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Disaster and emergency personnel must master a variety of medical skills and must be able to perform under various stressful circumstances. In general, medical personnel are highly educated and are expected to be self-critical individuals even under extreme circumstances. However, self-critical abilities seldom are trained or evaluated within these circumstances. The combination of training for critical tasks and coping with stress can be trained in a personalized way by using serious gaming techniques. Immersion in the real-life stressful context, by means of a game, is a strong trigger for the intrinsic motivation to learn. Serious gaming could be useful, but it is unclear in what way games should include self-critical learning and coping with stress.
Methods:
Several studies on the possibilities of serious gaming for medical personnel were performed: (1) an investigation on self-directed learning in ambulance workers; (2) an adventure based learning experiment with military physician; and (3) a literature review on games and stress.
Results:
The more subjects are capable of self-critical learning, the more they benefit from a game. Subjects can actively take control on what, how, and when they want to learn, which has an effect on self-efficacy and coping. Moreover, self-critical learning can be enhanced in a game, using feedback directed at the effects of stress on the critical performance of (medical) tasks.
Conclusions:
The ways serious games can enhance self-critical learning and coping with stress will be elaborated upon.
Triage is an effective method to streamline patient flow and shorten the delay for definitive care. We studied the effects of shift duties and patient volume on triage.
Methods:
Patients presenting to the emergency department were tagged with a red, yellow, or green wristband as per the Simple Triage and Rapid Treatment (START) protocol. A mass-casualty incident (MCI) was defined as ≥7 red patients or ≥20 patients at one time. The data was analyzed using SPSS version 10.
Results:
Out of 25,928 patients, triage was performed for 25,468 (98.2%); 8,390 (32.3%) presented during the morning shift (08:00–14:00 hours), 7,119 (27.5%) during the evening shift (14:00–20:00 h); and 10,185 (39.2%) during the night shift (20:00–08:00 h). Of the patients, 8,303 were triaged during the morning shift, 6,994 during the evening shift, and 9,978 during the night shift. Of the subjects, 1,431 (5.6%) were tagged red, 10,634 (41.7%) with yellow, and 13,424 (52.7%) were tagged green. Of the patients, 694 (2.7%) were retriaged. During the morning shift, 327 were tagged as red, 3,512 as yellow, and 4,465 as green, and 243 were retriaged. During the evening shift, 383 were tagged as red, 2,918 as yellow, and 3,685 as green, and 194 were retriage. During the night shift, 705 patients were tagged as red, 4,116 as yellow, and 5,165 as green. Sixteen MCIs occurred during the night shift, four during the morning shift, and one during the evening. Total numbers of patients presented during a MCI were 1,227. Of these, 102 were tagged as red, 463 as yellow, and 642 as green, and 79 were re-triaged.
Conclusions:
High patient volume during the night shift hampers triage during peace time and MCIs.