Medical emergencies in the spotlight at FMC

(Southern Health News, September 2019)

Medical emergencies in the spotlight at FMC

What happens when the unthinkable happens? A new ‘whole of hospital’ training simulation  initiative at Flinders Medical Centre is putting hospital staff through their paces in preparation for ‘high stakes’ clinical scenarios.

The Emergency Department doctor’s brow is furrowed with stress. She leans over the heavily pregnant patient and checks her pulse. Nothing.

Before her, the worst possible scenario:  A young woman in apparent cardiac arrest and her unborn child in foetal distress.

The ED Resuscitation Team swings into action. Equipment is quickly set in place. Resuscitation begins in earnest. Urgent calls are made and medical staff from other specialties are called in to join the team.

The seconds drag on into minutes, but there is still no pulse. The team continues.

There is no time to waste, however. There is still a chance of survival for the unborn baby. The team prepare the patient for an emergency caesarean section.

Minutes later, there is a collective sigh of relief as a healthy infant is born. The team continue to try and resuscitate the mother, until the bitter acceptance sets in that they have lost the patient.   

Thankfully, the above scenario was only a mock simulation and the patient, a mannequin. But medical emergencies like this have happened in past and will happen again.

‘We term them ‘low frequency, high stakes’ scenarios, because they don’t happen often but they are critically important. Timely decisions and actions can be life-saving,’ said Associate Professor Andrew Blyth, the Clinical Director of SALHN’s Emergency Departments.

‘With such uncommon events there is little opportunity to learn from direct experience, so there is all the more need to reflect, train and prepare. This is why simulation forms such an important part of the safety culture of the airline industry.’

To address this, a multi-disciplinary Simulation Interest Group was recently established at FMC in collaboration with Flinders University. The focus of the group is simulating low frequency, high stakes emergencies, with the aim of preparing staff to achieve the best possible outcomes for patients in the circumstances.

So far, five in-situ simulations have been held at FMC, ranging from the peri-mortem Caesarean section simulation described above, to emergency bypass in heart attack, to managing an extremely sick baby. The emergencies involve staff from multiple departments across the hospital coming together to form a team at short notice.

Team member and FMC Intensive Care Consultant Dr Shivesh Prakash said simulated rehearsal of complex care in the actual work environment not only allowed testing of facilities, logistics and equipment, but also improved teamwork.

‘For example, the peri-mortem C-section simulation in the Emergency Department included obstetric, neonatal, anaesthetic, intensive care and emergency medicine consultants,’ he said.

‘This was the first time ever at FMC that consultants from all of those specialties had met to rehearse for such a challenging event, and we were right at the point of care, rather than in a simulation lab.’

The mock simulations are videotaped, and a debriefing is held afterwards to identify opportunities for improvement and reinforce what was done well. There have already been many positive changes as a result, and the plan is to establish a quality cycle of implementing improvements and repeat simulation testing. 

Associate Professor Blyth said the in-situ simulations have provided many practical benefits.

‘The scenarios have a very real feel to them, and there is a true sense of urgency and anxiety at times. But the environment is also a very safe one for medical and nursing staff and technicians to learn and practice in. It allows them to identify any issues ahead of time, and work towards solving them as a team. In-situ multi-disciplinary simulation should be core to the hospital safety culture.’

‘There is evidence that simulation based testing and improvement of care results in better patient outcomes, and our experience so far shows that it will work here at FMC, too.'

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