About

Simulation is an important part of modern medical education and delivery. It allows for practice of specific procedural skills and team dynamics. Below is an example of a trauma team in-situ simulation.

SimWars is an inter-varsity simulation competition for healthcare students in Ireland.

Internal Competition

Teams will be selected to participate in the internal competition on 05-Oct- 2019. Teams will participate in simulation and will be judged on their team work. 4 teams of 5 people each will be selected for training during the year. Possible presentations will be given to teams in advance of the competition.

Training

From late October to February, there will be weekly trainings (less RCSI holidays). Participating in trainings is mandatory and absences may prevent you from competing in Cork.

Training topics:

• Teamwork
• Crew Resource Management
• Leadership Skills
• Basic Life Support
• Advanced Cardiac Life Support
• Advanced Trauma Life Support Topics
• Management of common emergency medicine presentations

Competition

3 teams will represent RCSI on 07-Mar-2019 in Cork, the 4th team will also travel to Cork as alternates.

Team Structures

The structure of teams during any simulation will depend on the scenario. However as a guide, a typical structure for a resuscitation team in the emergency department is outlined below. In reality there can be significant crossover between roles so effective communication is essential. Please note that teams participating in SimWars do not decide which team member performs which role during the simulations. Therefore each team member should be prepared to work in any role.

Doctor 1 - Team Leader

Doctor 2 – Airway

Doctor 3 – Circulation

Doctor 4 – Assessment

Doctor 5 or ED Nurse* – Assist Airway/Procedures/Monitoring

Team Roles

Team Leader

The role of the team leader is to coordinate the timely delivery of appropriate patient care. This requires them to maintain the team’s structure, direct its strategy and act as hub for information and decision-making. To this end it is widely accepted that teams leaders who remain ‘hands off’ (i.e. not performing any clinical tasks) are better able to maintain their team’s structures and dynamics. This is often referred to as ‘Lighthouse Leadership’. For this approach to work effectively it requires that both team leaders and members understand its principles. Teams members for example, should recognise that as the team’s hub for information and decision-making, significant cognitive demands are placed on the leader. As a result, if team members overload the leader with irrelevant, incomplete or poorly communicated information, they will unnecessarily reduce the teams leaders ‘cognitive bandwidth’ – their capacity to process information and make decisions. Teams members should ensure then, that any information communicated is relevant, accurate and succinct.

Similarly the team leader should recognise that by maintaining this ‘birds eye view’, they free up the cognitive bandwidth of individual team members, allowing them to focus more fully on micro level and fine motor tasks, such as securing the airway or conducting a primary survey.

Airway

The airway doctor is typically responsible for securing the patient’s airway and cervical spine, as well as for the monitoring of the patient neurological status. Because of their location (adjacent to the patients head) they will often be communicating with the patient. They will also be responsible for coordinating any change in patient position (e.g. log rolling during the primary survey).

Circulation

The circulation doctor is typically responsible for assessing and monitoring of the patient’s cardiovascular status (including ECG monitoring), securing intravenous access, drawing of blood samples and sending these for appropriate laboratory studies, administration of required intravenous medications and fluid resuscitation. The circulation doctor is also responsible for the administration of blood products and co-ordinating with the haematology department and the hospitals blood bank. The circulation doctor is also commonly responsible for the ordering of imaging studies and performing other procedures at the request of the team leader.

Assessment

A general surgeon or emergency doctor often carries out the assessment role. It involves conducting both a primary and secondary survey to determine the extent of the patient’s injuries or illness and feeding this information to the team leader. The primary survey will be performed in tandem with the airway and circulation doctor and will include assessments of airway, breathing, circulation, disability, and complete (but dignified) exposure of patient for examination (ABCDE), The assessment doctor should ensure that all relevant monitoring is attached and working to allow for proper assessment e.g. ECG monitoring, blood pressure, pulse oximetry, urinary catheter etc. The secondary survey includes collection of an AMPLE history and a head-to-toe assessment of the patient

ED Nurse or Assisting Doctor

This is the emergency-nursing role. During the SimWars competition either a medical or nursing student can perform this. This is role that requires a proactive approach and good communication skills in order to anticipate the needs of other team members and provide assistance where needed. The team leader must effectively utilise this team member where demand for their assistance is high. Performing CPR, applying pressure to the site of haemorrhage, preparation of intravenous medication and fluids, setting up of intubation equipment and attaching ECG and other monitoring are just some of the tasks that can be completed by the ED nurse/Assisting doctor.