Introduction: Due to the technical progress point-of-care ultrasound (POCUS) is increasingly used in critical care medicine. However, optimal training strategies and support for novices have not been thoroughly researched so far. Eye-tracking, which offers insights into the gaze behavior of experts may be a useful tool for better understanding. The aim of this study was to investigate the technical feasibility and usability of eye-tracking during echocardiography as well as to analyze differences of gaze patterns between experts and non-experts. Methods: Nine experts in echocardiography and six non-experts were equipped with eye-tracking glasses (Tobii, Stockholm, Sweden), while performing six medical cases on a simulator. For each view case specific areas of interests (AOI) were defined by the first three experts depending on the underlying pathology. Technical feasibility, participants’ subjective experience on the usability of the eye-tracking glasses as well as the differences of relative dwell time (focus) inside the areas of interest (AOI) between six experts and six non-experts were evaluated. Results: Technical feasibility of eye-tracking during echocardiography was achieved with an accordance of 96% between the visual area orally described by participants and the area marked by the glasses. Experts had longer relative dwell time in the case specific AOI (50.6% versus 38.4%, p = 0.072) and performed ultrasound examinations faster (138 s versus 227 s, p = 0.068). Furthermore, experts fixated earlier in the AOI (5 s versus 10 s, p = 0.033). Conclusion: This feasibility study demonstrates that eye-tracking can be used to analyze experts and non-experts gaze patterns during POCUS. Although, in this study the experts had a longer fixation time in the defined AOIs compared to non-experts, further studies are needed to investigate if eye-tracking could improve teaching of POCUS.

Background: Stakeholder engagement plays a vital role in driving advancements in product development. This imperative now extends to the healthcare domain, driven by the scarcity of healthcare professionals and the pressing demand for effective solutions. Through the application of design thinking and co-design methodologies, this study endeavours to promote comprehensive stakeholder involvement, creating streamlined processes and adaptable templates geared towards fostering innovative solutions for tele-emergency medicine. Methods: In this study design thinking and co-design methods are developed, adapted, and tested, to create effective tools and demonstrate their application. This is part of a process involving stakeholders and lead users to develop a telemedicine solution for emergency medical services. This research is descriptive in kind, offering a transparent and holistic portrayal of the co-design process. The rural region of Burgenland in Austria was chosen for this study, with the challenges of its weak infrastructure offering valuable insights. The tools were tested in co-design workshops, with the participants continuously observed by the research team. Results: Seventeen healthcare professionals, emergency medical technicians and academics participated in a co-design process to develop a telemedicine solution for emergency medical services. The results section presents practical co-creative healthcare innovation tools and templates that have been shown to facilitate the co-design process. Conclusions: The study developed and applied co-design elements for the creation of a prototype concept for telemedicine in emergency medicine and offers valuable insights for similar projects involving diverse stakeholders. It shows that structured co-design activities help all stakeholders to jointly create solutions that meet the overall needs.

Background: In times of demographic change and an immense shortage of qualified personnel in emergency medical services, telemedicine could offer more efficient solutions for better care. Given the community-based nature of emergency services, local communities play an important role. This study explored the expectations of healthcare professionals and volunteers for telemedicine tools in prehospital emergency medicine. Methods: This mixed-methods study was conducted in the rural region of Burgenland in Austria with stakeholders of the local emergency medical service in two focus groups (13 participants) and 99 quantitative questionnaires. Results: Combining quantitative and qualitative data, we found that a majority of respondents (almost 80%) already experienced basic telemedicine and consider it valuable. In particular, there is a strong expectation for diagnostic support and inquiries related to potential hospitalization. Findings from two focus groups emphasized the importance of cultivating an improved learning culture, developing a specific mindset, and refining soft skills. The optimal telemedicine solution includes a knowledgeable and experienced tele-emergency physician coupled with user-friendly technology. Conclusion: To be clear about the expectations of stakeholders, it is essential to involve all stakeholders right from the beginning. The solution should prioritize the integration of existing structures and be seamlessly incorporated into an evolving learning culture, while also fostering the necessary mindsets alongside educational aspects.

This study aimed to address the challenges faced by rural emergency medical services in Europe, due to an increasing number of missions and limited human resources. The primary objective was to determine the necessity of having an on-site emergency physician (EP), while the secondary objectives included analyzing the characteristics of rural EP missions. A retrospective study was conducted, examining rural EP missions carried out between January 1st, 2017, and December 2nd, 2021 in Burgenland, Austria. The need for physical presence of an EP was classified based on the National Advisory Committee for Aeronautics (NACA) score into three categories; category A: no need for an EP (NACA 1–3); category B: need for an EP (NACA 1–3 along with additional medical interventions beyond the capabilities of emergency medical technicians); and category C: definite need for an EP (NACA 4–7). Descriptive statistics were used for analysis. Out of 16,971 recorded missions, 15,591 were included in the study. Approximately 32.3% of missions fell into category A, indicating that an EP’s physical presence was unnecessary. The diagnoses made by telecommunicators matched those of the EPs in only 52.8% of cases. The study suggests that about a third of EP missions carried out in rural areas might not have a solid medical rationale. This underscores the importance of developing an alternative care approach for these missions. Failing to address this could put additional pressure on already stretched EMS systems, risking their collapse.

Background: With the increasing availability and use of digital tools such as virtual reality in medical education, there is a need to evaluate their impact on clinical performance and decision-making among healthcare professionals. The Trauma SimVR study is investigating the efficacy of virtual reality training in the context of traumatic in-hospital cardiac arrest. Methods and analysis: This study protocol (clinicaltrials.gov identifier: NCT06445764) for a single-center, prospective, randomized, controlled trial focuses on first-year residents in anesthesiology/intensive care, traumatology, and emergency medicine. The study will compare the clinical performance in a simulated scenario between participants who received virtual reality training and those who received traditional e-learning courses for preparation. The primary endpoint is the time to a predefined intervention to treat the underlying cause of the simulated traumatic cardiac arrest. Secondary endpoints include protocol deviations, cognitive load during simulated scenarios, and the influence of gender and personality characteristics on learning outcomes. The e-learning and the virtual reality training content will be developed in collaboration with experts from various medical specialties and nursing, focusing on procedural processes, guideline adherence specific to trauma patient care, and traumatic in-hospital cardiac arrest. Results: The results of this study will provide valuable insights into the efficacy of virtual reality training, contributing to the advancement of medical education, and serve as a foundation for future research in this rapidly evolving field.

Background/Objectives: Adequate cardiopulmonary resuscitation (CPR), defibrillation, and treatment of reversible causes are essential for improving the survival of patients suffering from out-of-hospital cardiac arrests (OHCAs). The Advanced Life Support (ALS) algorithm includes reversible causes for cardiac arrest. This study aimed to develop an interactive mobile checklist to identify reversible causes of OHCA (REBECCA) and evaluate their usability and usefulness among emergency physicians. Methods: This mixed-methods study was conducted at the Emergency Medical Service Vienna, Austria. All participants were emergency physicians from the Medical University of Vienna. An interactive mobile checklist was developed using a participatory design approach involving a focus group of 10 emergency physicians. Usability and applicability were assessed using structured questionnaires. Descriptive statistics were used to summarize participant characteristics and evaluation outcomes. Results: Among the included participants, 70% were specialists with a median prehospital experience of 2.0 (1.0–4.3) years. Although most participants were confident about their level of professional experience with OHCA, 85% still found the checklist to be helpful. The majority of the participants preferred the digital checklist over the paper-based checklist and appreciated its integration with the point-of-care ultrasound (POCUS) application. Although the participants did not communicate a significant need for further details on most causes, a small majority favored more information on intoxication and electrolyte disorders. Conclusions: The majority of the included emergency physicians found the REBECCA checklist helpful regardless of training level, whereas almost no physician needed further detailed information on the reversible causes. Our findings underscore the potential importance of future investigations aiming to reduce the cognitive load of emergency physicians during OHCA scenarios.