Canadian Armed Forces, 1 Canadian Field Hospital, 147 Flanders Row, Garrison Petawawa, Ontario, K8H 2X3, Canada; Vancouver General Hospital, 855 W 12th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada.
Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
Am J Surg. 2018 May;215(5):927-929. doi: 10.1016/j.amjsurg.2018.01.016. Epub 2018 Feb 3.
BACKGROUND: Damage-control and emergency surgical procedures in trauma have the potential to save lives. They may occasionally not be performed due to clinician inexperience or lack of comfort and knowledge. METHODS: Canadian Armed Forces (CAF) non-surgeon Medical Officers (MOs) participated in a live tissue training exercise. They received tele-mentoring assistance using a secure video-conferencing application on a smartphone/tablet platform. Feasibility of tele-mentored surgery was studied by measuring their effectiveness at completing a set series of tasks in this pilot study. Additionally, their comfort and willingness to perform studied procedures was gauged using pre- and post-study surveys. RESULTS: With no pre-procedural teaching, participants were able to complete surgical airway, chest tube insertion and resuscitative thoracotomy with 100% effectiveness with no noted complications. Comfort level and willingness to perform these procedures were improved with tele-mentoring. Participants felt that tele-mentored surgery would benefit their performance of resuscitative thoracotomy most. CONCLUSION: The use of tele-mentored surgery to assist non-surgeon clinicians in the performance of damage-control and emergency surgical procedures is feasible. More study is required to validate its effectiveness.
背景:创伤急救中的损伤控制性手术和紧急外科手术具有挽救生命的潜力。由于临床医生经验不足或缺乏舒适度和知识,这些手术有时可能无法进行。
方法:加拿大武装部队(CAF)的非外科医生医疗人员(MO)参加了一项活体组织培训练习。他们使用智能手机/平板电脑平台上的安全视频会议应用程序接受远程指导。通过测量他们在这项试点研究中完成一系列任务的效果,研究了远程指导手术的可行性。此外,通过预研究和后研究调查来衡量他们对研究程序的舒适度和意愿。
结果:在没有术前教学的情况下,参与者能够以 100%的有效性完成手术气道、胸腔管插入和抢救性开胸术,没有注意到任何并发症。通过远程指导,舒适度和进行这些程序的意愿得到了提高。参与者认为远程指导手术最有利于他们进行抢救性开胸术。
结论:使用远程指导手术来协助非外科医生临床医生进行损伤控制性和紧急外科手术是可行的。需要进一步研究来验证其有效性。
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