in disaster medicine training charles stewart md emdm
TRANSCRIPT
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In Disaster Medicine Training
Charles Stewart MD EMDM
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It may be used for both
individuals and teams
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Simulation is a technique, not technology, to replace or amplify real experiences with guided experiences……. in an interactive fashion
Gaba Qual Saf Health Care 2004; 13
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Doctors Trained On Patient Simulators exhibit Superior SkillsBeth Israel Medical Centre
New Virtual Reality Surgery Simulator hones Surgeons' Skills, Improves
Patient SafetyOregon Health & Science University School of
Medicine
Clinical Simulation Technology Used To Improve Communication Of Medical Teams
Washington University School of Medicine
Science Daily
Medical Simulation Works!
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Role Playing
Task trainers
Computer patient
Manniquin simulators
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Benefit of Simulators
• Student can practice key skills in a safe environment
• Teacher can break down the task into components
• Student can receive immediate feedback
• Teacher can create the same situation to assess performance repeatedly
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Benefits of Simulators
• Simulators are great for teaching and assessing:
• Procedural skills
• Treatment/interventions
• Invasive monitoring
• Allowing mistakes….
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Simulations in DM
• Focus on medical management
• Crisis resource management skills are reinforced
• Increased complexity
• Can be videotaped for review and reflection
• “What will you do differently next time?
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Limitations
• Not great for:
• 2-way communication skills
• Treating the patient as a person
• Representing family/staff/other team members
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Medical Simulation
Hardware & InfrastructureAre NOT inexpensive….
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Medical Simulation
Manpower and TrainingAre also NOT inexpensive….
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The “Usual” Training Model
“SODOTO”
•See One
•Do One
•Teach One
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SODOTO
“SODOTO”
•Often used in surgical training
•Frequently used for procedures in other specialties.
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In Disaster Medicine
• If you’ve seen three disasters of the same kind,
• you are either in the wrong part of the world…
• very unlucky…
• Or both….
• SoDoTo doesn’t work well in this situation.
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ADLS
– At the conclusion of this ADLS course the student will be able:
☺Identify the Critical Need to Be Prepared for Natural Disasters and Events involving: chemical, biological, nuclear, radiological, and explosive incidents.
☺Define “all-hazards: and list possible etiologies
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ADLS
☺Identify the components of the DISASTER paradigm and apply the paradigm using both the M.A.S.S. and the ID-me BDLS triage model
☺Meet the Acute Care needs of patients involved in either a public health emergency or a natural disaster
☺Rapidly and effectively become part of the public health system
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ADLS
☺Demonstrate the ability to participate in a coordinated, multidisciplinary, mass casualty incident using personal protective equipment
☺Demonstrate the use of elements of decontamination site selection and the operation of basic chemical and radiological detection.
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ADLS
☺Demonstrate the ability to operate within the Incident Command System and exercise leadership competencies related to emergency preparedness and response.
So... How do we teach this?
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ADLS
ADLS™ makes use of interactive scenarios and drills in which the participants treat simulated patients in a disaster.
Through the use of high fidelity mannequins the student can gain experience in treating conditions that they would normally not treat even with years of experience.
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Our friends....help us Teach ADLS
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Simulations Are Ideal For Disaster Training
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• Provides the opportunity to train on unusual medical problems….
• Problems… that you won’t (hopefully) see
• Problems… that require unusual resources
• Problems… that require unusual equipment or personal protective gear.
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Also provides a balance between the emotional load associated with the crisis experience and the professional lessons that can be learned.
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• Also….
• Provides professionals with the skills to cope competently with those mistakes that could not be prevented
• Reduces occurrences of errors in real life
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In order for this to work....
Trainees must have some ability to invoke a
“Suspension of Disbelief”
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This is a ‘disaster’....
And we invoke the“Suspension of
Disbelief”
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During training, we need to avoid MONITOR Focus
Looking at the monitor to prompt the next clinical decision!
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Feedback
• Students are asked how they thought the scenario went
• Leading questions probe the students’ thought processes
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And then we talk....
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A hidden benefit of feedback
• The immediacy of the post simulation reflective learning process may provide trainees with snapshot of their abilities in certain clinical areas
• For some = impetus for further self assessment/new learning in those areas that are perceived as being less than optimal or below expectation
For some this =
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Is Resource Intensive and Time Consuming for both Trainers & Trainees
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Initial exposure raises awareness
Repeated exposure to simulation improves performance
High Impact
But does will it translate into improved clinical outcomes?
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Reliability
Validity
Predictive validity
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2008 Academic Emergency Medicine Consensus Conference on the Science of
Simulation
• Objective methods and measures to demonstrate simulator training actually improves patient safety
• Effective feedback of information from error reporting systems into simulation training to improve patient safety
• Methods and outcome measures to demonstrate teamwork improves disaster response
• ……………..
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Other’s experiences...
• Abrahamson SD, Canzian S, Brunet F. Using simulation for training and to change protocol during the outbreak of severe acute respiratory syndrome. Critical Care 2006;10(R3):
• Schwid HA, Rooke GA, Ross BK, Sivarajan M. Use of a computerized advanced cardiac life support simulator improves retention of advanced cardiac life support guidelines better than a textbook review. Crit Care Med 1999;27:821-824.
• AND MANY MORE....
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We’ve done this a few times......• Since the inception of OIDEM in
2006...
• We’ve trained 133 students in Advanced Disaster Life Support in 4 classes per year.
• But... we don’t just do ADLS for disaster training
• We have bi-monthly simulation training sessions for our residents
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...• We’ve stated team training with
nursing students in Emergency Procedures.
• We help the Urban Search and Rescue Teams with their disaster exercises
• We help with Advanced Trauma Life Support procedure training.
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Our ‘friends’ help us teach in ways that living people just can’t...in places or situations we can’t put living people...and react to agents that we can’t use on living people...
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Thank you....
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• Charles Stewart MD EMDM
• Director of Research andProfessor of Emergency MedicineDepartment of Emergency Medicine
• Director, Oklahoma Institute for Disaster and Emergency Medicine