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Simulation

DAY OF SIMULATION

The day has come! Plan to arrive approximately one hour before the session start time to meet staff, setup the equipment, and organize the room. Most community hospital participants will be on-time and will be expected to end on-time, so be prepared to follow the strict start and end time. The following equipment will be setup: Simbaby with i.v.line attached to a collecting bag in each arm of manikin, computer, compressor, monitor, B-line with two video views of the room, medication tray (lay out the foreign body tray first with the code tray) and documents, including the clinical and teamwork data collection form, sign-in sheet and AV consent form. These documents are located in the links below.

Simbaby should be place on the stretcher with all cords being placed under a blanket. Hiding the cords allows for more realism for the participants. Ensure that the simulator has chest rise and fall and that the all other parts (pulse, lung and heart sounds) are working. During orientation allow the participants to palpate the pulse, auscultate lung and heart sounds as well as look into oral cavity. Do not forget to put lego piece before the first case and after the orientation. Ask the participants to step out while you do so.

Monitor should be placed as close to the actual monitor as possible. We typically place the monitor on a tripod for safety and in the direct line of sight for participants. We expect participants to place the patient on leads and O2 sensor, so ensure that the monitor does not prohibit this action.

Computer and compressor are place out of the way on a three-tiered plastic table. This table is usually placed in a corner of the room. This table is the area is used by the person who would be running the simulator and the individual providing direct real-time information to the team, e.g. lab values and physical assessment cues.

Medication tray is placed in the room usually on a bed side table. The medication tray for the foreign body case is the first tray that should be setup along with the code tray. The case specific tray changes as

each case changes. Syringes, needles, and a calculator should be setup along side the medication tray.

B-line equipment is also placed on the three-tier plastic table. The cameras are attached and cords are usually hidden or taped to the wall, out of the way of the participants. One camera is angled above the stretcher to capture all hands-on activity on the simulator. The other camera is angled on the medication area to capture medication calculations and drug administration.

Documents including the sign-in sheet and AV consent form are placed on a bedside table outside the door of the resuscitation room. As participants arrive encourage them to sign-in and complete consent before the start of the session.

SIMULATION DAY

Participants have arrived, everything is in order, and your team is ready. Time to begin! Use the Orientation Manual, Cases, Data Collections sheets and Debriefing Scripts in the links below to help guide you. Here are some tips:

• Begin the session with an introduction to the project and your team.

• Have participant introduce themselves.

• We like to use the saying, “What happens in Vegas, stays in Vegas.” In other words, what happens in the session stays in the session.

• Be sure to remind participants that this is a learning environment and that they will not be judged. Rather is a test of the system.

• Reiterate that the participants can use all the tools that the facility provides including computer programs, apps, and code books. Again, we are not testing the participants on how to care for a plastic mannequin, rather we are testing the system that they are working in. Is the system prepared to care for a critically ill and injured child?

• Review the format of the day. Each simulation begins with a “patch” from a BLS unit. The participants will have 60 seconds to formulate their team before the actual simulation begins. The simulation will begin. It ends when the moderator says, “curtain down.” Debriefing of the session last about 15-20 minutes post simulated scenario and is a reflection of the performance.

• Orient them to the mannequin. Walk them from head to toe on what the Simbaby and the Megacode kid can and cannot do and what is expected of them.

• Mention the importance of “suspending disbelief.” The simulator has limitations but the more the participants put into the scenario and caring for the fake child, the more that will be gained. We mention a “Disney World” story where an older sibling points out all the fake things in the amusement park to the younger sibling. But if you believe and use your imagination, the more enjoyment and the more realism will occur.

• Introduce the participants to the medication tray and the code tray. Review what is expected of the (to order, calculate, draw-up, and administer medications as they would with a real patient).

• Discuss that they are expected to DO, not just SAY what they want. For example, if they want 20cc/kg bolus, a team member needs to place and IV or IO, get the fluid, spike the bag, hook it up to the patient, an administer the fluid. All interventions happen in real-time.

DATA COLLECTION DURING SIMULATION:

We collect data using video recording of the sessions and in-person data capture. In-person data capture is focused on

medication administration, calculation, and any variables that are noteworthy (events that may not be able to view on video - like side conversations between team members or equipment sizes). The video is used for general review if any important

variables are missed during the session and to review for the drowning case and to score CPR technique and BLS

maneuvers.

After each CASE the teams are also scored by the research team on teamwork and communication using the CTS tool.

Please see links below for instructions on using this tool. Please complete the CTS tool after every case for every team!

Before completion of the day, complete the Emergency Medical Services for Children pedsready.org survey with either the

Pediatric Champion, ED Manager, or ED Educator, and make sure they ACTUALLY HAVE the written policies, guidelines and equipment mentioned in the survey, rather than what they THINK they have. Save the survey as a PDF form and email it to our team.

Data Forms to complete by ImPACTS team member:

• Data Collection forms for each case

• CTS tool after each case

• Pedsready.org survey in-person on site

Initial contact

Seeking out and connecting with new sites

Preparation

Follow up meetings, Prep for simulation day

Simulation

Carrying out simulations, Data collection

Follow up

Post-simulation meetings, Continued contact