DESIGNING & BUILDING EFFEC TIVE SCENARIOS
Simulation to improve handoff, airway & bariatric patient safety
By Jennifer McCarthy, MAS, NRP, MICP, CHSE; Amar P. Patel, DHSc, MS, NRP; Andrew E. Spain, MA, NCEE,
EMT-P & Timothy Whitaker, BS, CHSE, CHSOS, EMT-P
“Safety is defined and measured more by its absence than its presence.”—James T. Reason
In our last column, we discussed an EMS patient safety culture as it relates to the 10 EMS safety goals identified by the
Center for Patient Safety.
In our next two articles, we’ll discuss in
more detail the remaining EMS identified
patient safety goals. (Table 1 provides examples
of simulation activities for building a culture
of patient safety into your students.)
HANDOFF OF CARE
It’s estimated that handoff of care is
the most dangerous point in patient
care that can lead to medical errors.
Vital information can easily be lost
in translation or forgotten if not
provided in a written format.
Due to the risk involved, adopting a standardized mechanism to
handoff patients between healthcare providers is essential to
improving patient safety.
Throughout healthcare, a well-accepted acronym for improving patient handoff is the acronym SBAR, which stands for
situation, background, assessment and recommendations. Patient handoff is an EMS
safety goal that can overlap into most EMS
EMS providers know first-hand how difficult
managing an airway in the prehospital environment can be. The environment alone serves
as a difficult factor adding to the complexity
of the procedure. Proficiency in basic airway
maneuvers is as vital as advanced techniques.
Simulation activities must include objectives beyond uncomplicated, commonly performed airway skills. It’s important to develop
activities that place manikins in environments
that mimic the EMS patient care environment.
Many education programs place manikins
on tables or at waist height, which doesn’t
provide a realistic environment for providers
to achieve or maintain airway competency.
Utilizing real or simulated ambulance
space is important for mental mapping
related to equipment set-up during a procedure within the ambulance. Proper equipment
set-up is shown to improve airway management success rates.
Objectives that require emphasis on both
basic procedures and assessing for airway difficulties reinforces the importance of systematic
approach, which improves provider success.
Utilizing pictures to allow individualized
assessment is an easy way to modify an already
existing vetted scenario. If an actual patient
would be diaphoretic based on the scenario,
then mimic those factors during the simulation activity to promote practicing as real to
life as possible.
Recreating opportunities to perform high-risk/low-frequency procedures is important for
maintained competence at all healthcare levels.
Activities should include teamwork and
communication techniques especially in com-
plex, high-acuity cases. Lastly, developing
activities that promote interaction with varied
level EMS providers can also be important for
improving patient safety culture.
It’s reported that 30% of adult patients are
obese. EMS system culture often ridicules
providers that request a lift assist. This culture is detrimental to provider safety in EMS.
Even if an agency’s culture has evolved and
personnel are provided with bariatric equipment and encouraged to request assistance,
some experienced providers resist
the change of procedure and place
themselves and their patient in an
Overcoming these intrinsic
hurdles brings us next to the bariatric patient assessment. Bariatric
patient assessments require unbiased, non-judgmental interaction.
Anatomical changes present in
bariatric patients may complicate
otherwise simple skills like ECG
application or repositioning for
obtaining lung sounds.
Simulating the complexities of bariatric
system response and care requires creative
simulation design for suspension of disbelief.
Recruiting bariatric standardized patients can
assist in achieving a real-life patient interaction
experiences and realistic evaluation of communication techniques and patient treatments.
Enhancing the use of the EMS safety goals
by incorporating them into simulation activities is an important way to achieve a culture of improved patient safety. Many of the
patient safety goals can be integrated into a
single EMS simulation activity, since they’re
prevalent on most EMS patient interactions.
Although we’ve provided some ideas for
sample activities in this column, remember
to be creative and come up with ideas of your
Enhancing the use of the
EMS safety goals into
simulation activities is
important to achieve
improved EMS patient safety.