1. Anaesthesia Crisis Simulation

2. Background Anaesthesia early adoption SBME Anaesthesia early adoption SBME Driven by Gaba, Emily Bromily Driven by Gaba, Emily Bromily Similarities commercial airlines Similarities commercial airlines Increased monitor/environmental fidelity Increased monitor/environmental fidelity EMAC courses EMAC courses

3. New Zealand Both EMAC course providers in N Island Both EMAC course providers in N Island New anaesthetic registrar crisis course New anaesthetic registrar crisis course More SBME for trainees near these centres More SBME for trainees near these centresBut Limited access for S island based Dr’s Limited access for S island based Dr’s Different equipment/environment Different equipment/environment Lack of team based approach using local teams Lack of team based approach using local teams

4. Christchurch Anaesthetics Limited SBME despite demand Limited SBME despite demandPROMPT EMAC Course x1 in training CORE 7 EMST/APLSPATCH Ad hoc morning sessions Ad hoc morning sessions

5. The Problem SBME effective SBME effective Significant simulation debriefing resources Significant simulation debriefing resources Dose response relationship Dose response relationship Fidelity important to a point – buy in Fidelity important to a point – buy in Full simulation suite facilities expensive and not realistic for peripheral centres Full simulation suite facilities expensive and not realistic for peripheral centres

6. Solutions 2 avenues 2 avenues 1) Collaborative approach with UoOSC 2) Development novel approach using equipment already available in the hospital at no cost.

7. The “In situ” simulator Clinical engineering calibration machines can be used to drive any monitor Clinical engineering calibration machines can be used to drive any monitor This allows scenarios to be run “in situ” This allows scenarios to be run “in situ” in the clinical environment in the clinical environment

8. Sp02

9. Sp02 “False finger” to attach Sp02 probe “False finger” to attach Sp02 probe Dial up Sp02 and HR Dial up Sp02 and HR Realistically changes over a number of seconds Realistically changes over a number of seconds Sometimes a little temperamental Sometimes a little temperamental Short period of flat line when changes made Short period of flat line when changes made

10. NIBP

11. NIBP Useful graduations Useful graduations 60/40, 80/50, 100/60, 120/80 etc Y connector! Y connector!

12. MP450 ECG, IBP

13. Allows adjustment HR and common rhythms. Allows adjustment HR and common rhythms. Also invasive BP trace but fixed at 120/80 so limited utility. Also invasive BP trace but fixed at 120/80 so limited utility. Must attach to 5 lead ECG for all rhythms to be available Must attach to 5 lead ECG for all rhythms to be available

14. The In situ OT set up

17. Video

18. Junior Trainee Crisis Sessions 0700 coffee, muffins, Non threatening 0700 coffee, muffins, Non threatening 4 scenarios 4 scenarios (anaphylaxis, MI VF arrest in PACU, Aspiration on LMA, Blocked ETT) 4-6 trainees, 50% attended all. 4-6 trainees, 50% attended all. Trainee tech Trainee tech Guest “Volunteer” debriefer Guest “Volunteer” debriefer Sign up sheet, evaluation survey and Post scenario resources provided on drop box Sign up sheet, evaluation survey and Post scenario resources provided on drop box

21. These scenarios have been a valuable learning experience

22. Fidelity

23. What were the strengths of the OT set up More realistic, better prepared for real-life situation More realistic, better prepared for real-life situation Acting in real environment Acting in real environment same environment we spend the majority of our time in which makes how we might respond to the situation in real life more realistic and how we make use of the resources in that environment. same environment we spend the majority of our time in which makes how we might respond to the situation in real life more realistic and how we make use of the resources in that environment. Familiar environment, with equipment that we use everyday. Familiar environment, with equipment that we use everyday. It's where we work and where we would actually experience these events It's where we work and where we would actually experience these events Same environment as place of work. Realistic scenarios with added realism from use of usual monitors and anaesthetic machines. Same environment as place of work. Realistic scenarios with added realism from use of usual monitors and anaesthetic machines.

24. Weaknesses of in OT set up Already identified, but would be useful having people playing their usual roles, ie real nurses Already identified, but would be useful having people playing their usual roles, ie real nurses Difficult to hear lung sounds, other people in scenario should have a card of what they can / cannot offer to do Difficult to hear lung sounds, other people in scenario should have a card of what they can / cannot offer to do having a scenario where when you do call for help and you gets heaps of willing assistants who may not be the most skilled/appropriate to assist in that particular situation and the subsequent distraction/stress this can provide and/or strains on communication when having to deal with that and the emergency at hand. having a scenario where when you do call for help and you gets heaps of willing assistants who may not be the most skilled/appropriate to assist in that particular situation and the subsequent distraction/stress this can provide and/or strains on communication when having to deal with that and the emergency at hand. Acting outside usual roles is unrealistic but necessary. Acting outside usual roles is unrealistic but necessary. Within limitations of mannikin (aka can't actually have real patients having cardiac arrest...) no real weaknesses Within limitations of mannikin (aka can't actually have real patients having cardiac arrest...) no real weaknesses Not using volatile is the only unrealistic aspect, but understandable. Not using volatile is the only unrealistic aspect, but understandable.

25. Issues Clinical area Clinical area limited availability scrupulous control of equipment scrupulous control of equipment Set up time/ chasing collecting bits Set up time/ chasing collecting bits Potential for unskilled debrief vulnerable participants Potential for unskilled debrief vulnerable participants Dropbox Dropbox

26. Questions