Initial test of emergency procedure performance in temporary negative pressure isolation by using simulation technologies.
OBJECTIVE
The potential of infectious disease spread in diseases such as tuberculosis, infectious disease epidemic such as avian flu and the threat of terrorism with agents capable of airborne transmission have focused attention on the need for increased surge capacity for patient isolation. Total negative pressure isolation using portable bioisolation tents may provide a solution. The study assesses the ability of health care workers to perform emergency procedures in this environment.


METHODS
Physician performance in completing predetermined critical actions in 5 emergency care scenarios inside and outside of a bioisolation tent ("setting") was studied in an advanced medical simulation laboratory. By design, no pretraining of subjects about total negative pressure isolation use occurred. Impact of setting on time to completion of predetermined critical actions was the primary outcome measured. Secondary variables studied included impact of study groups, scenarios, and run order (inside or outside of the tent first). Subjective assessments were obtained through questionnaires.


RESULTS
Four teams of 3 physicians completed 5 emergency patient care scenarios during 2 4-hour sessions. Mean time to completion of critical actions was for tent/no tent 298 seconds/284 seconds (P=.69, one way ANOVA), respectively. Mean time to completion for first versus second performance of a scenario in the crossover design was 338 versus 243 (P=.01). The mean score for self-assessed performance did not differ according to setting.


CONCLUSIONS
The ability of physicians naive to the total negative pressure isolation environment to perform emergency medical critical actions was not significantly degraded by a simulated bioisolation tent patient care environment.
Davis
Mark A
MA
Institute for International Emergency Medicine and Health, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Landesman
Roxanne
R
Tadmor
Boaz
B
Hopmeier
Michael
M
Shenhar
Gili
G
Barker
Tobias
T
Pozner
Charles N
CN
Binstadt
Emily S
ES
Nelson
Stephen
S
Look
Rodney
R
Shubina
Maria
M
Walls
Ron M
RM
D000704:Analysis of Variance; D001274:Atmospheric Pressure; D002983:Clinical Competence; D018592:Cross-Over Studies; D004190:Disasters; D004635:Emergency Medicine / Q000193:education* / Q000295:instrumentation; D004867:Equipment Design; D006801:Humans; D017053:Infection Control / Q000295:instrumentation / Q000592:standards; D007318:Inservice Training; D007396:Internship and Residency; D010356:Patient Isolation / Q000295:instrumentation / Q000592:standards*; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis
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