ABCDE approach to victims by lifeguards: How do they manage a critical patient? A cross sectional simulation study
Decision-making in emergencies is a multifactorial process based on the rescuer, patient, setting and resources. The eye-tracking system is a proven method for assessing decision-making processes that have been used in different fields of science. Our aim was to evaluate the lifeguards' capacit...
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| Published in: | PloS one Vol. 14; no. 4; p. e0212080 |
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| Format: | Journal Article |
| Language: | English |
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| Abstract | Decision-making in emergencies is a multifactorial process based on the rescuer, patient, setting and resources. The eye-tracking system is a proven method for assessing decision-making processes that have been used in different fields of science. Our aim was to evaluate the lifeguards' capacity to perform the ABCDE (Airway-Breathing-Circulation-Disability-Exposure) approach when facing a simulated critically ill-drowned victim.
A cross-sectional simulation study was designed to assess the skills and sequence of the ABCDE approach by 20 professional lifeguards. They had to assess a victim and act according to his/her clinical status by following the ABCDE primary assessment approach. The two kinds of variables were recorder: those related to the quality of each step of the ABCDE approach and the visual behaviour using a portable eye-movement system. The eye-tracking system was the Mobile Eye system (Bedford, USA).
None of the study participants were able to complete correctly the ABCDE approach. Lifeguards spent more time in the Circulation step: Airway (15.5±11.1 s), Breathing (25.1±21.1 s), Circulation (44.6±29.5 s), Disability (38.5±0.7 s). Participants spent more time in viewpoints considered as important (65.5±17.4 s) compared with secondary ones (34.6±17.4 s, p = 0.008). This was also represented in the percentage of visual fixations (fixations in important viewpoints: 63.36±15.06; fixation in secondary viewpoints: 36.64±15.06; p = 0.008).
Professional lifeguards failed to fully perform the ABCDE sequence. Evaluation by experts with the help of eye-tracking technology detected the lifeguards' limitations in the assessment and treatment of an eventual critically ill victim. Such deficits should be considered in the design and implementation of lifeguards' training programmes. |
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| AbstractList | INTRODUCTIONDecision-making in emergencies is a multifactorial process based on the rescuer, patient, setting and resources. The eye-tracking system is a proven method for assessing decision-making processes that have been used in different fields of science. Our aim was to evaluate the lifeguards' capacity to perform the ABCDE (Airway-Breathing-Circulation-Disability-Exposure) approach when facing a simulated critically ill-drowned victim. METHODSA cross-sectional simulation study was designed to assess the skills and sequence of the ABCDE approach by 20 professional lifeguards. They had to assess a victim and act according to his/her clinical status by following the ABCDE primary assessment approach. The two kinds of variables were recorder: those related to the quality of each step of the ABCDE approach and the visual behaviour using a portable eye-movement system. The eye-tracking system was the Mobile Eye system (Bedford, USA). RESULTSNone of the study participants were able to complete correctly the ABCDE approach. Lifeguards spent more time in the Circulation step: Airway (15.5±11.1 s), Breathing (25.1±21.1 s), Circulation (44.6±29.5 s), Disability (38.5±0.7 s). Participants spent more time in viewpoints considered as important (65.5±17.4 s) compared with secondary ones (34.6±17.4 s, p = 0.008). This was also represented in the percentage of visual fixations (fixations in important viewpoints: 63.36±15.06; fixation in secondary viewpoints: 36.64±15.06; p = 0.008). CONCLUSIONProfessional lifeguards failed to fully perform the ABCDE sequence. Evaluation by experts with the help of eye-tracking technology detected the lifeguards' limitations in the assessment and treatment of an eventual critically ill victim. Such deficits should be considered in the design and implementation of lifeguards' training programmes. Decision-making in emergencies is a multifactorial process based on the rescuer, patient, setting and resources. The eye-tracking system is a proven method for assessing decision-making processes that have been used in different fields of science. Our aim was to evaluate the lifeguards' capacity to perform the ABCDE (Airway-Breathing-Circulation-Disability-Exposure) approach when facing a simulated critically ill-drowned victim. A cross-sectional simulation study was designed to assess the skills and sequence of the ABCDE approach by 20 professional lifeguards. They had to assess a victim and act according to his/her clinical status by following the ABCDE primary assessment approach. The two kinds of variables were recorder: those related to the quality of each step of the ABCDE approach and the visual behaviour using a portable eye-movement system. The eye-tracking system was the Mobile Eye system (Bedford, USA). None of the study participants were able to complete correctly the ABCDE approach. Lifeguards spent more time in the Circulation step: Airway (15.5±11.1 s), Breathing (25.1±21.1 s), Circulation (44.6±29.5 s), Disability (38.5±0.7 s). Participants spent more time in viewpoints considered as important (65.5±17.4 s) compared with secondary ones (34.6±17.4 s, p = 0.008). This was also represented in the percentage of visual fixations (fixations in important viewpoints: 63.36±15.06; fixation in secondary viewpoints: 36.64±15.06; p = 0.008). Professional lifeguards failed to fully perform the ABCDE sequence. Evaluation by experts with the help of eye-tracking technology detected the lifeguards' limitations in the assessment and treatment of an eventual critically ill victim. Such deficits should be considered in the design and implementation of lifeguards' training programmes. Decision-making in emergencies is a multifactorial process based on the rescuer, patient, setting and resources. The eye-tracking system is a proven method for assessing decision-making processes that have been used in different fields of science. Our aim was to evaluate the lifeguards' capacity to perform the ABCDE (Airway-Breathing-Circulation-Disability-Exposure) approach when facing a simulated critically ill-drowned victim. A cross-sectional simulation study was designed to assess the skills and sequence of the ABCDE approach by 20 professional lifeguards. They had to assess a victim and act according to his/her clinical status by following the ABCDE primary assessment approach. The two kinds of variables were recorder: those related to the quality of each step of the ABCDE approach and the visual behaviour using a portable eye-movement system. The eye-tracking system was the Mobile Eye system (Bedford, USA). None of the study participants were able to complete correctly the ABCDE approach. Lifeguards spent more time in the Circulation step: Airway (15.5±11.1 s), Breathing (25.1±21.1 s), Circulation (44.6±29.5 s), Disability (38.5±0.7 s). Participants spent more time in viewpoints considered as important (65.5±17.4 s) compared with secondary ones (34.6±17.4 s, p = 0.008). This was also represented in the percentage of visual fixations (fixations in important viewpoints: 63.36±15.06; fixation in secondary viewpoints: 36.64±15.06; p = 0.008). Professional lifeguards failed to fully perform the ABCDE sequence. Evaluation by experts with the help of eye-tracking technology detected the lifeguards' limitations in the assessment and treatment of an eventual critically ill victim. Such deficits should be considered in the design and implementation of lifeguards' training programmes. Introduction Decision-making in emergencies is a multifactorial process based on the rescuer, patient, setting and resources. The eye-tracking system is a proven method for assessing decision-making processes that have been used in different fields of science. Our aim was to evaluate the lifeguards’ capacity to perform the ABCDE (Airway-Breathing-Circulation-Disability-Exposure) approach when facing a simulated critically ill-drowned victim. Methods A cross-sectional simulation study was designed to assess the skills and sequence of the ABCDE approach by 20 professional lifeguards. They had to assess a victim and act according to his/her clinical status by following the ABCDE primary assessment approach. The two kinds of variables were recorder: those related to the quality of each step of the ABCDE approach and the visual behaviour using a portable eye-movement system. The eye-tracking system was the Mobile Eye system (Bedford, USA). Results None of the study participants were able to complete correctly the ABCDE approach. Lifeguards spent more time in the Circulation step: Airway (15.5±11.1 s), Breathing (25.1±21.1 s), Circulation (44.6±29.5 s), Disability (38.5±0.7 s). Participants spent more time in viewpoints considered as important (65.5±17.4 s) compared with secondary ones (34.6±17.4 s, p = 0.008). This was also represented in the percentage of visual fixations (fixations in important viewpoints: 63.36±15.06; fixation in secondary viewpoints: 36.64±15.06; p = 0.008). Conclusion Professional lifeguards failed to fully perform the ABCDE sequence. Evaluation by experts with the help of eye-tracking technology detected the lifeguards’ limitations in the assessment and treatment of an eventual critically ill victim. Such deficits should be considered in the design and implementation of lifeguards’ training programmes. Introduction Decision-making in emergencies is a multifactorial process based on the rescuer, patient, setting and resources. The eye-tracking system is a proven method for assessing decision-making processes that have been used in different fields of science. Our aim was to evaluate the lifeguards’ capacity to perform the ABCDE (Airway-Breathing-Circulation-Disability-Exposure) approach when facing a simulated critically ill-drowned victim. Methods A cross-sectional simulation study was designed to assess the skills and sequence of the ABCDE approach by 20 professional lifeguards. They had to assess a victim and act according to his/her clinical status by following the ABCDE primary assessment approach. The two kinds of variables were recorder: those related to the quality of each step of the ABCDE approach and the visual behaviour using a portable eye-movement system. The eye-tracking system was the Mobile Eye system (Bedford, USA). Results None of the study participants were able to complete correctly the ABCDE approach. Lifeguards spent more time in the Circulation step: Airway (15.5±11.1 s), Breathing (25.1±21.1 s), Circulation (44.6±29.5 s), Disability (38.5±0.7 s). Participants spent more time in viewpoints considered as important (65.5±17.4 s) compared with secondary ones (34.6±17.4 s, p = 0.008). This was also represented in the percentage of visual fixations (fixations in important viewpoints: 63.36±15.06; fixation in secondary viewpoints: 36.64±15.06; p = 0.008). Conclusion Professional lifeguards failed to fully perform the ABCDE sequence. Evaluation by experts with the help of eye-tracking technology detected the lifeguards’ limitations in the assessment and treatment of an eventual critically ill victim. Such deficits should be considered in the design and implementation of lifeguards’ training programmes. |
| Audience | Academic |
| Author | Barcala-Furelos, Roberto Abelairas-Gómez, Cristian Sáez-Gallego, Nieves María Rodríguez-Núñez, Antonio Fernández-Méndez, Felipe Otero-Agra, Martín |
| AuthorAffiliation | 6 Faculty of Education, University of Castilla la Mancha, Toledo, Spain 3 Faculty of Education and Sport Sciences, REMOSS Network Research, University of Vigo, Pontevedra, Spain 2 University College of Nursing, University of Vigo, Pontevedra, Spain 7 Pediatric Area, Pediatric Emergency and Critical Care Division, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain 4 Faculty of Education Sciences, Universidade de Santiago de Compostela, Santiago de Compostela, Spain 1 CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain 8 Mother-Child Health and Development Network (Red SAMID), Carlos III Health Institute, Madrid, Spain University of Palermo, ITALY 5 Institute of Health Research of Santiago (IDIS), Santiago de Compostela, Spain |
| AuthorAffiliation_xml | – name: 3 Faculty of Education and Sport Sciences, REMOSS Network Research, University of Vigo, Pontevedra, Spain – name: 6 Faculty of Education, University of Castilla la Mancha, Toledo, Spain – name: 1 CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain – name: University of Palermo, ITALY – name: 4 Faculty of Education Sciences, Universidade de Santiago de Compostela, Santiago de Compostela, Spain – name: 8 Mother-Child Health and Development Network (Red SAMID), Carlos III Health Institute, Madrid, Spain – name: 7 Pediatric Area, Pediatric Emergency and Critical Care Division, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain – name: 5 Institute of Health Research of Santiago (IDIS), Santiago de Compostela, Spain – name: 2 University College of Nursing, University of Vigo, Pontevedra, Spain |
| Author_xml | – sequence: 1 givenname: Felipe surname: Fernández-Méndez fullname: Fernández-Méndez, Felipe organization: University College of Nursing, University of Vigo, Pontevedra, Spain – sequence: 2 givenname: Martín surname: Otero-Agra fullname: Otero-Agra, Martín organization: Faculty of Education and Sport Sciences, REMOSS Network Research, University of Vigo, Pontevedra, Spain – sequence: 3 givenname: Cristian orcidid: 0000-0002-1056-7778 surname: Abelairas-Gómez fullname: Abelairas-Gómez, Cristian organization: Institute of Health Research of Santiago (IDIS), Santiago de Compostela, Spain – sequence: 4 givenname: Nieves María surname: Sáez-Gallego fullname: Sáez-Gallego, Nieves María organization: Faculty of Education, University of Castilla la Mancha, Toledo, Spain – sequence: 5 givenname: Antonio surname: Rodríguez-Núñez fullname: Rodríguez-Núñez, Antonio organization: Mother-Child Health and Development Network (Red SAMID), Carlos III Health Institute, Madrid, Spain – sequence: 6 givenname: Roberto surname: Barcala-Furelos fullname: Barcala-Furelos, Roberto organization: Institute of Health Research of Santiago (IDIS), Santiago de Compostela, Spain |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31039154$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1136_bmjopen_2019_032023 crossref_primary_10_3390_jcm11020435 crossref_primary_10_1016_j_ajem_2020_06_042 crossref_primary_10_1186_s12873_021_00509_0 crossref_primary_10_36740_EmeMS202201106 crossref_primary_10_1186_s13052_023_01464_1 crossref_primary_10_36740_EmeMS202104104 |
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| ContentType | Journal Article |
| Copyright | COPYRIGHT 2019 Public Library of Science 2019 Fernández-Méndez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2019 Fernández-Méndez et al 2019 Fernández-Méndez et al |
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| References_xml | – volume: 129 start-page: 103 year: 2018 ident: ref7 article-title: Is drowning a mere matter of resuscitation? publication-title: Resuscitation doi: 10.1016/j.resuscitation.2018.06.018 contributor: fullname: D Szpilman – volume: 36 start-page: 461 year: 2019 ident: ref13 article-title: The use of pupillometry in aquatic lifesavin : vigilance as a key factor in drowning publication-title: Retos contributor: fullname: SL García – ident: ref1 – volume: 366 start-page: 2102 year: 2012 ident: ref5 article-title: Drowning publication-title: N Engl J Med doi: 10.1056/NEJMra1013317 contributor: fullname: D Szpilman – volume: 40 start-page: 703 year: 2018 ident: ref33 article-title: Difficult debriefing situations : A toolbox for simulation educators publication-title: Med Teach doi: 10.1080/0142159X.2018.1468558 contributor: fullname: VJ Grant – volume: 19 start-page: 480 year: 2017 ident: ref22 article-title: Real-time visual feedback during training improves laypersons’ CPR quality: a randomized controlled manikin study publication-title: CJEM doi: 10.1017/cem.2016.410 contributor: fullname: E Baldi – volume: 12 start-page: 51 year: 2017 ident: ref23 article-title: Eye Tracking: A Novel Approach for Evaluating and Improving the Safety of Healthcare Processes in the Simulated Setting publication-title: Simul Healthc doi: 10.1097/SIH.0000000000000192 contributor: fullname: EA Henneman – volume: 21 start-page: 138 year: 2018 ident: ref25 article-title: Analysis of eye-tracking behaviours in a pediatric trauma simulation publication-title: CJEM doi: 10.1017/cem.2018.450 contributor: fullname: O Damji – volume: 75 start-page: 106 year: 2017 ident: ref31 article-title: The ABCDE primary assessment in the emergency department in medically ill patients: An observational pilot study publication-title: Neth J Med contributor: fullname: TJ Olgers – volume: 34 start-page: 2224 year: 2016 ident: ref3 article-title: Drowning timeline: a new systematic model of the drowning process publication-title: Am J Emerg Med doi: 10.1016/j.ajem.2016.07.063 contributor: fullname: D Szpilman – volume: 54 start-page: 64 year: 2018 ident: ref32 article-title: Original Article Application of ABCDE approach in assessment and re-evaluation of critically ill patients, audit from tertiary hospital in Khartoum—Sudan publication-title: Sudan Med J contributor: fullname: MMG Mohamed – volume: 29 start-page: 1044 year: 2011 ident: ref2 article-title: Delay and performance of cardiopulmonary resuscitation in surf lifeguards after simulated cardiac arrest due to drowning publication-title: Am J Emerg Med doi: 10.1016/j.ajem.2010.06.026 contributor: fullname: A Claesson – year: 2012 ident: ref8 article-title: Advanced Trauma Life Support Student Course Manual – start-page: 975752 year: 2014 ident: ref9 article-title: Combining first-person video and gaze-tracking in medical simulation: A technical feasibility study publication-title: Sci World J contributor: fullname: A Szulewski – volume: 84 start-page: 1174 year: 2013 ident: ref18 article-title: Simulation technology for resuscitation training: A systematic review and meta-analysis publication-title: Resuscitation doi: 10.1016/j.resuscitation.2013.04.016 contributor: fullname: WC Mundell – volume: 72 start-page: 289 year: 2018 ident: ref26 article-title: Getting Inside the Expert’s Head: An Analysis of Physician Cognitive Processes During Trauma Resuscitations publication-title: Ann Emerg Med doi: 10.1016/j.annemergmed.2018.03.005 contributor: fullname: MR White – volume: 12 start-page: e0169591 year: 2017 ident: ref20 article-title: Use of a Real-Time Training Software (Laerdal QCPR) Compared to Instructor-Based Feedback for High-Quality Chest Compressions Acquisition in Secondary School Students: A Randomized Trial publication-title: PloS One doi: 10.1371/journal.pone.0169591 contributor: fullname: A Cortegiani – volume: 16 start-page: 9 year: 2008 ident: ref29 article-title: Three decades (1978–2008) of Advanced Trauma Life Support (ATLSTM) practice revised and evidence revisited publication-title: Scand J Trauma Resusc Emerg Med doi: 10.1186/1757-7241-16-19 contributor: fullname: K Søreide – start-page: CD004173 issue: 8 year: 2014 ident: ref30 article-title: Advanced trauma life support training for hospital staff (Review) publication-title: Cochrane Database Syst Rev contributor: fullname: S Jayaraman – volume: 13 start-page: 51 issue: SUPPL. 1 year: 2004 ident: ref17 article-title: The use of simulation for training teamwork skills in health care: How low can you go? 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Adult basic life support and automated external defibrillation publication-title: Resuscitation doi: 10.1016/j.resuscitation.2015.07.015 contributor: fullname: GD Perkins – year: 2017 ident: ref12 article-title: Learning and Treatment of Anaphylaxis by Laypeople: A Simulation Study Using Pupilar Technology publication-title: Biomed Res Int contributor: fullname: F Fernandez-Mendez – volume: 95 start-page: 100 year: 2015 ident: ref16 article-title: European Resuscitation Council Guidelines for Resuscitation 2015 Section 3. 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A Systematic Review and Meta-analysis publication-title: JAMA contributor: fullname: DA Cook – volume: 40 start-page: 62 year: 2018 ident: ref24 article-title: Eye-tracking technology in medical education: A systematic review publication-title: Med Teach doi: 10.1080/0142159X.2017.1391373 contributor: fullname: H Ashraf – volume: 19 start-page: 1 year: 2017 ident: ref4 article-title: Challenges and feasibility of applying reasoning and decision-making for a lifeguard undertaking a rescue publication-title: Int J Emerg Ment Health doi: 10.4172/1522-4821.1000379 contributor: fullname: D Szpilman – year: 2014 ident: ref15 article-title: PHTLS. Prehospital Trauma Life Support – volume: 10 start-page: e0125685 year: 2015 ident: ref21 article-title: Effect of High-Fidelity Simulation on Medical Students ‘ Knowledge about Advanced Life Support: A Randomized Study publication-title: PLoS One doi: 10.1371/journal.pone.0125685 contributor: fullname: A Cortegiani |
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| Snippet | Decision-making in emergencies is a multifactorial process based on the rescuer, patient, setting and resources. The eye-tracking system is a proven method for... Introduction Decision-making in emergencies is a multifactorial process based on the rescuer, patient, setting and resources. The eye-tracking system is a... INTRODUCTIONDecision-making in emergencies is a multifactorial process based on the rescuer, patient, setting and resources. The eye-tracking system is a... IntroductionDecision-making in emergencies is a multifactorial process based on the rescuer, patient, setting and resources. The eye-tracking system is a... Introduction Decision-making in emergencies is a multifactorial process based on the rescuer, patient, setting and resources. The eye-tracking system is a... |
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| Title | ABCDE approach to victims by lifeguards: How do they manage a critical patient? A cross sectional simulation study |
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