SS9.4 Evaluation of practice in emergency skills in European Accident & Emergency departments. How is the performance of non Medical staff assessed ? Dr Eric REVUE, MD Dr N FLACKE VORDOS, Dr MIRANDA J, Dr BRUNET J-M Accident & Emergency Department, SAMU 28 Victor Jousselin’s Hospital, Dreux, France 4th European congress on Emergency Medicine 6th October 2006

2 Nonspecialized nursing personnel cannot perform the complex tasks of CPR occasional providers,including physicians, have poor retention of CPR skills, As nurses often recognize patients with a cardiac arrest, they should be trained and be able to perform CPR adequately Is there any evidence that the management of a cardiac arrest should be better in-hospital ? Management of in-hospital cardiac arrest is now considered as a hospital quality indicator the survival rate of an in hospital cardiac arrest after CPR is only < 17 % (3% outside of the Intensive Care Unit) it does not exceed survival rates of out-of-hospital cardiac arrest !! In hospital cardiac arrest. Weil MH, Fries M. Crit care Med 2005;33: A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy. A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy. Zafari AM, Zarter SK, Heggen V, Wilson P, Taylor RA, Reddy K, Backscheider AG, Dudley SC Jr. J Am Coll Cardiol Aug 18;44(4):853-4.Zafari AMZarter SK Heggen VWilson PTaylor RAReddy KBackscheider AGDudley SC JrJ Am Coll Cardiol Aug 18;44(4):853-4.

3 Emergency Skills in Europe ? Questionnaire return by 368/520 European A&E Dept Austria,Belgium,Denmark,Finland,France,Germany,Greece, Italy,Netherlands,Portugal,Spain,Sweden, Switzerland,UK Is there a Teaching Centre for emergency skills ?Is there a Teaching Centre for emergency skills ? Does the non medical staff receive training in emergency skills ?Does the non medical staff receive training in emergency skills ? In what manner is the staff trained? Theory ? Practice ?In what manner is the staff trained? Theory ? Practice ? Is the staff of your department particularly trained in taking care of CPR, intubation, polytrauma, acute distress ?...Is the staff of your department particularly trained in taking care of CPR, intubation, polytrauma, acute distress ?... Is the training of staff done regularly?Is the training of staff done regularly? Is there a procedure (or algorithm) on the taking care of a in-hospital vital distress?Is there a procedure (or algorithm) on the taking care of a in-hospital vital distress? Do you think that the realization of emergency skills should be properly defined and organized through continuous training?Do you think that the realization of emergency skills should be properly defined and organized through continuous training?

4 39,7% 79,2% 45,8 % 42,8% 46,4% 80,2% 32,8 %

5 Emergency skills in European A&ED More than 95% of participants answered that the acquisition of emergency skills should be properly defined and organized for A&E and ALS vehicle staff on the basis of continuous training.

6 Training Program : review of literature skills and knowledge decline over time ! Hamilton R: Nurses’ knowledge and skill retention following cardiopulmonary resuscitation training – a review of literature. Journal of Advanced Nursing 2005;51(3), Hamilton R: Nurses’ knowledge and skill retention following cardiopulmonary resuscitation training – a review of literature. Journal of Advanced Nursing 2005;51(3), Cummings RO, Chamberlain D, Hazinski MF, Nadkarni V, Klooeck W, Kramer E. Recommended guidelines for reviewing, reporting and conducting research on in-hospital resuscitation: the “Ulstein style”. American Heart Association.Circulation 1997;95: Cummings RO, Chamberlain D, Hazinski MF, Nadkarni V, Klooeck W, Kramer E. Recommended guidelines for reviewing, reporting and conducting research on in-hospital resuscitation: the “Ulstein style”. American Heart Association.Circulation 1997;95: O’Steen DS, Kee CC, Minick MP.The retention of advances cardiac life support knowledge among registered nurses. J Nurs Sraff Dev 1996; 12:66-72 O’Steen DS, Kee CC, Minick MP.The retention of advances cardiac life support knowledge among registered nurses. J Nurs Sraff Dev 1996; 12:66-72 Leah V, Coast TJ. In- hospital resuscitation what should be teaching ? Resuscitation 1999;41: Leah V, Coast TJ. In- hospital resuscitation what should be teaching ? Resuscitation 1999;41: Lynch B, Einspruch E, Nichol G. Effectiveness of a 30-min CPR self instruction program for lay responders: a controlled randomized study. Resuscitation 67 (2005) Lynch B, Einspruch E, Nichol G. Effectiveness of a 30-min CPR self instruction program for lay responders: a controlled randomized study. Resuscitation 67 (2005) guidelines, clinical algorithm clinical competence and performance continuous education resident teacher- training program CPR training equipment : self-study and practice: e- learning, video methods of training resuscitation :mannequin- based simulations number : every 6 months duration of working group:1- 2 H Learning gains between the pre- and post- tests Assessment : satisfaction questionnaires, cross-sectional evaluation of knowledge and skills of personnel : before and 1 year after the start of the training course

7Conclusions The training of the European Emergency Team is highly variable The training of the European Emergency Team is highly variable 85 % of participants believe that staff is not adequately trained 85 % of participants believe that staff is not adequately trained A procedure of management of vital distress exists in 42 % of the European ED A procedure of management of vital distress exists in 42 % of the European ED a majority of ED are motivated to train their team to emergency skills a majority of ED are motivated to train their team to emergency skills We should analyze the effects of training course by the EMT on reduction of incidence and mortality from in-hospital emergencies We should analyze the effects of training course by the EMT on reduction of incidence and mortality from in-hospital emergencies Further research is needed into how the European A&ED can adequately develop a collaborative learning program of emergency skills. Further research is needed into how the European A&ED can adequately develop a collaborative learning program of emergency skills.

8 Thank you