W Zink1, A Völkl, E Martin, A Gries. 1. Klinik für Anaesthesiologie, Ruprecht-Karls-Universität Heidelberg, Germany.
Abstract
BACKGROUND: Introducing a chest tube is a routine emergency procedure in trauma victims. Emergency coniotomy or establishing an intraosseous access, however, are not often necessary, but in individual cases these techniques can be decisive for patient survival. The aim of this study was to present and evaluate a model for teaching these techniques, since the majority of emergency physicians do not have adequate experience in this area. METHODS: In November 2001 our institution organized the first workshop on "Invasive emergency techniques (INTECH): chest tube, emergency coniotomy, and intraosseous access" in collaboration with the Institute of Anatomy II of the University of Heidelberg. After presenting basic anatomy and also particular features of the relevant regions of the body, the techniques of introducing a thoracic drainage, performing a coniotomy, and establishing an intraosseous access were presented. Video demonstrations as well as practical exercises on corpses followed the theoretical part of the course. At the end of each lesson, the participants were asked anonymously why they took part in the workshop and about their previous experience with these emergency techniques in written form and also asked to assess the didactic concept of the workshop (scale 1=very good up to 6=very poor). RESULTS: Of the 86 participants, 66 completed the questionnaire (77%) and 40 of the participants had been working as emergency physicians for 6.5+/-6.3 years (range 0.5-22) with approx. 13+/-8 (range 4-30) interventions per month. The most common reason for participating was lack of practice (52%): prior to the workshop, 98% of the emergency physicians had never performed a coniotomy, 85% had never established an intraosseous access, and 28% had never introduced a chest tube in an emergency setting. The theoretical parts of the course received the following scores: "Basic anatomy" 2.3+/-0.8, "coniotomy" 1.7+/-0.7, "intraosseous access" 1.5+/-0.5, and "thoracic drainage " 1.7+/-0.7. In the practical part they were given the scores: "coniotomy" 1.9+/-0.7, and "intraosseous access" and "thoracic drainage" both 1.6+/-0.8. Finally, the "positioning demonstrations" were given scores of 1.7+/-0.8 and the practical exercises as a whole 1.4+/-0.7. CONCLUSIONS: These results show that even emergency physicians with many years of practice have too little knowledge about thoracic drainage, even though it is required in the management of trauma victims. Over 80% of the emergency physicians have no experience with certain other emergency measures recommended as lifesaving in individual cases. Despite the criticism that the participants of the workshop were a selected study group, these numbers seem to reflect reality: Institutions with emergency medicine departments have reported considerable and serious deficiencies in providing emergency care to patients with polytrauma. These gaps could be closed by implementing practice-oriented workshops in collaboration with anatomical institutes. As these institutes use fixated corpses for training purposes, the differences in working with living patients would have to be made clear. In spite of this minor restriction, practical exercises could counteract the deficits in the care of emergency patients and should therefore be integrated into a future educational concept on a long-term basis.
BACKGROUND: Introducing a chest tube is a routine emergency procedure in trauma victims. Emergency coniotomy or establishing an intraosseous access, however, are not often necessary, but in individual cases these techniques can be decisive for patient survival. The aim of this study was to present and evaluate a model for teaching these techniques, since the majority of emergency physicians do not have adequate experience in this area. METHODS: In November 2001 our institution organized the first workshop on "Invasive emergency techniques (INTECH): chest tube, emergency coniotomy, and intraosseous access" in collaboration with the Institute of Anatomy II of the University of Heidelberg. After presenting basic anatomy and also particular features of the relevant regions of the body, the techniques of introducing a thoracic drainage, performing a coniotomy, and establishing an intraosseous access were presented. Video demonstrations as well as practical exercises on corpses followed the theoretical part of the course. At the end of each lesson, the participants were asked anonymously why they took part in the workshop and about their previous experience with these emergency techniques in written form and also asked to assess the didactic concept of the workshop (scale 1=very good up to 6=very poor). RESULTS: Of the 86 participants, 66 completed the questionnaire (77%) and 40 of the participants had been working as emergency physicians for 6.5+/-6.3 years (range 0.5-22) with approx. 13+/-8 (range 4-30) interventions per month. The most common reason for participating was lack of practice (52%): prior to the workshop, 98% of the emergency physicians had never performed a coniotomy, 85% had never established an intraosseous access, and 28% had never introduced a chest tube in an emergency setting. The theoretical parts of the course received the following scores: "Basic anatomy" 2.3+/-0.8, "coniotomy" 1.7+/-0.7, "intraosseous access" 1.5+/-0.5, and "thoracic drainage " 1.7+/-0.7. In the practical part they were given the scores: "coniotomy" 1.9+/-0.7, and "intraosseous access" and "thoracic drainage" both 1.6+/-0.8. Finally, the "positioning demonstrations" were given scores of 1.7+/-0.8 and the practical exercises as a whole 1.4+/-0.7. CONCLUSIONS: These results show that even emergency physicians with many years of practice have too little knowledge about thoracic drainage, even though it is required in the management of trauma victims. Over 80% of the emergency physicians have no experience with certain other emergency measures recommended as lifesaving in individual cases. Despite the criticism that the participants of the workshop were a selected study group, these numbers seem to reflect reality: Institutions with emergency medicine departments have reported considerable and serious deficiencies in providing emergency care to patients with polytrauma. These gaps could be closed by implementing practice-oriented workshops in collaboration with anatomical institutes. As these institutes use fixated corpses for training purposes, the differences in working with living patients would have to be made clear. In spite of this minor restriction, practical exercises could counteract the deficits in the care of emergency patients and should therefore be integrated into a future educational concept on a long-term basis.