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In Disaster Medicine Training Charles Stewart MD EMDM

In Disaster Medicine Training Charles Stewart MD EMDM. Simulation has a long history. Photos LTC(ret) M. Synovitz. Current “Sims” at Altus Air Force Base Oklahoma. Photos LTC(ret) M. Synovitz. The military has also been a major developer of medical simulation technology.

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In Disaster Medicine Training Charles Stewart MD EMDM

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  1. In Disaster Medicine Training Charles Stewart MD EMDM

  2. Simulation has a long history...

  3. Photos LTC(ret) M. Synovitz

  4. Current “Sims” atAltus Air Force BaseOklahoma Photos LTC(ret) M. Synovitz

  5. The military has also been a major developer of medical simulation technology

  6. My first introduction to medical simulation was the EFMB....3 continuous days of simulation, testing, and performance...

  7. The Combat Casualty Care Course is a military introduction to simulation for RN’s and MD’s on active duty

  8. Military Health Systems Digital SimulationTraining Currently Available MC4/SA (Medical Communications for Combat Casualty Care/Situational Awareness) CHCS (Composite Health Care System) CHCSII-T (Composite Health Care System II-Theater) TRAC2ES (TRANSCOM Regulating and Command & Control Evacuation System) DMLSS (Defense Medical Logistics Standard Support) DMLSSAM (Defense Medical Logistics Standard Support-Assemblage Management) TCAM (TAMMIS Customer Assistance Module)

  9. Oklahoma • We are particularly ‘blessed’ with disasters… • Tornadoes • Heavy weather • Ice Storms • Floods • Wildfires

  10. So... How do we teach readiness for this! • We have chosen several methods... Picher tornado, 2008

  11. Simulations Are Ideal For Disaster Training

  12. HSEEP • The Homeland Security Exercise and Evaluation Program (HSEEP) is a capabilities and performance-based exercise program which provides a standardized policy, methodology, and terminology for exercise design, development, conduct, evaluation, and improvement planning. • It is ONE way of looking at disaster simulations... • It is loosely based on the ARTEP.

  13. HSEEP • Describes two major types of exercise • Discussion based • Discussion-based exercises familiarize participants with current plans, policies, agreements and procedures, or may be used to develop new plans, policies, agreements, and procedures. • Operations based • Operations-based Exercises validate plans, policies, agreements and procedures, clarify roles and responsibilities, and identify resource gaps in an operational environment.

  14. HSEEP ‘Exercises’ • Discussion • Seminars • Not really a simulation or exercise • Workshop • Also not really simulation or exercise

  15. Simulations • Table top exercises • Very good for identification of potential problems in the emergency operations plans • Useful for training key leadership and management to plan and work together.

  16. Tabletop Simulations Duncan OK, 2009

  17. Tabletop Simulations Duncan, OK, Jan 27-28 2010(and they were better prepared, we think!)

  18. Games • A game is a simulation of operations that often involves two or more teams, usually in a competitive environment, using rules, data, and procedure designed to depict an actual or assumed real-life situation.

  19. ACLS Games...

  20. Ground TruthVideo Game

  21. Text EMDM Disaster Preparedness Game

  22. Operational Simulations • Individual (small groups) simulations • Teach procedures that you can’t usually do - and may not be able to find the opportunity to see/do. • Example - organophosphate poisoning treatment. • Often used in training responders to disasters

  23. Simulations • Drills • Small team simulations: • Very good for unit cohesiveness, training for scenarios that are not often seen.

  24. Operational Simulations • Functional Exercise • A functional exercise examines the coordination, command, and control between various multi-agency coordination centers • A functional exercise does not involve any "boots on the ground." • (Often difficult to differentiate from table-top exercises)

  25. Operational Simulations • Full scale exercises: • A full-scale exercise is a multi-agency, multi-jurisdictional, multi-discipline exercise involving functional (e.g., joint field office, emergency operation centers, etc.) and "boots on the ground" response (e.g., firefighters decontaminating mock victims).

  26. Operational Simulations • Full scale exercises: • Useful for ensuring that agencies work/play well together. • Useful for identification of command structure problems • VERY expensive!

  27. Tulsa Airport 2010 Lots of people, lots of volunteers, and lots of vehicles.

  28. Tulsa Airport 2010 Plane crashes are especially tough to simulate because most don't actually happen on runways. Instead, they usually occur in remote areas, and that makes it difficult for so many emergency vehicles to respond so quickly.

  29. Tulsa Airport 2010 Photos, Channel 6, KOTV 23 Agencies, 304 casualties, and an airplane

  30. We also use medical simulations...

  31. 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

  32. It may be used for both individuals and teams

  33. Medical Simulation in Emergency Medicine • ABEM was the first medical specialization board to adopt simulation within their oral board examinations... from the first ABEM board in 1980. • These oral examinations are a far cry from the high fidelity simulations now available.

  34. Medical Simulation In Disaster Medicine... Works Doctors Trained On Patient Simulators exhibit Superior Skills Beth Israel Medical Centre New Virtual Reality Surgery Simulator hones Surgeons' Skills, Improves Patient Safety Oregon Health & Science University School of Medicine Clinical Simulation Technology Used To Improve Communication Of Medical Teams Washington University School of Medicine Science Daily

  35. Medical Simulation • Role Playing • Like ABEM oral examinations • Task trainers • Computer patient • Manniquin simulators

  36. Benefit of Simulators • Student can practice key skills in a safeenvironment • Teacher can break down the task into components • Student can receive immediate feedback • Teacher can create the same situation to assess performance repeatedly

  37. Benefits of Simulators • Simulators are great for teaching and assessing: • Procedural skills • Treatment/interventions • Invasive monitoring • Allowing mistakes….

  38. 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?

  39. Limitations • Not great for: • 2-way communication skills • Treating the patient as a person • Students tend to treat the sim as a “dummy.” • Representing family/staff/other team members

  40. Medical Simulation Hardware & Infrastructure Are NOT inexpensive…. We have over $1x106 investedin our equipment

  41. Medical Simulation Manpower and Training Are also NOT inexpensive….

  42. The “Usual” Training Model “S1D1T1” • See One • Do One • Teach One

  43. S1D1T1 “S1D1T1” • Often used in surgical training • Frequently used for procedures in other specialties. • The 2nd year resident is frequently teaching the 1st year resident…

  44. 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…. • S1D1T1 doesn’t work well in this situation.

  45. We also have invested in the AMA sponsored NDLS as a training method to help introduce responders at multiple levels to disaster medicine

  46. 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

  47. 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

  48. 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.

  49. 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?

  50. 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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