In situ simulation is a pivotal aspect of medical training, offering practitioners the opportunity to refine their skills in real-world scenarios. By immersing medical professionals in lifelike scenarios, in situ simulation fosters both technical and non-technical skills, ensuring effective teamwork, decision-making, and patient care.
Learning Objectives
Learning objectives - Non clinical
- Develop strong team collaboration and effective decision-making skills in scenarios involving anticoagulant reversal and chest drain procedures.
- Enhance leadership abilities and efficient role allocation within the medical team.
- Practice making time-critical decisions that can significantly impact patient outcomes.
Learning objectives - Clinical (Medical)
- Recognize life-threatening injuries in elderly patients promptly and accurately.
- Demonstrate proficient management of haemopneumothorax cases, including safe blood product prescription and anticoagulant reversal techniques.
- Gain practical experience in inserting chest drains to stabilize critical patients.
Learning objectives - Clinical (Nursing)
- Identify signs of patient deterioration and escalate concerns appropriately.
- Master the process of drawing up Tranexamic Acid (TXA) and preparing Octaplex for administration.
- Learn the proper setup and administration of blood transfusions through BELMONT systems.
- Ensure safe transfusion practices and comprehend the setup of chest drain kits
Faculty - Anoopkishore Chidambaram, ED SpR, Louisa Chan, ED and PHEM Consultant, Helen Crossley, ED Consultant, Henna Wong, Haematology Consultant
RCEM Curriculum Coverage Topics (SLOs)
SLO 2 - Support the ED team by answering clinical questions and making safe decisions
SLO 3 - Identify sick adult patients, be able to resuscitate and stabilise and know when it is appropriate to stop
SLO 6 – Proficiently deliver key procedural skills needed in Emergency Medicine
SLO 7 - Deal with complex and challenging situations in the workplace
The Case
An elderly woman living alone experiences increasing breathlessness. Her concerned son, who regularly checks on her, notes a deterioration and calls an ambulance. On arrival, her condition is critical, with oxygen saturation at 74% on room air. After nebuliser treatment, she improves temporarily. This prompts a series of assessments and interventions, culminating in a trauma call activation due to suspected major haemorrhage.
Technical Skills
- Early recognition of potential major trauma cases, especially in elderly patients.
- Timely activation of the major haemorrhage protocol.
- Skillful administration of Tranexamic Acid (TXA) and calcium for major haemorrhage cases.
- Proper management of haemopneumothorax, involving chest drain placement, blood product administration, and anticoagulant reversal.
Human Factors / Non-Technical Skills
- Clear delineation of team leader responsibilities for effective coordination.
- Implementation of closed loop communication to ensure task completion.
- Effective communication during "2222 calls" and use of checklists for procedural tasks.
- Emphasis on thorough documentation for patient care continuity.
- Timely involvement of additional support from EPIC/NIC teams.
- Recognising the importance of a dedicated scribe during critical events for accurate documentation.
Latent Threats identified
- Failure to brief porters, leading to the dismissal of the initial major hemorrhage protocol call.
- Lack of awareness among certain specialties about the ongoing simulation activity.
Some comments from participant feedback from own reflections:
- Enhanced teamwork and leadership skills.
- Improved closed-loop communication.
- Recognising the need for early assistance.
- Efficient utilisation of medical equipment.
- Successful activation of the major haemorrhage protocol.
- Valuable education regarding blood administration practices.
Suggested improvements from participants:
- Incorporate more in situ simulation opportunities
- Notify radiology teams as part of the trauma call activation process.
