scholarly journals P010: Code Silver: Lessons learned from the design and implementation of Active Shooter Simulation In-Situ Training (ASSIST)

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S80-S81
Author(s):  
N. Argintaru ◽  
A. Petrosoniak ◽  
C. Hicks ◽  
K. White ◽  
M. McGowan ◽  
...  
Keyword(s):  
Trauma Centre ◽  
Lessons Learned ◽  
Trauma Patients ◽  
Active Shooter ◽  
Framework Analysis ◽  
In Situ Simulation ◽  
Design And Implementation ◽  
Medical Response ◽  
In Situ Training

Introduction: Hospital shootings are rare events that pose extreme and immediate risk to staff, patients and visitors. In 2015, the Ontario Hospital Association mandated all hospitals devise an armed assailant Code Silver protocol, an alert issued to mitigate risk and manage casualties. We describe the design and implementation of ASSIST (Active Shooter Simulation In-Situ Training), an institutional, full-scale hybrid simulation exercise to test hospital-wide response and readiness for an active shooter event, and identify latent safety threats (LSTs) related to the high-stakes alert and transport of internal trauma patients. Methods: A hospital-wide in-situ simulation was conducted at a Level 1 trauma centre in downtown Toronto. The two-hour exercise tested a draft Code Silver policy created by the hospital’s disaster planning committee, to identify missing elements and challenges with protocol implementation. The scenario consisted of a shooting during a hospital meeting with three casualties: a manikin with life-threatening head and abdomen gunshot wounds (GSWs), a standardized patient (SP) with hypotension from an abdominal GSW, and a second SP with minor injuries and significant psychological distress. The exercise piloted the use of a novel emergency department (ED)-based medical exfiltration team to transport internal victims to the trauma bay. The on-call trauma team provided medical care. Ethnographic observation of response by municipal police, hospital security, logistics and medical personnel was completed. LSTs were evaluated and categorized using video framework analysis. Feasibility was measured through debriefings and impact on ED workflow. Results: Seventy-six multidisciplinary medical and logistical staff and learners participated in this exercise. Using a framework analysis, the following LSTs were identified: 1) Significant communication difficulties within the shooting area, 2) Safe access and transport for internal casualties, 3) Difficulty accessing hospital resources (blood bank) 4) Challenges coordinating response with external agencies (police, EMS) and 5) Delay in setting up an off-site command centre. Conclusion: In situ simulation represents a novel approach to the development of Code Silver alert processes. Findings from ethnographic observations and a video-based analysis form a framework to address safety, logistical and medical response considerations.

An Active Shooter in Your Hospital: A Novel Method to Develop a Response Policy Using In Situ Simulation and Video Framework Analysis

2020 ◽  
pp. 1-9 ◽  
Author(s):  
Niran Argintaru ◽  
Winny Li ◽  
Christopher Hicks ◽  
Kari White ◽  
Melissa McGowan ◽  
...  
Keyword(s):  
High Risk ◽  
Situational Awareness ◽  
Medical Personnel ◽  
Control Measures ◽  
Effective Control ◽  
Active Shooter ◽  
Framework Analysis ◽  
In Situ Simulation ◽  
Medical Response

ABSTRACT Hospital shootings (Code Silver) are events that pose extreme risk to staff, patients, and visitors. Hospitals are faced with unique challenges to train staff and develop protocols to manage these high-risk events. In situ simulation is an innovative technique that can evaluate institutional responses to emergent situations. This study highlights the design of an active shooter in situ simulation conducted at a Canadian level-1 trauma center to test a Code Silver active shooter protocol response. We further apply a modified framework analysis to extract latent safety threats (LSTs) from the simulation using ethnographic observation of the response by law enforcement, hospital security, logistics, and medical personnel. The video-based framework analysis identified 110 LSTs, which were assigned hazard scores, highlighting 3 high-risk LSTs that did not have effective control measures or were not easily discoverable. These included lack of security during patient transport, inadequate situational awareness outside the clinical area, and poor coordination of critical tasks among interprofessional team members. In situ simulation is a novel approach to support the design and implementation of similar events at other institutions. Findings from ethnographic observations and a video-based analysis form a structured framework to address safety, logistical, and medical response considerations.

An In Situ Simulation-Based Training Approach to Active Shooter Response in the Emergency Department

2018 ◽  
Vol 13 (02) ◽  
pp. 345-352 ◽  
Author(s):  
Mark S. Mannenbach ◽  
Carol J. Fahje ◽  
Kharmene L. Sunga ◽  
Matthew D. Sztajnkrycer
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Low Frequency ◽  
Training Model ◽  
The United States ◽  
Lessons Learned ◽  
Added Value ◽  
Active Shooter ◽  
In Situ Simulation

ABSTRACTWith an increased number of active shooter events in the United States, emergency departments are challenged to ensure preparedness for these low frequency but high stakes events. Engagement of all emergency department personnel can be very challenging due to a variety of barriers. This article describes the use of an in situ simulation training model as a component of active shooter education in one emergency department. The educational tool was intentionally developed to be multidisciplinary in planning and involvement, to avoid interference with patient care and to be completed in the true footprint of the work space of the participants. Feedback from the participants was overwhelmingly positive both in terms of added value and avoidance of creating secondary emotional or psychological stress. The specific barriers and methods to overcome implementation are outlined. Although the approach was used in only one department, the approach and lessons learned can be applied to other emergency departments in their planning and preparation. (Disaster Med Public Health Preparedness. 2019;13:345–352)

Trauma Resuscitation Using in situ Simulation Team Training (TRUST) study: latent safety threat evaluation using framework analysis and video review

2020 ◽  
pp. bmjqs-2020-011363
Author(s):  
Andrew Petrosoniak ◽  
Mark Fan ◽  
Christopher M Hicks ◽  
Kari White ◽  
Melissa McGowan ◽  
...  
Keyword(s):  
Human Factors ◽  
Improve Patient Safety ◽  
Significant Risk ◽  
Trauma Centre ◽  
Contributing Factors ◽  
Framework Analysis ◽  
Trauma Resuscitation ◽  
In Situ Simulation ◽  
Video Review

IntroductionTrauma resuscitation is a complex and time-sensitive endeavour with significant risk for error. These errors can manifest from sequential system, team and knowledge-based failures, defined as latent safety threats (LSTs). In situ simulation (ISS) provides a novel prospective approach to recreate clinical situations that may manifest LSTs. Using ISS coupled with a human factors-based video review and modified framework analysis, we sought to identify and quantify LSTs within trauma resuscitation scenarios.MethodsAt a level 1 trauma centre, we video recorded 12 monthly unannounced ISS to prospectively identify trauma-related LSTs. The on-call multidisciplinary trauma team participated in the study. Using a modified framework analysis, human factors experts transcribed and coded the videos. We identified LST events, categorised them into themes and subthemes and used a hazard matrix to prioritise subthemes requiring intervention.ResultsWe identified 843 LST events during 12 simulations, categorised into seven themes and 38 subthemes, of which 23 are considered critical. The seven themes relate to physical workspace, mental model formation, equipment, unclear accountability, demands exceeding individuals’ capacity, infection control and task-specific issues. The physical workspace theme accounted for the largest number of critical LST events (n=152). We observed differences in LST events across the four scenarios; complex scenarios had more LST events.ConclusionsWe identified a diverse set of critical LSTs during trauma resuscitations using ISS coupled with video-based framework analysis. The hazard matrix scoring, in combination with detailed LST subthemes, supported identification of critical LSTs requiring intervention and enhanced efforts intended to improve patient safety. This approach may be useful to others who seek to understand the contributing factors to common LSTs and design interventions to mitigate them.

scholarly journals P073: Emergency department trauma team in situ simulations at an urban, academic centre to improve team communication and detect latent safety threats

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S90-S91
Author(s):  
N. Kester-Greene ◽  
L. Notario ◽  
H. Heipel ◽  
L. DaLuz ◽  
A. Nathens ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Ad Hoc ◽  
Effective Means ◽  
Trauma Team ◽  
Trauma Patients ◽  
Team Communication ◽  
Interprofessional Communication ◽  
In Situ Simulation ◽  
Ad Hoc Teams

Innovation Concept: Effective communication for ad hoc teams is critical to successful management of multisystem trauma patients, to improve situational awareness and to mitigate risk of error. OBJECTIVES 1. Improve communication of ad hoc teams. 2. Identify system gaps. INNOVATION Team in situ simulations provide a unique opportunity to practice communication and assess systems in the real environment. Our trauma team consists of residents and staff from emergency services, general surgery, orthopedics, anaesthesia, nursing and respiratory therapy. Methods: A team of subject matter experts (SME's) from trauma, nursing, emergency medicine and simulation co-developed curriculum in response to a needs assessment that identified gaps in systems and team communication. The simulation occurred in the actual trauma bay. The on-call trauma team was paged and expected to manage a simulated multisystem trauma patient. Once the team arrived, they participated in a briefing, manikin-based simulation and a communication and system focused debriefing. Curriculum, Tool, or Material: Monthly scenarios consisted of management of a blunt trauma patient, emergency airway and massive hemorrhage protocol. Teams were assessed on communication skills and timeliness of interventions. Debriefing consisted of identification of system gaps and latent safety threats. Feedback was given by each discipline followed by SME's. Information was gathered from participant evaluations (5-point Likert scale and open ended questions) and group debrief. Feedback was themed and actions taken to co-create interventions to communication gaps and latent safety threats. As a result, cricothyroidotomy trays were standardized throughout the hospital to mitigate confusion, time delay and unfamiliarity during difficult airway interventions. Participants felt the exercise was an effective means of practicing interprofessional communication and role clarity, and improved their attitude towards the same. Conclusion: In situ simulation-based education with ad hoc trauma teams can improve interprofessional communication and identify latent safety threats for the management of multisystem trauma patients.

P14 First steps into In Situ simulation: our experiences and lessons learned

2019 ◽  
Author(s):  
Rebecca Darge ◽  
Linda Crinigan ◽  
Maurice Collins ◽  
Claire Gibbons ◽  
Corinne Hield ◽  
...  
Keyword(s):  
Lessons Learned ◽  
In Situ Simulation

843 Improving Practical Skills Training with In-Situ Trauma Simulation

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Fisher ◽  
A Nambiar ◽  
R Subramanian
Keyword(s):  
Training Session ◽  
Skills Training ◽  
Confidence Score ◽  
Average Score ◽  
Trauma Patients ◽  
Practical Skills ◽  
In Situ Simulation ◽  
Before And After ◽  
Average Confidence

Abstract Introduction Safe and effective management of trauma patients requires numerous practical skills. Our in-situ trauma simulation identified key areas requiring increased training and exposure. This enabled improvement to education, patient safety and efficiency when managing these emergencies. Method We carried out a simulated trauma call according to ATLS principles, recording the time and person completing each task. Key areas for improvement were identified; most notably the application of Femoral Traction Splints (FTS). 0/7 doctors present were not able to do this. Subsequently, a formal training day was delivered, with 38 attendees across specialties, assessing confidence before and after the session. Results Prior to the training session, 52.6% of attendees did not have formal teaching using FTS and 65.8% had never used one. Confidence with FTS application was measured on a scale of 1 (not confident) to 5 (very confident), with an average score of 2.6/5. After training, the average confidence score was 4.7/5 (p < 0.01). 100% of participants found the session very useful. Conclusions In-situ simulation allows identification of key areas for improvement in training of practical skills. Essential tailored teaching can then be delivered to increase exposure and confidence for these necessary practical skills.

The clock is ticking: using in situ simulation to improve time to blood administration for bleeding trauma patients

CJEM ◽  
2020 ◽  
Vol 23 (1) ◽  
pp. 54-62
Author(s):  
Alice Gray ◽  
Lucas B. Chartier ◽  
Katerina Pavenski ◽  
Melissa McGowan ◽  
Gerald Lebovic ◽  
...  
Keyword(s):  
Trauma Patients ◽  
In Situ Simulation

scholarly journals Lessons Learned From an Evaluation of Serious Gaming as an Alternative to Mannequin-Based Simulation Technology: Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Natalie C Benda ◽  
Kathryn M Kellogg ◽  
Daniel J Hoffman ◽  
Rollin J Fairbanks ◽  
Tamika Auguste
Keyword(s):  
Simulation Training ◽  
Controlled Trial ◽  
Lessons Learned ◽  
Serious Game ◽  
Educational Method ◽  
Serious Gaming ◽  
In Situ Simulation ◽  
Training Tool ◽  
Simulation Scenario

BACKGROUND The use of new technology like virtual reality, e-learning, and serious gaming can offer novel, more accessible options that have been demonstrated to improve learning outcomes. OBJECTIVE The aim of this study was to compare the educational effectiveness of serious game–based simulation training to traditional mannequin-based simulation training and to determine the perceptions of physicians and nurses. We used an obstetric use case, namely electronic fetal monitoring interpretation and decision making, for our assessment. METHODS This study utilized a mixed methods approach to evaluate the effectiveness of the new, serious game–based training method and assess participants’ perceptions of the training. Participants were randomized to traditional simulation training in a center with mannequins or serious game training. They then participated in an obstetrical in-situ simulation scenario to assess their learning. Participants also completed a posttraining perceptions questionnaire. RESULTS The primary outcome measure for this study was the participants’ performance in an in-situ mannequin-based simulation scenario, which occurred posttraining following a washout period. No significant statistical differences were detected between the mannequin-based and serious game–based groups in overall performance, although the study was not sufficiently powered to conclude noninferiority. The survey questions were tested for significant differences in participant perceptions of the educational method, but none were found. Qualitative participant feedback revealed important areas for improvement, with a focus on game realism. CONCLUSIONS The serious game training tool developed has potential utility in providing education to those without access to large simulation centers; however, further validation is needed to demonstrate if this tool is as effective as mannequin-based simulation. CLINICALTRIAL Not applicable.

scholarly journals P103: A human factors-based framework analysis for patient safety: the trauma resuscitation using in situ simulation team training (TRUST) experience

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S113
Author(s):  
A. Petrosoniak ◽  
M. Fan ◽  
P. Trbovich ◽  
K. White ◽  
S. Pinkney ◽  
...  
Keyword(s):  
Patient Safety ◽  
Human Factors ◽  
Improve Patient Safety ◽  
Significant Risk ◽  
Individual Responsibility ◽  
Team Approach ◽  
Framework Analysis ◽  
Trauma Resuscitation ◽  
In Situ Simulation

Introduction: Effective trauma resuscitation requires a coordinated team approach, yet there is a significant risk for error. These errors can manifest from sequential system-, team- and knowledge based failures, defined as latent safety threats (LSTs). In situ simulation (ISS), a point-of-care training strategy, provides a novel prospective approach to identify factors that impact patient safety. This study quantified and formulated a hierarchy of LSTs during risk-informed ISS trauma resuscitations. Methods: At a Level 1 trauma centre, we conducted 12 multi-disciplinary, unannounced ISSs to prospectively identify trauma-related LSTs. Four, risk-informed scenarios were developed based on 5 recurring themes found within the trauma program’s morbidity and mortality process. The actual, on-call trauma team participated in the study. Simulations were video recorded with 4 cameras, each positioned at a different angle. Using a framework analysis methodology, human factors experts transcribed and coded the videos. Thematic structure was established deductively based on existing literature and inductively based on observed ISS events. All LSTs were prioritized for future patient safety, systems and ergonomic interventions using the Healthcare Failure Mode and Effect Analysis (HFMEA) matrix. Results: We identified 893 LSTs from 12 simulations. LST analysis resulted in 8 themes subcategorized into 43 codes. Themes were associated with team-, knowledge- or system-related issues. The following themes emerged: situational awareness, provider safety, mental model alignment, team/individual responsibility, team resources, equipment considerations, workplace environment and clinical protocols. The HFMEA hazard scoring process identified 13 high priority codes that required urgent attention and intervention to mitigate negative patient outcomes. Conclusion: A prospective, video-based framework analysis represents a novel and robust approach to LST identification within trauma care. Patterns of LSTs within and between simulations provide a high degree of transparency and traceability for an inter-professional trauma program review. Hazard matrix scoring facilitates the classification and prioritization of human factors interventions intended to improve patient safety.

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