PG14 Simulated resuscitative thoracotomy training for emergency department middle grades

Abstract

Introduction Knife crime in the United Kingdom remains a leading cause of death (table 1), particularly in the younger population. 259 deaths due to stabbing were recorded year ending March 2019.1 Watford General Hospital is a large district general hospital with approximately 150,000 Emergency Department (ED) attendances per year and an incidence of 1–2 patients per year presenting with life-threatening penetrating chest trauma. It is a low frequency, high stakes emergency with patients sometimes arriving out of hours when the department is covered by middle grade doctors who have little or no experience of resuscitative thoracotomy. Training in resuscitative thoracotomy is strongly recommended for emergency medicine trainees working in centres that do not have cardiothoracic expertise.2 Objective The aim of this novel immersive simulation training was to provide all middle grade ED doctors with; the knowledge the skills hands–on experience in performing a resuscitative clamshell thoracotomy. Method In order to allow 18 middle grades the opportunity to have hands-on practice, 6 back-to-back simulations were required, with trainees working in teams of 3. The simulations were in workshop format, guided by a senior consultant experienced in thoracotomy. TraumaFX Ltd were contacted for advice regarding feasibility of the day and provided costings for the hire of two thoracotomy manikins and a technician who repaired the manikins between simulations. Results A total of 18 ED doctors (ST1-6) attended during the course of the day and completed an evaluation form. Confidence levels for the doctors performing resuscitative thoracotomy after the training ranged from 3 (reasonably confident) to 5 (very confident) with an average score of 4.1 Realism of the manikin scored highly (4.8 average), as did the venue (4.9 average), style of instructors (4.6 average) and pre-learning material (4.5 average). Feedback on the session was extremely positive for both technical and non-technical skills, evidenced by learning points identified on the evaluation form: ‘no CPR, sharps awareness and technique with scalpel’ ‘how to cut the pericardium…’ ‘practical skills, decision making, leadership…’ ‘take the leadership, decisions on time, no CPR, learn skills, communication…’ Conclusions This novel way of delivering clamshell thoracotomy training to a large number of middle-grade ED doctors in a short period of time is educationally sound. It met our objectives and reinforced the importance of clear closed-loop communication, delegation, team-working and leadership. References Office of National Statistics: Homicide in England and Wales 2019. 13thFebruary 2020 The Royal College of Emergency Medicine: Curriculum and Assessment Systems for Training in Emergency Medicine. August 2015