IntroductionDebriefing is a process of communication that takes place between a team following a clinical case. Debriefing facilitates discussion of individual and team level performance and identifies points of excellence as well as potential errors made. This helps to develop plans to improve subsequent performance. While the American Heart Association and the UK Resuscitation Council recommend debriefing following every cardiac arrest attended by a healthcare professional, it has not become part of everyday practice. In the emergency department (ED), this is in part attributable to time pressures and workload. Hot debriefing is a form of debriefing which should occur ‘there and then’ following a clinical event. The aim of this quality improvement project was to introduce hot debriefing to our ED following all cardiac arrests.MethodsA hot debriefing tool was designed following simulated cardiac arrest scenarios and team feedback. This tool was then introduced to the ED for use after all cardiac arrests. The team lead was asked to complete a debrief form. These completed hot debrief forms were collated monthly and compared with the department’s cardiac arrest register. Any changes made to cardiac arrest management following hot debriefing were recorded. Qualitative feedback was obtained through questionnaires.ResultsDuring the 6-month study period, 42% of all cardiac arrest cases were followed by a hot debrief. Practice changes were made to resus room equipment, practitioners’ non-technical skills and the department’s educational activities. 95% of participants felt the hot debriefing tool was of ‘just right’ duration, 100% felt the process helped with their clinical practice, and 90% felt they benefited psychologically from the process.ConclusionThe introduction of a hot debriefing tool in our department has led to real-world changes to cardiac arrest care. The process benefits participants’ clinical practice as well as psychological well-being.

Background The SARS-CoV-2 pandemic and government-enforced restrictions have impacted medical practices. Aims The aim of our study was to investigate the impact SARS-CoV-2 and public health restrictions had on trauma presentations to a regional paediatric emergency service. Methods We carried out a multisite retrospective longitudinal study of all paediatric ED attendances from 2018 including 13 March to 7 June 2020. This aligned with the initial government-enforced public health phases: delay phase, mitigation phase and reopening phase 1. Results There were 7975 total regional attendances during government-enforced restrictions. This represents 17.5% and 15.6% reductions in site attendances when compared with the two previous years. Regional attendances reduced by 52.5% in 2020 compared with 2018 and 50.9% compared with 2019. Following an initial reduction in injury attendances at the beginning of the 'lockdown' (p = 0.076), the number of injuries consistently grew as weeks progressed (p < 0.05), reaching a peak of 44.6% of all attendances. As restrictions eased, the most common location where injuries occurred moved to areas outside the home (p < 0.000). There was a significant change in injury type, final disposition and device-associated injury (p < 0.05). Wheeled recreational devices were associated with over 20% of all injuries by reopening phase 1. Conclusions This study reveals that total attendances and total injuries reduced during initial phases of the lockdown. This was followed by a significant increase in injury presentations, which reached a peak of 44.6% of all attendances. We identified potential modifiable characteristics of paediatric trauma which can be addressed by future public health strategies.

Dry needling is an invasive procedure using solid filament needles to treat myofascial pain and dysfunction. It is becoming a widely used adjunct to traditional physiotherapy treatment. Despite its rate of growth there still remains questions marks over the effectiveness of dry needling and its potential to cause adverse events. Recent reviews largely agree that there is an improvement in the patient’s pain and range of motion in the short term when compared to no treatment, but evidence remains inconclusive for long term effects. Dry needling is an invasive therapy and clinicians need to have an appropriate indication for providing dry needling therapy while also determining whether the therapy will place the patient under any unacceptable risk of adverse events. One paper found the rate of mild adverse events to be as high as19.18%. The most common adverse events experienced were bleeding, bruising and pain during or following treatment. To minimise the risk of adverse events treating clinicians should receive appropriate training and certification to provide dry needling therapies. This commentary aims to present the most current evidence surrounding dry needling effectiveness, safety profile and the need for appropriate levels of professional competence.

team in the emergency department in situ simulation training as this gives a more realistic perspective.

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