In a recent emergency response training exercise, Risk Response and Rescue conducted several staged medical scenarios at a mine site in the Hunter. We pride ourselves on providing “real life” training scenarios contextualised to their workplace. To this effect, we conduct training with both live patients and mannequins, utilising makeup and moulage to simulate injuries, as well as a theatrical workplace accident to best tailor the training in the workplace. On this particular occasion, we had two current practising Intensive Care Paramedics conducting the training session, ensuring the simulations were as realistic as possible, but also maintaining the safety of all participants.
The simulation was conducted in a decommissioned washery. A risk assessment was conducted by the Emergency Services Co-ordinator to ensure the location was safe to use. Our training was conducted over two days, with the first day focussing on refreshing the students’ knowledge of Primary and Secondary survey, airway management, CPR skills, triage and several other topics, relating to medical and traumatic emergencies. The second day focussed on practical skills, with the entire afternoon dedicated to the simulation. The training was targeted at the Emergency Response Team (ERT), with their Emergency Services Operator (ESO) in the classroom. The aim was to let the ERT manage the situation, with the ESO to intervene only for minimal guidance and support.
The simulation was set up to imitate a scaffolding collapse in the washery, over two levels, with the added risk of a live electricity wire, and other dangers including unstable working environment, manual handling, difficult extrication and two patients spread over two levels. This required the participants to identify and rectify dangers before making patient contact.
Participants then had to prioritise treatment, triage and extrication based on patient presentation, utilising the trauma triage tools they had recently learnt in classroom-based learning.
Both learner teams demonstrated very similar approaches to the simulation and their performance can be summed up together.
On first arrival, the ESO approached the scene with some members of the ERT. They were confronted with the first live patient who had significant, though not life threatening, injuries. The patient was also ambulant on scene, but high distressed. The purpose of this was to specifically challenge the team not to become focussed on what was immediately in front of them, rather than on the entire scene. Both teams demonstrated appropriate scene awareness and proceeded to further survey the area before initiating emergency response procedures and treatment. This identified several dangers that needed to be mitigated and also a second patient on lower level, that had fallen five metres, unconscious and with life thretening injuries.
Management of the Scene
The first patient was recognised to be walking and was taken away from scene for further treatment and risk mitigation. This patient’s injuries were assessed and treated away from any danger, with a Primary Secondary survey conducted. The ERT split into two groups, one group attending to the first patient, and the other focussing on the unconscious patient. The ESO recognised that their skills would best be utilised with the critical patient.
The dangers of the live electricity and unstable scaffolding was managed immediately by both emergency response teams, recognising that neglecting to do this would be very dangerous for all involved.
The critical patient was found to be unconscious, as they did not respond to verbal or physical stimuli.
Send for Help:
Members of the Emergency Response Team notified their ESO immediately about the condition of the patient, who raised the alarm appropriately, as per their specific workplace procedure. This was also simulated by using radio communications with their control centre and the simulation facilitators.
Arrest Life-Threatening Haemorrhage:
The patient had a large wound to the back of the head, and the students’ first task was to control this bleeding immediately, prior to all other treatment.
The patient’s airway was assessed to be at risk, due to their being unconscious. Per skills recently learned, students demonstrated airway management in the way of the triple airway manoeuvre, manual airway support and even an oral airway. The live patient was not able to tolerate this, and the students were able to assess that this meant they were able to maintain their own airway with some minimal support. The patient simulated vomiting at one point, and the students were able to successfully log roll the patient and clear the airway.
Spinal alignment was maintained with manual in-line stabilisation, including at times when the patient needed to be moved or log rolled. Students recognised that airway takes precedence over spinal control, a very important learning outcome and in line with current ARC guidelines for emergency response.
The patient’s breathing was assessed and found to be adequate. Nil other treatment was required at this point.
Patient’s overall perfusion was assessed, demonstrated by students taking a heart rate and manual blood pressure, and nil other treatment was required at this point.
Patient was deemed to be unconscious, with an LOC of “U”. Due to the height of the fall and the patient being unconscious with a head injury, a high index of suspicion was maintained that the patient had a high possibility of a spinal injury, thus spinal precautions were maintained throughout extrication. It must be noted that the patient did not regain consciousness in this scenario at any point, and all assessments had to be made through clinical indicators.
Patient was found to be normothermic and students attempted to keep them warm throughout the scenario, recognising the dangers of hypothermia in trauma patients.
Following the Primary Assessment and observations, a thorough Secondary Assessment (Nose to Toes) was conducted, with the patient exposed completely to reveal abrasions and a large bruise to the left abdominal/lower chest area. This was treated appropriately and monitored for any worsening of symptoms. The patient was covered after this assessment to maintain warmth.
The ERT and the ESO were then faced with the challenge of a difficult extrication, to remove the patient from the scene to the awaiting ambulance. This was conducted by a rope rescue, which included the use of a Stokes litter, spine board, manual handling carry and a three point pulley descent system. During this time there was the clear demonstration of a team leader and a well organised emergency response plan, with all members of the team performing their roles, whilst also demonstrating safe work practices.
Handover and Debriefing
Following the safe and successful extrication of the patient, the team performed a comprehensive handover to the simulation co-ordinator utilising the IMIST AMBO handover tool, which the students had previously learnt.
Post simulation and clean up, an extensive debrief was held to identify strengths, weaknesses and challenges. Overall, both trainers were extremely happy with the performance of the teams, with only minor recommendations to make. It was an excellent opportunity to deliver workplace-specific training and simulation to students who were involved and engaged all day, and it was great to see them utilise the content to allow them to perform at such a high standard, contextualised to their workplace.
Click Here for real life emergency response training that translates into real performance.