On November 8-10, 2012, 2^nd International Congress on Neurology and Epidemiology (ICNE 2012) was held in Acropolis, Nice, France. In this conference, we presented a paper about a concept of neuroresuscitation and a simulation-based hands-on training course, called Immediate Stroke Life Support (ISLS), for medical staff in the neurological emergency fields. This report demonstrates the out-line of ICNE 2012 and our presentation.

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Introduction Revisions in laws regarding donated organs have expanded the availability of these tissues, leading medical institutions deal with new problems. Organ donation rates appear to have increased, as the revised laws make it possible for the families of the certified brain dead patients to offer organs on their own accord. However, emergency departments are so busy that they have difficulties managing organ donation property. To address this issue, we gave our emergency department staff simulation training, with the aim of deepening awareness as well as furthering understanding the revisions to the laws. Methods We performed two simulations of the procedures for processing organs donation from certified brain dead patients. The first scenario dealt with a hypothetical patient that died from an endogenous illness, while the second dealt with a virtual victim of an exogenous illness. Participants were surveyed for training efficacy after each occasion of simulation training through the use of a questionnaire. Results We were able to evaluate our behavior for processing organs donated from for processing organs donated from certified brain dead patients through two sessions of simulation training. The questionnaire survey following the first simulation showed that the staff had a poor understanding of providing care for or managing families in these situations, and that they were devoid of understanding of simulation as a whole. The second occasion incorporated training on care and management of families, resulting in their improved understanding of how medical institutions should deal with wishes of families that spoke for the certified brain dead patient. It was thus recognized that the care and management of families are important points in the organ donation process. Discussion and summary In Japan, end-of-life care of families, medical transplantation, and organ donation have rarely been subjects of medical education. In advanced emergency medical service settings of the future, all wishes of the dead or their families may not be met. Therefore, simulation training plays an important role in improving the quality of medical institutions and is also helpful for reinforcement of behavioral objectives and staff education.

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Now that the general public is permitted to use automated external defibrillator (AED), it is necessary for medical student to be able to correctly perform basic life support. At our university, we have long recognized the importance of education in cardiopulmonary resuscitation and have offered an emergency scenario using basic life support on objective structured clinical examination (OSCE) in the fifth-year of undergraduate education. We evaluated the scoring system by subjective estimate compared to objective estimate using personal computer system.
Thirty three fifth-year students performed basic life support on OSCE scenario. We estimated the practical examination with regard to artificial breathing and chest compression by estimators using check list and by simulator with personal computer system at the same time.
We made a comparison between two estimates. The subjective estimate by estimators using check list was not accurate more than the objective one using personal computer system. There ware great differences with regard to chest compression between two estimates.
The objective estimate using personal computer system played an important role to estimate the quality of artificial breathing and chest compression compared to the subjective estimate. We also have to offer a course in basic life support based on an objective estimate.

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To improve the survival rate of in-hospital cardiac arrest, the quality of CPR in the first responder and rescue team is important. In our hospital, a variety of training courses is heled so that a possible appropriate training for multidisciplinary from three years ago. AHA-BLS / ACLS course and ICLS course for medical doctors and nurses and JMECC course for medical doctors of internal medicine are held. For all staff other than medical doctors and nurses, the chest compression-only CPR and AED training are carried out. At the same time, we aim to build on the registration system for in-hospital cardiac arrest and DNAR (do not attempt resuscitation), and began preparations for RRS(Rapid Response System). To analyze the effectiveness of CPR course to all staff in the hospital, we conducted a questionnaire survey before and after training to 564 people participated. After the training using a 5-level-response answer-back questionnaire, the proportion of high 4-5 points of willingness to do CPR improved from 30% to 75 percent. Also for the use of AED, the willingness was increased similarly from 42% to 77%. As a result of in-hospital cardiac arrest survey, the emergency call in the night was delayed to start CPR, so the entire broadcast “Hurry calls” is carried out 24 hours. DNAR was performed in 80% of all death in hospital, however, of which the advance directive documents were obtained only half. Therefore, the ethical establishment of DNAR should be established in performing in-hospital cardiac arrest efforts. It is planned to continue to consider the various efforts by RRS establishment in the hospital for the patient's safety.

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Introduction To assess the effectiveness of education based on BLS lectures and training, this study analyzed factors such as motivation for rescue before and after lectures and the training, changes in life-saving knowledge. Lectures on motivation for rescue with performance of CPR and use of an AED were given to 156 4^th year students of the Faculty of Pharmacy of Kinki University. Methods Comparisons were made before and after the lectures and after the training using a 5-level-response answer-back questionnaire. In addition, the percentages of correct answers before and after lectures and training regarding chest compression tempo, hand position, and selection issues in patient conditions for indicating the use of AED were compared to analyze changes in life-saving knowledge. Results Motivation for rescue with performance of CPR and use of AED increased significantly after the lectures and training (p<0.001). Motivation for rescue pre-lecture was not significantly different between genders and presence or absence of lecture experience in the past. However, the level of improvement in motivation for rescue with use of AED was significantly different after the training compared to before the training among student with no previous experience of a lecture （p<0.05）. Accuracy rate of chest compression tempo, which is the index for change in life-saving knowledge improved significantly after the lectures and training (p<0.001). Accuracy rate of hand position in chest compression improved significantly after the training (p<0.001). With regard to patient conditions for indicating use of AED, accuracy rate did not increase significantly after the lectures, but did increase significantly after the training (p<0.001). Conclusions The present BLS lecture and training were effective in improving motivation for rescue with the performance of CPR and use of AED, and life-saving knowledge. Moreover, they were shown to be effective educationally for pharmacy students.

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Background Medical care is accomplished not only by health care providers, but medical care recipients, their family, social system are closely related. Various team models for the purpose of integrated cooperation between health care providers have been developed so far.
Methods In August, 2013, TeamSTEPPS Workshop was held in our University Hospital by the Fellows' Section of the Japanese Society of Internal Medicine. We explored the effectiveness and problem of TeamSTEPPS, a evidence-based team training program for medical safety by questionnaire survey.
Results Attendees' and observers' interests, understanding, and sympathy on patient safety and TeamSTEPPS much improved soon after attendance to the workshop. TeamSTEPPS was shown to rapidly improve the multidisciplinary health care providers' awareness and recognition of team approach to health care.
Conclusions Approach of TeamSTEPPS can be applied to the simulation education of the emergency and intensive care medicine to multidisciplinary health care providers. Also, we would emphasize the needs for the education of appropriate response after occurrence of the medical error and malpractice to be included in the course of TeamSTEPPS.

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[in Japanese]

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[in Japanese]

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