Julian Stella

Ovarian torsion: 10‐year perspective

Objective:  To define the presenting symptoms and clinical progress of surgically proven cases of ovarian torsion presenting to a tertiary womens hospital.

What a disaster?! Assessing utility of simulated disaster exercise and educational process for improving hospital preparedness.

INTRODUCTION Recent events have brought disaster medicine into the public focus. Both the government and communities expect hospitals to be prepared to cope with all types of emergencies. Disaster simulations are the traditional method of testing hospital disaster plans, but a recent, comprehensive, literature review failed to find any substantial scientific data proving the benefit of these resource- and time-consuming exercises. OBJECTIVES The objective of this study was to test the hypothesis that an audiovisual presentation of the hospital disaster plans followed by a simulated disaster exercise and debriefing improved staff knowledge, confidence, and hospital preparedness for disasters. METHODS A survey of 50 members of the medical, nursing, and administrative staff were chosen from a pool of approximately 170 people likely to be in a position of responsibility in the event of a disaster. The pre-intervention survey tested factual knowledge as well as perceptions about individual and departmental preparedness. Post-intervention, the same 50 staff members were asked to repeat the survey, which included additional questions establishing their involvement in the exercise. RESULTS There were 50 pre-intervention tests and 42 post-intervention tests. The intervention resulted in a significant improvement in test pass rate: pre-intervention pass rate 9/50 (18%, 95% confidence interval ((CI) = 16.1-19.9%) versus post-intervention pass rate 21/42 (50%, 95% CI = 42.4-57.6%; chi-square test, p = 0.002). Emergency department (ED) staff had a stronger baseline knowledge than non-ED staff: ED pre-test mean value for scores = 12.1 versus non-ED scores of 6.2 (difference 5.9, 95% CI = 3.3-8.4); t-test, p <0.001. Those that attended > or = 1 component had a greater increase in mean scores: increase in mean attendees was 5.6, versus the scores of non-attendees of 2.7 (difference 2.9, 95% CI = 1.0-4.9); t-test, p = 0.004. There was no significant increase in the general perception of preparedness. However, the majority of those surveyed described the exercise of benefit to themselves (53.7%, 95% CI = 45.5-61.8%) and their department (63.2%, 95% CI = 53.5-72.8%). CONCLUSIONS The disaster exercise and educational process had the greatest benefit for individuals and departments involved directly. The intervention also prompted enterprise-wide review, and an upgrade of disaster plans at departmental levels. Pre-intervention knowledge scores were poor. Post-intervention knowledge base remained suboptimal, despite a statistically significant improvement. This study supports the widely held belief that disaster simulation is a worthwhile exercise, but more must be done. More time and resources must be dedicated to the increasingly important field of hospital disaster preparedness.

Use of ultrasound to facilitate accurate femoral nerve block in the emergency department

Objective:  To compare the accuracy of ultrasound (US)‐assisted femoral nerve blocks (FNB) with the fascial pop (FP) technique, examining the rates of success and complications.

Implementation and performance evaluation of an emergency department primary practitioner physiotherapy service for patients with musculoskeletal conditions

The study aims to describe the implementation of a primary practitioner physiotherapy service within a large regional ED and to evaluate its impact on waiting time and length of stay.

Video of a disaster drill is effective in educating registrars on the hospital disaster plan.

Objective:  To test whether an instructional video of edited footage from a disaster drill is effective in educating registrars on the hospital disaster plan.

Evaluation of emergency medicine trainees' ability to use transport equipment.

Objective:  To assess the skills of advanced emergency medicine trainees in the use of commonly used transport equipment and to determine what teaching has been undertaken and what level of confidence trainees have in their ability to use the equipment tested.