Emergency Medicine Cases in Underwater and Hyperbaric Environments: The Use of in situ Simulation as a Learning Technique

IntroductionHyperbaric chambers and underwater environments are challenging and at risk of serious accidents. Personnel aiming to assist patients and subjects should be appropriately trained, and several courses have been established all over the world. In healthcare, simulation is an effective learning technique. However, there have been few peer-reviewed articles published in the medical literature describing its use in diving and hyperbaric medicine.MethodsWe implemented the curriculum of the Master’s degree in hyperbaric and diving medicine held at the University of Padova with emergency medicine seminars created by the faculty and validated by external experts. These seminars integrated traditional lectures and eight in situ simulation scenarios.ResultsFor the hyperbaric medicine seminar, simulations were carried out inside a real hyperbaric chamber at the ATIP Hyperbaric Treatment Centre, only using air and reproducing compression noise without pressurization to avoid damages to the manikins. The four scenarios consisted of hyperoxic seizures, pneumothorax, hypoglycemia, and sudden cardiac arrest. Furthermore, we added a hands-on session to instruct participants to prepare an intubated patient undergoing hyperbaric oxygen treatment with a checklist and simulating the patient transfer inside and outside the hyperbaric chamber. The diving medicine seminar was held at the Y-40 The Deep Joy pool in Montegrotto Terme (Italy), also involving SCUBA/breath-hold diving (BHD) instructors to rescue subjects from the water. These diving medicine scenarios consisted of neurologic syndrome (“taravana/samba”) in BHD, drowning of a breath-hold diver, pulmonary barotrauma in BHD, and decompression illness in a SCUBA diver.ConclusionWith this experience, we report the integration of simulation in the curriculum of a teaching course in diving and hyperbaric medicine. Future studies should be performed to investigate learning advantages, concept retention, and satisfaction of participants.

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In-situ simulation for the detection of latent risk threats in a hyperbaric medicine department

Undersea and Hyperbaric Medicine ◽

10.22462/04.06.2020.6 ◽

2020 ◽

Vol 47 (1) ◽

Keyword(s):

Care Delivery ◽

Health Care Delivery System ◽

Clinical Environment ◽

Medicine Department ◽

In Situ Simulation ◽

Quality Improvement Process ◽

Effective Manner ◽

Hyperbaric Medicine

Simulation (SIM) can be used in the quality improvement process to discover latent risk threats (LRTs) by running in-situ simulation cases in the clinical environment. We utilized this methodology in the hyperbaric chamber to run six in-situ SIM sessions between February 2017 and January 2019. The debriefing portion of each SIM was used to discuss and document all discovered LRTs. These safety threats were aggregated and categorized, resulting in a total of 22 unique LRTs. LRTs included problems or challenges with equipment, team education, policy/processes, communications, and medications. At a three-month follow-up, the hyperbaric leadership team had addressed each of the 22 unique LRTs. SIM can be used to identify, categorize and prioritize LRTs in an effective manner, in order to improve the health care delivery system in a hyperbaric medicine department.

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LO095: Developing and implementing an interprofessional in-situ simulation program in an academic, tertiary-care emergency department: barriers, successes and the Ottawa Hospital experience

CJEM ◽

10.1017/cem.2016.132 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S63-S63

Author(s):

C. Poulin ◽

B. Weitzman ◽

G. Mastoras ◽

L. Norman ◽

A. Pozgay ◽

...

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Patient Care ◽

Financial Support ◽

Tertiary Care ◽

Simulation Program ◽

In Situ Simulation ◽

Simulation Center ◽

The Impact

Introduction / Innovation Concept: During Emergency Department (ED) resuscitation of critically ill patients, effective teamwork and communication among various healthcare professionals is essential to ensure favorable patient outcomes and to minimize threats to patient safety. However, numerous individual and system factors create barriers to effective team functioning. Simulation center- based training has been used to improve Crisis Resource Management skills among physician and nursing trainees, but in-situ simulation is a relatively new concept in adult Emergency Medicine in North America. Methods: To enhance patient care and team effectiveness, an ED nursing and physician group was created to develop and implement a novel interprofessional in-situ simulation program in two Canadian, academic tertiary-care emergency departments. Departmental approval and financial support was obtained and sessions commenced in January 2015. Curriculum, Tool, or Material: Monthly high-fidelity simulation sessions are held in the ED resuscitation rooms at both campuses of our hospital. Each session is facilitated and debriefed by simulation-trained Emergency Medicine faculty and senior residents, a nurse educator and a research assistant. Technical support is provided by our simulation center staff. Participants are recruited from the physicians, residents, nurses, respiratory therapists and other support staff working in the ED. To minimize the impact on patient care, two additional nurses are scheduled to cover nursing assignments on “sim days”. Simulations are limited to fifteen minutes, followed by a twenty minute debriefing. Conclusion: We have successfully developed and implemented an interprofessional in-situ simulation program in our ED. Participant feedback has been overwhelmingly positive. Lack of financial support, reluctance of staff to participate, and overwhelmed resources are some of the challenges to running a program like this in a busy ED environment. However, there are clear benefits: empowering team members, culture change, identification of latent safety threats, and a perception of improved teamwork and communication.

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Addressing Barriers to Telemedicine Use in Rural Emergency Medicine: Leveraging In Situ Simulation

Telemedicine Journal and e-Health ◽

10.1089/tmj.2021.0026 ◽

2021 ◽

Author(s):

Jessica C. Schoen ◽

Christopher S. Russi ◽

Torrey A. Laack

Keyword(s):

Emergency Medicine ◽

In Situ Simulation

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What are the measures that can be used to assess performance during in situ Paediatric Emergency Medicine Simulation?

BMJ Simulation and Technology Enhanced Learning ◽

10.1136/bmjstel-2016-000140 ◽

2017 ◽

Vol 3 (3) ◽

pp. 83-87 ◽

Cited By ~ 1

Author(s):

Jennifer Amanda Mann ◽

Damian Roland

Keyword(s):

Emergency Medicine ◽

Performance Evaluation ◽

Clinical Skills ◽

Evaluation Methods ◽

In Situ Simulation ◽

Paediatric Emergency ◽

Paediatric Emergency Medicine ◽

Study Selection ◽

Key Terms

BackgroundPaediatric in situ simulation within emergency departments is growing in popularity as an approach for improving multidisciplinary team working, enabling clinical skills development and exploring the importance of human factors in the clinical setting. However, measuring the success of such programmes is often through participant feedback of satisfaction and not measures of performance, which makes it difficult to assess whether such programmes lead to improvements in clinical behaviour.ObjectiveTo identify the measures that can be used to assess performance during in situ paediatric emergency medicine simulations.Study selectionA literature search of EMBASE, ERIC and MEDLINE was performed using the key terms (Paediatrics and Emergency and Simulation.) MeSH and subheadings were used to ensure all possible variations of the key terms were included within the search.FindingsThe search revealed 607 articles, with 16 articles meeting inclusion criteria. Three themes of evaluation strategy were identified—the use of feedback forms (56% n=9/16), performance evaluation methods (63% n=10/16) or other strategies (25% n=4/16), which included provider comfort scores, latent safety threat identification and episodes of suboptimal care and their causation.ConclusionsThe most frequently used method of assessment in paediatric emergency department simulation are performance evaluation methods. None of the studies in this area have looked at patient level outcomes and this is therefore an area which should be explored in the future.

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