Photography by Doug Nicholson. Photo was taken before the COVID-19 pandemic, and before Sunnybrook’s universal masking policy was in effect.
One morning each month, Sunnybrook’s trauma team receives an urgent emergency page about an incoming patient. It could be someone with a gunshot wound, a brain injury or a major pelvic fracture. They’ve been rushed to the largest trauma centre in Canada to receive life-saving treatment, and it’s all hands on deck. The team’s leader, surgeons, nurses, residents, respiratory therapists and others race to the trauma bay. But when they arrive, they’re not met with a person in serious distress.
Instead, there’s a high-fidelity mannequin on the stretcher. It looks human; however, it’s actually a prop used for simulation-based training. The mannequin can blink. Its pupils dilate. It is linked to a monitor showing its vital signs. It may even have a head wound to prompt the team that a head bleed may be present.
While simulated learning has been practiced for many years at Sunnybrook, the new “in situ” simulations are conducted in the actual trauma bay of the emergency department, rather than in a lab or SIM centre away from everyday equipment and where real trauma patients are treated.
“The element of surprise is important,” says Dr. Luis da Luz, a surgeon, head trauma team leader and a member of Sunnybrook’s trauma research group.
Although the simulation session is always in the morning, when real trauma cases are less common, no one except the simulation organizers know what to expect when they reach the bay. The lesson takes about 30 minutes and the team gathers immediately afterward to debrief and troubleshoot for another 30 minutes. For instance, during the simulation they might discover that their intraosseous insertion kit (for administering medication and fluids directly into bone marrow) was kept locked in a cabinet away from the trauma bed, creating a two-minute delay.
“Two minutes in a life-threatening situation is too long,” says Dr. da Luz. “We’re able to identify problems and resolve them, so the team is more prepared to act when a real trauma comes. That’s the beauty of the thing.”