At http://healthcare.partners.org/bwhintranet/viewbulletinclips.cfm?listingid=524 is an article "Simulating Emergency Scenarios" about the Center for Medical Simulation (CMS). "A joint venture between the Anesthesia departments of Harvard Medical School’s teaching hospitals, the Center offers medical professionals the chance to simulate a medical emergency in a realistic environment."

This article might be available only this week. It's from a weekly publication "BWH Bulletin" (Brigham and Women's Hospital, Boston) and can be seen from outside BWH.

-- Driad (Driad@mailcity.com), February 28, 2001

Answers

Very interesting. Of course these people *know* what to do, but with disastor events that only happen once in a blue moon, skills get rusty.

My mother heads up the HazMat preparedness in her ED, and one a year they do a simulation chemical spill/hazardous waste emergency. Of course, her favorite ER eppy is Exodus.

I also recall reading an article about a tornado up north here year ago, and how all the ED staff wished they had was a garden hose. Apparently, these victims had mud caked on every part and oriface of their bodies. The article said that they thought a garden hose would have been high enough pressure without being painful.

-- Cathy (cybercathy@wi.rr.com), March 01, 2001.

I couldnt get that page to load.... Anyways, my fav episode of ER is Exodus (and Blizzard) because I think that those sort of things with the adrenaline rush are cool. I have never seen one of those HAZMAT or Mass Casualty Incidents, but I have certanly had the chance! Dont think I am stupid, it is not me that does this, the stupid fools that live in a near by community . . . . Well, a little more than 4 months ago some fool crashed his car into a gas pump and set it on fire nearly blowing the station up, which also happens to be across the major intersetion from the fire station! Well, just 2 weeks ago, about 100 feet from that gas station, some construction crews broke a natural gas line and caused a major HAZMAT incident, which i think all HAZMAT units in the county responded to ... hehe, stupid people. We also tend to have big firey crashes on the numerous interstates that criss-cross the county. I remember about 4 where tractor trailers ran over cars and blow them up that have occured in the last few years, and a car once went through a sound barrier on the side of the road and almost landed on the roof of a house! Hmm, this kind of sounds like an episode of ER ... hehe. Well, i hope you all find the stupidity of people near my home funny! They better stay away from my house ...

-- Steven Jacobson (steven@episodeguides.com), March 01, 2001.

That's nothing terribly new -- Laerdal has had simulator manniquins out on the market (full ACLS/ATLS patient scenarios) for a couple of years now; I've used them periodically to do refresher instruction for both courses. I find that these kinds of skills do degrade if you don't use them on a regular basis, so anything that helps providers who don't exercise the skillset frequently is a good thing.

My old air ambulance service, Shock Trauma Air Rescue, has an interesting mobile program they claim is first in North America -- basically, a large RV with the dummy in the back and all the equipment around it. The thing drives around and trains community health care providers.

These dummies are pretty cool. They have anatomically correct and functional airways, complete with cricothyroid membranes, so you can practice intubation and cricothyrotomy. Some incorporate electrode patches to trick monitors and defibrillators, but I've never used any of them. I've seen one or two that incorporated breakable ribs; many allow you to place peripheral IV lines, chest tubes, do saphenous cutdowns -- about the only thing you can't do is a thoracotomy.

They don't replace actual hands-on patient training, but they're useful. I use smaller versions of the dummies -- Fred the Head, for instance -- to teach lesser skills, like intubation (for Fred), and I find that people trained on the head have more confidence when they approach their first "live" patient than if I did it like on ER: "Y'ever intubated before?" "No.." "Well, no time like the present.."

-- Mike Sugimoto (phloem@fumbling.com), March 01, 2001.