In Disaster Medicine Training

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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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Medical Simulation 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
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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 Infrastructure Are NOT inexpensive.
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Medical Simulation
Manpower and Training Are 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 youve seen three disasters of the same kind,
• you are either in the wrong part of the world
• very unlucky
• Or both.
• SoDoTo doesnt 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 wont (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 theSuspension 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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Others 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 200610(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 199927821-824.
• AND MANY MORE....

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Weve done this a few times......

• Since the inception of OIDEM in 2006...
• Weve trained 133 students in Advanced Disaster
  Life Support in 4 classes per year.
• But... we dont just do ADLS for disaster
  training
• We have bi-monthly simulation training sessions
  for our residents

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...

• Weve 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 cant... in places or situations we
cant put living people... and react to agents
that we cant 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
• charles-e-stewart_at_ouhsc.edu