電子期刊 |
ISSN:1684-193X
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Updated
July 26, 2003
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Contents:
Volume 2, Number 1; July, 2003 |
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Development
of a New Confined Space Model |
Hsien-Fa Lee; Tzong-Luen Wang, MD, PhD;
Yi-Kong Lee, MD; Hang Chang, MD, PhD |
From the Research and Educatio Assessment development
(Lee HF) and Department of Emergency Medicine (Wang TL, Chang
H), Shin-Kong Wu Ho-Su Memorial Hospital; Department of Emergency
Medicine(Lee YK), Buddish Dalin Tzu Chi General Hospital.
Correspondence to Dr. Hang Chang, Department
of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, 95
Wen Chang Road, Taipei, Taiwan. E-mail M001043@ms.skh.org.tw
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Abstract
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Confined
space medicine is one of the most important training for urban search
and rescue. However, the construction of a confined space for training
is usually time- and cost-consuming. To construct a virtual confined
space, we utilized the materials available at hand such as 30 to
50 long tables, 60 paper boxes, 20 large curtains, 4 Manikins for
resuscitation and intubation, 1 pack of flour, 5 rolls of sealing
tapes and 1 make-up box in six training courses in 2002. We designed
a questionnaire to evaluate the reality, difficulty, safety, creativity,
and applicability of the model. The time elapse for constructing
the virtual confined space was in average 45+5 min and that
for cleaning up 25+5 min. The average cost for setting up
the tunnel was 950+80 NSD. Of 432 questionnaires, the average
scores for 5 items were 7.8+1.4 for reality, 6.5+1.8
for difficulty, 9.0+0.6 for safety, 9.3+1.1 for creativity,
and 9.0+0.8 for applicability. For the items of applicability,
the subheadings of adequacy for practicing BTLS, definitive care,
communication, and full evaluation were obtained 9.4+1.4,
9.3+1.2, 8.6+1.4 and 8.3+1.5, respectively
(P<0.05 by ANOVA). In conclusion, we create a simple model of
virtual confined space that will be of help in the comparable training
courses.
Key words---Confined Space Medicine; USAR; Virtual
Model; Disaster Medicine |
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Introduction
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A confined space
is any space large enough to access, but has limited entry and is
unsuitable for continuous employee occupancy. 1,2
Confined spaces usually contain the potential safety hazards such
as physical, chemical, or atmospheric injury. 3
In additional, it deserves specific training for the rescuers to
operate any measures and procedures in the limited space in a time-efficient
manner. 4 In the United States, Occupational
Safety and Health Administration (OSHA) has implemented many guidelines
for confined space rescue. 5 We also
think it is essential for us to have adequate confined space rescue
training in the viewpoint of disaster medicine.
Without proper training, confined space rescue becomes a game of
chance. OSHA studies demonstrated that hundreds of people have miscalculated
their chance for survival in confined space operations. 5
The objective for the rescuer is to recognize when the odds are
stacked against them, and then to implement a change in the operation
to increase the margin of safety, or stack the odds in their favor.
However, most of the training sites for confined space rescue in
the United Sates contain training tower, trench rescue and water
tower rescue. They provide good virtual circumstances for the students
to operate under standard procedures. 3
However, the buildings and equipments are space-occupying and need
good financial support. It may become a barrier for us to generalize
the training program in Taiwan. We then developed a simplified model
of confined space which mimics the real circumstances but is cost-effective.
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Methods |
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Designing the simple model of confined space |
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To construct a virtual confined
space, we utilized the materials available at hand such as 30 to
50 long tables, 60 paper boxes, 20 large curtains, 4 Manikins for
resuscitation and intubation, 1 pack of flour, 5 rolls of sealing
tapes and 1 make-up box.
The steps of construction were as follows:
1. Align the long tables face to face to form a tunnel with different
bending angle, height and width along the whole pathway. The basic
height of the tunnel was about 50 to 60 cm and the width less than
80 cm.
2. Place the manikins in different areas along the tunnel, at least
5m apart each other. Each manikin was arranged with different orientation.
3. Cover the tunnel with paper boxes and seal with tapes.
4. Put some flour or powder to mimic the dusts that could be found
in the confined space.
5. Cover the tunnel externally with the curtains or sheets to make
the tunnel poorly illuminated.
6. Pre-set one end of the tunnel as the entry and the other the
exit.
The time elapse for constructing the virtual confined space was
recorded and averaged.
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Evaluation of the efficiency and safety
of the model |
To evaluate the efficiency of the
model, we designed a questionnaire to analyze the opinions of the
students during disaster medical assistance team (DMAT) training
courses from January 2002 to December 2002. The questionnaire was
composed of 5 vision scales (scoring from 0 to 10) for the following
items: reality, difficulty, safety, creativity, and applicability.
Under the item of applicability, the student was asked to evaluate
the adequacy of practicing standard basic trauma life support (BTLS),
adaptation of definite care, communication and full evaluation within
the tunnel. The scores were recorded and averaged. |
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Statistical analysis |
The categorical data were inputted in Microsoft Excel
2000 for descriptive statistics and further qualitative analysis.
ANOVA with a Newman-Keuls post hoc test was used to determine whether
any significant differences existed among continuous data. A P
< 0.05 was considered to be statistically significant. |
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Figure 1.Scorings for four subheadings of the item applicability |
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Results |
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The data obtained
from six DMAT training courses were enrolled for analysis. The time
elapse for constructing the virtual confined space was in average
45 +5 min and that for cleaning up 25 +5 min. The average cost for
setting up the tunnel was 950 +80 NSD.
There were 432 students who attended DMAT training course and completed
questionnaire. Three hundreds and twenty-eight of them were nursing
staffs, 44 physicians and 60 staffs of logistics or administrative.
The average scores for 5 items were 7.8 +1.4 for reality, 6.5 +1.8
for difficulty, 9.0 +0.6 for safety, 9.3 +1.1 for creativity, and
9.0 +0.8 for applicability. No definite injury was documented during
six training courses.
For the items of applicability, the subheadings of adequacy for
practicing BTLS, definitive care, communication, and full evaluation
were obtained 9.4 +1.4, 9.3 +1.2, 8.6 +1.4 and
8.3 +1.5, respectively (Figure) .
The latter two were significantly lower than the former two (P<0.05
by ANOVA).
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Discussion |
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According to past
experience, most disaster victims received search and rescue from
their neighbors, family, friends or the person who happen to be
at the disaster scene. Few victims are able to get prehospital care
from doctors or nursing staff due to hospital itself is a disaster
victim. 6-9 Immediately after the occurrence
of disaster most of the staff in hospital has to manage their institute.
It is unrealistic to expect the help from hospital staff for an
external disaster at the first minute. In this study, we set up
the standard procedure as well as the simulated model of urban search
and rescue (USAR) in a confined space. We successfully complete
the provider manual as well as instructor manual of USAR in a confined
space. The publications can be used as a guideline in that kind
of scenario.
It is believed that the understanding of the unique environment
and knowledge of confined space medicine will enhance the survival
of and reduce morbidity in the extricated patient. Approach and
treatment needs to begin as soon as possible to maximize the chances
of survival. The chance of extricating a live victim drops usually
dramatically after 24 hours following the building collapse. Many
past experiences supported the concept. 13-15
Confined space rescue involves mainly USAR and partially disaster
medical assistant teams.3,5 USAR is one of the emergency support
functions according to the design of the United States. Personnel
assigned to task forces of their USAR Response System are highly
trained and possess specialized expertise and equipment. Under their
incident command systems, so-called emergency support function #9
addresses only US&R instead of all other forms of search and
rescue (e.g., water, wilderness, subterranean) that are managed
under different authorities.3 To fulfill the requests that rapid
activation to complete rescue within 72 golden hours and response
for any incident or anticipated incident likely to result in overwhelming
collapsed structures, their training include incident support, structural
collapse technique, medical support and logistic support. In the
context of their medical specialist training, confined space medicine
is an important issue.3,10-12 Although a throughout confined space
medicine training include rescuer’s safety, atmospheric monitoring
and stabilization of the victims, a virtual confined space is essential
for such a training course.
To our knowledge, a virtual confined space includes the scene of
training tower, trench and water tower. 5
According to the past experience of Fire Service Administration,
it still cost about 200 thousands NSDs even though only a simply
confined space was temporarily constructed. Besides, the safety
of the students might be another problem. Because of limitation
of space and cost, we developed a model of confined space for training
that could fulfill most of the skills that should be involved. The
design costs less than one thousand NSDs and is safe for each participant.
The model has the characteristics of a confined space including
limited entry and exist, narrow space, poor ventilation, poor illumination
and unstable infrastructure. The cost-effectiveness and safety guarantying
of the model provides a good way for generalization of confined
space training.
The limitations of the model for confined space medicine were as
follows. First, as the data revealed, the model could not provide
adequate training of communication and full evaluation because of
the use of the manikins at the scene. Further modification with
volunteer instead at the scene may increase the likelihood of confined
space rescue. How to apply some noise-proof appliances over the
tunnel should also be considered in the future. Second, the tunnel
mimicked mainly the condition of the trench, but could not simulate
well the conditions of training towers. In other words, our model
could not afford the operations in the descending of a vertical
hole. The same problem was also met in the situations of water towers.
In conclusion, we create a simple model of virtual confined space
that will be of help in the comparable training courses.
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