Enhancing emergency front-of-neck airway training: a mixed methods study on the impact of external noise and startle stressors.

INTRODUCTION

Our aim was to investigate whether emergency front-of-neck airway training utilising low-fidelity manikins in a 'tea-trolley' format could be improved by the incorporation of stress inoculation training. This would be an important advance as clinicians report that cognitive overload impairs performance during real emergencies. We hypothesised that environmental noise and simulated blood splatter would result in a heightened stress experience.

METHODS

Thirteen anaesthetic residents completed the study, performing emergency front-of-neck access first under non-stressed conditions and later with the addition of noise and startle stressors. The primary outcome was a change in salivary cortisol, measured before and after each training session. Secondary outcomes included participant proficiency; time to perform the procedure; and perceived stress and utility of the training. Semi-structured interviews explored participant perceptions of the training.

RESULTS

Environmental noise and simulated blood splatter resulted in a quantitatively and qualitatively heightened stressful experience for the participants in paired comparisons. There was no significant change in median (IQR [range]) salivary cortisol levels after participants completed the non-stressed training: 6.4 (4.3-8.1 [3.3-16.2]) nmol.l vs. 9.2 (5.8-11.3 [3.8-14.1]) nmol.l, respectively (p = 0.133). There were, however, significant changes following stressed training: 4.9 (4.3-11.6 [1.1-11.6]) mol.l vs. 9.2 (8.0-12.1 [4.4-20.1]) nmol.l, respectively (p = 0.005). Participants' semi-structured interviews and questionnaire results evidenced that the adaptations created a more stressful yet valuable training experience.

DISCUSSION

Environmental noise and simulated blood splatter increased participant stress. Participants performed emergency front-of-neck access equally well in both sessions, suggesting this technical skill is stored in their stress-resistant long-term memory. These relatively low-cost adaptations could enhance emergency front-of-neck airway tea-trolley training by facilitating stress inoculation training and so better prepare clinicians for real-world emergencies.

PLAIN LANGUAGE SUMMARY

We wanted to find out if we could make emergency training better for doctors. This training helps them learn how to quickly make a hole in the neck to help someone breathe if other ways don't work. Right now, doctors practice on simple plastic models during quick training sessions, like ones you might find on a tea trolley. But in real emergencies, doctors can get very stressed, which can make it harder to think clearly. So, we wondered if adding things like loud noise and fake blood to the training would help doctors get used to working under pressure. Thirteen doctors who are learning to give anaesthetics took part in the study. First, they did the training in a quiet, calm setting. Then, they did the same training again, but this time with loud noises and surprises, like fake blood splashing. We measured how stressed they felt by testing their spit for a stress chemical called cortisol, both before and after the training. We also looked at how well and how fast they did the job, and asked them how they felt about the training. The loud noises and fake blood made the doctors feel more stressed, both from the test results and from what they told us. When the training was calm, their stress levels didn’t change much. But with noise and fake blood, their stress levels went up a lot. Even though they were more stressed, they still did the job just as well. The doctors said the training felt more real and useful when it included the stress. Adding noise and fake blood made the doctors feel more pressure, like in real emergencies. This kind of training doesn't cost much more but could help doctors be more prepared when it really counts.