Journal of Emergency Medicine, Trauma and Acute Care - 2 - International Conference in Emergency Medicine and Public Health-Qatar Proceedings, October 2016

Introduction: MVC accident is one of the major cause of mortality and morbidity in children. In 2010, road traffic accidents were the major cause of 228 deaths and 568 major injuries in Qatar.(4). Children in cars who are not restrained, have a great risk of being injured. Our aim from this study is to check parents' awareness of the important of using child restrain (car seat) and reasons behind preventing them from not using it.

Objectives: Check parents' awareness of using car seat in Qatar. And do they know related information about installing car seat in their car and how to use it? Methods: A prospective cross sectional qualitative survey study was conducted at PEC Alsadd of Hamad Medical Corporation from (May 1st 2015 to October 31st 2015). A total number of 212 sample questionnaires were filled by parents whom visited PEC because of their children illness. All have been given survey questionnaire to fill while they are in waiting area. Then research assistants collect filled questionnaires.

Results: Distribution of Male: female is 40.6% (86) and 59.4% (126) 70.8% (150) have car seat and 29.2% (62) have no car seat. The Qatari: non-Qatari population is 10% (21): 90% (121) in the study. Among the Qatari respondent, 85.7% (18) have car seat and 14.3% (3) have no car seats. 12% of cases were children with chronic illness. 84% parents have 4wd cars. 80% of parents have university certification, though only 65% of them who have car seat. And 31% of them who use always car seats.

Conclusion: This study showed the importance of doing more parents education about the importance of using car seats.

Background: Cranial computed tomography (CT) scan is a commonly performed neuroimaging prior to lumbar puncture (LP) in children with suspected meningitis to rule out intracranial hypertension or space occupying lesions. The purpose of this study was to assess the accuracy of physicians' prediction of CT abnormal cerebral findings in pediatric meningitis.

Subjects and methods: A prospective observational study design was performed over a 12-month period. Eligible patients were admitted to the Emergency Department (ED) where a structured questionnaire was filled independently by two physicians before undergoing cranial CT scan and prior to LP.

Results: In this study, 72 patients met the inclusion criteria with a mean age of 7.04 ± 3.38 years. The mean physicians' prediction score of abnormal CT findings was 6.0 ± 3.0 vs. 2.48 ± 2.01 of no abnormalities (difference 3.5 ± 1.0 (95% CI: 1.5, 5.5; p = 0.001). Relative risk of CT abnormalities associated with decreased level of consciousness was 7.33 (95% CI: 1.5, 33.67), Glasgow coma scale was 23.3 (95% CI: 7.7, 70.7), and abnormal posture was 8.9 (95% CI: 1.9, 41.7). Apart from mild headache (2.8%), vomiting (2.8%), dizziness (4.2%), no serious complications related to LP procedure have been reported.

Conclusion: Physician's clinical decision could predict absence of abnormal findings on cranial CT scan before LP in children with suspected meningitis. Our results suggest that LP could be performed with avoidance of CT scanning of the head in pediatric meningitis provided the presence of normal consciousness level, Glasgow coma scale ≥ 13 and normal neurologic examination.

Endoscopic third ventriculostomy (ETV) is a common minimal-invasive neurosurgical procedure with well-documented complications. We report the case of a 6-year-old female child who underwent ETV, external ventricular drainage (EVD) catheter insertion and biopsy for a tumour arising from the pineal gland causing obstructive hydrocephalus and raised intra cranial pressure (ICP). Vital signs were stable pre-operatively and anaesthesia was maintained using propofol infusion. The operative bed was irrigated with normal saline under pressure after ETV, which immediately resulted in sinus tachycardia intra-operatively and central neurogenic hyperventilation (CNH) with respiratory alkalosis and transient lactic acidosis an hour after the surgery. Only few case reports have been reported in adults with CNH and respiratory alkalosis. Hyperventilation resulting in lactic acidosis is a well-known entity but lactic acidosis following CNH due to transient hypothalamic dysfunction after endoscopic third ventriculostomy has not been reported previously. Our patient was managed with benzodiazepines and oxygen delivered by a rebreathing mask, which resulted in complete recovery within 12 hours. This case highlights the importance of ICP measurement and monitoring and assessment of the type, volume and pressure of fluid used for brain irrigation during ETV, to prevent complications. ETV may cause intra-operative hemodynamic disturbances such as tachycardia, hypertension and hyperthermia followed by post-operative transient hypothalamic dysfunction and CSF acidosis leading to sequelae of CNH with acute respiratory alkalosis and transient lactic acidosis. We emphasize the importance of ICP monitoring during neuroendoscopic procedures, as an inadvertant rise in ICP appears to be the central factor leading to the various ill effects encountered both intra and post-operatively. Moreover, although normal saline has been the irrigation fluid of choice for neurosurgeons, a multitude of laboratory studies suggest it being less ideal and it might be prudent to look into alternatives, namely artificial CSF and Ringer's Lactate.

Introduction: Proteinuria in burn patients is common, and it could be associated with acute kidney injury (AKI) with bad outcomes. We evaluated the incidences, outcomes, characteristics and determinants of proteinuria as a biomarker and its influence on AKI and outcomes in burn patients.

Methods: This retrospective study was carried out on a group of patients with burn injuries admitted though Emergency Department to burn unit of Hamad General Hospital during a five-year period. Positive urine analysis (R/M) readings were defined as mild ( ±  or 1+) or heavy ( ≥  2+) proteinuria, and AKI was diagnosed and staged according to the Risk, Injury, Failure, Loss, End Stage (RIFLE) classification system. Patient characteristics, management and outcomes were evaluated as well for associations with proteinuria.

Results: Of the selected admitted patients to the burn unit during the study period (n = 249), 86 (34.5%) were classified as having proteinuria. In the patients whose total burn surface areas (TBSA) were > 30% (n = 50), 37 patients (74%) had proteinuria and 27 of these patients (72.9%) met AKI criteria. No patients without proteinuria developed AKI. Intensive care unit (ICU) mortality rates were 1%, 16 % and 30% (P <  0.001) in the groups with no, mild and heavy proteinuria, respectively.

Conclusions: We observed a high prevalence of proteinuria in patients with severe burns (>30% TBSA). Severely burned patients with proteinuria had a high risk of developing AKI and a poor prognosis for survival. This suggests that proteinuria should be used as a biomarker for identifying burn patients at risk of developing AKI.

Background: Ambulance services in Saudi Arabia are organised through the Red Crescent, the organisation that is responsible for ensuring adequate ambulance service for all communities in Riyadh. Paramedics are the first responders among the healthcare providers responsible for saving patients' live outside hospital settings. Work-related stress is a serious problem that affects the health and well-being of employees as well as the productivity of organisations. Stress has a huge impact on the performance and productivity of emergency health workers.

Objective: To explored the factors associated with stress and identified the effects of stress and burnout on Red Crescent ambulance workers.

Methods: This study explored the factors associated with stress and identified the effects of stress and burnout on Red Crescent ambulance workers. A cross-sectional study was conducted among ambulance workers at Saudi Red Crescent centers across four regions of the Ar-Riyadh province of Saudi Arabia. Questions about sociodemographic information, working conditions, level of burnout, and job stress were included in the questionnaires.

Results: Study sample responses regarding personal burnout level. The arithmetic mean, standard deviation, frequencies, and the responses (in %) to statements describing the personal burnout level are shown in Table 14.

Conclusion: Stress level and work-related burnout was a leading cause of poor performance and resulted in the inability of employees to perform assigned tasks.

Background/aims: Prognosis for patients with cirrhosis admitted to medical intensive care unit (MICU) is poor. The objective of this study was to assess the predictors for hospital mortality and admission of cirrhotic patients to MICU in Qatar.

Materials and methods: We conducted a retrospective cohort study of consecutive adult cirrhotic medical-ICU patients whom hospitalized from 2007 through 2012 to Hamad General Hospital-Qatar. We compared them to cirrhotic patients who admitted to medical wards during same period of time. All data were recorded and analyzed with respect to demographic parameters, clinical features and laboratory as well as radiology characteristics on day one of admission to MICU. Cirrhosis diagnosis was established either with a liver biopsy or the combination of physical, laboratory and radiologic findings. Predictors of mortality were defined by logistic regression analysis.

Results: The cohort comprised 109 cirrhotic MICU patients, 86.2% were males and their mean age ± SD = 51.6 ± 11.5. MICU-cirrhotic had longer hospital length of stay (LoS) than medical wards-cirrhotic (both for survivors and non-survivors). Mortality was higher for the MICU-cirrhotic group than medical wards group (27 (24.8%) deaths vs. 12 (5.3%) deaths, respectively, p = 0.001). In multivariate logistic regression analyses, older age >60 years (p = 0.04), APATCH-II score (p = 0.001) and MELD score (p = 0.02) were independent predicting factors for overall mortality. Furthermore, admission with severe hepatic encephalopathy, upper gastrointestinal bleeding and SOFA score were independent predicting factors for MICU admission.

Conclusion: Severe hepatic encephalopathy, upper gastrointestinal bleeding and SOFA score predict MICU admission of cirrhotic patients. Among MICU cirrhotic patients, older age, APATCH-II score and MELD score predict mortality.

Introduction: Use of ECMO has been shown to be an acceptable intervention for patients with respiratory failure refractory to optimal ventilator management. As experience with ECMO grows the indications for its use are also expanding.

Case: Our patient is a 20-year-old female who was found lying on the roadside after being hit by a moving vehicle. She was rushed into the trauma room where she was intubated for low Glasgow coma scale, CT head, chest, abdomen and pelvis showed severe head injury with possible diffuse axonal injury, blunt chest injury, blunt abdominal injury with splenic injury was admitted under the care of TICU, repeat CT head showed multiple hemorrhagic contusions. Ventriculostomy with ICP monitoring device was inserted. She was aggressively treated for severe brain injury by neuroprotective interventions. Over following days had severe ARDS. Despite appropriate antibiotic therapy, lung protective ventilation, HFOV, patient had severe hypoxemia. Patient was evaluated for ECMO despite her severe neurological injury with ICH, possible poor neurological recovery. After discussions involving primary team, ECMO was considered initiated using femoral-Jugular cannulation. No systemic anticoagulation was used. Tracheostomy was placed and was weaned off ECMO over next week. ECMO decannulation was performed on 7th day. Patient had multiple interventions by the orthopaedic, weaned off decannulation in 18 days and tracheostomy was closed. Patient had neurological recovery was discharged to the rehabilitation.

Discussion: ECMO is an established salvage therapy for profound respiratory failure and the need for systemic anticoagulation has often contraindicated its use in patients with severe intracranial pathology, and in particular, recent hemorrhage like our patient. Advances in circuit and oxygenator technology have challenged this concern and cases of ECMO support with intracranial pathology have been recently described. Risks and benefits of systemic anticoagulation need to be considered during ECMO support.

Conclusions: Extracorporeal membrane oxygenation is an acceptable therapy for patients with profound respiratory failure secondary to trauma and intracranial pathology contraindicating the use of systemic anticoagulation.

Background: Anticipating falls in the Emergency Department is a very challenging task as it's often the most unpredictable setting. Fall risk assessment tools used in inpatient units do not adequately capture the risk factors present in patients presenting to the Emergency Department. The MORSE scale is implemented only at a latter phase of patient admission to the inpatient unit. The purpose of this study is to develop and implement a simple, fast and effective tool to identify the risk of fall at the triage.

Methods: We designed a tool to identify patients at risk of fall. We planned to randomly assign 200 patients equally in to the test and control arm. We created the Fall Risk Assessment Tool specifically for the use in the Emergency Department. The study was conducted at Hamad General Hospital, Emergency Department triage area. If a patient was identified as at risk for fall, a Fall risk sticker was pasted on top of the ED paper to indicate the risk. Any patient identified as at risk was re-evaluated throughout their stay in the Emergency Department.

Results: Hundred patients identified as at risk for fall at the initial triage were re-evaluated for fall risk using standard MORSE scale. Reassessment showed 67% of the cases identified at the initial triage come under high risk category using Morse scale, 31% had moderate risk and only 2% had low risk. There were no reported cases of fall. Hundred patients, excluded as low risk for fall at the initial triage were re-evaluated for risk for fall using the standard Morse Scale. Reassessment showed 98% of the excluded patient's came in the low risk category and 2% had moderate risk as per the MORSE scale.

Conclusion: Our tool was as safe as and effective in predicting falls as the MORSE Scale.

The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is an emerging infection that causes severe illness in patients, particularly those with comorbidities; and has a high mortality rate. Healthcare associated outbreaks have been reported across the Gulf region and the Republic of Korea. While there have been cases of MERS-CoV in Qatar, no healthcare associated outbreaks have been reported. The aim of this paper is to give a description of the infection prevention and control protocol implemented by the Primary Health Care Corporation to manage suspected or probable cases of MERS-CoV in the primary health care setting. This paper focuses on Alshahania Health Centre which is considered to be a high risk area due to its proximity to the camel shelter and race track. In order to gain an understanding of how patients visiting the health center are managed. Data was collected through a visit to the Alshahania Health Centre which included discussions with staff and documentation review. Our findings show that the infection control protocol implemented at Alshahania Health Centre is very robust and ensures that staff has clearly defined responsibilities in the management of a suspected case of MERS-CoV. A dedicated Isolation Team ensures a timely risk assessment is carried out which then triggers actions that reduce the risk of exposure to both patients and staff. The experience at Alshahania Health Centre also demonstrates that good communication and leadership are important factors in order to successfully embed infection control in clinical practice and prevent healthcare associated outbreaks of MERS-CoV.

Introduction: Despite the potential benefits of EMR systems to improve patient care, many attempts at implementing them have failed or met with high levels of user resistance, Implementations that failed have often been those with which the users were dissatisfied with the system.

Aim: The aim of this study is to assess the satisfaction of both the physicians and nurses with the newly introduced EMR system at the Emergency Department of Al Wakra Hospital, to find out if there was a significant difference between physician and nurse's perception to the system. And to determine which of the individual attributes of EMR were related to physician and nurse satisfaction.

Methods: Study design: cross sectional survey four month after of the introduction of the EMR system (Cerner) we surveyed 40 physicians and 96 nurses at the Emergency Department of Al Wakra Hospital. The questionnaire assessed: perceptions regarding EMR ease of use; concerns about impact upon work, and quality of patient care.

Results: The total satisfaction rate was 88.2%. 72.5% among the physicians and 94.5% among the nurses, both physicians and nurses were satisfied with the ease of use of the system, they find it generally to have a positive impact on their work, however both didn't find it to have an impact in reducing ED overcrowding.

Conclusion: Both physicians and nurses were satisfied with the EMR system.

Background: Non-adherence to antimicrobial guidelines is a major factor leading to emergence of antimicrobial drug resistance.

Objective: This study was carried out to investigate the adherence to local antimicrobial guidelines in the Emergency Department (ED) at Al Wakra Hospital in the state of Qatar.

Materials and methods: This cross-sectional, retrospective study was carried out in the Emergency Department of Al Wakra Hospital in Qatar. Prescriptions of 219 patients were investigated to study the adherence to antimicrobial guidelines. The relation of sex, age and emergency unit type to antimicrobial adherence as well as the appropriateness of antimicrobial prescribed on discharge were also evaluated.

Results: Overall adherence and non-adherence to local antimicrobial guidelines was found to be 41% and 59% of prescriptions respectively (P-value = 0.007). Participants had mean age of 42 ± 15.5. More adherence to guidelines was found among female patients and in critical care units. Furthermore, antimicrobial prescribed to patients on discharge was found to be appropriate in 60% of patients (P-value = 0.04).

Conclusion: Education of physicians and additional studies should be conducted in order to further investigate and improve adherence to antimicrobial guidelines.

Hospitals' track-and-trigger systems to identify and respond efficiently to patient's deterioration became an evidence base tool for patient safety and medical management worldwide. A prospective study about the Impact of Rapid Response Team Implementation in the Cuban Hospital was developed since September 2014 up to September 2015. The patients admitted in medical and surgical wards were screened upon admission and rescreened during every shift by nurses using the National Early Warning Score (NEWS), a multidisciplinary medical response team was designed and proper actions were done according to the acuity of illnesses and patient needs. The 100% of patients admitted were screened and properly followed during every shift, the system gave us the possibility for early detection of all the patients deteriorated, 9.9% in total, the 3.6% of patients admitted were transferred to ICU in deteriorated condition, decreasing to 0 the code blue activation and the unexpected mortality in wards. Early recognition and timely and competent clinical response gave us the opportunity to be proactive to protect our patients against life threatening situations. We recommend extend this result to all the hospital service using a wider system to include maternity and pediatric population, the implementation of the Qatar Early Warning System (QEWS) will be our next step to protect all the patients admitted in our Hospital.

Background: In 2011, HMCAS designed new Evidence-Based CPG. The previous protocols were not fit for purpose and not best practice. The service had multiple tiers of clinical practice among staff without standardization of care. CPG development is a knowledge management process to ensure standardization of care and a safer patient experience. This research sets out learning from two rounds of CPG development over 4 years.

Methods: The guidelines development process was mapped prior to starting in January 2015. CPG development and implementation went through 5 steps: 1. Scoping the guidelines: defining the purpose, the scope of service, and the end users of the guidelines. We conducted a staff survey to understand their views on presentation and purpose. 2. Establishing a working group to identify specific guidelines, clinical outcomes desired, and develop a writing template. 3. Conducting evidence reviews to draft the guidelines and then consulting with all role players to ensure guidelines are best practice and practical, and aligned to clinical pathways. 4. Guidelines publication considering ease of use, clarity, and balance between details and practicality. Finally, guidelines approval. 5. Guidelines implementation: Identifying champions to action alignment to systems (logistics/governance/management) and to redesign the corresponding educational curriculum.

Results: The development and implementation of the guidelines has resulted in significant changes within the Ambulance Service over 4 years. Reducing multiple tiers of care down to two tiers, standardized education of 900 existing and new clinical staff around guidelines, implementation of standardized pre-packed equipment within the ambulances, and standardized care to the community. This project was recognized by the MD's Stars of Excellence award 2013.

Conclusions: To implement standardized care and EBM, CPG are required. Guidelines development and implementation needs expertise, collaborative development, and champions who will undertake deliberate alignment of service activities and education to the guidelines.

Background: Hip fractures are very common in UK population (excluding Scotland) accounting for 64102 hospital admissions in 2014. FCIB is part of a best practice tariff and a quality indicator audited annually by the National Hip Fracture Database in UK, as part of NICE clinical guidelines. The ED protocol for fracture neck of femur (NOF) includes fascia Iliaca compartment block (FICB), which is a new service development as part of treatment.

Study objectives: To assess whether all patients with NOF were getting FICB prior to transfer from ED and to asses if FICB gave adequate pain relief.

Methods: A retrospective study new service evaluation was carried out on 58 patients admitted to orthopaedic ward from the ED with a diagnosis of fracture NOF. Exclusion criteria was contraindication to compartment blocks. This study focussed on the care received by the patients in the ED during the period from October 2014 to March 2015. A data collection spread sheet was developed with parameters based on the NICE guidelines, RCEM guidelines and the trust policy for performing FICB.

Results: Of the 58 cases, 51.72% of these received FICB and were documented. Of these 63.3% of patients had FICB performed within 4 hours of arrival to ED. The other 49% lacked evidence for FICB, assumed it was not done. Post-block pain scores were poorly documented. 82% of the blocks were performed by non-consultant doctors. One case of block failure and side effect.

Conclusion: This new service benefited patients with hip fracture, however has issues relating to compliance and consistency of service delivery and all efforts should be made to improve these.

Background: Spontaneous rupture of the renal pelvis is very rare and hence diagnosis may be delayed. Diagnosis of the rupture is best evaluated by CT and treatment is primarily removal of the underlying cause, followed by conservative management.

Presentation: An otherwise healthy 31-year-old male suffered abdominal pains and vomiting. His pain was at the right iliac fossa and suprapubic areas, which he rated as 7/10(NRS). He also reported dysuria of 2 days but with no other associated symptoms. On examination, Patient was vitally stable. On palpating his abdomen, there was right iliac fossa tenderness but no rebound tenderness, guarding nor rigidity, and the remainder of the examination was unremarkable. He received repeated analgesics; IV acetaminophen 1 g, 4 doses of IV fentanyl and in view of persistent pain and 2 additional doses of IV morphine. Abdominal ultrasonography were suggestive of distal right ureteric stone measuring 6 mm in diameter and mildly dilated upper and lower calyces with mild perinephric fluid. Along with, Tubular non-compressible structure 9 mm in diameter seen in RIF surrounded by minimal amount of fluid, giving an impression of query acute appendicitis with right distal ureteric stone. CT abdomen with double contrast revealed no features of acute appendicitis. However, there was a 4 mm stone in the lower end of the right ureter causing obstruction. Delayed series films showed rupture of the renal pelvis.

Conclusion: Rupture of renal calyx should be considered as one of the differential diagnosis for an unusual acute abdomen, not responsive to analgesics.

Background: Increasing levels of physical inactivity is associated with growing trends of childhood obesity as evidence suggests today's children physically inactive and unfit. The study aims to assess the effect of socio-demographic and lifestyle factors on mode of travel in school-aged children (10–15 years).

Methods: 4,497 school-aged children were selected from wave-1 of Understanding Society database in a multi-stage random sample with 81.8% response rate. Cross-sectional design was used to examine the relationship between active travel with demographic and lifestyle factors.

Results: Univariate analysis showed significant relation of age, region, smoking and eating fast food to the active commuter school-children. Multivariate adjusted analyses shows that children of ages 13 to 15 years were more likely to travel actively compared to those aged 10 to 12 years (OR = 1.92, 95%CI:1.65-2.23). Those engaged in sporting activity 3 times or more per week were more likely to be active travel compared to those less than twice per week (OR = 1.21, 95%CI:1.02-1.43). Children eating fast food once or less than per week were more likely to travel actively compared to unhealthy eaters. Most children living in their respective regions were less likely to travel actively.

Discussion: The positive association between active mode of travel and elder school children (13–15 years), who perform sport activities three times or greater per week and eating fast food once or less per week with active travel, reflect their free choice of mode of travel. Children who practiced sport more than three times per week and who ate less fast food showed healthy behaviors.

Introduction: Simulation is almost synonymous with computerised mannequins although they are not always essential components of the learning experience as what often matters most is the facilitation process of the learning experience rather than the technology.

Methods: We developed Visually Enhanced Mental Simulation (VEMS) for staff to demonstrate cognitive and decision making skills away from the practical context. Scenario participants are oriented by facilitators to the VEMS process which is a simulation approach that involves a whiteboard, laminated cards, and a poster to represent equipment and the patient. It requires participants to verbalise thoughts and actions including equipment settings, and actual communication with the patient and bystanders represented by the facilitators. Information like physiological parameters and interventions made by the participating crew are written on the whiteboard. Scenarios use the same scripts as what is prepared for full-scale simulation and are followed by a debriefing. It is complemented by parallel skills sessions, and ultimately both aspects are combined into full-scale scenario-based simulation.

Results: VEMS has been facilitated with uni/multi-professional teams of healthcare professionals for pre-hospital, interfacility, and handover scenarios. Comparison between VEMS and mannequin-based scenarios is ongoing and currently shows just a slightly less positive rating for VEMS although they advocate for this modality prior to full-scale simulation. VEMS reduces pressure on equipment demand and the staff engagement is such that similar clinical practitioner's mistakes are “observed” in both types of simulation approaches.

Conclusion: VEMS can be run almost anywhere as it requires a minimum of equipment but still requires time and experienced facilitators. Briefing about the process and expectations are as important as the preparation of the scenario script and clinical knowledge and facilitation style of the facilitators. VEMS can be very engaging for multiprofessional teams and address learning outcomes similar to what would be achieved in full-scale simulation.

Background: “Orientation” is an important phase when joining a new institution. It is the period when someone builds an understanding of their role/responsibilities in a new setting, and for colleagues to gauge someone's level of knowledge and competence. HMCAS recruits mostly overseas nursing qualified staff with variable experience and transforms them into Ambulance Paramedics (AP) all providing the same level of care in accordance to our Clinical Practice Guidelines.

Methods: Skills assessment using a 17–20 stations Objective Structured Clinical Examination (OSCE) process was introduced in the Training Department during a week-long instructor development workshop in 2013. Instructors were coached to develop practical/theoretical OSCE stations and took part in pilot sessions as examiners with new APs. The OSCE is now a core AP training programme component with weekly sessions to assess new staff on what they have been taught up to that point in time.

Results: Over 120 OSCE sessions have occurred in 2 years exposing about 600 staff to a minimum of 3 sessions each. A bank of over 40 stations has been developed and validated, and a team of trained examiners is used. As determined by the course evaluation form, although seen as a stressful experience, instructors and staff find it a very beneficial and effective assessment modality to prepare them for clinical practice. It motivates staff to study and they even request to have an OSCE per year as part of their continuing professional development.

Conclusion: We are committed and have processes in place to sustain the facilitation of OSCE sessions as it is a very practical way of assessing a wide range of skills over a set time period and gauging staff progress through consecutive sessions. The initial preparation is time consuming but we encourage other departments to explore this approach as part of their orientation/training programme.

Background: Whilst Head CT scanning carries an important role in the identification of clinically significant intracranial injuries, there are associated risks of radiation. Our initial audit of clinical notes and survey of EM physicians revealed a rate of 45% CT scans for pediatric minor head injuries with around half of requests not indicated. In 36% there were issues with documentation. The aim is to achieve a sustained compliance with Internationally acceptable guidelines of Head CT scanning for pediatric minor head trauma at Hamad General Hospital Emergency Department (ED).

Intervention: We conducted staff education through weekly program of Continuing Medical Education for emergency physicians, prominent display and availability of handouts of the International clinical decision rules (NICE guidelines, PECARN) in all clinical areas within the ED, encourage proper documentation for all head injury cases to meet JCI standards of documentation, and formulate a revised pediatric head injury guideline based on the international clinical decision rules.

Methods and results: The audit in August 2014 showed that 62 CT head were done, 45% of them were deemed unnecessary when measured against NICE guidelines. Also there was deficient documentation in 36% of cases due to the unavailability and difficulty accessing the guidelines. We supplied all areas in the ED with handouts of the guidelines, and conducted shop floor education for ED physicians. Regular sessions were conducted during educational activities and emergency seminars. The re-audit in January 2015 showed decreasing rate of CT scans at the rate of 22% achieving a reduction by 33% and improvement in the documentation by 31%. The overall reduction of and decreasing the percentage of unindicated CT head by around 30%.

Conclusion and recommendation: Managing minor head injury in pediatric age group becomes more safe by increasing the physician awareness about the evidence based updated guidelines.

Objective: The objective of this study was to collect feedback from Ambulance Paramedics (AP) with respect of their experience of using an External Chest Compression Device (ECCD) on cardiac arrest patients. Aspects of particular interest were ease of use and their perceived effectiveness of delivered CPR.

Background: HMCAS crews attend to several hundreds of cardiac arrests a year. To achieve Return of Spontaneous Circulation (ROSC), the key requirements are the provision of effective chest compressions delivering oxygen to the brain, maintaining coronary perfusion pressure, and priming the heart for successful defibrillation. Providing effective manual chest compressions in the austere Qatar pre-hospital setting with high temperatures is challenging, hence all HMCAS emergency vehicles have been equipped with ECCD.

Methods: HMCAS receives daily reports compiled by its Documentation Officers. These reports highlight specific cases in which use of the ECCD was indicated but not implemented. These cases are followed up and audited to assess if non-provision of automated chest compressions was clinically acceptable. HMCAS monitors specific key performance indicators, i.e. ’Use of the LUCAS™2 in Adult Medical CPR Cases’ as well as ’ROSC in Medical CPR’. Feedback was collected over a 3-month period using a 10-point Likert scale type questionnaire distributed to ambulance paramedic teams who had used the ECCD during a real medical cardiac arrest case.

Results: The results are based on 54 returned feedback questionnaires. Using a scale with 1 being very difficult and 10 being very easy, ambulance paramedics’ mean rating of the device's ease of use was of 8.8/10. Similarly, on a scale indicating perceived effectiveness, staff indicated that they found the chest compressions provided by ECCD to be highly effective (mean = 9.41/10).

Conclusion: HMCAS staffs are highly satisfied with making use of the device since it provides them with a safer work environment and they are less fatigued after finishing a CPR case, especially during the summer months.