The Need for MedSMART: Medical Errors and the Inadequacy of Training There is no question that training in the form envisaged by MedSMART is badly needed all over the world. The existence of medical errors highlighted in the recent report of the Medical Section of the U.S. Academy of Sciences (To err is human) is evident in medical practice as much in the U.S. as it is anywhere else in the world. Major mistakes in treatment, often fatal, are reported with equal frequency in countries with advanced medical systems such as France, Germany, the United Kingdom, or Italy. Dehydration – an easily diagnosed and equally easily treated condition – is the major source of infant mortality in Africa; and mismanagement of a relatively simple injury can lead to the demise of patients in many regions of South America, the Far East, or even Europe. These facts serve as a powerful indicator of substantial inadequacy of medical care the world over. Many elements, such as access to medical facilities, the level of available resources, or local medical policies, contribute to the generally unsatisfactory state of health care operations. However, one factor — inadequate training —- appears to be the principal contributor to the high rate of medical error. Several studies conducted in Europe and in the U.S. showed an alarmingly rapid loss of diagnostic and manual medical skills within a relatively short period following the original training. Many of these studies emphasized the need for frequent and intensive refresher training. Yet only relatively a few studies were devoted to training inadequacies by addressing remedial issues in a realistic or relevant manner. This is particularly true in regions where access to high-level medical expertise is either very difficult or nonexistent. Even fewer investigators devoted their attention to the problems of training prehospital providers such as paramedics, community nurses, or rescue workers. In the majority of countries, many ambulance companies are based on volunteerism. Typically, the operational resources are scarce. In several cases, inadequacy of funds results in limited medical supplies, shortage of even rudimentary equipment, and substandard and outdated training. Yet it is often the element of outdated training that determines the fate of the patient. Inadequate medical assistance at the site of the injury based on inadequate training is typically the major contributor to the futility of the subsequent resuscitative efforts at the local emergency medical facility. Thus, the issue of proper training of prehospital personnel is a critical one that demands immediate attention at local, national, and international levels. The significance of medical training based on cross-national principles is emphasized by the ever increasing frequency of international medical effort during humanitarian or disaster relief operations. During such activities, the medical personnel trained in accordance with national rescue/medical assistance philosophies and policies are forced to operate in a complex environment of large multinational medical operations at the disaster site. Unsurprisingly, the initial stages of such operations are badly hampered by language and cultural differences. By the time the collaborative effort finally takes off as an efficient activity, the number of easily avoidable fatalities increases dramatically. The recent advent of highly sophisticated medical training tools such as Human Patient Simulators, virtual reality-based systems, or Web-based training platforms increased the hope that training based on their use would result in rapid and readily perceptible changes. Unfortunately, many of the technology-based devices are hampered by the inadequacies that accompany the very platform used. Thus, Web-based systems are often too simplified, do not expose the trainee to the tempo and stress of medical emergency, and are often either limited in their medical scope or inflexible in interactions (preset algorithms). Virtual reality systems are limited to single procedures (typically laparoscopy) that are, at least presently, of limited use in emergency procedures and of practically no use during field operations. Human Patient Simulators (HPS) are expensive, demand technical support, and require the presence of highly sophisticated training personnel. Moreover, while the HPS may be considered an ideal tool for training in both pre- and in-hospital emergencies, the majority of HPS units are stationary, located predominantly at major medical training centers whose operations concentrate on the education of their own staff and students.

Traumatic injury in the Middle Ages is the same as traumatic injury today. So are the needs for its treatment

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