Emergency Medicine (EM) trainees (ST3 and above) in the Peninsula region were invited to attend a trauma catch up day at Derriford Hospital, to ensure that trainees who had potentially been disadvantaged by the covid pandemic were able to update their major trauma skill set. We had 15 spaces available, and excellent uptake from trainees, meaning we were over-subscribed and had to prioritise senior trainees for attendance.
Funding was provided via the Training Recovery Fund from Health Education England and allowed a range of animal models to be purchased for the session.
The training day was arranged by Dr Annette Rickard, with consultant faculty from both EM and anaesthetics who volunteered to attend (Dr David Wise, Dr Suzy Connor, Dr Paul Moor, Dr Becky Kingdon, Dr Ian McCarthy) to facilitate a mixture of simulation, group discussion, practical procedure, and lecture-based sessions. Support from nurse educators Martin McElroy and Dani Thorpe-Gray in procuring equipment and running the simulation sessions was also a huge bonus.
The objectives for the training sessions were not only to ensure trainees were comfortable performing rare but essential practical skills, but also incorporating Trauma Team Leader teaching with an emphasis on human factors and communication skills, as well as decision making in trauma.
Dr Suzy Connor led the lateral canthotomy session, beginning with a simulation case and debrief with emphasis on human factors and team leadership skills. The simulation case involved a patient with head and facial injuries, and obvious swelling and proptosis of the eye.
Suzy then gave a lecture drawing from her own experience of a case in the Emergency Department, where a patient had experienced a delay in recognising the need for a lateral canthotomy. Teaching centred around assessment of patients with facial and ocular injuries, and how to perform the procedure. This was followed with a practical session, led by Dr Ian McCarthy, who has carried out the procedure several times recently, with porcine head models.
Front of Neck Access
A further simulation scenario was facilitated by Dr Annette Rickard (in full skeleton regalia), involving a patient with gross facial injuries and requiring a rapid sequence induction for intubation and ventilation. This gave a further opportunity for candidates to practice trauma team leading and led onto discussion around decision-making and non-technical skills during the debrief. The inclusion of nursing colleagues assisting in both running the simulation and filling nursing roles on the simulation trauma team allowed a true multi-disciplinary team feel, as well as allowing feedback to be gained from a nursing perspective.
Dr Paul Moor (anaesthetic cons, intermittently resplendent in glittery red horns) delivered a lecture with an overview of the Difficult Airway Society guidelines for management of challenging airways and the indications for surgical front of neck access. Discussion centred around the indications and decision-making around this, as well as practical hints and tips, and demonstration videos.
Sheep larynxes were used for demonstrating the skill and then for candidate practice to get hands on experience.
Damage Control Resuscitation, Thoracotomy and Trauma Line Insertion
Dr Becky Kingdon started the session with a simulation case of a multiply injured patient who deteriorated and eventually lost palpable pulses, entering a low output state and a traumatic cardiac arrest. The debrief focussed on non-technical skills such as closed loop communication and team dynamics, as well as practical learning and discussion around activation of the major haemorrhage protocol (MHP), damage control surgery declarations, and the differences between these processes in Trusts throughout the region.
Dr Annette Rickard initially led the lecture session with learning around code red trauma calls and HMP, followed by Dr David Wise presenting traumatic cardiac arrest SOPs, with emphasis on priorities for the patient in traumatic cardiac arrest, and priorities before proceeding to thoracotomy. A detailed step by step guide to the practical procedure, along with common pitfalls and tips, were based on his own experience and his published SOP.
David followed with a trauma line insertion talk through (no holes made in volunteer model Annette). There was plenty of discussion around the utility of thoracotomy in trauma, including timelines, indications, and current evidence.
The porcine thoraxes allowed for a demonstration of the procedure for an emergency thoracotomy, including the technique for gaining access to the chest, opening the pericardium, compressing the lungs and proximal aorta, and internal cardiac massage.
After closing the session, all attendees were invited to the pub for a social gathering for further learning (!).
Feedback from Candidates
“Excellent to start with sim to contextualise”
“Really useful going through theory lecture and videos prior and having lots of facilitators to help!”
“Using and handling real tissue to get a more realistic appreciation of to perform the skills”
“I feel I have cemented my approach to these skills that I haven’t done in real life and feel more able to mentally rehearse them now that I have a feel of doing it on the models”
“Great to focus on the HALO procedures in a supportive environment”
“Getting the chance to work through this on the pigs was invaluable- thank you”
“Good number of skills taught/learnt. There is often a temptation to try and get through too much. This was just right.”
“I wish I had had this before starting working in the MTC. It was a brilliant day, addressed some difficult to practice skills and met goals of catching up after decreased exposure in covid.”
“Thank you, please continue to run this, I would love to do this at intervals during my career to keep skills up!”
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