Using simulation to optimize the resuscitation of trauma patients

A child involved in a car crash. A young man injured in a hunting accident. A teenager who fractures her spine while diving. Accidents can happen anywhere, anytime.

Trauma centres, typically large tertiary care hospitals, are well equipped to deal with these cases, but Quebec is a large province where many major injuries occur far from tertiary care. When this happens, critically-ill trauma victims are brought to their nearest hospital for lifesaving interventions, to assess and stabilize the patient until they can be transferred to a trauma centre.

The resuscitative efforts of the health care team during that initial intervention, particularly in that first hour, has a critical impact on patient outcomes. While these institutions are staffed by well-qualified physicians and health care teams, the infrequent but high-stakes nature of these encounters necessitates opportunities to support their skill development.

With that goal, health care practitioners from across the province of Quebec came together on November 20 to learn the foundational skills to care for these critically ill trauma patients. The Advanced Trauma Care – Pediatric to Adultcourse was organized by McGill University’s Steinberg Centre for Simulation and Interactive Learning (SCSIL) as part of the Fédération des médecins spécialistes du Québec (FMSQ) – Journées de formation interdisciplinaire. This course employed cutting-edge simulation practice and was led by expert faculty who understand and work in tertiary care and resource-limited settings.

Continuing professional development for Quebec’s medical specialists

Over 10,000 medical specialists are members of the FMSQ, an umbrella organization that comprises 35 associations and represents 59 medical specialties from across Quebec. Dr. Sam Daniel, Professor in Pediatric Surgery and Otolaryngology at McGill and Director of Continuing Professional Development at the FMSQ, notes that that an important part of the FMSQ’s mission is to provide continuing professional education and development opportunities to its members in order to ensure that patients in Quebec receive the best possible medical care. They often partner with simulation centres across the province to support this training.

Dr. Sam Daniel

“There’s nothing more valuable than a simulation centre to provide a safe environment for our physicians to enhance their skills, acquire new techniques and improve the care they are providing,” says Dr. Daniel. “We are very grateful for our longstanding association with McGill and the SCSIL for providing this opportunity, and are extremely impressed with the quality of the workshop and with the knowledge of all the educators and staff.”

Tuhinur Islam, Simulation Technician

A one-of-a kind workshop

This course is unique in that it outlines the commonalities in pediatric and adult trauma patients while highlighting important differences, explains Dr. Farhan Bhanji, Director of Education at the SCSIL, who worked with Drs. Dan Deckelbaum and Dan Poenaru to co-lead the development of this course.

Dr. Farhan Bhanji

“We want physicians who are outside of tertiary care centres to feel comfortable managing trauma patients of all ages. There are courses for adult trauma, such as the Advanced Trauma Life Support^© (ATLS), and for pediatric care, like the Trauma Resuscitation in Kids (TRIK) but until now, nobody has put those together in a meaningful way to cover both adult and pediatric trauma in a comprehensive one-day workshop,” says Dr. Bhanji. “This course employs simulation-based training which engages the learners both intellectually and emotionally. Research shows that it is the best educational method to get learners to incorporate new things that they’ve learned into their practice.”

Emphasizing teamwork in resource-limited settings

Dr. Dan Deckelbaum is a trauma surgeon and critical care physician at the McGill University Health Centre (MUHC), and Director of Surgical Education at the SCSIL. He is also Co-Director of the Centre for Global Surgery and has adapted team training practices from his work around the world in resource-limited settings.

“Often in smaller hospitals, health care teams are put in difficult positions. They see the big traumas, just like the major trauma centres do, but they don’t have the resources to be able to care for the patients using a 360-degree approach. This course is designed to help them provide top-of-the-line resuscitation in a team setting.” He notes the importance of understanding the designated roles and responsibilities of all members of the multidisciplinary team and of practicing together so that the expectations are clear.

A safe space to learn

This approach resonates deeply with Dr. Mathieu Ratté Larouche, an orthopedic surgeon from Trois-Riviѐres who found it very useful to gain a deeper understanding of everyone’s role within the team, and to practice those roles and techniques. “The team at our hospital receives many trauma patients, and I am frequently asked to concentrate on the musculoskeletal aspect of the trauma. What’s interesting is that here, I am learning a bit about everyone’s role. This will allow me to assist with other tasks as the team works together towards a common goal, which is to save the patient.”

Dr. Dan Poenaru (left), Dr. Mathieu Ratté Larouche (right)

Dr. Ratté Larouche believes that having the opportunity to practice safely in a high-stress simulated environment helps prepare teams to work quickly and effectively under pressure: “In the everyday life of a doctor or a health care professional, we don’t accept errors. It’s hard to live with. But today, we are here to practice these difficult situations, to get important feedback on our actions and to learn from our mistakes. I invite everyone to practice simulation because this is how we can excel and improve. Honestly, I think this will make us better physicians.”

Dr. Geneviѐve Soucy, a general surgeon who works at a small hospital in Gaspésie, also embraced the opportunity to learn through simulation. “We step outside of our comfort zone when we do these simulations. We don’t see trauma cases every day at our hospital; these situations can be a bit dramatic. We are always learning. Today, I learned a lot about tweaking communication strategies. The instructors gave us really good advice and feedback. They recognized errors that we may be likely to make in a real situation, and they didn’t hesitate to share their comments with us; I find that very important. If I can bring these learnings back to share with my team, in my small centre, that will be a real plus. If we can improve the next reanimations, the next trauma situations, I think that will help everyone involved.”

Dr. Geneviѐve Soucy (left), Dr. Dan Deckelbaum (right)

Keeping up with evolving needs

The reality is that medicine, and health care in general, changes over time. It’s hard to keep up with everything, so continuing professional development is essential.

“As soon as the instructors heard about this opportunity to help their colleagues, they jumped in to plan this course to help them deliver better care. That makes me really proud,” says Dr. Bhanji.

Dr. Chady El Tawil (left), Dr. Joe Nemeth (right)

One of the instructors, Dr. Joe Nemeth, is an emergency medicine physician and trauma team leader at the MUHC and Associate Professor in the Department of Emergency Medicine at McGill. He noted that there is clearly a need for advanced trauma training in both adult and pediatric populations: “The group assembled to provide this educational experience has extensive experience in not only teaching but in diverse and challenging clinical trauma-related presentations. This is a worthwhile pedagogical initiative for all involved, including the faculty.”

Fifteen participants and seven instructors took part in the Advanced Trauma Care – Pediatric to Adult course, coming together on a Saturday to explore ways to learn more and do more for their patients. “It’s incredible so see such a willingness to participate, to improve one’s knowledge, technical skills and team functioning in order to provide better service to their communities,” expressed Dr. Deckelbaum.

As one of the course codevelopers, pediatric surgeon Dr. Dan Poenaru found it very fulfilling to interact with health care specialists from across the province, to answer their questions and alleviate their concerns. “I think that ultimately, what this workshop provides to our learners is confidence. They know that the next time they are faced with an unfamiliar trauma, they will be able to confidently provide for the patient. They are ready. That, to me, is gold.”