- Email: [email protected]
TF1 “From Head To Toe!” Developing Competency in Adult Trauma Resuscitations
Research Forum Abstracts used included cane, baseball bat, keys, liquor bottle, necklace, purse strap, knife, kitchen utensils, broken plate, broken glassware, broken cabinet door, flashlight, and roach spray. The most common injuries were bruises (58%), lacerations (17%), abrasions (16%), and fractures (4%). Bruises in these victims were most commonly caused by blunt assault with hand/fist (49%) or both hand/fist and feet/knees (16%). Abrasions were most commonly caused by blunt assault with hand/fist (56%), both hand/fist and feet/knees (15%), and with objects (15%). Lacerations were most commonly caused by blunt assault with objects (32%), hand/fist (29%), and penetrating assault (18%). Fractures were most commonly caused by blunt assault with both hands/ fist and feet/knees (43%), or only the feet/knees (29%). Conclusion: Victims of physical elder abuse with visible injuries are rarely assaulted with a weapon, but are most commonly struck with the hand/fist or the feet/knees of their assailant(s). When an inanimate object was used, it was most commonly a household object and commonly came from the kitchen. Future research of abuserelated injury patterns is critically needed to assist health care providers in identifying suspicious injuries and protecting vulnerable older adults.
EMF4
Characterization of Emergency Presentations at Regional Referral Hospital in a Low-Income Country
Bisanzo M, Saboda K, Nambaziira R, Wangoda R, Zziwa G, Dreifuss B, Hammerstedt H, Periyanayagam U, Tugumisirize F, Rice B, Global Emergency Care Collaborative/UMASS, Worcester, MA; University of Arizona, Tuscon, AZ; Global Emergency Care Collaborative, Boston, MA; Masaka Regional Referral Hospital, Masaka, Uganda; Idaho Emergency Physician, Boise, ID; Brigham and Women’s Hospital, Boston, MA; New York University, New York, NY
Study Objectives: Emergency care remains largely underdeveloped and underfunded in low-income countries. There is little information about the epidemiology of emergency presentations in these countries, which leaves educators and policy makers with little guidance when developing educational programs and allocating resources toward emergency care. Furthermore, lack of pre-intervention outcome data complicates assessment of the impact that newly introduced emergency care programs have on important patient oriented outcomes. This study documents the epidemiology and outcome of patients with emergent illnesses and injuries at a Ugandan Regional Referral Hospital. Methods: This was a prospective cohort of acutely ill and injured patients presenting for care between November 1, 2014 and February 28, 2015 at Masaka Regional Referral Hospital in central Uganda. A database of emergent patient visits was created and data was collected on all patients presenting to the hospital emergency department and on all patients under twelve years of age who reported to the outpatient clinic. A standardized protocol that had previously been developed in Uganda was used to follow-up all patients three days after their index visit. Patients who remained in the hospital three days after presentation were followed up on the ward. Those who were discharged initially or were discharged from ward before the third day had follow-up attempted via phone call. Results: A total of 8,549 patient presentations occurred during the study period, of which 4,554 were triaged to the emergency department (ED). Of patients triaged to the ED 18.5% were under 5 years, 14.3% were between 5-18, and 7.9% were over 65 years old. Fifty patients (0.6%) either expired in the ED or were dead on arrival. Providers tested 25.8% of ED patients for malaria (5.5% were positive). Less than 1% of all patients were tested for HIV. Trauma accounted for 22.9% of all ED visits and 63.6% of traumatic deaths (21 of 33) occurred in the ED. Three-day mortality for the ED cohort was 3.5% for all patients and 3.2% for trauma patients. Three-day mortality for children under five was 3.1%. Three-day follow-up rates improved from 53.8% to 72.8% over the first four months of the program. Conclusion: This regional referral hospital emergently manages a mixture of communicable and non-communicable diseases. There is a very high acuity as evidenced by in-ED mortality rate and three-day mortality rate, but overall mortality rate was lower than expected. Using a standardized protocol allowed for three-day follow-up in approximately 70% of patients over the study period.
TF1
“From Head To Toe!” Developing Competency in Adult Trauma Resuscitations
Stobart-Gallagher M/Einstein Medical Center Philadelphia, Philadelphia, PA
Introduction: At our institution, trauma is run through a combined cooperative of the emergency medicine (EM) and surgical residency programs. A formal curriculum is
S156 Annals of Emergency Medicine
currently lacking for the PGY1 EM residents rotating on this service, who are then expected to become proficient team leaders in combined resuscitations. Competency is defined as the ability to do something successfully or efficiently. ACGME currently requires that residents demonstrate “competency in adult trauma resuscitations” as a key index procedure prior to graduation. Therefore, the primary learners are first year residents rotating through the trauma service to these introduce concepts early. The curriculum will also be available to surgical residents as secondary learners if desired. Study Objectives: The primary goal is for the learner to achieve competency in adult trauma resuscitations: by identifying injuries, perceiving when life-saving interventions are required and acting upon it. The secondary objective is to evaluate if initiating this curriculum will have an impact on in-training exam (ITE) scores in the trauma subcategory. Methods: This curriculum is designed as a self-guided, self-paced instructional system based in a modular asynchronous format. The entire curriculum will be available using Google Classroom. Each learner will perform a pre-test assessment prior to initiating the curriculum; administration will have the ability to review. This will allow our program to monitor the learner’s progress. The modules use interactive power point presentations using a visual diagnosis theme. The educational content is derived from both written emergency medicine and trauma texts as well as published on-line FOAM Ed (Free Open Access Medical Education). These FOAM Ed resources encompass evidence-based Web sites, emergency medicine specific training Web sites, and You Tube videos produced specifically for education. Each module will include self-assessment questions with answers provided and at the end of the rotation, each resident will receive a direct clinical skills evaluation using a provided checklist during a live trauma resuscitation. Using multiple assessment techniques will provide the resident with a well-rounded evaluation of their performance early in residency. To evaluate the impact of the curriculum, ITE scores before and after initiation will be compared. Conclusion: It is essential for emergency medicine residents to have competency in adult trauma resuscitations for daily use as a well-rounded physician. As junior residents, they are placed on a designated trauma service for 4 weeks and therefore, a self-guided modular curriculum allowing them to work at their own pace while participating in resuscitations on a daily basis will not only introduce the material, but also aid in retention and hopefully in reproduction as senior residents.
TF2
The Core Curriculum of Medical Toxicology Walsh SJ/Einstein Medical Center, Huntingdon Valley, PA
Introduction: The core content of medical toxicology was established by toxicology experts from emergency medicine, pediatrics, and preventative medicine. It outlines the content and organization of the medical toxicology certification and cognitive expertise examinations. These topics contained in the core content are essential to the unsupervised practice of medical toxicology. Study Objectives: To provide medical toxicology fellows instruction on the core content of medical toxicology, and prepare them for the unsupervised practice of medical toxicology. An additional objective of this curriculum to to prepare fellows for the American Board of Emergency Medicine’s medical toxicology qualifying examination. Methods: This project utilizes a variety of teaching methods to provide the fellow with instruction on the core content of medical toxicology. The methods used in this novel curriculum include self-directed reading sessions, “traditional” lectures, “TEDTalk-” style lectures, small-group discussions, journal club, peer-to-peer teaching, highfidelity medical simulation, and site visits. The primary textbooks used include Goldfrank’s Toxicologic Emergencies (Ninth Edition), Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient (First Edition), and Clinical Environmental Health and Toxic Exposures (Second Edition). The curriculum includes 16 quizzes that assess the fellow’s comprehension of the core content. Additionally, a 200-question in-training examination will be administered annually prior to the formal in-training examination administered by medical toxicology fellowship programs in May. Conclusion: The anticipated goals of instituting a formalized curriculum in the core content of medical toxicology at our institution include preparing fellows for the unsupervised practice of medical toxicology as well as a 100% pass rate on the medical toxicology qualifying examination. Surrogate goals include demonstrable clinical improvement from the first to second year of training, as well as improved performance on the medical toxicology in-training examination. Considering that the curriculum has been instituted in the last year, formal results are pending.
Volume 66, no. 4s : October 2015
EMF4
Characterization of Emergency Presentations at Regional Referral Hospital in a Low-Income Country
Bisanzo M, Saboda K, Nambaziira R, Wangoda R, Zziwa G, Dreifuss B, Hammerstedt H, Periyanayagam U, Tugumisirize F, Rice B, Global Emergency Care Collaborative/UMASS, Worcester, MA; University of Arizona, Tuscon, AZ; Global Emergency Care Collaborative, Boston, MA; Masaka Regional Referral Hospital, Masaka, Uganda; Idaho Emergency Physician, Boise, ID; Brigham and Women’s Hospital, Boston, MA; New York University, New York, NY
Study Objectives: Emergency care remains largely underdeveloped and underfunded in low-income countries. There is little information about the epidemiology of emergency presentations in these countries, which leaves educators and policy makers with little guidance when developing educational programs and allocating resources toward emergency care. Furthermore, lack of pre-intervention outcome data complicates assessment of the impact that newly introduced emergency care programs have on important patient oriented outcomes. This study documents the epidemiology and outcome of patients with emergent illnesses and injuries at a Ugandan Regional Referral Hospital. Methods: This was a prospective cohort of acutely ill and injured patients presenting for care between November 1, 2014 and February 28, 2015 at Masaka Regional Referral Hospital in central Uganda. A database of emergent patient visits was created and data was collected on all patients presenting to the hospital emergency department and on all patients under twelve years of age who reported to the outpatient clinic. A standardized protocol that had previously been developed in Uganda was used to follow-up all patients three days after their index visit. Patients who remained in the hospital three days after presentation were followed up on the ward. Those who were discharged initially or were discharged from ward before the third day had follow-up attempted via phone call. Results: A total of 8,549 patient presentations occurred during the study period, of which 4,554 were triaged to the emergency department (ED). Of patients triaged to the ED 18.5% were under 5 years, 14.3% were between 5-18, and 7.9% were over 65 years old. Fifty patients (0.6%) either expired in the ED or were dead on arrival. Providers tested 25.8% of ED patients for malaria (5.5% were positive). Less than 1% of all patients were tested for HIV. Trauma accounted for 22.9% of all ED visits and 63.6% of traumatic deaths (21 of 33) occurred in the ED. Three-day mortality for the ED cohort was 3.5% for all patients and 3.2% for trauma patients. Three-day mortality for children under five was 3.1%. Three-day follow-up rates improved from 53.8% to 72.8% over the first four months of the program. Conclusion: This regional referral hospital emergently manages a mixture of communicable and non-communicable diseases. There is a very high acuity as evidenced by in-ED mortality rate and three-day mortality rate, but overall mortality rate was lower than expected. Using a standardized protocol allowed for three-day follow-up in approximately 70% of patients over the study period.
TF1
“From Head To Toe!” Developing Competency in Adult Trauma Resuscitations
Stobart-Gallagher M/Einstein Medical Center Philadelphia, Philadelphia, PA
Introduction: At our institution, trauma is run through a combined cooperative of the emergency medicine (EM) and surgical residency programs. A formal curriculum is
S156 Annals of Emergency Medicine
currently lacking for the PGY1 EM residents rotating on this service, who are then expected to become proficient team leaders in combined resuscitations. Competency is defined as the ability to do something successfully or efficiently. ACGME currently requires that residents demonstrate “competency in adult trauma resuscitations” as a key index procedure prior to graduation. Therefore, the primary learners are first year residents rotating through the trauma service to these introduce concepts early. The curriculum will also be available to surgical residents as secondary learners if desired. Study Objectives: The primary goal is for the learner to achieve competency in adult trauma resuscitations: by identifying injuries, perceiving when life-saving interventions are required and acting upon it. The secondary objective is to evaluate if initiating this curriculum will have an impact on in-training exam (ITE) scores in the trauma subcategory. Methods: This curriculum is designed as a self-guided, self-paced instructional system based in a modular asynchronous format. The entire curriculum will be available using Google Classroom. Each learner will perform a pre-test assessment prior to initiating the curriculum; administration will have the ability to review. This will allow our program to monitor the learner’s progress. The modules use interactive power point presentations using a visual diagnosis theme. The educational content is derived from both written emergency medicine and trauma texts as well as published on-line FOAM Ed (Free Open Access Medical Education). These FOAM Ed resources encompass evidence-based Web sites, emergency medicine specific training Web sites, and You Tube videos produced specifically for education. Each module will include self-assessment questions with answers provided and at the end of the rotation, each resident will receive a direct clinical skills evaluation using a provided checklist during a live trauma resuscitation. Using multiple assessment techniques will provide the resident with a well-rounded evaluation of their performance early in residency. To evaluate the impact of the curriculum, ITE scores before and after initiation will be compared. Conclusion: It is essential for emergency medicine residents to have competency in adult trauma resuscitations for daily use as a well-rounded physician. As junior residents, they are placed on a designated trauma service for 4 weeks and therefore, a self-guided modular curriculum allowing them to work at their own pace while participating in resuscitations on a daily basis will not only introduce the material, but also aid in retention and hopefully in reproduction as senior residents.
TF2
The Core Curriculum of Medical Toxicology Walsh SJ/Einstein Medical Center, Huntingdon Valley, PA
Introduction: The core content of medical toxicology was established by toxicology experts from emergency medicine, pediatrics, and preventative medicine. It outlines the content and organization of the medical toxicology certification and cognitive expertise examinations. These topics contained in the core content are essential to the unsupervised practice of medical toxicology. Study Objectives: To provide medical toxicology fellows instruction on the core content of medical toxicology, and prepare them for the unsupervised practice of medical toxicology. An additional objective of this curriculum to to prepare fellows for the American Board of Emergency Medicine’s medical toxicology qualifying examination. Methods: This project utilizes a variety of teaching methods to provide the fellow with instruction on the core content of medical toxicology. The methods used in this novel curriculum include self-directed reading sessions, “traditional” lectures, “TEDTalk-” style lectures, small-group discussions, journal club, peer-to-peer teaching, highfidelity medical simulation, and site visits. The primary textbooks used include Goldfrank’s Toxicologic Emergencies (Ninth Edition), Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient (First Edition), and Clinical Environmental Health and Toxic Exposures (Second Edition). The curriculum includes 16 quizzes that assess the fellow’s comprehension of the core content. Additionally, a 200-question in-training examination will be administered annually prior to the formal in-training examination administered by medical toxicology fellowship programs in May. Conclusion: The anticipated goals of instituting a formalized curriculum in the core content of medical toxicology at our institution include preparing fellows for the unsupervised practice of medical toxicology as well as a 100% pass rate on the medical toxicology qualifying examination. Surrogate goals include demonstrable clinical improvement from the first to second year of training, as well as improved performance on the medical toxicology in-training examination. Considering that the curriculum has been instituted in the last year, formal results are pending.
Volume 66, no. 4s : October 2015