On October 30th, the HEMS group conducted a simulation exercise on Browns Island, in the Hauraki Gulf. The scenario – devised, organised, and conducted by Dr Sam Bendall – involved two patients simulated by low-fidelity mannequins, with monitoring readings simulated using iPads, iPhones, and the SimMon App.
The first patient was a 50 year old male who had fallen down a steep slope, and had come to rest lodged against a small tree. He had chest injuries with a pneumothorax which rapidly tensioned, pelvic fractures, and a femoral fracture. He was tachycardic, hypotensive, and hypoxic.
During his assessment it was revealed that his 6 year old son, who had epilepsy, had taken a cell phone to call for help from high ground. The boy, who was out of sight, had suffered a seizure, hit his head on a fence post, and had a severe head injury with trismus.
Key learning objectives of the scenario, observed separately by multiple observers, were:
1. Teamwork and Communication
2. Team integration
3. Planning and Preparation
4. Situational awareness
5. Communication at the scene
7. Paediatric equipment and protocols.
Following the scenario and debrief, the main learning points identified were:
1. As a team we need to make sure we don’t lose impetus, and that our communication is clear, cohesive, and efficient, and results in things being done.
2. When the situation changes (in this case when it became clear that the second patient was critically ill) , a ‘time-out’ or similar must occur involving all team members to ensure that everyone is ‘on the same page’. In this scenario there was a lapse in communication that led to the team members with the patient needing RSI not having vital equipment. There was discussion around the practicalities of a ‘time out’, with acknowledgement that it may not be physically possible for the team to get together, and the crewman may have a vital role as an information conduit. Given the different backgrounds of the team members, there is also a need for everyone to speak/understand the same language.
3. When the team is split between multiple casualties, the doctor needs a radio.
4. The equipment in its current format cannot be split easily between multiple casualties. Further creative thinking, research, and development is required.
Our sincere thanks to ARHT, Leon Ford (who seems to be able to procure anything at any time – “A crashed 747 for training, by tomorrow? No problem”.), Rob Anderson (who seemed strangely happy to be taking three doctors on a one-way trip to a rat-infested island), the crew of the Police launch Deodar II, Mike Shepherd and Trish Wood at Starship for the loan of paediatric simulation equipment (we even got the shirt off Mike’s back), and our many observers who gave up their time.
Photos by Andrew Petrosoniak, Pieter Lubbert, and Scott Orman