SIMulatED RDH Emergency Department - Author: Rebecca Day

Scenario Run Sheet: Unrestrained Miniature Missile

Learning Objectives

Target Group: ED Regs and Nurses

General

Crisis Resource Management Principles

Scenario Specific

Pre arrival planning phase – SPACE/PERSONEL/EQUIPMENT/DRUGS AND FLUIDS/CALCS/BRIEFING TEAM

RDH specific handover procedure – team to assess, leader & scribe to take handover

Concomitant primary survey and AMPLE history taking

Scenario Overview

Brief Summary: 2am on Friday night. Call from ambulance to inform of 16month old infant involved in MVA in Humpty Doo. Child unrestrained (on parents lap in rear of car). 20-30km/hr – rear ended another vehicle at the traffic lights. Rolled onto floor of car and cried immediately. Parent at side of road with child in her arms on arrival of crew, no longer crying and is interactive. Front end damage to car. Small haematoma to left frontal region with no signs of skull fracture. Child has breast fed en route to hospital. All other passengers uninjured.

Mum is distressed and crying, blaming herself for the accident as the child wasn’t in a car seat.

The child will have no significant injuries otherwise and the focus of the SIM is not on management but more on preparation and assessment.

Intro Time	Scenario Time	Debrief Time	Soundbite
10	20	20	10

Observers’ Engagement Task

CRM Priciples diagram given – how many of these CRM principles did you see in action?

Equipment Checklist

Mannikin:	Baby
Monitoring:	iSimulate
Docs and Forms	EDNA, Green sheet
Equipment	Paed Trolley/Broselow
Consumables	Nil
Medications	Liquid Panadol

Sim Prompts	Nil
Sim Equipment	Nil

Participants

Staff ED Reg x2

Nursing x3

Instructor Roles: Confederate - Mother

Additional Information/Medical History

Demographics

16M child, fully vaccinated, 3 siblings with grandmother, if specifically asked the mother has had FACS involved previously due to neglect. Mother is 30 years old, history of ETOH but now abstinent.

HPC

Unrestrained MVA trauma at low speed, now well with minimal frontal haematoma

PMH

Bronchiolitis x2

Proposed Scenario Progression

MIST handover from Triage Nurse

Trauma alert/(vs call)

10mins to prep including SPACE/PERSONEL/EQUIPMENT/DRUGS AND FLUIDS/CALCS/BRIEFING TEAM

Handover with scribe and team leader while team assess patient

A-E assessment – can be done with child on mothers lap/whilst breastfeeding, both on bed

Management of distressed mother

AMPLE Hx

Analgesia provided – simple Panadol at most as child happy

Scenario Preparation/Baseline Parameters

Stage 1	Progression Trigger	Stage 2	Progression Trigger	Stage 3
RR	34	NIL	NIL
SpO2	100
HR/Rhythm	120
BP	100/50
T
Other

Debriefing/Guided Reflection Overview

Opening Gambit	Anticipated themes:
Exploration with key players
Engaging the general group
Sharing facilitator’s thoughts
Any other questions or issues to discuss?
Summary

The Soundbite

Why do we handover in the way we do?To minimise delays to A-E assessment To minimise delays to monitoring

To minimise delays to time critical procedures

Less distractions for the assessment team who need to be fully focussed on the patient

The scribe can hear everything

Quiet and calm

SJA handovers can be variable in content – sometimes not succinct and organosed, this way allows

the team leader to process and summarise the info to the group

General Feedback Prompts/Examples:

Opening Gambit:

What did you feel were your specific challenges there?

Let’s talk.

Can you describe to me what was happening to the patient during that scenario?

Can you describe to me what was going on?

What was important to you in choosing to manage that situation?

Can you tell me what your plan was and to what extent that went according to plan?

That seemed to me to go smoothly, what was your impression?

That looked pretty tough. Shall we see if we can work out together what was going on there so that you can find a way to avoid that situation in the future?

Exploration with key players

Questions to deepen thinking

Questions to widen conversation

Introduce new concepts; challenge perceptions; listen and build

So what you’re saying is…

Can you expand on…

Can you explain what you meant by…

When you said…

I noticed that you…

Engaging the general group

Let’s check with the rest of the group how they reacted to you saying that.

Did you [scenario participants/observers] feel the same?

What did you [scenario participants/observers] want from [scenario participant] at that point?

What ideas or suggestions has anyone else got for how to deal with that situation?

Sharing facilitator’s thoughts

Use advocacy with inquiry to share your observations and explore their perception

What does the protocol say on…..

What do you think was happening ….?

How do you think … would respond to…. ?

What about next time…..?

Do you think there’s anything to be gained from…?

Any other questions or issues to discuss?

Summary