BackgroundStudying the effect on functioning of the emergency department of disasters with a potential impact on staff members themselves usually involves table top and simulated patient exercises. Computerized virtual reality simulations have the potential to configure a variety of scenarios to determine likely staff responses and how to address them without intensive utilization of resources. To decide whether such studies are justified, we determined whether a novel computer simulation has the potential to serve as a valid and reliable model of on essential function in a busy ED.MethodsTen experienced female ED triage nurses (mean age 51) mastered navigating a virtual reality model of triage of 4 patients in an ED with which they were familiar, after which they were presented in a testing session with triage of 6 patients whose cases were developed using the Emergency Severity Index to represent a range of severity and complexity. Attitudes toward the simulation, and perceived workload in the simulation and on the job, were assessed with questionnaires and the NASA task load index. Z-scores were calculated for data points reflecting subject actions, the time to perform them, patient prioritization according to severity, and the importance of the tasks. Data from questionnaires and scales were analyzed with descriptive statistics and paired t tests using SPSS v. 21. Microsoft Excel was used to compute a correlation matrix for all standardized variables and all simulation data.ResultsNurses perceived their work on the simulation task to be equivalent to their workload on the job in all aspects except for physical exertion. Although they were able to work with written communications with the patients, verbal communication would have been preferable. Consistent with the workplace, variability in performance during triage reflected subject skill and experience and was correlated with comfort with the task. Time to perform triage corresponded to the time required in the ED and virtual patients were prioritized appropriately according to severity.ConclusionsThis computerized simulation appears to be a reasonable accurate proxy for ED triage. If future studies of this kind of simulation with a broader range of subjects that includes verbal communication between virtual patients and subjects and interactions of multiple subjects, supports the initial impressions, the virtual ED could be used to study the impact of disaster scenarios on staff functioning.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-016-2337-3) contains supplementary material, which is available to authorized users.

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clinical presentation, and surgical approach/outcomes, all being obtained from a prospectively managed hospital database.Results: A total of 16 patients <50 years old underwent carotid procedures. Average age was 46years (41-49), 47% were male and 75% were Caucasian. Prevalence of risk factors were on average: smoking, 94% (mean 1.3 packs per day, and 32 pack-years [range, 10-100]); hypertension, 69% (1.4 medications); diabetes, 31%; a diagnosis of hypercholesterolemia, 61% (mean total cholesterol 195 mg/dL, only one >240 mg/dL); none with creatinine >1.5 mg/dL. A total of 63% were transferred to our institution from an average distance of 142 miles. A total of 13 (81%) had neurologic events before diagnosis (69% stroke, 15% amaurosis, 8% TIA, 8% combination), the rest were asymptomatic. No carotid dissections. Duplex showed 33% had stenosis >90%, 47% had a stenosis >70%, and the rest had a stenosis 50% to 69%. Average time to surgery was 29 days (4-85; median, 15). Patch angioplasty was done in 75%, the rest with eversion. Complications included: 1 hyperperfusion syndrome, 0 new strokes or cranial nerve injuries, 1 DVT (which prolonged hospitalization). Hospitalization averaged 2.6 days (range, 1-12; mode, 1).Conclusions: Carotid endarterectomy in adults <50 most commonly follows a stroke in Caucasian patients, with a carotid stenosis >70%. Both genders are at risk, commonly have hypertension. and average >30 pack-years of smoking. Those treated do well from surgery, comparable to the outcomes published in older adults.