Anaesthesia Crisis Simulation
Background
• Anaesthesia early adoption SBME
• Driven by Gaba, Emily Bromily
• Similarities commercial airlines
• Increased monitor/environmental fidelity
• EMAC courses
New Zealand
• Both EMAC course providers in N Island
• New anaesthetic registrar crisis course
• More SBME for trainees near these centres
But
• Limited access for S island based Dr’s
• Different equipment/environment
• Lack of team based approach using local
teams
Christchurch Anaesthetics
• Limited SBME despite demand
PROMPT
EMAC Course x1 in training
CORE 7
EMST/APLS
PATCH
Ad hoc morning sessions
The Problem
• SBME effective
• Significant simulation debriefing resources
• Dose response relationship
• Fidelity important to a point – buy in
• Full simulation suite facilities expensive
and not realistic for peripheral centres
Solutions
• 2 avenues
1) Collaborative approach with UoOSC
2) Development novel approach using
equipment already available in the
hospital at no cost.
The “In situ” simulator
• Clinical engineering calibration machines
can be used to drive any monitor
• This allows scenarios to be run “in situ”
in the clinical environment
Sp02
Sp02
• “False finger” to attach Sp02 probe
• Dial up Sp02 and HR
• Realistically changes over a number of
seconds
• Sometimes a little temperamental
• Short period of flat line when changes
made
NIBP
NIBP
• Useful graduations
60/40, 80/50, 100/60, 120/80 etc
• Y connector!
MP450 ECG, IBP
MP450 ECG, IBP
• Allows adjustment HR and common
rhythms.
• Also invasive BP trace but fixed at 120/80
so limited utility.
• Must attach to 5 lead ECG for all rhythms
to be available
The In situ OT set up
Video
Junior Trainee Crisis Sessions
• 0700 coffee, muffins, Non threatening
• 4 scenarios
(anaphylaxis, MI VF arrest in PACU,
Aspiration on LMA, Blocked ETT)
• 4-6 trainees, 50% attended all.
• Trainee tech
• Guest “Volunteer” debriefer
• Sign up sheet, evaluation survey and Post
scenario resources provided on drop box
supervised)
other
Seizure in
PACU
Failure to w ake
in PACU
MH Crisis
MI
LA Toxicity
Anaphylaxis
Burns
Can't intubate,
can't ventilate
Endobronchial
intubation
SOB in PACU
Cardiac arrest
Massive
Haemorrhage
Bronchospasm
Severe Trauma
Severe
Laryngospasm
Failed
intubation
0
2
4
6
1 Very Unconfident
2
3
4
5 Very confident
Seizure in PACU
Failure to wake in PACU
MH Crisis
MI
LA Toxicity
Anaphylaxis
Burns
Can't intubate, can't ventilate
Endobronchial intubation
SOB in PACU
Cardiac arrest
Massive Haemorrhage
Bronchospasm
Severe Trauma
Severe Laryngospasm
Failed intubation
0%
10% 20%
30%
40%
50% 60%
70%
80% 90% 100%
These scenarios have been a
valuable learning experience
strongly disagree
disagree
neither agree nor disagree
agree
strongly agree
Fidelity
Fidelity of in OT set up
7
6
5
4
3
2
1
0
1
2
3
4
5
Fidelity (1: very unrealistic, 5 very realistic
Fidelity Breakdown
Patient fidelity (realism of mannekin, clinical
findings compared to a real patient)
Technical fidelity (similarity of machine, alarms,
traces etc to normal workplace)
1
2
3
Environmental fidelity (similarity of environment
eg. in theatre/drug trolley etc to normal
workplace)
4
5
Scenario fidelity (clinical accuracy and realism
of scenario)
0% 10 20 30 40 50 60 70 80 90 100
% % % % % % % % % %
What were the strengths of the OT set up
• More realistic, better prepared for real-life situation
• Acting in real environment
• same environment we spend the majority of our time in
which makes how we might respond to the situation in real
life more realistic and how we make use of the resources in
that environment.
• Familiar environment, with equipment that we use
everyday.
• It's where we work and where we would actually
experience these events
• Same environment as place of work. Realistic scenarios
with added realism from use of usual monitors and
anaesthetic machines.
Weaknesses of in OT set up
• Already identified, but would be useful having people
•
•
•
•
•
playing their usual roles, ie real nurses
Difficult to hear lung sounds, other people in scenario
should have a card of what they can / cannot offer to do
having a scenario where when you do call for help and you
gets heaps of willing assistants who may not be the most
skilled/appropriate to assist in that particular situation and
the subsequent distraction/stress this can provide and/or
strains on communication when having to deal with that
and the emergency at hand.
Acting outside usual roles is unrealistic but necessary.
Within limitations of mannikin (aka can't actually have real
patients having cardiac arrest...) no real weaknesses
Not using volatile is the only unrealistic aspect, but
understandable.
Issues
• Clinical area
limited availability
scrupulous control of equipment
• Set up time/ chasing collecting bits
• Potential for unskilled debrief vulnerable
participants
• Dropbox
Questions