Simulation as a tool to improve the safety of pre‐hospital anaesthesia – a pilot study *

We conducted a pilot study of the effects of simulation as a tool for teaching doctor‐paramedic teams to deliver pre‐hospital anaesthesia safely. Participants undertook a course including 43 full immersion, high‐fidelity simulations. Twenty videos taken from day 4 and days 9/10 of the course were reviewed by a panel of experienced pre‐hospital practitioners. Participants’ performance at the beginning and the end of the course was compared. The total time from arrival to inflation of the tracheal tube cuff was longer on days 9/10 than on day 4 (mean (SD) 14 min 52 s (2 min 6 s) vs 11 min 28 s (1 min 54 s), respectively; p = 0.005), while the number of safety critical events per simulation were fewer (median (IQR [range]) 1.0 (0–1.8 [0–2]) vs 3.5 (1.5–4.8 [0–8], respectively; p = 0.011). Crew resource management behaviours also improved in later simulations. On a personal training needs analysis, participants reported increased confidence after the course.

[1]  P M Kuduvalli,et al.  Unanticipated difficult airway management in anaesthetised patients: a prospective study of the effect of mannequin training on management strategies and skill retention , 2008, Anaesthesia.

[2]  J. Weller,et al.  Generalisability of Behavioural Skills in Simulated Anaesthetic Emergencies , 2008, Anaesthesia and intensive care.

[3]  B. Flanagan,et al.  Review of mannequin‐based high‐fidelity simulation in emergency medicine , 2008, Emergency medicine Australasia : EMA.

[4]  S. Russo,et al.  Self-reported changes in attitude and behavior after attending a simulation-aided airway management course. , 2007, Journal of clinical anesthesia.

[5]  B. Graf,et al.  Simulation as an additional tool for investigating the performance of standard operating procedures in anaesthesia. , 2007, British journal of anaesthesia.

[6]  Saba Sarwar,et al.  National Confidential Enquiry into Patient Outcome and Death , 2007 .

[7]  J. Kendall,et al.  High-level simulators in emergency department education: thoughts from the trainers’ perspective , 2007, Emergency Medicine Journal.

[8]  Amitai Ziv,et al.  Training and assessment of trauma management: the role of simulation-based medical education. , 2007, Anesthesiology clinics.

[9]  T. Manser,et al.  Comparison of anaesthetists' activity patterns in the operating room and during simulation , 2007, Ergonomics.

[10]  William C. McGaghie,et al.  Simulation-Based Training of Internal Medicine Residents in Advanced Cardiac Life Support Protocols: A Randomized Trial , 2005, Teaching and learning in medicine.

[11]  R. Mackenzie,et al.  PREHOSPITAL CARE For Debate...: A license to practise pre-hospital and retrieval medicine , 2005 .

[12]  D. Gaba.  What makes a "good" anesthesiologist? , 2004, Anesthesiology.

[13]  J. Woodhouse,et al.  Acute Care Skills in Anesthesia Practice: A Simulation-based Resident Performance Assessment , 2004, Anesthesiology.

[14]  J. Hammond,et al.  Simulation in critical care and trauma education and training , 2004, Current opinion in critical care.

[15]  H. Schwid,et al.  Evaluation of Anesthesia Residents Using Mannequin-based Simulation: A Multiinstitutional Study , 2002, Anesthesiology.

[16]  T. Krummel,et al.  Use of a human patient simulator in the development of resident trauma management skills. , 2001, The Journal of trauma.

[17]  M D Cusimano,et al.  A computer-based trauma simulator for teaching trauma management skills. , 2000, American journal of surgery.

[18]  D. Gaba,et al.  Assessment of Clinical Performance during Simulated Crises Using Both Technical and Behavioral Ratings , 1998, Anesthesiology.

[19]  T. Clutton-Brock,et al.  Association of Anaesthetists of Great Britain and Ireland , 1984 .