A paediatric simulation was conducted at our Clinical Governance Day on 6 April 2016. The sim itself and the summary below were crafted by Dr. Sarah Gollance.

en.wikipedia.org/wiki/chemical_warfare

Our simulation scenario was a tasking to a young girl in respiratory distress after a chemical exposure while playing in the garden shed (which dad had left unlocked after cleaning the pool). The child exhibited signs of chlorine exposure with irritation to the eyes, face and airways.

Chlorine is a highly irritating gas and potential sources of exposure are multiple due to the common use of chlorine and its compounds for water disinfection. Acute accidental inhalation can be responsible for symptoms ranging from upper airway irritation to more serious respiratory effects, such as intense coughing, wheezing, dyspnoea and decreased lung function.

In this simulation, on HEMS arrival, the child smelt of chlorine and was distressed with coughing, bronchospasm and hypoxia. She was in the care of a very angry mother, as the father had been responsible for leaving the door unlocked. A decision was made to intubate the child for further management and safe transfer to the tertiary children’s hospital.

Learning outcomes from this SIM :

– Safety: the importance of PPE in this case was reiterated and we discussed the role of decontamination in this case.

– Make your environment work for you: the scenario was held in the “living room” of the patient’s house with the child sitting on the sofa. When in a situation like this, utilise your surroundings and make them work for you. Move the stretcher to an area with more access, better lighting or next to say, the kitchen table – a level at your height for the kit dump.

– Engage parent in child’s care: a child’s anxiety will often be multifactorial. Involve parent in calming and assuring child. Inform parents of the next anticipated steps and keep them involved where you are able – for both the parent and the child.

– Preparation is key: Optimise your patient, optimise your environment and team, optimise patient physiology prior to induction, anticipate & prepare for adverse outcomes, be ready! Have drug doses checked and ready in labelled 5 or 10 ml syringes to prevent drug errors. Use the Paediatric Drug Dose Guide and don’t hesitate to keep the booklet out and open (in fact we recommend it). In an agitated child, consider DSI with ketamine to improve physiology prior to induction. An open access copy of a paper regarding DSI in children is found on prehospitalmed.com.

– Communication: early allocation of roles and shared mental model allows the team to move forward together with fluidity. Update parents as much as possible, this will be probably be one of the worst days of their lives.