Emergency simulation

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GILLES WEBER, AUDREY MAGAT

Publié il y a 3 ans

15.07.2023

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Since 2012, the emergency department has been organising training sessions using mannequins, during which teams simulate real-life situations.

A 65-year-old man arrives at the emergency department. He lost consciousness in his flat and complains of chest pain. Upon arrival, his heart rate is already racing, his blood pressure is dropping, and then his heart stops. Cardiopulmonary resuscitation is started, adrenaline is injected, and the airway is secured. He will survive. This patient is actually an ultra-sophisticated simulation mannequin. Since 2012, the Emergency Department has offered training days focused on resuscitation room care, that is, situations requiring immediate intervention, such as cardiac arrest, serious trauma, or severe respiratory distress.

These advanced life support (ALS) training simulations, dating back to the early days of aviation, present doctors and nurses with vital emergency scenarios. "By taking the time to analyse their behaviour in critical situations, teams improve at the medical and nursing level and also train essential aspects, such as communication, leadership, and team management," explains Nicolas Beysard, associate physician in the CHUV emergency department and trainer. In total, nearly 1,000 people have participated in these simulations since the training was created.

1 / Coming closer to reality

Trainers prepare a range of emergency scenarios. The mannequins are dressed, styled, and made up with blood or vomit, depending on the situation. "The problem is that we only have middle-aged Caucasian male mannequins in our department, so we need to find ways to adapt them," says Nicolas Beysard. The mannequin is high-tech, with a variable pulse and the ability to produce sounds, controlled by a technician-operated microphone.

2 / Scenario in action

Four twenty-minute scenarios, each followed by a forty-five-minute debriefing, are scheduled throughout the day. These training sessions take place twice a month over ten months. In the room, oxygen masks sit alongside various probes, the defibrillator, and real medicine cabinets. Patient management must not exceed thirty minutes.

3 / Keeping pace

The team, comprising at least seven people, includes emergency and intensive care physicians and nurses. Other specialists, such as orthopaedics or anaesthesia, can be added as needed. Each situation is conducted under the direction of a "leader", usually the doctor. The leader's role is to indicate which procedures to perform or which medications to give.

4 / Teamwork

Each team member must wear a label showing their first name and role. "There are too many of us to know each other," explains Yves Lemaire, the nurse responsible for medical simulations. “Addressing someone by their first name fosters closeness and promotes team cohesion.”

5 / Live complications

From the control room, the evaluation team observes how care is administered. They can modify the mannequin's vital parameters, for example, by inducing cardiac arrest or a return to a stable rhythm, in line with the healthcare team's decisions.

6 / A palpable focus

Tension and concentration are at their peak. Apart from the machines' sounds, the teams work calmly. Their movements are precise. They quickly immerse themselves in the simulation. Forgetting the mannequin, the team identifies the vital organs at risk and begins cardiac massage. The issue of survival, even simulated, is omnipresent.

7 / Making sure the message gets through

Communication is essential in emergency situations. It is therefore necessary to ensure we are heard and to “close the loops," says the executive physician. “In other words, repeat the given order to confirm that it has been understood.” During the intervention, the leader summarises the situation several times and reviews the patient’s vital data.

8 / Feedback

During the debriefing, everyone shares their impressions. The training team guides them to take a critical look at their own experience. "It is more instructive to see your weaknesses yourself," says trainer Marie Guinat, head of the intensive care clinic. The simulation days are not evaluations. “The participants must act as usual to spot bad reflexes and communication issues.” The simulation’s interdisciplinarity also allows us to view each profession and responsibility differently.

Emergency / Training / Team

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