Simulation at BEEP DOCTORS - BEEP Doctors Cumbria - Volunteer Emergency Doctors

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Simulation at BEEP DOCTORS

September 7th, 2022

Part of the service the Beep Doctors (BASICS Cumbria) Ltd. provide is the delivery of enhanced emergency medical care beyond what is routinely available in the pre-hospital environment.
Imagine the scenario, a farming accident in rural Cumbria leaves a local farmer trapped in complex machinery. There are also signs of internal bleeding and they need to be rushed to hospital as quickly as possible to stop it – however, despite the best efforts of rescuers he is unable to be freed quickly and requires a pre-hospital amputation in order to save his life.
There situations are thankfully rare. Although, because of this, very few emergency responders are trained to perform such advanced interventions. Surgical amputation, open heart surgery and emergency caesarean sections are beyond the training and scope of practice of the average paramedic and these skills are usually reserved for critical care teams (such as our collegues on the air ambulance).
However, in a situation where the air ambulance is responding to another serious incident or is unable to fly due to weather conditions, the enhanced care teams at Beep Doctors can provide similar enhanced care interventions to patients across Cumbria.
Even among enhanced care practitioners, exposure to these skills can be scarce. On average only one pre-hospital emergency amputation is performed each year across the whole of the UK. Meaning that it may be a once in a career procedure for even the most experienced emergency medical practitioner.
This is where simulation comes in. Our teams spend hours in the training labs learning how to do this procedure, over and over and over again until they are confident with it inside and out. This skill, and many others like it, can be drilled and drilled and drilled until the procedures become so engrained that they can be reproduced automatically, like driving a car around familiar streets.
But just knowing how to do these procedures is not enough. These scenes are often emotionally charged, and our doctors need to be able to deliver peak performance under very demanding and stressful conditions.
Imagine the scenario above – the farmer with the trapped arm – but instead of it being a sunny Wednesday afternoon, its 2am on a Sunday morning and it’s dark. What if when the Beep doctor arrives they are met by hysterical and inconsolable family members? What if the ambulance technician is new, has never heard of a surgical amputation and is equally as flustered by having to assist with such a high-stakes procedure. What if the farmer has injured their head, is confused, and is trying to fight anybody who comes close? What if as soon as the surgical equipment is prepared, it starts raining… or snowing?
All these scenarios can add a huge amount of pressure onto an already extremely stressful situation, and consequently make performing an emergency amputation much riskier. Thankfully, all these scenarios can be replicated in simulation

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This so-called “stress inoculation” involves carefully designed exposure to demanding scenarios followed by a structured debrief exploring the techniques that can be used to deal with these challenges effectively. Our doctors then undergo similarly stressful scenarios to give them the opportunity to put these techniques into practice.
These scenarios also offer a rich training opportunity for doctors who are new to BEEP or who are new to pre-hospital care. They are also used as part of a rigorous assessment and sign off process to ensure all our responders can perform at the required standard before responding to incidents.
Simulation is critical to create high performing teams. It enables our doctors to train for these low frequency, high consequence scenarios and the emotionally challenges that come with them. Simulation can also be used to help test new systems and processes to identify any latent safety threats. For example, what is the most efficient way to organise a kit bags? Will this layout work for all of the scenes we attend? All scenarios are followed by a structured debrief to emphasise key learning points and allows our doctors to receive peer observation and expert feedback from other pre-hospital clinicians.
However, simulation training is not only for junior members of our team and all our doctors including our consultants in Pre-Hospital Emergency Medicine, regularly take part in simulations to ensure that they remain on top of their skills.

If anyone would like to donate cash to BEEP Doctors, they can do so in a variety of ways, including by texting BEEP to 70085 to donate £2 or BEEP to 70450 to donate £10. More information is available on emailing