Our most recent CGD witnessed a truly inspiring trio of SIMWARS set pieces. Rarity, Realism and Really scary situations were the themes of the scenarios. Much was gained from the extensive debriefs made possible by how these days are set out and the amazing turnout we receive. Some of the vignettes and images we’d like to share :

1. Peri-mortem C-section Learning Points :

• Sharing the mental model :  verbalising game plan and sequence of events to follow so that everyone in the team is on the same page.
• Task allocation : making sure that a task is allocated to the person with the most appropriate skill set e.g. Paramedic resuscitates the mother while Dr resuscitates the baby.

2. Amputation Scenario Learning Points :

• Taking handover from on scene crew : important for fostering team working.
• RSI vs amputation timing; dependent on
  • Scene assessment vs. clinical assessment
  • Patient position and location
  • Patient comfort : analgesia vs sedation vs GA challenge
• Contact SRC before or after the event

3. Major Incident Scenario Learning Points :

• Triage : together vs separately.  Latter may be more suited to casualties spread over wide area but make sure both have triage cards and mode of communication.
• Triage sieve (in the field) vs sort (in treatment area)
• Triage : important to assess, identify patients to treat and move on – not get distracted by clinical management.
• Documentation is key including      number and category of casualties.       Appoint a scribe to follow and include times.
• Consideration to Paramedic      triaging and doctor waiting and treating in treatment area.  Guided by Scene Commander.
• Cruciform® system : to read more      see www.cwc-services.com/products-services/triage

Our SIMWAR teams were of course responsible for setting each others’ scene and running the entire process for each other. Much conceptual depth and practical advice on how to do this was provided earlier in the day by our own (previously a Sim Fellow at Westmead as well) Andy Coggins. The references for his comprehensive breakdown of how simulation is becoming vital to modern medical education are given below.

1. Simulation Training References

• ★ Simulation Overview.  Weller      J et al. Simulation in Clinical Teaching And Learning. MJA 2012; 196 (9) 594
• Nestel et al. Key Challenges in Simulated      Patient Programs: An International Comparative Case Study.  BMC Med Education 2011, 11:69

• Boulet J. Summative assessment in      medicine: the promise of simulation for high-stakes evaluation.  Acad Emerg Med 2008; 15: 1017-1024. 35
• Boulet J et al. Reliability and validity      of a simulation-based acute care skills assessment for medical students      and residents.  Anesthesiology 2003; 99:      1270-1280.

2. Debriefing References

• Pendelton’s Rules (an      alternative is ‘SETGO’).

www.csmen.scot.nhs.uk/media/17983/presentation_effective_feedback_feb_2012.pdf

• ★ Rudolf et al. There’s No Such Thing as “Nonjudgmental” Debriefing:      A Theory and Method for Debriefing with Good Judgment. Simulation      Healthcare 2006;1: 49–55
• Video on High Fidelity Case Based      Simulation Debriefing http://vimeo.com/33991081
• Debriefing      Quick Reference Guide

3. Simulation Evidence Base References

• Weller J, Robinson B, Larsen P, Caldwell      C. Simulation-based training to improve acute care skills in medical      undergraduates. N Z Med J 2004; 117:
• Grantcharov T et al. Randomized clinical      trial of virtual reality simulation for laparoscopic skills training. Br J      Surg 2004; 91: 146-150.

4. Further Information Websites

• Sim-Health : www.simhealth.com.au
• NHET-Sim (AUSETT) : www.nhet-sim.edu.au
• Debriefing Assessment for Simulation      in Healthcare (DASH) : http://www.harvardmedsim.org/debriefing-assesment-simulation-healthcare.php

Finally we had an update on the OSCAR II Trial by Sandy Mueke. Below is a précis for those who missed it and are ready to help us recruit test subjects in the coming weeks!

Aim : Assessment of a NiBP measuring device in retrieval setting with regards to its accuracy and reliability during helicopter flight.  Comparison to IABP measurement.

Inclusion criteria : stable adult patient with an arterial (radial/ulnar/brachial) in situ; patient being transferred to a participating hospital (see list on blue form).

Exclusion criteria : unstable patient, upper limb trauma, coagulopathy.

Bankstown co-ordinator : John Glasheen

Equipment : in ready room with blue forms to be completed for each patient recruited.  Completed forms to be placed in OSCAR II box in ready room.

Task : attach to same arm as IABP, press the button to start and measure 10 times during the helicopter transfer. Make a note of the MAP on the IABP monitor and the time for each measurement.