Teamwork in emergency medical services

Emergency medical care is delivered by highly trained and motivated individuals working in groups. In some cases, these groups function as teams, but their teamwork has been poorly studied and rarely is the result of focused training. Medical outcome traditionally is described using patient parameters and often is related to the economics of care delivery. Errors in medical care typically are blamed on individuals and occasionally on system problems. Teams and teamwork, although a major part of the medical delivery system, usually are not included in training, outcome measures, or rigorous quality improvement efforts.

This article outlines issues involved in the analysis of medical errors as they relate to measures of individual and team performance and introduces concepts related to emergency care teamwork and team training. Through analogy with aviation analysis of errors and corrective training, medical care similarly is being analyzed and error-reduction efforts studied and implemented. The potential benefit of teamwork training for EMS personnel, including air medical crews, is discussed.     

Defining Components of Team Leadership and Membership in Prehospital Emergency Medical Services

Background: Teamwork is critical for patient and provider safety in high-stakes environments, including the setting of prehospital emergency medical services (EMS). Objective: We sought to describe the components of team leadership and team membership on a single patient call where multiple EMS providers are present. Methods: We conducted a two-day focus group with nine subject matter experts in crew resource management (CRM) and EMS using a structured nominal group technique (NGT). The specific question posed to the group was, “What are the specific components of team leadership and team membership on a single patient call where multiple EMS providers are present?” After round-robin submission of ideas and in-depth discussion of the meaning of each component, participants voted on the most important components of team leadership and team membership. Results: Through the NGT process, we identified eight components of team leadership: a) creates an action plan; b) communicates; c) receives, processes, verifies, and prioritizes information; d) reconciles incongruent information; e) demonstrates confidence, compassion, maturity, command presence, and trustworthiness; f) takes charge; g) is accountable for team actions and outcomes; and h) assesses the situation and resources and modifies the plan. The eight essential components of team membership identified included: a) demonstrates followership, b) maintains situational awareness, c) demonstrates appreciative inquiry, d) does not freelance, e) is an active listener, f) accurately performs tasks in a timely manner, g) is safety conscious and advocates for safety at all times, and h) leaves ego and rank at the door. Conclusions: This study used a highly structured qualitative technique and subject matter experts to identify components of teamwork essential for prehospital EMS providers. These findings and may be used to help inform the development of future EMS training and assessment initiatives.     

部分型母源性１６单亲二体型与均称型胎儿生长受限

【目的】应用人类全基因组单核苷酸多态性芯片（ＳＮＰ ａｒｒａｙ）探讨特发性均称型胎儿生长受限（Ｓｙｍｍｅｔｒｉｃ ＦＧＲ）的病因。【方法】对血清学筛查唐氏综合征高风险且系列超声检查发现２０周前已出现胎儿生长受限征象的３６例孕妇行羊水胎儿细胞Ｇ显带染色体核型分析,其中核型正常的３４例孕妇,应用人类全基因组ＳＮＰａｒｒａｙ对羊水中的胎儿细胞及父母双方的外周血细胞进行遗传学分析。 【结果】 发现２例部分型母源性１６单亲二体型（ｍＵＰＤ １６）,１例位点为１６ｐ１２．２－ｐ１３．３,长度约为２１．０Ｍｂｐ和１６ｑ２４．１－２４．３,长度约为４．１ Ｍｂｐ;另１例位点为１６ｑ２１－ｑ２４．３,长度约为２４．１ Ｍｂｐ。【结论】 部分型母源性１６单亲二体型可能与均称型胎儿生长受限的发生有关,影响胎儿生长发育的基因有可能定位于１６ｑ２４。     

空间站睡眠区不同送风角度下的流场仿真分析

目的通过分析空间站睡眠区内部流场,为睡眠区通风设计提供参考,并保障航天员睡眠的舒适与安全。方法参照实验样品建立三维空间站睡眠区的仿真模型,利用计算流体力学仿真软件Fluent对其内部流场、温度场以及浓度场进行了数值计算分析。同时,本文探究了不同送风角度对睡眠区内部气流组织的影响,选取头部速度比例、空气龄以及吹风感作为指标进行评价。结果送风角度为水平向下-10°时最佳,不仅能够保证乘员的安全需要,而且能够满足热舒适性要求。结论仿真方法可以用于睡眠区后续的计算分析;送风角度对于睡眠区内部流场有较大影响,水平向下-10°最优。     

舰艇人员职业人格与战斗士气关系的研究

目的 研究舰艇人员职业人格与战斗士气的关系,探讨舰艇人员职业人格对战斗士气的影响.方法 对488名舰艇人员的职业人格和战斗士气进行了量表测量,将所得数据与常模比较,进行t检验、相关分析、单因素方差分析和多重比较分析.结果 (1)舰艇人员职业人格测验的各因子分均显著高于常模分.(2)舰艇人员的责任感、进取心、聪慧性、宜人性、内外向和情绪稳定性分数与战斗士气总分及各因子分显著相关.(3)在职业人格的责任感、进取心、聪慧性、宜人性、内外向和情绪稳定性因子上,不同人格分数等级的艇员其战斗士气差异有统计学意义.结论 舰艇人员的责任感、进取心、聪慧性、宜人性、内外向和情绪稳定性与战斗士气密切相关,提示舰艇人员的职业人格会影响战斗士气.     

畸变产物耳声发射在船员听力调查中的应用

目的 探讨畸变产物耳声发射(DPOAE)在船员噪声性听力损伤诊断中的应用价值.方法 100名船员(其中噪声性耳聋组52人,听阈正常组48人)为实验组,另外50名听力正常人为对照组.对2组人员进行纯音听力测定和DPOAE检测,比较2组的听阈值和DPOAE幅值及引出率.结果 噪声性聋组与对照组比较,所有频区听阚值差异均有统计学意义(P<0.05),噪声性聋组DPOAE幅值和引出率较对照组明显下降(P<0.05),随着接触噪声工龄的延长,DPOAE引出率逐渐下降(P<0.05).听阈正常组DPOAE幅值和引出率也较对照组明显下降(P<0.05).结论 船员早期噪声性听力损伤纯音听阈可能正常,应用DPOAE可用于船员噪声性听力损伤的早期诊断和评估.     

新型舰艇远航食品研究

目的 采用含气调理食品加工新技术,研制软罐头新品种和组合包装形式,提高食品的可接受性和使用的方便性.方法 建立含气调理食品加工实验室,制定软罐头新产品工艺配方、杀菌公式并进行试制,对软罐头材料(ET/BOPA/AL/CPP)进行评价.结果 试制了60个新品种,组成6人一餐份组合式包装,共10个食谱;软罐头材料的指标达到设计要求.结论 软罐头新品种和6人一餐份组合包装营养构成合理,可接受性好,使用方便.     

Implementing checklists in the operating room

Checklists have established themselves as a key safety process in the operating room environment. This paper describes the background and context of how checklists have evolved in medicine. It also highlights ongoing challenges with particular attention to the importance of nontechnical skills or human factors training with relation to checklist design, testing and implementation and ongoing coaching.     

Significance of time awake for predicting pilots' fatigue on short‐haul flights: implications for flight duty time regulations

European regulations restrict the duration of the maximum daily flight duty period for pilots as a function of the duty start time and the number of scheduled flights. However, late duty end times that may include long times awake are not specifically regulated. In this study, fatigue levels in pilots finishing their duty late at night (00:00–01:59 hour) were analysed and compared with pilots starting their duty early (05:00–06:59 hour). Fatigue levels of 40 commercial short‐haul pilots were studied during a total of 188 flight duty periods, of which 87 started early and 22 finished late. Pilots used a small handheld computer to maintain a duty and sleep log, and to indicate fatigue levels immediately after each flight. Sleep logs were checked with actigraphy. Pilots on late‐finishing flight duty periods were more fatigued at the end of their duty than pilots on early‐starting flight duty periods, despite the fact that preceding sleep duration was longer by 1.1 h. Linear mixed‐model regression identified time awake as a preeminent factor predicting fatigue. Workload had a minor effect. Pilots on late‐finishing flight duty periods were awake longer by an average of 5.5 h (6.6 versus 1.1 h) before commencing their duty than pilots who started early in the morning. Late‐finishing flights were associated with long times awake at a time when the circadian system stops promoting alertness, and an increased, previously underestimated fatigue risk. Based on these findings, flight duty limitations should consider not only duty start time, but also the time of the final landing.