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Background: Neuromuscular monitoring should be applied routinely to avoid residual neuromuscular block. However, anaesthetists often refrain from applying it, even when the equipment is available. We aimed to increase neuromuscular monitoring in six Danish anaesthesia departments via e-learning.Methods: Interrupted time series study, with baseline data from a previous study and prospective data collection after implementation of the module, which was available for 2 weeks from 21 November 2016. We included all patients receiving general anaesthesia with muscle relaxants until 30 April 2017. Main outcome was application of acceleromyography, grouped as succinylcholine only and non-depolarising relaxants.Secondary outcomes were last recorded train-of-four ratio (non-depolarising) relaxants and score on a ten-question pre-and post-course multiple-choice test. Results:The post-intervention data consisted of 6525 cases (3099 (48%) succinylcholine only, 3426 (52%) non-depolarising relaxants). Analysing all departments, we found a positive pre-intervention trend in application of acceleromyography for both groups, of estimated 7.5% and 4.8% per year, respectively (p < .001). The monitoring rate increased significantly for succinylcholine in two departments post-intervention (p = .045 and .010), and for non-depolarising relaxants in one department (p = .041), but followed by a negative trend of −37.0% per year (p = .041). The rate was already close to 90% at the time of the intervention and the mean last recorded train-offour ratio was 0.97 (SD 0.21), also without a significant change. The median score on the post-course test increased from 7 (IQR 5-8) to 9 (IQR 8-10) (p < .001, Wilcoxon Signed-Ranks Test). Conclusion:We found no overall effect of the e-learning module on application of neuromuscular monitoring, although the post-course test indicated an effect on anaesthetists' knowledge in this field.

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Background Early cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator (AED) can increase 30-day survival from 10% up to 70%. An unmanned aerial vehicle (UAV) might have a role in transporting an AED to the site of an OHCA. The aim of this experimental study was to describe the potential benefit of an UAV system for delivery of an AED in a rural environment. Materials and methods Optimal placement and response times for AED equipped UAV were calculated using GIS-models based on two weighting alternatives. UAV delivery testflights were performed using three different techniques. Results All OHCA cases with a cardiac aetiology n = 7923 in Stockholm county 2006-2013 were analyzed. Ten optimal locations with a 10 km radius in the greater Stockholm area were identified for implementation of UAV systems. With a simulated 50/50 weighting n = 7905 cases were found primarily in the city centre. The UAV arrived before EMS in 32% of cases with a mean timesaving of 1.5 min. With a simulated 80/20 weighting including n = 134 OHCA cases in primarily remote areas, the UAV arrived before EMS in 93% of cases with a mean timesaving of 19 min. Delivery of the AED in testflights n = 14 was successful in favourable conditions within sight primarily by latch-released technique or by landing the UAV on flat ground. Conclusions By using GIS models optimal placement of UAV systems can be calculated. These locations might in the future significantly reduce time to defibrillation and serve as a complement to EMS services. A4 Prehospital patient safety incidentsa description based on a national mandatory reporting system

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