Simulation is preparing Canterbury health professionals to work at their best under pressure and in the most unexpected situations.

When 38-year-old motorcyclist Richard is wheeled into the Emergency Department (ED), he’s clinging to life. His lower left leg has been severed after colliding with a car’s trailer. He’s lost dangerous amounts of blood and is in severe shock.

For 45 minutes, the team of eight doctors and nurses work hard to save the father-of-two’s life. They secure his mangled leg with a tourniquet and pump litres of blood into him. Eventually, Richard’s condition is stabilised. He’s sent off to an operating theatre where a surgical team do their best to repair his amputated stump. Exhausted and relieved, the emergency staff prepare to debrief the case.

Richard is not a real patient. He’s a mannequin, spurting fake blood, and is used as part of a Canterbury DHB simulation training exercise. But the emergency staff’s intense effort in saving “Richard” shows the situation felt very real to them.

“Simulation exercises can be pretty confronting for clinicians as they have to be brutally honest about how they performed and what they could have done better. But from the difficulty comes improved care.”

ED consultant Dr Laura Joyce leads the detailed debrief with ED staff. It’s a robust and brutally honest dissection of their teamwork, communication and clinical management. Honesty and self-reflection is required to ensure the exercise results in learning and improvement. Teams of ED staff regularly take part in simulation exercises, as do other departments such as paediatrics and anaesthetics.

Simulation Centre coordinator Christine Beasley says the purpose is to give clinicians the chance to practise critical medical skills in a safe environment before dealing with them for real. Many of the scenarios may occur only once or twice in a person’s career, but getting it right first time is essential.

“You wouldn’t expect the All Blacks to win the World Cup without practising their skills and teamwork before running out on the field. People expect health professionals to get it right first time, even if the situation is one they’ve never encountered before and they’re working with an unfamiliar team.”

Beasley works for weeks with clinical experts to ensure simulation scenarios are exact and realistic. Every last detail is taken into account. “If blood needs to be labelled, in the simulation exercise it must be labelled. The same detail is required with every other aspect. What happens in the exercise has to replicate exactly what happens in real life. This is how staff learn, and this is how they identify processes that could be improved.”

Simulations range from simple scenarios involving one type of health professional to complex cases involving multiple disciplines. The exercises are held in clinical areas of the hospital or at the Simulation Centre on the Christchurch Hospital campus. Beasley has a range of mannequins and works with the health board’s biomedical engineering team to produce the necessary technology and patient responses. This includes replicating real patients who can breathe normally or abnormally, have a pulse, blood pressure and speak; as well as using make-up and fake body parts. Actors are also employed when participants’ emotional intelligence and communication skills need to be tested.

Beasley says giving participants the chance to reflect on their relationships with team members and their communication skills is as important as the clinical skill and decision-making required in exercises. “We’re looking at how they work as a team, how they communicate with each other to ensure the patient gets the best care possible. It’s about being precise, safe and efficient.”

Beasley, a registered nurse, says she regularly hears from medical staff who have dealt with a scenario in a simulation exercise before facing it in real life. One example followed an emergency caesarean simulation exercise. A doctor involved in the exercise had to perform one a few months later – removing a baby of 30-week’s gestation, then performing life-saving chest compressions on its mother, all in less than four minutes in an unsterile environment outside an operating theatre. “Mum and baby both survived, and that’s not usually the case,” Beasley says. “It’s not a massive leap to assume practising the exact procedure, following the protocols and best way of working and communicating in a team, contributed to the positive outcome for this mother and baby.”

“You learn from doing things more than reading things. It’s much easier to perform well under pressure if you’ve done something before and are familiar.”Simulation training helps to reduce the stress that a new and challenging situation can cause; familiarity with a situation allows clinicians to channel their energy into thinking and focusing on what’s most important – the patient.

“Simulation exercises can be pretty confronting for clinicians as they have to be brutally honest about how they performed and what they could have done better. But from the difficulty comes improved care.”