Concepts of Emergency/Trauma Nursing and Emergency/Disaster Preparedness
Simulation Scenario
Utilizing the QSEN Knowledge, Skills and Attitudes for Pre-Licensure Nurses
Level of Scenario:
Beginning _____
Intermediate _____ Complex __X__
Estimated time to complete:
6 to 8 hours
Simulation Learning Objectives:
At the completion of this simulation, the student will:
1) Recognize the patient or designee as the source of control and full partner in providing
compassionate and coordinated care based on respect for patient’s preferences, values and
needs.
a. Be able to teach the importance of blood glucose monitoring to the patient with
diabetes.
b. Knowledge
 Integrate understanding of multiple dimensions of patient centered care
- Coordination and integration of care
- Information, communication, and education
- Physical comfort and emotional support
- Involvement of family and friends
- Transition and continuity
 Demonstrate comprehension understanding of the concepts of pain and
suffering, including physiologic models of pain and comfort
 Describe the limits and boundaries of therapeutic patient-centered care
 Discuss principles of effective communication
 Examine nursing roles in assuring coordination, integration, and continuity
of care
c. Skills
 Elicit patient values, preferences and expressed needs as part of clinical
interview, implementation of care plan and evaluation of care
 Communicate patient values, preferences and expressed needs to other
members of health care team
 Provide patient-centered care with sensitivity and respect for the diversity
of the human experience
 Assess presence and extent of pain and suffering
 Asses levels of physical and emotional comfort
 Elicit expectations of patient and family for relief of pain, discomfort, or
suffering
 Initiate effective treatments to relieve pain and suffering in light of patient
values, preferences and expressed needs

Remove barriers to presence of families and other designated surrogates
based on patient preferences
 Assess level of patient’s decisional conflict and provide access to resources
 Engage patients or designated surrogates in active partnerships that
promote health, safety and well-being, and self-care management
 Facilitate informed patient consent for care
 Assess own level of communication skill in encounters with patients and
families
 Participate in building consensus or resolving conflict in the context of
patient care
 Communicate care provided and needed at each transition in care
d. Attitudes
 Values seeing health care situations “through patients’ eyes”
 Value the patient’s expertise with own health and symptoms
 Appreciate the role of the nurse in relief of all types and sources of pain or
suffering
 Recognize that patient expectations influence outcomes in management of
pain or suffering
 Value active partnership with patients or designated surrogates in
planning, implementation, and evaluation of care
 Respect patient preferences for degree of active engagement in care
process
 Appreciate shared decision-making with empowered patients and families,
even when conflicts occur
 Value continuous improvements of own communication and conflict
resolution skills
2) Function effectively within nursing and inter-professional teams, fostering open
communication, mutual respect, and shared decision-making to achieve quality patient
care.
a. Provide SBAR report to the OR nurse.
b. Successfully triage victims of a mass casualty event as evidenced by correct triage
tag designations.
c. Apply, administer and perform all necessary nursing interventions to a patient with
traumatic injuries.
d. Knowledge
 Describe own strengths, limitations, and values in functioning as a member
of a team
 Describe scopes of practice and roles of health care team members
 Describe strategies for identifying and managing overlaps in team member
roles and accountabilities
 Recognize contributions of other individuals and groups in helping
patient/family achieve health goals
 Describe impact of own communication style on others



Discuss effective strategies for communicating and resolving conflict
Describe examples of the impact of team functioning on safety and quality
of care
Examine strategies for improving systems to support team functioning
e. Skills

Demonstrate awareness of own strengths and limitations as a team
member
 Initiate plan for self-development as a team member
 Function competently within own scope of practice as a member of the
health care team
 Assume role of team member or leader based on the situation
 Initiate requests for help when appropriate to situation
 Clarify roles and accountabilities under conditions of potential overlap in
team member functioning
 Integrate the contributions of others who play a role in helping
patient/family achieve health goals
 Communicate with team members, adapting own style of communicating
to needs of the team and situation
 Solicit input from other team members to improve individual, as well as
team, performance
 Follow communication practices that minimize risks associated with
handoffs among providers and across transitions in care
 Assert own position/perspective in discussions about patient care
 Participate in designing systems that support effective teamwork
f. Attitudes
 Acknowledge own potential to contribute to effective team functioning
 Appreciate importance of intra- and inter-professional collaboration
 Value the perspectives and expertise of all health team members
 Respect the centrality of the patient/family as core members of any health
care team
 Respect the unique attributes that members bring to a team, including
variations in professional orientations and accountabilities
 Value teamwork and the relationships upon which it is based
 Appreciate the risks associated with handoffs among providers and across
transitions in care
3) Integrate best current evidence with clinical expertise and patient/family preferences and
values for delivery of optimal health care.
a. Perform a rapid trauma assessment on patients with traumatic injuries.
b. Knowledge
 Describe reliable sources for locating evidence reports and clinical practice
guidelines
 Explain the role of evidence in determining best clinical practice

Describe how the strength and relevance of available evidence influences
the choice of interventions in provision of patient-centered care
c. Skills
 Locate evidence reports related to clinical practice topics and guidelines
d. Attitudes
 Value the concept of EBP as integral to determining best clinical practice
 Appreciate the importance of regularly reading relevant professional
journals
 Value the need for continuous improvement in clinical practice based on
new knowledge
4) Use data to monitor the outcomes of care processes and use improvement methods to
design and test changes to continuously improve the quality and safety of health care
systems.
a. Be able to use lab data and clinical manifestations to determine the effectiveness of
treatment.
b. Knowledge
 Describe strategies for learning about the outcomes of care in the setting in
which one is engaged in clinical practice
 Recognize that nursing and other health professions students are parts of
systems of care and care processes that affect outcomes for patients and
families
c. Skills
 Use measures to evaluate the effect of change
d. Attitudes
 Value own and others’ contributions to outcomes of care in local care
settings
 Appreciate the value of what individuals and teams can do to improve care
5) Minimizes risk of harm to patients and providers through both system effectiveness and
individual performance.
a. Knowledge
 Examine human factors and other basic safety design principles as well as
commonly used unsafe practices (such as, work-arounds and dangerous
abbreviations)
 Describe the benefits and limitations of selected safety-enhancing
technologies (such as, barcodes, Computer Provider Order Entry,
medication pumps, and automatic alerts/alarms)
 Discuss effective strategies to reduce reliance on memory
 Delineate general categories of errors and hazards in care
 Discuss potential and actual impact of national patient safety resources,
initiatives and regulations
b. Skills
 Demonstrate effective use of technology and standardized practices that
support safety and quality

Demonstrate effective use of strategies to reduce risk of harm to self or
others
 Use appropriate strategies to reduce reliance on memory (such as, forcing
functions, checklists)
c. Attitudes
 Value the contributions of standardization/reliability to safety
 Appreciate the cognitive and physical limits of human performance
 Value own role in preventing errors
6) Uses information and technology to communicate, manage knowledge, mitigate error, and
support decision making.
a. Knowledge
 Explain why information and technology skills are essential for safe patient
care
 Describe examples of how technology and information management are
related to the quality and safety of patient care
b. Skills
 Apply technology and information management tools to support safe
processes of care
 Document and plan patient care in an electronic health record
 Employ communication technologies to coordinate care for patients
 Respond appropriately to clinical decision-making supports and alerts
 Use high quality electronic sources of healthcare information
c. Attitudes
 Appreciate the necessity for all health professionals to seek lifelong,
continuous learning of information technology skills
 Protect confidentiality of protected health information in electronic health
records
Room Set-up:
Adult patient in one hospital bed. Pediatric patient in the other hospital bed. Have a medication
room/cart and a computer for charting available. Scatter 15 stuffed animals around the room
with one patient scenario and triage tag attached to each stuffed animal. Two of the stuffed
animals will “turn into” our patients in the Emergency Department: Patient 9 and Patient 11.
Brief overview of Scenario:
A school bus was on its way to a farm for a class trip when the driver lost control, drove
off the highway onto a downward-sloped grass median, causing the bus to turn on its side. The
bus contained 1 bus driver, 2 teachers, 2 parents, and 10 preschoolers. Several witnesses called
911 and reported the accident. The fire department and EMS are dispatched to the scene.
A car containing 4 nurses carpooling to a nursing convention came upon the accident
about 30 seconds after the fire department arrived. The nurses decided to pull over and offer
assistance until EMS arrived. The nurses triage the patients as the fire fighters extricate them
from the bus.
Cody is a 4-year-old white male brought in by EMTs (Basic Life Support) via ambulance
with a yellow triage tag after being involved in the school bus accident. When the school bus
tipped over Cody was thrown from his seat and fell onto the corner of a seat on the opposite
side of the bus, causing blunt trauma to the abdomen. Cody is diagnosed with active internal
bleeding in the abdomen and needs to go to the operating room as soon as possible.
Eve is a 61-year-old black female brought in by EMTs (Basic Life Support) via ambulance
with a yellow triage tag after being involved in the school bus accident. Eve was a restrained
driver, had no apparent injuries, but was believed to be hypoglycemic. Eve is diagnosed with an
altered mental status related to hypoglycemia. Once stabilized, she is discharged to home.
Educator will assign 2-4 students to triage the 15 patients. Have the students place a
paperclip over the color on the triage tag for each patient. Time the students. Once the
students have completed triage, collect the stuffed animals with the patient scenarios and
triage tags attached. Discuss each patient scenario with the class and decide if each patient
was triaged appropriately.
Transition the clinical group to the Emergency Department. The student nurses will assume
the care of Patient 9 and Patient 11.
Date of creation: 02/19/2012
Review/revisions: 05/04/2012, 10/05/2012, __________, __________, __________
Brief Description of Patient 9:
Name: Cody Gull
Gender: male
Age: 4
Weight: 40 pounds
Height: 37 inches
Religion: none
Major Support: mother and father
Allergies: none
Medications: none
Immunizations: Childhood
PMH: none
Last oral intake: 1 egg and 2 slices of bacon at
7am
History of Presenting Illness: Patient involved
in a school bus accident. Bruising over
abdomen. Complains of belly pain.
Psychomotor skills required prior to
simulation:
o Foley catheter insertion
o IV set up
o Medication administration
o NG tube insertion
o Blood specimen collection
o Computer documentation
Cognitive skills required prior to simulation:
(i.e. independent reading, video review,
computer simulations, lecture):
o IV fluid calculations
o Lecture/lab on concepts of
Emergency/Trauma Nursing and
Emergency/Disaster Preparedness
o Required readings per course outline
Concepts needed for review:
o Patient-centered care
o Teamwork and collaboration
Social History: none
Primary Diagnosis: abdominal bleeding
related to blunt trauma
Surgeries/Procedures: exploratory abdominal
surgery and repair of bleeding site
Setting/Environment: emergency department
Simulator Manikin/s Needed: pediatric male
Props:
o Gloves
o Patient identification bracelet
o Pediatric non-rebreather mask
o ECG leads and wires
o Cardiac monitor
o Intravenous catheter
o IV start kit
o IV tubing with primary line isontonic
crystalloid running
o Urinary catheter
o NG tube
o Suction canister
o Blood pressure cuff
o Pulse-oximeter
o Blood tubes
o Blood transfusion
o Cervical collar
o Computer
o Medication cart/room
Assignment of Roles:
S = student
E = educator
_S_ Primary Nurse
_S_ Secondary Nurse
_S_ Family Member #1
_S_ Family Member #2
_S_ Observer
_E_ Physician/Advanced Practice Nurse
_S_ Imaging
o
o
o
o
o
o
Evidence-based practice
Quality Improvement
Safety
Informatics
Medical asepsis
Fluid resuscitation
Medications and fluids:
o IV fluids: 0.9% NS
o IVPB: Zosyn (tazobactam) 12.5mg/kg in
50mL 0.9% NS
o IV Push: Morphine
Diagnostics available:
o Labs
o X-rays
o CT Scan
o MRI
o ECG
Student information needed prior to
scenario:
o Has been oriented to simulator
o Understands guidelines/expectations for
scenario
o Has accomplished all pre-simulation
requirements
o All participants understand their assigned
roles
o Has been given time frame expectations
Report students will receive prior to starting
the simulation (report from EMS responders):
Cody is a 4 y/o white male brought in by EMTs
(Basic Life Support) via ambulance with a
yellow triage tag after being involved in a
school bus accident. When the school bus
tipped over Cody was thrown from his seat,
and fell onto the corner of a seat on the
opposite side of the bus. A cervical collar was
placed as a precaution and he was placed on a
back board. Cody was on scene for
approximately 20 minutes waiting for an
_S_ Unlicensed Assistive Personnel
Identify educator roles needed:
Educator will give patient responses to any/all
actions performed by students.
Important information related to roles:
At least one observer should be noting what is
being done correctly, wrong, and what is
questionable.
available ambulance. He is complaining of
abdominal pain and bruising to the left
abdomen and left retroperitoneal area has
been noted. No other injuries have been
noted. Oxygen is being administered via nonrebreather mask. Parents are on their way to
the hospital, but have not yet arrived.
VS on scene: BP 78/46, HR 120, RR 32.
VS in ambulance: BP 76/46, HR 126, RR 28
Critical Lab Values: Hgb 11, Hct 45%, RBC 4.0
Medication Calculations: Fluid resuscitation
using Pediatric Advanced Life Support (2010)
recommendations 20mLs/Kg isontonic
crystalloid for treatment of hemorrhagic shock
in the pediatric patient.
Zosyn (tazobactam) 12.5mg/kg in 50mL 0.9%
NS
Morphine 0.05 mg/kg (up to 15 mg)
Blood pressure calculation in pediatric
patients SBP 70 + (2 x age in years)
Timing
Initial Stage:
VS: BP 70/40, HR 130,
RR 28, temp 98.1
Scenario Progression Outline: Patient 9
Programming Data
Expected
Interventions
Program VS
Wash hands
Have manikin moan
with pain
Resp: Maintaining
own airway, lungs
Lung sounds clear
clear, cervical collar in
place
Muffled bowel
sounds
CV: Sinus tachycardia,
weak pulses all 4
extremities
Neuro: AAO, PERRLA,
Don personal
protective equipment
Teaching Points for
Debriefing
Initial care of the
trauma patient in the
emergency
department
Confirm patient
identity
ABCDEFGHI of rapid
trauma assessment
Collaborate with
healthcare team
SAMPLE history
Continue O2 100%
NRB
Facilitating family
presence
Fluid resuscitation
able to move all
extremities, GCS 15
Place patient on ECG
monitor
GI/GU: muffled bowel
sounds
Obtain vital signs
Skin: bruising to the
left abdomen and left
retroperitoneal area
Pain: Points to crying
face on Faces Scale
IV access x 2, large
bore
Labs anticipated
Physical comfort and
emotional support
Communication with
the team
Obtain blood
specimens: CBC, BMP, Minimizing harm to
T&C, blood glucose
patient and providers
Determine IV fluid
dose (364 mLs 0.9%
NS)
GCS should be done
Remove clothing,
cover with warm
blanket
Insertion of foley
catheter
Check urine for blood
Consider insertion of
NG tube
Bring family in for
SAMPLE history,
inform family of
patient status, allow
family to remain with
patient
Medication for pain
and sedation for
diagnostic testing
Remove from
backboard
Send for CT head,
neck, chest,
abdomen, and pelvis
Stage 1: Worsening
Condition
VS: BP 65/palp, HR
160, RR 20
Resp: snoring
respirations at 20
BPM
CV: Sinus tachycardia,
weak central pulses,
unable to palpate
peripheral pulses
Neuro: losing
consciousness, GCS
10
Skin: cold, clammy,
diaphoretic
Program new vital
signs
Give results of
procedures:
o Hgb 11, Hct 45%,
RBC 4.0, all other
labs normal
o X-ray cervical
spine negative
o CT abdomen,
positive bleeding
from spleen
Give assessment
information in
response to student
questions of that
system.
Chart assessment and
interventions
Adjust head position
to maintain airway
Patient prep for
surgery
Insert advanced
Communication with
airway (nasal) and use the team
bag, valve, mask
ventilation
Minimizing harm to
patient and providers
Obtain consent for
emergency blood
Informed consent for
transfusion
care
Begin emergency
blood transfusion
Core Measures:
Surgical Care
Improvement Project
Begin antibiotics
Obtain consent for
surgery
Utilize pre-surgical
checklist
Give SBAR report to
OR nurse
Chart assessment and
interventions
Brief Description of Patient 11:
Name: Eve Breslin
Gender: female
Age: 61
Weight: 185 pounds
Height: 63 inches
Religion: Baptist
Major Support: Husband
Psychomotor skills required prior to
simulation:
o IV set up
o Medication administration
o Blood specimen collection
o Use of glucometer
o Computer documentation
Cognitive skills required prior to simulation:
Allergies: none
Medications: none (prefers not to take)
Immunizations: childhood
PMH: Type 2 diabetes, hypertension
Last oral intake: half bottle of water just
before accident
History of Presenting Illness: Patient was the
driver of a school bus when she drove off the
highway onto a downward-sloped grass
median, causing the bus to turn on its side.
She was wearing her seatbelt.
Social History: smokes cigarettes, 1 pack per
day
Primary Diagnosis: altered mental status
related to hypoglycemia
Surgeries/Procedures: none
Setting/Environment: emergency department
(i.e. independent reading, video review,
computer simulations, lecture)
o Lecture/lab on concepts of
Emergency/Trauma Nursing and
Emergency/Disaster Preparedness
o Required readings per course outline
Concepts needed for review:
o Patient-centered care
o Teamwork and collaboration
o Evidence-based practice
o Quality Improvement
o Safety
o Informatics
Medications and fluids:
o Dextrose 50% 25g/50mL prefilled syringe
IV push
Diagnostics available:
o Labs
o X-rays
o CT Scan
o ECG
Simulator Manikin/s Needed: Adult female
Props:
o Gloves
o Patient identification bracelet
o Adult non-rebreather mask
o ECG leads and wires
o Cardiac monitor
o Intravenous catheter
o IV start kit
o Blood pressure cuff
o Pulse-oximeter
o Blood tubes
o Cervical collar
o Computer
Assignment of Roles:
S = student
E = educator
Student information needed prior to
scenario:
o Has been oriented to simulator
o Understands guidelines/expectations for
scenario
o Has accomplished all pre-simulation
requirements
o All participants understand their assigned
roles
o Has been given time frame expectations
Report students will receive prior to starting
the simulation (report from EMS responders):
Eve is a 61 y/o black female brought in by
EMTs (Basic Life Support) via ambulance with
a yellow triage tag after being involved in a
school bus accident. Eve was wearing her
seatbelt and firefighters had to cut the
_S_ Primary Nurse
_S_ Secondary Nurse
_S_ Family Member #1
_S_ Observer
_E_ Physician/Advanced Practice Nurse
_S_ Imaging
_S_ Unlicensed Assistive Personnel
Identify educator roles needed:
Educator will give patient responses to any/all
actions performed by students.
Important information related to roles:
At least one observer should be noting what is
being done correctly, wrong, and what is
questionable.
Critical Lab Values: blood glucose 31
restraint to remove her from her driver’s seat.
A cervical collar was placed as a precaution
and she was placed on a back board. Eve told
the EMTS that she was feeling shaky before
she lost control of the bus. She believed her
sugar was low due to skipping breakfast this
morning. She was cold, clammy and
diaphoretic on scene and waited
approximately 25 minutes for an available
ambulance. During the wait, Eve developed an
altered mental status. EMTs attempted to
administer oral glucose, but Eve became
combative and spit it out.
In route to the hospital, oxygen is being
administered via non-rebreather mask. Her
husband is on his way to the hospital, but has
not yet arrived.
VS on scene: BP 146/78, HR 112, RR 24.
VS in ambulance: BP 140/76, HR 120, RR 22
Timing
Initial Stage:
VS: BP 140/78, HR
120, RR 22, temp 97.6
Scenario Progression Outline: Patient 11
Programming Data
Expected
Interventions
Program VS
Wash hands
Lung sounds
diminished
Resp: lungs
diminished bilaterally, Normal bowel sounds
cervical collar in place
Give result of blood
CV: Sinus tachycardia, glucose: 31
pulses all 4
extremities
Neuro: responsive to
verbal stimuli, pupils
4, equal and reactive,
GCS 13
GI/GU: positive bowel
Don personal
protective equipment
Teaching Points for
Debriefing
Initial care of the
trauma patient in the
emergency
department
Confirm patient
identity
ABCDEFGHI of rapid
trauma assessment
Collaborate with
healthcare team
SAMPLE history
Continue O2 100%
NRB
Facilitating family
presence
Labs anticipated
Place patient on ECG
monitor
Obtain vital signs
Hypoglycemia
treatment
sounds
IV access
Skin: cold, clammy,
diaphoretic
Attempt to feed
patient
Communication with
the team
Minimizing harm to
patients and
providers
Obtain blood
specimen: CBC, BMP,
T&C, blood glucose
Give dextrose
GCS should be done
Remove clothing,
cover with warm
blanket
Bring family in for
SAMPLE history,
inform family of
patient status, allow
family to remain with
patient
Remove from
backboard
CT scan head, neck
Stage 2:
VS: BP 150/80, HR
106, RR 16
CV: Sinus tachycardia,
pulses all 4
extremities
Neuro: AAO, PEERLA,
able to move all
extremities, GCS 15
Program new vital
signs
Chart assessment and
interventions
Remove cervical
collar
Patient-centered care
Discharge instructions
Give results of
procedures:
o Repeat blood
glucose 82, all
other labs normal
o X-ray cervical
spine negative
Give assessment
Feed patient protein
and carbohydrates
Diabetic education
Chart assessment and
interventions
GI/GU: positive bowel
sounds
Skin: warm and dry
information in
response to student
questions of that
system.
Debriefing/Guided Reflection Questions for this Simulation
How do you feel you performed triaging at the multiple casualty event?
What could be improved with your triaging?
Did you obtain consent to treat the pediatric patient? How?
How do you feel you performed your rapid trauma assessment?
What could be improved with your rapid trauma assessment?
Did you remember to implement all nursing interventions for your patients in the emergency
department?
Did you assess for pain and comfort?
How did you collaborate with other healthcare providers to assure that your patients were
comfortable?
How did you coordinate care in the emergency department to provide patient-centered care?
How did you feel about having the family stay in the room with your patient?
Do you feel that you communicated your needs and the needs of the patient clearly to the
healthcare team?
Why was it important for you to conduct a pre-surgical checklist and provide an SBAR report to
the OR nurse?
Recognizing that the patient is source of control and full partner in care, were you able to
educate Eve on the importance of diabetes management?
How will you improve your triage, rapid trauma assessment and nursing intervention skills?
Do you feel ready to participate in a drill or a disaster after this week? Why or why not?
References
Emergency Nurses Association (2007). Disaster management. In Trauma nursing core course
provider manual (6th ed.) (pp. 249-272). Des Plaines, IL: Emergency Nurses Association.
Ignatavicius, D. & Workman, M.L. (2010). Concepts of emergency and disaster preparedness. In
Medical-surgical nursing: Patient-centered collaborative care (6th ed.) (pp. 159-168). St.
Louise, MO: Saunders Elsevier.
Ignatavicius, D. & Workman, M.L. (2010). Concepts of emergency and trauma nursing. In
Medical-surgical nursing: Patient-centered collaborative care (6th ed.) (pp. 126-140). St.
Louise, MO: Saunders Elsevier.
Quality and Safety Education for Nurses (2012). Competency KSAs pre-licensure. Retrieved from
http://www.qsen.org/ksas_prelicensure.php
The Joint Commission (2012). Surgical care improvement project. Retrieved from
http://www.jointcommission.org/surgical_care_improvement_project/
Laskowski-Jones, L. (2010). Concepts of emergency and disaster preparedness. In Ignatavicius,
D. & Workman, M.L. (Eds.), Medical surgical nursing: Patient-centered collaborative care
(pp. 159-168). St. Louis, MO: Saunders Elsevier.
Laskowski-Jones, L. & Toulson, K. (2010). Concepts of emergency and trauma nursing. In
Ignatavicius, D. & Workman, M.L. (Eds.), Medical surgical nursing: Patient-centered
collaborative care (pp. 126-140). St. Louis, MO: Saunders Elsevier.