Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Learning Objectives: To orient emergency medicine residents and medical students to c-arm operation and dynamic utilization. Additionally to use the modality to teach fracture identification, reduction and splinting techniques.

Introduction: Adult and pediatric extremity fractures are a common presentation to Emergency Departments (EDs). Utilizing a c-arm dynamically helps facilitate more efficient and successful fracture reduction and splinting. The familiarization of utilizing a c-arm for fracture reduction is a critical skill for emergency medicine education and clinical practice.

Objective: To orient emergency medicine residents and medical students to c-arm operation and dynamic utilization. Additionally to use the modality to teach fracture identification, reduction and splinting techniques. We then assessed how effective this modality was at meeting those objectives for our learners.

Curricular Design: Fractures were simulated in cadaveric goat legs cast into an opaque gelatin mold. The fractures could not be identified visually and were interrogated by palpation and fluoroscopically using a c-arm. Participants were given tutorials on proper fluoroscopic technique and allotted time to practice reductions in a non-clinical setting. We sent a six-question follow-up survey inquiring how effective this simulation was on a seven-point Likert scale ranging from “Not Effective” (1) to “Very Effective” (7). Twenty emergency medicine residents completed the post-simulation survey (74% response rate). For 40% of the residents, this was the first time using the c-arm. The simulation was quite effective at familiarizing residents to a c-arm with a mean score of 5.9 (SD=0.93), general fracture identification (4.9, SD=1.8) and reduction technique (5.1, SD=1.2), however it was even more effective at teaching those skills fluoroscopically (6.1, SD=1.1 and 5.7, SD=1.5, respectively).

Impact/Effectiveness: This innovation utilized materials found in many emergency departments and nearby communities and created low-cost, mid-fidelity fracture simulations in a non-clinical setting. This approach allows clinical trainees to utilize the equipment necessary for efficient and successful fluoroscopically-guided fracture identification and reduction.