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The Effect of Prehospital Clinical Trial-Related Procedures on Scene Interval, Cognitive Load, and Error: A
Willem Stassen1, Craig Wylie1,2, Wesley Craig1
1Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
Prehospital Emergency Care
|September 15, 2023
Summary
Prehospital randomized controlled trials involving freeze-dried plasma (FDP) and hemoglobin-based oxygen carriers (HBOC) did not increase scene interval, cognitive load, or medical errors in simulated settings. This suggests trial procedures can be safely integrated into emergency care.
Area of Science:
- Emergency Medicine
- Clinical Trials
- Prehospital Care
Background:
- Prehospital randomized controlled trials are rare globally.
- Lack of experience risks protocol deviations, increased intervals, and errors, impacting patient safety.
- Assessing trial procedure impact on prehospital care is crucial.
Purpose of the Study:
- To evaluate the effect of trial-related procedures on simulated scene interval, cognitive load, medical errors, and time to action.
- To determine if incorporating FDP and HBOC administration affects prehospital care efficiency and safety.
Main Methods:
- Prospective simulation study with a crossover design involving ten prehospital clinician teams.
- Three simulation arms: (1) FDP + HBOC, (2) HBOC only, (3) standard care, all including hemorrhagic shock management.
- Measured scene interval, error rates, cognitive load (NASA-TLX), and competency (SATLAB).
Main Results:
- No significant differences in scene interval (p=0.27), error rates (p=0.28), or cognitive load (p=0.67) between simulation groups.
- No correlation found between cognitive load and error rates (r=0.15, p=0.42).
- All participants achieved competency in clinical care across all simulation arms.
Conclusions:
- Eligibility screening and trial procedures (FDP, HBOC) can be competently performed by prehospital clinicians without increasing scene time.
- Simulated trials suggest safe integration of trial procedures into prehospital emergency care.
- This approach supports cautious implementation of clinical trials in prehospital settings.
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