Hypotheses The investigators hypothesize that a communication delay of 80 seconds compared to no delay will be associated with longer procedural times and decreased quality during brachial plexus block scanning. Secondly, the communication delay will be associated with more errors in treatment and a delay of essential treatments in a medical emergency.
Background The near future will see crewed missions in deep space. As the number of people travelling to space increases, so will the chances of traumatic injury and other medical emergencies. Given many changes to body systems in microgravity and the scarcity of equipment and personnel in space, treating medical emergencies is already very difficult. Because most pain medications interfere with cognition, and general anesthesia would be very risky in these conditions, regional anesthesia ('nerve blocks') has been suggested as a less risky alternative. However, nerve blocks are highly specialized skills and responding to medical emergencies in general requires extensive medical training, it is likely that astronauts will require guidance from earth-based physicians.
As crews venture deeper into space, the ability of teams to communicate in real time with earth-based medical teams decreases. For missions to the moon, communication delays of 3 to 160 seconds in each direction are expected. In the event of a medical emergency, space crews may require consultation with ground teams. The investigators predict that this communication delay will impact task duration, create opportunities for miscommunication and potentially result in higher rates of complications.
Objectives
* Quantify the difference (communication delay versus no delay) in time to identify critical structures while scanning brachial plexus block sonoanatomy and time to essential treatment during a medical emergency. * Quantify the difference (communication delay versus no delay) in quality and ease of imaging while scanning brachial plexus block sonoanatomy. * Quantify the difference in completeness of emergency treatment using a composite measure (communication delay versus no delay). * Describe the challenges and solutions for team functioning and remote mentorship when a communication delay exists.
Methods This is a within-subjects, mixed-methods, simulation-based randomized study. Regional anesthesia novices (medical students) and Canadian Armed Forces (CAF) medical technicians or CAF nurses will be recruited and given a 4-hour training session on the basics of brachial plexus blocks and their complications. Participants will be placed in teams of 3, participating in two simulation scenarios. Once the team enters the simulation space, they will be able to ask for assistance from a "remote" team of experts. Teams will be guided through identifying the sonoanatomy for brachial plexus blocks and responding to a complication from placing a peripheral nerve block. Every team will complete both the no communication delay and 80-second communication delay. Teams will be randomly assigned the order in which they perform each condition.
Time to "block" (when the participant identifies where they would place the local anesthetic) and time to essential treatments during an emergency will be recorded. Participants will rate the ease of ultrasound image acquisition and ease of communication, while the expert team will rate the quality of the ultrasound images and the ease of communication. Quantitative outcomes will be analyzed using univariate statistics. After the scenario, teams will debrief the scenario with a focus on communication, safe identification of target nerves and their ability to respond to a complication. Transcriptions of the debriefing sessions will be analyzed for themes using qualitative analysis.
Medical students from Dalhousie University and Canadian Armed Forces (CAF) medical technicians or nurses at a minimum of Rank Qualification Medical Technician Private
prior experience and training in regional anesthesia techniques
visual/auditory impairments that make unmodified video chats difficult
Crossover
Real-time communication
Other interventionIn the no communication delay condition, the treating team of participants and mission control will be connected by real-time video chat. The video chat will be turned on and available once the participants start the scenario. The chat will remain on throughout the scenario.
Delayed communication
Other interventionIn the communication delay condition, there will be a 80-second induced delay between each transmission of communication. Both the treating team and mission control can send more than one message at a time, but the minimum delay will be maintained between receiving each individual message. The number and frequency of messages will not be restrained.
Time to nerve block
The investigators will measure the time to finish the block, defined as the time from the transducer first touching the patient to when the participant identifies where they would place the local anesthetic.
Time to medical intervention
The investigators will also record the time to medical intervention, defined as the time from a change in vital signs until definitive treatment (e.g. epinephrine for anaphylaxis, lipid emulsion for LAST).
Ease of image acquisition
Following the scenario but before the debrief, each participant will rate the ease of ultrasound image acquisition using a 5-point Likert scale (1 = very difficult, 2 = difficult, 3 = neutral, 4 = easy, 5 = very easy).
Ease of communication
Following the scenario but before the debrief, each participant will rate the ease of communication using a 5-point Likert scale (1 = very difficult, 2 = difficult, 3 = neutral, 4 = easy, 5 = very easy).
Composite emergency medical treatment
The completeness of essential treatments for the medical emergencies will be assessed using a composite score (Anaphylaxis: Fluid resus + Epinephrine + Secondary meds + O2/vent support; LAST: Identification of LAST + Intralipid + Midaz + O2/vent support)
Qualitative communication themes
The debriefing discussion will be audio recorded and later transcribed. Data transcription will occur as soon as possible after each interview. Transcripts of interviews will be later analyzed using thematic analysis.
Click on the lead sponsor to view all of their trials.
