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PubMed1996

A survey of advanced trauma life-support training for trainees in acute surgical specialties.

There have been few published data describing the demand for and amount of Advanced Trauma Life Support (ATLS) training received by trainees in acute surgical specialties. We undertook a survey on aspects of ATLS training, questioning all senior house officers in accident and emergency (A & E) medicine, general surgery and orthopaedic surgery in the west of Scotland in January 1995. More general surgical trainees were ATLS trained than orthopaedic or A & E trainees. Ninety-seven per cent of respondents felt ATLS was essential training for FRCS. There were few problems gaining study leave for the courses, but concern was expressed regarding the long waiting lists. ATLS training is therefore thought to be essential for surgical trainees, and the number of ATLS courses needs to be increased to cope with the demand.

Attitude of Health Personnel↗
PubMed1997

Community life support training: does it attract the right people?

Members of the public recruited by means of a local newspaper campaign for basic life support instruction by mass training sessions. Six hundred and seventy-two were trained and a random sample of 241 completed a questionnaire on their attitudes and willingness to attempt cardiopulmonary resuscitation in an emergency. At the end of the course almost all (99%) approved the concept of community training and 198 (82%) believed themselves capable of saving a life using the techniques they had been taught. Sixty-seven percent of respondents were related to someone with a heart problem and more than 97% expressed willingness to resuscitate a relative. Half would be willing to attempt resuscitation in unpleasant circumstances, but only a quarter thought that they might do so if the casualty had vomited. The campaign was successful in recruiting members of the public related to those with a higher risk of cardiac arrest and producing life supporters who intended to use their skills, should they be required.

Adolescent↗
PubMed2000

Pediatric advanced life support training of pediatricians in New Jersey: cause for concern?

OBJECTIVE: The Pediatric Advanced Life Support (PALS) course teaches the fundamental basics for pediatric emergency care, and it is recommended that all physicians, nurses, and paramedics who care for children complete training and refresher courses on a regular basis. The purpose of this study was to determine how many pediatricians in general practice participated in PALS courses in the first 3 years since its introduction in New Jersey. METHODS: A questionnaire was sent to all PALS training centers in New Jersey that administered the course from 1990 through 1993. The questionnaire was designed to determine the number of physicians trained; their specialty, and their practice setting. The questionnaire and follow-up telephone interviews focused on the perceptions of course coordinators as to why primary care pediatricians did or did not take PALS courses, and their recommendations for improving pediatrician participation. RESULTS: Two PALS training centers provided courses for only 1 year and did not maintain records of their students. A total of 3652 individuals completed training in the remaining 11 centers. Only 649 of these students were physicians. The largest groups of physicians who completed training were Emergency Medicine physicians (248) and Pediatric residents (175). Forty-two students were pediatricians in general office-based practice, which represents a crude rate of only 0.81% of New Jersey American Academy of Pediatrics (AAP) members. Training center coordinators offered several opinions for these findings. CONCLUSIONS: The majority of those students who participated in PALS training were not physicians. Pediatricians in general office practice accounted for a small percentage of those who could have participated. Further research should be conducted to determine attitudes toward PALS training and the barriers that exist to the office-based pediatrician participating in PALS training.

Child↗
PubMed1978

Life-support training in high-density population centers.

Death and disability from ischemic heart disease, trauma, and other medical emergencies may be reduced significantly by developing an Emergency Medical Services system based on training for the nonmedical population in basic life-support skills; this is particularly appropriate in high-density population centers where professional response time is complicated by confestion and traffic. A pilot project in New York City, which designed and implemented a first-response capability for medical emergencies in corporations, using employees in a system congruent with the fire warden plans in effect, was completed in May 1977. To obtain an initial assessment of the medical impact of such training and the effectiveness of such a medical emergency response system during the pilot phase, The Regional Emergency Medical Services Council of New York City, Inc., obtained reports from the 24 participating corporations on all reported medical and surgical emergencies occurring in the working environment. The authors conclude that this approach to development of a first response-capability can provide an effective community base for an effective Emergency Medical Services system in urban areas.

Adult↗
PubMed1994

Effect of advanced cardiac life-support training in rural, community hospitals.

OBJECTIVES: To define the effectiveness of training personnel in rural, community hospitals in advanced cardiac life support (ACLS) and the changes that result in the process and quality of care to patients with ischemic heart disease that can be attributed to participation by team members in an ACLS course. DESIGN: Case-controlled, retrospective abstraction of hospital records of 869 consecutive patients with ischemic heart disease, who were admitted during the year preceding and the year following the ACLS course. SETTING: Seven rural, community hospitals in Wisconsin. SUBJECTS: Physicians, nurses, and other critical care staff (others). INTERVENTIONS: Training in ACLS using 12 3-hr sessions in an interdisciplinary format by a multidisciplinary faculty. MEASUREMENTS AND MAIN RESULTS: Rates of successful attainment of the terminal behavior objectives by physicians and nurses were 84.0% and 78.8%, respectively. Less than 50% of others achieved a satisfactory level of competence. Performance on an examination of cognitive ability improved significantly for all groups (p < .005 for nurses; p < .05 for physicians). Enhancement of knowledge base and integrative skills occurred in all areas of designated ACLS content. Difficulty remained apparent relative to the pharmacologic effects of epinephrine and atropine. No statistically significant deterioration in didactic knowledge base could be detected 1 to 2 yrs after completion of the ACLS course. Slight deterioration in intubation and defibrillation skills occurred in < 3 months after completion of the course. Substantial costs were encumbered by the hospitals, despite the free training provided to the institutions. After ACLS training had been given, overall mortality rates decreased from 17.4% to 13.4% (p < .05). A pooled estimate of the decrease in the mortality rate was 1.4 +/- 3.8%/quarter. Across the entire spectrum of severity of illness, the probabilities for survival increased at a given severity of illness following completion of the course (p = .06). When extremes of severity of illness were excluded from the analysis, the differences in probability for survival over the midrange of severity were statistically significant (p < .05). CONCLUSIONS: Training directed to the entire team likely to participate in the provision of ACLS in the community hospital favorably affects the overall practice of ACLS and the survival rate of patients with ischemic heart disease.

Aged↗
PubMed1993

Enhancement of children's self-esteem through social support training for youth sport coaches.

The authors examined the impact of coaching behaviors on players' self-enhancement processes. Eight baseball coaches attended a preseason workshop designed to increase their supportiveness and instructional effectiveness. Behavioral guidelines were presented and modeled. A no-treatment control group had 10 coaches. Boys (N = 152) in both groups were interviewed pre- and postseason. Trained coaches differed from controls in player-perceived behaviors in accordance with the guidelines. They were evaluated more positively by their players, their players had more fun, and their teams exhibited a higher level of attraction among players, despite the fact that their teams did not differ from controls in won-lost records. Consistent with a self-esteem enhancement model, findings showed that boys with low self-esteem who played for the trained coaches exhibited significant increases in general self-esteem; low self-esteem youngsters in the control group did not.

Adult↗
PubMed1997

Poor correlation of mouth-to-mouth ventilation skills after basic life support training and 6 months later.

The purpose of the present study was to evaluate the cardiopulmonary resuscitation (CPR) skills of medical students after a 2-h basic life support class (n = 129) and 6 months later (n = 113). Mean +/- SD written test score decreased from 6.4 +/- 0.7 to 6.2 +/- 0.8 (P = 0.03). Mean +/- SD breaths delivered before CPR decreased from 2.9 +/- 0.6 to 2.2 +/- 1.2 (P = 0.0001), ventilation rate increased from 12.2 +/- 1.9 to 14.3 +/- 5.0 breaths/min (P = 0.0001), tidal volume increased from 0.75 +/- 0.2 to 0.8 +/- 0.31 (P = 0.11), minute ventilation from 9.1 +/- 2.6 to 10.8 +/- 3.61 (P = 0.0001), and stomach inflation from 13 +/- 22 to 18 +/- 27% of CPR breaths (P = 0.11). Mean +/- SD chest compression/min decreased from 56 +/- 9 to 54 +/- 12 (P = 0.34), depth of chest compression increased from 41 +/- 6 to 46 +/- 7 mm (P = 0.0001), hands held incorrectly on the thorax increased from 22 +/- 27 to 23 +/- 32% (P = 0.59), and leaning on the chest from 4 +/- 12 to 18 +/- 28% of compressions (P < 0.0001). In summary, ventilation skills were unpredictable; there was only a 5% chance that a given student would achieve the same mouth-to-mouth ventilation performance in both the BLS class and 6 months later. Despite the respiratory mechanics of the CPR manikin which prevented stomach inflation much better than an unconscious patient with an unprotected airway, stomach inflation occurred repeatedly. Teachers of basic life support classes need to consider the respiratory mechanics of the CPR manikin being used to assure clinically realistic and appropriate mouth-to-mouth ventilation skills.

Adult↗
PubMed1992

The association of advanced life support training and decreased per capita trauma death rates: an analysis of 12,417 trauma deaths.

This study identified a number of significant predictors of per capita county trauma mortality rates: rurality, percentage nonwhite population, percentage unemployment, and Advanced Life Support (ALS) versus Basic Life Support (BLS) status. Of these, ALS versus BLS status is not only the most significant independent predictor, it is the only predictor readily amenable to change. The aspects of ALS clearly associated with decreased trauma death rates should be identified and, if possible, undergo widespread implementation.

Adult↗