In just about every healthcare facility, announcements exist to let the staff know of emergency events. Even family members or visitors are aware that a crisis exists when they hear these announcements and can sense the hairs rise on the back of their neck. Several factors, including training (knowledge), skill, experience and practice, help mitigate this autonomic reaction in healthcare providers.
How does one hone their skills, and gain experience and practice without placing actual patients at risk of harm?
On Aug. 9, The University of Georgia Health Center practiced “Code Blue” drills. These drills were simulation-based and reviewed medical emergencies. The exercise was a collaborative inter-institutional and inter-disciplinary training drill involving The Augusta University/UGA Medical Partnership (Medical School) and the Partnership Simulation Center, under the direction of Dr. Aimee Martin, Campus Director of Simulation; Leonard DeRamus, MPAS, PA-C, Instructor of Emergency Medicine and Simulation Operator; and Sarah Gibbs, MS, Simulation Laboratory Coordinator.
Mr. Don Pruitt represented Athens Technical College, where he serves as Chair of EMS Programs and is a Paramedic Instructor. He instructs multiple emergency medicine related courses. Don served as an actor and provided his expertise and feedback.
The beneficiaries of this training included clinician and nursing staff of all UHC clinics. The drill would not have been successful without a number of individuals from UHC serving various supportive capacities, working in the background operational aspects of the drill.
Background: What is the significance of healthcare simulation and how are high-fidelity manikins used?
Increasingly, healthcare training is utilizing technology in a variety of ways to simulate (mimic) real life scenarios where cognitive and psychomotor skills can be combined and used external to the patient’s formal clinical exam room or hospital room. Simulation attempts to utilize these simulated patients and places students in an environment mimicking the “real” clinical environment to practice but does not create a risk to a “real” patient.
Simulation, using high-fidelity simulators, allows a team to assess physical findings (normal or abnormal with few limitations), gather history from the patient (the simulator operator speaking through the simulator) or confederates (actors).
Once data is collected, decision making occurs where the team leader in conjunction with his/her team begins to provide treatments and/or perform procedures (simulated or mimicked with a great deal of realism). Scenarios are designed in a manner to demonstrate a positive or negative response based on actions taken. This allows for critical thinking in a safe environment.
Immediately following the practical exercise, the team is involved in an instructor facilitated, self-reflective, debriefing of what was found, what observations were made, what decisions were made and the responses to them. Positives are reinforced and, in a non-critical way, points for improvement are discussed. Targeted objectives are reviewed with the development of “take-home” messages.
Simulation is felt to be a highly effective method of training and review as it allows a realistic approach to clinical scenarios that may be encountered and allows for development of team dynamics which has been proven to improve patient safety. The use of a dynamic, multi-sensory approach to learning is very beneficial to the participants.
What scenarios were used in the Code Blue Event?
The scenarios that were built for this exercise were based on real medical situations that have occurred in the UGA Health Center in the past.
The three medical cases that were built into the scenarios were a 20-year-old student experiencing seizures, a 22-year-old with cardiac arrhythmias, and a 25-year-old with anaphylaxis. Each of these scenarios were designed in great detail by DeRamus in order to make the simulated emergencies feel as real as possible to the responders.
What were the benefits/goals?
The goal of this exercise was not only to allow the health center staff to practice responding to medical emergencies that the Health Center has seen before, but to build teamwork and communication skills within each medical treatment team at the Health Center. Communication and teamwork are critical components of delivering effective emergency care in these situations.
How were the participants accessed?
Each medical treatment team was assessed using a Critical Actions Checklist, also created by DeRamus. The checklist provided a framework to access if specific critical actions in treatment were performed or not performed. The Checklist was an excellent tool in addressing the teams’ treatment actions in each 20-minute debriefing.
