In Disaster Medicine Training

Charles Stewart MD EMDM

It may be used for both

individuals and teams

Simulation is a technique, not technology, to replace or amplify real experiences with guided experiences……. in an interactive fashion

Gaba Qual Saf Health Care 2004; 13

Doctors Trained On Patient Simulators exhibit Superior SkillsBeth Israel Medical Centre

New Virtual Reality Surgery Simulator hones Surgeons' Skills, Improves

Patient SafetyOregon Health & Science University School of

Medicine

Clinical Simulation Technology Used To Improve Communication Of Medical Teams

Washington University School of Medicine

Science Daily

Medical Simulation Works!

Role Playing

Task trainers

Computer patient

Manniquin simulators

Benefit of Simulators• Student can practice key skills in a safe

environment• Teacher can break down the task into

components• Student can receive immediate

feedback• Teacher can create the same situation

to assess performance repeatedly

Benefits of Simulators

• Simulators are great for teaching and assessing:• Procedural skills• Treatment/interventions• Invasive monitoring• Allowing mistakes….

Simulations in DM• Focus on medical management• Crisis resource management skills are

reinforced• Increased complexity• Can be videotaped for review and

reflection• “What will you do differently next

time?

Limitations

• Not great for:• 2-way communication skills• Treating the patient as a person• Representing family/staff/other

team members

Medical Simulation

Hardware & InfrastructureAre NOT inexpensive….

Medical Simulation

Manpower and TrainingAre also NOT inexpensive….

The “Usual” Training Model

“SODOTO”•See One•Do One•Teach One

SODOTO

“SODOTO”•Often used in surgical training•Frequently used for procedures

in other specialties.

In Disaster Medicine• If you’ve seen three disasters of the

same kind, • you are either in the wrong part of

the world… • very unlucky…

• Or both….• SoDoTo doesn’t work well in this

situation.

ADLS– At the conclusion of this ADLS course the student will be able: ☺Identify the Critical Need to Be Prepared for Natural Disasters and Events involving: chemical, biological, nuclear, radiological, and explosive incidents. ☺Define “all-hazards: and list possible etiologies

ADLS☺Identify the components of the DISASTER paradigm and apply the paradigm using both the M.A.S.S. and the ID-me BDLS triage model ☺Meet the Acute Care needs of patients involved in either a public health emergency or a natural disaster ☺Rapidly and effectively become part of the public health system

ADLS☺Demonstrate the ability to participate in a coordinated, multidisciplinary, mass casualty incident using personal protective equipment ☺Demonstrate the use of elements of decontamination site selection and the operation of basic chemical and radiological detection.

ADLS☺Demonstrate the ability to operate within the Incident Command System and exercise leadership competencies related to emergency preparedness and response.

So... How do we teach this?

ADLSADLS™ makes use of interactive scenarios and drills in which the participants treat simulated patients in a disaster. Through the use of high fidelity mannequins the student can gain experience in treating conditions that they would normally not treat even with years of experience.

Our friends....help us Teach ADLS

Simulations Are Ideal For Disaster Training

• Provides the opportunity to train on unusual medical problems….• Problems… that you won’t

(hopefully) see• Problems… that require unusual

resources• Problems… that require unusual

equipment or personal protective gear.

Also provides a balance between the emotional load associated with the crisis experience and the professional lessons that can be learned.

• Also….• Provides professionals with the skills

to cope competently with those mistakes that could not be prevented

• Reduces occurrences of errors in real life

In order for this to work....Trainees must have some ability to invoke a“Suspension of Disbelief”

This is a ‘disaster’....

And we invoke the“Suspension of

Disbelief”

During training, we need to avoid MONITOR Focus

Looking at the monitor to prompt the next clinical decision!

Feedback

• Students are asked how they thought the scenario went

• Leading questions probe the students’ thought processes

And then we talk....

A hidden benefit of feedback

• The immediacy of the post simulation reflective learning process may provide trainees with snapshot of their abilities in certain clinical areas • For some = impetus for further self

assessment/new learning in those areas that are perceived as being less than optimal or below expectation

For some this =

Is Resource Intensive and Time Consuming for both Trainers & Trainees

Initial exposure raises awarenessRepeated exposure to simulation improves performance

High Impact

But does will it translate into improved clinical outcomes?

Reliability

Validity

Predictive validity

2008 Academic Emergency Medicine Consensus Conference on the Science of

Simulation• Objective methods and measures to

demonstrate simulator training actually improves patient safety

• Effective feedback of information from error reporting systems into simulation training to improve patient safety

• Methods and outcome measures to demonstrate teamwork improves disaster response

• ……………..

Other’s experiences...• Abrahamson SD, Canzian S, Brunet F. Using

simulation for training and to change protocol during the outbreak of severe acute respiratory syndrome. Critical Care 2006;10(R3):

• Schwid HA, Rooke GA, Ross BK, Sivarajan M. Use of a computerized advanced cardiac life support simulator improves retention of advanced cardiac life support guidelines better than a textbook review. Crit Care Med 1999;27:821-824.

• AND MANY MORE....

We’ve done this a few times......• Since the inception of OIDEM in 2006...

• We’ve trained 133 students in Advanced Disaster Life Support in 4 classes per year.

• But... we don’t just do ADLS for disaster training• We have bi-monthly simulation

training sessions for our residents

...• We’ve stated team training with

nursing students in Emergency Procedures.

• We help the Urban Search and Rescue Teams with their disaster exercises

• We help with Advanced Trauma Life Support procedure training.

Our ‘friends’ help us teach in ways that living people just can’t...in places or situations we can’t put living people...and react to agents that we can’t use on living people...

Thank you....

• Charles Stewart MD EMDM• Director of Research and

Professor of Emergency MedicineDepartment of Emergency Medicine

• Director, Oklahoma Institute for Disaster and Emergency Medicine

• charles-e-stewart@ouhsc.edu