Written by Phil Webster. Posted by Kariem.
A decade ago simulation was a small part of the learning sphere but in the modern day of medical education it is now becoming commonplace and a somewhat essential part of training. With its embrace, particularly in the field of critical care, comes the evolution of the equipment, science and methodology.
We had the good fortune of having the SiLECT team from Westmead starring Andrew Coggins and Mahesh together with GSA-HEMS’ own sim guru Clare Richmond, providing us with some pearls in how to run simulation and most importantly how to use the de-brief to learn and enquire. Continue reading
Here is the program for 16th July 2014, when we’ll have simulation experts Andrew Coggins and Clare Richmond – both emergency and retrieval physicians with extensive simulation experience – taking us through our paces on how to sim.
See here for directions
The following articles are recommended for pre-reading:
Back to the Basics in Medical Simulation: 11 Programmatic Factors from Academic Life in EM
Writing a Medical Simulation Case also from Academic Life in EM
Medical Education – Advocacy and Enquiry In a Nutshell from EmergencyPedia
See one, do one, teach one: the traditional medical training paradigm. Although we have now evolved to deliver safer patient care than this, the emphasis on visual-methods for learning has been present from days yonder. SEE one.
With the advent of pocketable teaching tools accessible anytime, anywhere, there runs the risk of delivering substandard visual material.
Phone in your hand, educational opportunity in front of you, hold up your phone vertically, press record, share the video, enhance the world of medical education.
To the undiscerning reader, the key flaw to this workflow may be missed. If you shoot your videos holding your smartphone vertically (also known as portrait mode), the video may occupy the entire smartphone screen and be more comfortable to hold the phone, true, but when that video is shared to those who wish to learn from the video, a slim, tall video with black bars either side will completely distract and potentially miss out on the crucial aspects of video footage that you wish to share. And it is annoying. Very. And what happens when you decide to turn your phone mid-filming to actually capture everything that deserves to be captured? Viewers will need to turn their computer screens/laptops/heads sideways to view the footage i.e. the video is unusable.
This is known as Vertical Video Syndrome (VVS) and has plagued the world for years now, despite a concerted campaign to end it.
Enter Horizon. This iOS-only app should be the new standard way of filming our medical education material. Using the iPhone gyroscope, Horizon will ensure that your videos are always shot in horizontal (landscape) whilst recording, even if you rotate your phone to vertical or anywhere in between. It is a clever use of software and hardware that really should be a standard feature of all smartphones. Until it is, we would encourage all users to film their medical educational material using this app. Or film horizontally. And allow your viewers to actually SEE one before they do one.
Sydney HEMS says ‘No’ to VVS.
Have a look at these three short videos… Taken on a recent Sydney HEMS mission.
Can you guess the diagnosis??
NB. Art line trace is in yellow, SaO2 in blue.
Post your answers below. First correct answer wins a crate of beer (maybe)!
Here are some of the learning points from the Sydney HEMS Clinical Governance Day 18th June 2014:
Some reminders cropped up that are worth revisiting:
- Rocuronium dosing for RSI: At least 1.2 mg/kg is recommended. Lower doses may be a reason for a lack of first-pass success at laryngoscopy. In the next iteration of out airway SOP we will be recommending 1.5 mg/kg
- Remember to do a thorough physical (ie. MANUAL – palpation) examination of the chest (including the parts of the lateral and posterior chest wall that you can access). Crepitus, deformity, and flail segments may otherwise be easy to miss.
- In maxillofacial disruption with haemorrhage, remember to reduce the fracture before splinting it, just as you would with a deformed limb. This often requires manually moving the midface by grasping the upper teeth. The subsequent placement of balloon catheters, when inserted horizontally in the nasal space, are more likely to be effective and correctly sited.
- During intubation the bougie should not be placed blindly (ie. no view of the interarytenoid notch from which to guide anterior placement) if other steps to optimise first pass success are not in place, namely optimal positioning and external laryngeal manipulation.
- It’s Winter, and late or last light winches may result in the team being inserted to the patient but not extracted by winch, sometimes necessitating an overnight stay in the field. Make sure in your personal kit you have thermals, gloves, beanie, and light sources including a head torch. Physicians should remember that the yellow survival pack should be put into the cabin prior to leaving base. Remember where it’s kept: in the boot for the AW139 and in the hangar SAR store for the EC145. If you spend the night in a canyon in Winter you’ll wish you had it!
- Winching near to cliff tops or mountain tops can risk turbulence as the air flows off the high land. It may sometimes be necessary for safety reasons to do a higher winch at these sites to ensure the aircraft is high enough to avoid this.
- In some winch missions the access skills of a second paramedic may be required, resulting in the physician being initially left behind. Options are then to bring the patient to the physician or to deliver the physician to a rendezvous point by another means (if the patient’s injuries warrant it).
Case challenges were put to the group based on real and imaginary obstetric retrieval challenges. Those who did the prereading fared best! A reminder of the references is here:
Post Partum Haemorrhage Guidelines
Life in the Fast Lane
Two great cases facilitated by HEMS doctors Phil Webster and Dave Monks, including a great prehospital resuscitative hysterotomy case using a model invented by Phil.
Here Dr Carla Richardson and paramedic Marty Pearce do an amazing job considering they had no idea what to expect from the scenario or the model. The case was a prehospital traumatic cardiac arrest in a near-term pregnant patient. Carla and Marty had completed intubation, bilateral thoracostomies, and started blood transfusion in the mother prior to hysterotomy.