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BackgroundCardiopulmonary resuscitation (CPR) metrics including compression rate and depth are associated with improved outcomes and the need for high-quality CPR is emphasized in both the American Heart Association (AHA) and Heart and Stroke Foundation of Canada (HSFC) guidelines. While these metrics can be utilized to assess the quality of CPR, they are infrequently measured in an objective fashion in the emergency department.ObjectivesAs part of an Emergency Department (ED) Quality Improvement (QI) project, we sought to determine the impact of real-time audio-visual (AV) feedback during CPR amongst ED healthcare providers.MethodsParticipants performed two minutes of uninterrupted CPR without AV feedback, followed by two minutes of CPR with AV feedback after a two-minute rest period in a simulated CPR setting. CPR metrics were captured by the defibrillator and uploaded to review software for analysis of each event.ResultsThe use of real-time AV feedback resulted in a significant improvement in the number of participants meeting AHA/HSFC recommended depth (38%, p = 0.0003) and rate (35%, p = 0.0002). Importantly, ‘compressions in target’, where participants met both rate and depth simultaneously, improved with AV feedback (19 vs 61%, p < 0.0001).ConclusionsWe found a significant improvement in compliance with CPR depth and rate targets as well as ‘compressions in target’ with the use of real-time AV feedback during simulation training. Future research is needed to ascertain whether these results would be replicated in other settings. Our findings do provide a robust argument for the implementation of real-time AV CPR feedback in Hamilton Emergency Departments.

Introduction: Two billion people are currently affected by complex humanitarian emergencies (CHEs) resulting from natural disasters and armed conflict. Many have been displaced into crowded camps with poor access to water, sanitation, and health care. Humanitarian response is challenging under these circumstances, raising concern about the impact of COVID-19 on crisis-affected populations. Methods: This article examines CHEs in the Democratic Republic of Congo, Bangladesh, and Yemen, where protracted crises have displaced millions of people. Through use of a conceptual model, we examine barriers and facilitators to an effective COVID-19 response in these complex settings, and explore the future impact of the pandemic on crisis-affected populations. Results: Younger populations, who tend to have less severe COVID-19 disease, and existing response mechanisms, including educational health messaging, may facilitate the COVID-19 response in some CHEs. However, pre-existing chronic illnesses and malnutrition, coupled with poor access to health care and limited water/sanitation infrastructure, may increase COVID-19 infection rates and mortality. Exacerbated health care shortages, food insecurity, interrupted immunizations, increased insecurity, and worsened poverty may have a particularly severe impact. Discussion: A wide-reaching global response, incorporating the voices of marginalized populations, is needed to effectively and equitably respond to this global pandemic. Given the potential future deployment of Canadian troops to CHEs, an understanding of the COVID-19 response and pandemic implications in CHEs is critical for Canadian Armed Forces members.

Background: Global Health opportunities are popular, with many reported benefits. There is a need however, to identify and situate Global Health competencies within postgraduate medical education. We sought to identify and map Global Health competencies to the current CanMEDS physician competency framework to assess the degree of equivalency and uniqueness between them. Methods: JBI scoping review methodology was utilized to identify relevant papers searching MEDLINE, Embase, and Web of Science. Studies were reviewed independently by two of three researchers according to pre-determined eligibility criteria. Included studies identified competencies in Global Health training at the postgraduate medicine level, which were then mapped to the CanMEDS framework. Results: A total of 19 articles met criteria for inclusion (17 from literature search and 2 from manual reference review). We identified 36 Global Health competencies; the majority (23) aligned with CanMEDS competencies within the framework. Ten were mapped to CanMEDS roles but lacked specific key or enabling competencies, while three did not fit within the specific CanMEDS roles. Conclusions: We mapped the identified Global Health competencies, finding broad coverage of required CanMEDS competencies. We identified additional competencies for CanMEDS committee consideration and discuss the benefits of their inclusion in future physician competency frameworks.