? Drawing on research carried out in a number of different countries, including Australia, China, India, Japan, the UK and the USA, the contributors consider the role of education in relation to natural disasters. The case studies expand conceptual and empirical understandings of the understudied relationship between education and natural disasters, uncover the potential and the limitations of education for mitigating, responding to, and potentially preventing, natural disasters. The contributors also consider the extent to which so-called natural disasters, such as mudslides caused by deforestation and flooding areas built on known flood plains, are linked to human behaviour and how education can impact on these\"-- Provided by publisher.

HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) is an evidence-based framework that supports emergency nurses to optimise safety, quality, and patient experience of care. HIRAID® was the intervention in a modified stepped-wedge cluster randomised controlled trial (SW-cRCT) in a convenience sample of 29 Australian emergency departments (Australian New Zealand Clinical Trials Registry: ACTRN12621001456842). The aim of this paper is to describe the methods and processes used to develop and deliver a theory-informed education program to support behaviour change during HIRAID® implementation. The HIRAID® education program was developed using: i) existing HIRAID® research using the Behaviour Change Wheel and Theoretical Domains Framework to identify enablers and barriers to HIRAID® use; ii) application of educational pedagogical theoretical frameworks (constructive alignment, backwards design, scaffolded learning); Bloom's taxonomy of educational objectives, and active and collaborative learning; iii) Australian standards related to safety, quality, clinical governance, and emergency nursing; and iv) behavioural diagnostic data from study sites (n = 670 nurses). HIRAID® education program consisted of HIRAID® Provider and Instructor Courses and was delivered using a 'train-the-trainer' model. Fifteen HIRAID® Instructor Courses were held from February 2021 to March 2023 with 162 participants, and at November 2023 over 1300 emergency nurses had completed the HIRAID® Provider Course. The theory-informed approach to the HIRAID® education program enabled development of a structured program and delivery in the dynamic and complex emergency department environment. The approach reported in this paper provides a blueprint for other researchers aiming to change behaviours in complex settings.

\"All adults who are responsible for the care of children should be prepared for disasters. This guide provides caregivers, educators, and program staff with preparation tips and step-by-step responses to disaster situations that are based on national standards and best practices to keep children safe\"-- Provided by publisher.

This study analyzed outcomes associated with nurse-performed ultrasound (US)–guided intravenous (IV) placement compared to standard of care (SOC) palpation IV technique on poor vascular access patients. This was a randomized, prospective single-site study. Phase 1 involved education/training of a cohort of nurses to perform US-guided IVs. This consisted of a didactic module and hands-on requirement of 10 proctored functional IVs on live subjects. Phase 2 involved patient enrollment. emergency department patients meeting strict criteria of poor access were randomized to US-guided or SOC palpation arm. A functional IV placed by a study nurse was considered successful. Unsuccessful placement implied the study nurse failed, and a rescue IV was attempted. Time to IV placement was the total time required to obtain a functional IV and, if needed, a rescue IV. A total of 124 subjects were enrolled; 63 were randomized to the US-guided arm, and 61 were randomized into the SOC arm; 2 patients were excluded, leaving 59 patients. Success rate was 76% for the US-guided arm and 56% for the SOC arm (P=.02). Compared to the SOC arm, the odds ratio for success for the US-guided arm was 2.52 (95% confidence interval, 1.09-5.92). The mean time to IV placement for the US-guided arm was 15.8 and 20.7 minutes for the SOC arm (P=.75). In difficult access patients, nurses were more successful in obtaining IV access using US guidance than palpation SOC technique. Lengthier placement times were observed more frequently when the SOC IV technique was used.

\"The rousing, captivating story of a Black physician, her career in medicine, and the deep inequities that still exist in the U.S. healthcare system Growing up in Brooklyn, New York, it never occurred to Uché Blackstock and her twin sister, Oni, that they would be anything but physicians. In the 1980s, their mother headed an organization of Black women physicians, and for years the girls watched these fiercely intelligent women in white coats tend to their patients and neighbors, host community health fairs, cure ills, and save lives. What Dr. Uché Blackstock did not understand as a child-or learn about at Harvard Medical School, where she and her sister had followed in their mother's footsteps, making them the first Black mother-daughter legacies from the school-were the profound and long-standing systemic inequities that mean just 2 percent of all U.S. physicians today are Black women; the racist practices and policies that ensure Black Americans have far worse health outcomes than any other group in the country; and the flawed system that endangers the well-being of communities like theirs. As an ER physician, and later as a professor in academic medicine, Dr. Blackstock became profoundly aware of the systemic barriers that Black patients and physicians continue to face. Legacy is a journey through the critical intersection of racism and healthcare. At once a searing indictment of our healthcare system, a generational family memoir, and a call to action, Legacy is Dr. Blackstock's odyssey from child to medical student to practicing physician-to finally seizing her own power as a health equity advocate against the backdrop of the pandemic and the Black Lives Matter movement\"-- Provided by publisher.

Thoracentesis is a common clinical procedure, but the optimal training method remains unclear. To investigate whether a novel teaching program combining e-learning and simulation-based self-directed, spaced learning (intervention) is non-inferior to a traditional instructor-led massed training approach (control). In this multicenter randomized, non-inferiority study, emergency physicians unable to perform thoracentesis were randomized to either the intervention group (e-learning and three self-directed simulation sessions over two weeks) or a control group (single three-hour instructor-led simulation course). Skill acquisition and retention were evaluated at two weeks and three months by blinded assessors. The primary outcome was passing rate at two weeks post training, with a non-inferiority margin of 10 %. Secondary outcome was passing rate at three months. A total of 63 participants (intervention group: 29, control group: 34) were included. The majority were female (72 % in the intervention group vs. 50 % in the control group). At two weeks, passing rates were 66 % (19/29) in intervention group and 65 % (18/26) control, with a risk difference of 0.8 %, CI-95 %: −30 %;30 %, p = 0.96. At three months, skill retention was significantly higher in the intervention group (92 %) compared to the control group (73 %), with a risk difference of 19 % CI-95 %: 10 %;30 %, p < 0.001. A novel training approach with self-directed spaced learning for thoracentesis resulted in comparable skill acquisition when comparing to traditional instructor-led massed training although the study was underpowered to demonstrate non-inferiority. Self-directed spaced learning was associated with superior for skill retention compared to instructor-led massed training after three months.

Immersive virtual reality (iVR) has emerged as a training method to prepare medical first responders (MFRs) for mass casualty incidents (MCIs) and disasters in a resource-efficient, flexible, and safe manner. However, systematic evaluations and validations of potential performance indicators for virtual MCI training are still lacking. This study aimed to investigate whether different performance indicators based on visual attention, triage performance, and information transmission can be effectively extended to MCI training in iVR by testing if they can discriminate between different levels of expertise. Furthermore, the study examined the extent to which such objective indicators correlate with subjective performance assessments. A total of 76 participants (mean age 25.54, SD 6.01 y; 45/76, 59% male) with different medical expertise (MFRs: paramedics and emergency physicians; non-MFRs: medical students, in-hospital nurses, and other physicians) participated in 5 virtual MCI scenarios of varying complexity in a randomized order. Tasks involved assessing the situation, triaging virtual patients, and transmitting relevant information to a control center. Performance indicators included eye-tracking-based visual attention, triage accuracy, triage speed, information transmission efficiency, and self-assessment of performance. Expertise was determined based on the occupational group (39/76, 51% MFRs vs 37/76, 49% non-MFRs) and a knowledge test with patient vignettes. Triage accuracy (d=0.48), triage speed (d=0.42), and information transmission efficiency (d=1.13) differentiated significantly between MFRs and non-MFRs. In addition, higher triage accuracy was significantly associated with higher triage knowledge test scores (Spearman ρ=0.40). Visual attention was not significantly associated with expertise. Furthermore, subjective performance was not correlated with any other performance indicator. iVR-based MCI scenarios proved to be a valuable tool for assessing the performance of MFRs. The results suggest that iVR could be integrated into current MCI training curricula to provide frequent, objective, and potentially (partly) automated performance assessments in a controlled environment. In particular, performance indicators, such as triage accuracy, triage speed, and information transmission efficiency, capture multiple aspects of performance and are recommended for integration. While the examined visual attention indicators did not function as valid performance indicators in this study, future research could further explore visual attention in MCI training and examine other indicators, such as holistic gaze patterns. Overall, the results underscore the importance of integrating objective indicators to enhance trainers' feedback and provide trainees with guidance on evaluating and reflecting on their own performance.

Peripheral intravenous (PIV) access is a common procedure in the emergency department (ED). However, conditions such as obesity and hypovolemia can often make access difficult by the traditional landmark technique. The use of ultrasonography has improved the success of PIV placement in this setting. A novel Ultrasound (US)-Guided PIV Access program was initiated in our ED to train emergency nurses, U.S. Navy corpsmen, and physicians. This was an observational study of emergency providers performing US-guided PIV placement. After a training session, all ED providers began utilizing the US for difficult intravenous access patients. All complications, location of access, and previous experience level were recorded. The choice of a transverse, longitudinal, or a combination approach was also recorded. We did not observe significant differences in ability with US-guided PIV access when comparing success rates between emergency physicians, nurses, and technicians (p = 0.13). In the novice user, a transverse or a novel combination of a transverse and longitudinal method appears to be the most successful. ED physicians, nurses, and corpsmen can successfully place US-guided peripheral catheters for venous access. Developing a training program for emergency providers in US-guided venous cannulation is feasible and safe.

The coronavirus disease (COVID-19) pandemic necessitated alternative methods to ensure the continuity of medical education. Our study explores the efficacy and acceptability of a digital continuous medical education initiative for medical residents during this challenging period. From September to December 2020, 47 out of 60 enrolled trainee doctors participated in this innovative digital Continuous Medical Education (CME) approach. We utilized the Script Concordance Test to bolster clinical reasoning skills. Three simulation scenarios, namely Advanced Trauma Life Support (ATLS), Advanced Life Support (ALS), and European Paediatric Life Support (EPLS), were transformed into interactive online sessions via Zoom™. Participant feedback was also collected through a survey. Consistent Script Concordance Testing (SCT) scores among participants indicated the effectiveness of the online training module. Feedback suggested a broad acceptance of this novel training approach. However, discrepancies observed between formative SCT scores, and summative Multiple-Choice Questions (MCQ) assessments highlighted areas for potential refinement. Our findings showcase the resilience and adaptability of medical education amidst challenges like the global pandemic. The success of methodologies such as SCT, endorsed by prestigious bodies like the European Resuscitation Council and the American Heart Association, suggests their potential in preparing health care professionals for emergent situations. This research offers valuable insights for shaping future online CME strategies.

Resuscitative thoracotomy (RT) is a critical, time-sensitive procedure that may be performed by emergency medicine (EM) physicians. The left anterolateral thoracotomy (LAT) is the technique traditionally used in the United States. However, its limited exposure may hinder effective intervention. The modified bilateral clamshell thoracotomy (MCT), developed by Barts Health NHS Trust clinicians at London's Air Ambulance (LAA), offers greater exposure and may be more suitable for EM physicians. This study aimed to determine the optimal RT technique for EM physicians while also assessing technical challenges, procedural concerns, and provider preferences. EM staff and resident physicians from a level one trauma center participated after receiving standardized training on both MCT and LAT techniques. Participants were randomized to perform each technique on live tissue swine with a novel penetrating injury model. Success was defined as heart delivery from the pericardial sac, cardiac hemorrhage control, and full thoracic aorta occlusion. The primary outcome was time to successful RT completion. Secondary outcomes included procedural success rates, adequate exposure, hemorrhage control, cross-clamping success, iatrogenic injuries, and participant feedback. Ten EM physicians completed the study. There was not a significant difference in time to successful completion of the MCT and LAT techniques (585 s vs 664.9 s, hazard ratio 0.63, CI 95 % 0.27 to 1.49). Success rates were similar (80 % vs 70 %, difference − 10 %, 95 % CI -50.6 % to 30.6 %). Provider procedure preference favored the MCT over the LAT (100 % vs 0 %). Though participants were more experienced with the LAT, the MCT performed as well and was universally preferred. The MCT may be the ideal technique for EM physicians confronting a penetrating thoracic injury with pulselessness or extremis in the absence of a surgical provider.