Articles: critical-care.
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During high-fidelity simulations in the Critical Care Air Transport (CCAT) Advanced course, we identified a high frequency of insulin medication errors and sought strategies to reduce them using a human factors approach. ⋯ This study demonstrates the value of descriptive error analysis during high-fidelity simulation using audio-video review and effective risk mitigation using training and cognitive aids to reduce medication errors in CCAT. As demonstrated by post-intervention observations, a human factors approach successfully reduced decision-based error by using didactic training and cognitive aids and reduced skill-based error using hands-on training. We recommend the development of a Clinical Practice Guideline including an SSI protocol, guidelines for a 2-person check, and a cognitive aid for implementation with deployed CCAT teams. Furthermore, hands-on training for insulin preparation and administration should be incorporated into home station sustainment training to reduced medication errors in the operational environment.
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The Critical Care Air Transport (CCAT) Advanced Course utilizes fully immersive high-fidelity simulations to assess personnel readiness for deployment. This study aims to determine whether simple well-defined demographic identifiers can be used to predict CCAT students' performance at CCAT Advanced. ⋯ Our main result is that simple readily available metrics available to unit commanders can identify those members at risk for poor performance at CCAT Advanced readiness training; these include RNs with rank Major or above, RTs with rank Senior Airman, and RTs who engage in unit sustainment training less often than monthly. Finally, MD specialties which are nontraditional for CCAT have significantly lower CCAT Advanced passing rates, reserve/guard students did not outperform active duty students, there was no difference in the performance between different RN specialties, and for MD and RN students' previous deployment experience was a strong predictor of passing.
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A successful working relationship between the Military Medical Officer (MMO) and Commanding Officer (CO) is critical for mission success. However, there is a gap in the professional literature outlining evidence-based practices for teaching early career MMOs how to strategically develop this relationship. The purpose of this study, therefore, was to explore our participants' perceptions of how MMOs can foster a positive and productive working relationship with the CO. ⋯ Communication, presence, and role fulfillment are essential elements for optimizing the MMO-CO working relationship. Learning these roles during medical school may enhance early career physicians' mission readiness.
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Naval operations rely on Corpsmen to provide combat casualty and primary care services to the fleet, including the Fleet Marine Force. The United States faces new conflict challenges with near-peer adversaries in the modern geo-political climate. Corpsmen will likely require new skills to care for patients in anti-access/area-denial regions and transport patients across expansive maritime environments. To help them adapt to these new challenges, we evaluated the need for Corpsmen curriculum reform at the III Marine Expeditionary Force (MEF). This model begins with a general needs assessment to target gaps between the current and ideal approaches identified by the stakeholders. ⋯ The discussion emphasizes the importance of contextual factors in developing a Corpsmen-based curriculum, focusing on themes such as Training, Performance, and Impact. Tasking highlights critical areas for curriculum development, especially in educating Corpsmen as Educators, Leaders, and First-responder Caregivers. Gaps in training were identified, particularly in Non-trauma and First-responder Care, impacting Corpsmen's ability to handle diseases and injuries independently. Drawing parallels with Community Health Worker and Physician Extender (PE) education paradigms, we suggest adapting existing models to meet Corpsmen's needs. The discussion also delves into the history of employing PEs and developing training programs within the Naval Service. We propose a combination of Community Health Worker and PE-based education to enhance Corpsmen's competency and job satisfaction while facilitating their transition to civilian health care. Standardized curricula and training programs could improve skill transferability and readiness for Corpsmen in both military and civilian settings.
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Both quantitative and qualitative aspects of muscle status significantly impact clinical outcomes in critically ill patients. Comprehensive monitoring of baseline muscle status and its changes is crucial for risk stratification and management optimization. However, repeatable and accessible indicators are lacking. We hypothesized that creatinine production rate (CPR) could serve as an integrative indicator of skeletal muscle status. ⋯ CPR represents an integrative indicator of skeletal muscle status in critically ill patients, reflecting both quantitative and qualitative aspects. Monitoring CPR in the ICU may facilitate risk stratification and optimization of patient care.