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المحاكاة الجسدية هي جوهر المكون النفسي الحركي للتدريب ، لكن التطبيق الناجح لتقنية مناسبة للتحكم في النزف يتطلب فهمًا أكثر اكتمالاً لمتطلبات السيناريوهات السريرية المحددة. على هذا النحو ، قمنا بتصميم تطبيق قائم على الويب والهاتف يتضمن بيئة ألعاب للتعلم ومشاركة المستخدم التي تكمل النموذج المادي. يعمل تطبيق CrashSavers الظاهري كقاعدة منزلية للمستخدم ويتضمن (1) إرشادات خطوة بخطوة حول كيفية إنشاء جهاز محاكاة منخفض التكلفة ، (2) مادة تعليمية حول المعرفة التشريحية واتخاذ القرارات السريرية لتقنيات التحكم في النزف المناسبة ، (3) جهاز محاكاة افتراضي لإتقان خطوات هذه التقنيات الفردية ، و (4) مكون التقييم الذاتي.

يتضمن تطبيق أسلوب اللعبة مادة تعليمية حول المعرفة التشريحية واتخاذ القرار. بالإضافة إلى ذلك ، هناك تعليمات بالفيديو حول كيفية تنفيذ تقنيات التحكم في النزف بشكل مناسب (الضغط ، والتعبئة ، واستخدام العاصبة ، ونشر قسطرة فولي) بناءً على سيناريوهات المحاكاة والحياة الواقعية.

أخيرًا ، سيتضمن المكون التعليمي للتطبيق محاكيًا افتراضيًا لإتقان خطوات هذه التقنيات الفردية. سيكون هناك أيضًا بعد الانتهاء من جميع الوحدات التعليمية ، سيتخرج المستخدمون لأداء المهارات على نموذج المحاكاة الفيزيائية.

المستخدمون

The country of Guatemala, like many LMIC countries, lacks an organized EMS system and there is very little established infrastructure for prehospital care. All prehospital care is provided by three independent firefighting companies, largely utilizing volunteer services. Transport vehicles and other medical equipment are rarely available, and often firefighters buy the necessary equipment at their own expense. Given the lack of formalized prehospital infrastructure, there is also a gap in medical training and education of these prehospital staff. Anyone with a 6th-grade education is eligible to become a firefighter in Guatemala, and must subsequently complete a 2 week, 160-hour course endorsed by USAID. One of the firefighter training programs offers an optional 2.5 year EMT course, but very few actually complete this. Due to the lack of training and volunteer status of most of the firefighters who provide pre-hospital care, the majority of prehospital care consists of a "scoop and run" approach rather than taking vital signs, doing ultrasounds, or providing significant stabilization prior to transport to definitive care. Ultimately, 8,500 firefighters with basic first aid training and little to no equipment attend to the emergency needs of 18 million Guatemalans. These volunteers would greatly benefit from formalized training in hemorrhage control techniques.

اكتساب المهارات

Effective hemorrhage control requires prompt, decisive action and forceful application of pressure or a tourniquet. Using our program, the user will learn how to externally compress a wound, apply a tourniquet, and deploy foley catheters to arrest hemorrhage to a physical model of a lower extremity. The model has been constructed of low-cost materials available at a hardware store (PVC pipe, wire mesh, metal racking, springs, tubing, plumber's tape) integrated with an electrical and fluid pumping system.

Full details on the simulator construction and manual can be viewed here

In brief, the user will apply direct compression, packing, a tourniquet, and/or a foley catheter to our physical simulator model to arrest 'hemorrhage' (simulated by red fluid).

The user will have two means of feedback

(1) direct visualization of the arrest of hemorrhage

(2) a readout of the pressure applied by the user, measured by sensors in the model and shown in the accompanying smartphone application.

Effective application of pressure, packing, tourniquet, and/or foley catheter tamponade in our system will directly translate into clinical effectiveness of these skills as we will measure the pressure exerted in order to arrest hemorrhage.

Example of skill Acquisition - Foley Catheters

Foley catheter hemorrhage control will be used in two different scenarios. In the first, the patient  has a deep, narrow wound in an extremity, likely due to a penetrating injury. Foley catheters provide  a low-cost method of performing direct compression to the deep wound without additional ischemia  of the extremity distal to the injury as is the case when a tourniquet is used. This is particularly  useful given the extended transfer times from rural areas, as well as the long wait times for  definitive surgery once the patient has arrived at a trauma center. In the second scenario, foley catheters can be used to control hemorrhage at anatomical junctions, such as the axilla or groin, in  which tourniquets cannot be applied. 


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