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Background and aimThere are no investigations on hand hygiene during cardiopulmonary resuscitation (CPR), even though these patients are at high risk for healthcare-associated infections. We aimed to evaluate the number of indicated hand hygiene per CPR case in general and the fraction that could be accomplished without delay for other life-saving techniques through standardized observations.Materials and methodsIn 2022, we conducted Advanced Cardiovascular Life Support (ACLS) courses over 4 days, practicing 33 ACLS case vignettes with standard measurements of chest compression fractions and hand hygiene indications. A total of nine healthcare workers (six nurses and three physicians) participated.ResultsA total of 33 training scenarios resulted in 613 indications for hand disinfection. Of these, 150 (24%) occurred before patient contact and 310 (51%) before aseptic activities. In 282 out of 310 (91%) indications, which have the highest impact on patient safety, the medication administrator was responsible; in 28 out of 310 (9%) indications, the airway manager was responsible. Depending on the scenario and assuming 15 s to be sufficient for alcoholic disinfection, 56–100% (mean 84.1%, SD ± 13.1%) of all indications could have been accomplished without delaying patient resuscitation. Percentages were lower for 30-s of exposure time.ConclusionTo the best of our knowledge, this is the first study investigating the feasibility of hand hygiene in a manikin CPR study. Even if the feasibility is overestimated due to the study setup, the fundamental conclusion is that a relevant part of the WHO indications for hand disinfection can be implemented without compromising quality in acute care, thus increasing the overall quality of patient care.

Background: Paediatric emergencies are challenging for healthcare workers, first aiders, and parents waiting for emergency medical services to arrive. With the expected rise of virtual assistants, people will likely seek help from such digital AI tools, especially in regions lacking emergency medical services. Large Language Models like ChatGPT proved effective in providing health-related information and are competent in medical exams but are questioned regarding patient safety. Currently, there is no information on ChatGPT’s performance in supporting parents in paediatric emergencies requiring help from emergency medical services. This study aimed to test 20 paediatric and two basic life support case vignettes for ChatGPT and GPT-4 performance and safety in children. Methods: We provided the cases three times each to two models, ChatGPT and GPT-4, and assessed the diagnostic accuracy, emergency call advice, and the validity of advice given to parents. Results: Both models recognized the emergency in the cases, except for septic shock and pulmonary embolism, and identified the correct diagnosis in 94%. However, ChatGPT/GPT-4reliably advised to call emergency services only in 12 of 22 cases (54%), gave correct first aid instructions in 9 cases (45%) and incorrectly advised advanced life support techniques to parents in 3 of 22 cases (13.6%). Conclusion: Considering these results of the recent ChatGPT versions, the validity, reliability and thus safety of ChatGPT/GPT-4 as an emergency support tool is questionable. However, whether humans would perform better in the same situation is uncertain. Moreover, other studies have shown that human emergency call operators are also inaccurate, partly with worse performance than ChatGPT/GPT-4in our study. However, one of the main limitations of the study is that we used prototypical cases, and the management may differ from urban to rural areas and between different countries, indicating the need for further evaluation of the context sensitivity and adaptability of the model. Nevertheless, ChatGPT and the new versions under development may be promising tools for assisting lay first responders, operators, and professionals in diagnosing a paediatric emergency. Trial registration: not applicable

Introduction: Learning motivation is essential to obtain and maintain ultrasound competencies in emergency medicine. Where refresher training is not mandatory, self-assessment is required to evaluate one’s competencies and the need for further training. This can be flawed by overconfidence effects, which inhibits learners´ metacognition and possibly learning motivation. Methods: In this cross-sectional multicentre project, we presented eight ultrasound loops of different pathologies to emergency physicians of different specialities. In addition, the physicians assessed their own and others’ competence and learning motivation using the Situational Motivation Scale comprising intrinsic motivation, external and identified regulation, and amotivation. Results: We were unable to detect generalized overconfidence effects in 86 physicians. However, the subgroup analysis revealed that some specialist physicians with completed training were overconfident, while those still in training were not. Overplacement negatively correlated with intrinsic learning motivation and identified regulation and positively correlated to amotivation. Further analyses revealed that learning motivation was associated with the interactions of the physicians’ risk perception, speciality, and self-assessment. Discussions Our results show that some overconfidence effects are present even in the advanced skill of emergency ultrasound. However, an absence of feedback can lead to a misjudgement of own competencies and even reduce their willingness to participate in training. Particularly trainers and experts whose skills are not further assessed could pose a risk to the patient as they may overconfidently train learners incorrectly. Therefore, lifelong training in emergency ultrasound should include ongoing expert training to avoid misconceptions and ensure patient safety.