This week we ran an in-situ simulation with our duty crew (crewman, paramedic and doctor). We had great participation in a challenging scenario of massive hemorrhage in a blunt trauma patient.

As our simulation experience continues to grow we are always trialling new things. This past week we integrated several techniques that helped enhance the scenarios fidelity.

The scenario was a patient who had fallen off his motorbike at highspeed. There was a paramedic already on scene when our team arrived. The patient was in shock: BP 95/60, 130bpm, RR 28, 87% on room air, GCS 15.

Here’s a brief outline of what we did and why!

• In-situ simulation: Make the most of the availability of your team. On the job training during a work day is a great way of maximizing educational opportunities. It doesn’t require that people come in on their day off and they still get paid while at work except their learning. We don’t use any expensive simulation centre – instead only using our training packs and equipment we were able to run this scenario at NO COST!

Mid way through a resus. We have all hands on deck, even getting our cameraman Matt to hold the IV!

• Set the scene with a video: using footage from the TV show Rescue 1 (filmed on our helicopters) we were able to begin the simulation with our team watching 2 minutes of a scenario to help them better picture the scene and envision the challenges of the local surroundings
• Live patient actor: in scenarios that don’t require intubation this is especially powerful since we were able to capture our team’s ability to communicate with a live patient. Our patient had multiple traumatic injuries that was causing considerable pain. The team used managed the pain with ketamine and small doses of fentanyl. It was especially helpful to have a live patient since participants would receive real-time feedback if their pain regimen was working.

Having a live patient actor is a great asset and can add extra fidelity to the scenario. Definitely alters the way clinicians approach and speak with the patient.

• SimMon: I highly recommend this for anyone interested in doing in-situ simulation. Using an iPad and an iPhone, linked by Bluetooth (no Wifi needed) we are able to have a patient monitor with fully adjustable and modifiable vital signs! I have no relationship with the company that makes the app but we use it regularly and it’s must have for any educator running in-situ simulation. Available for download for less than $20NZD.
• Ultrasound images for eFAST: Our doctor (Alana) performed a pre-hospital FAST and lung ultrasound. We had images and video downloaded ahead of time on a computer to show her the findings. This provided more realistic visual feedback that closely mimics a real clinical setting.

Alana checking out the eFAST findings on the laptop. Diagnosing pneumothorax & positive FAST

• Integration of new medication: We are in the process of integrating a Tranexamic Acid protocol for trauma patients with suspected hemorrhage. This was our first time trialling the medication in a simulation setting. Great discussion around timing and especially helpful for our clinical team that we have clear guidelines when it can be administered.

• Observation/Feedback by an industrial engineer: Tammy Bryan, is an industrial engineer from Auckland District Health Board, who joined us to observe our work with an interest in the ergonomics of scene set up. This was useful for a current state analysis and the beginning to work towards any changes that can make us more efficient!

Huge thanks to Bruce Kerr, Greg Brownson and Alana Harper who participated as our clinical and operational crew for the scenario. Also a huge thanks to Alice who was our live patient for the scenario. She did an outstanding job acting as a patient in pain with multiple injuries! Don’t worry, our team took care of her with lots of pain meds administered! And Chris was our paramedic who provided outstanding pre-hospital care before the team arrived