Instructor courses
The first MACSIM instructor course was organized at the Regional Center for Assistance and Disaster Relief in Split, Croatia, November 10- 15, 2009 with Professor Sten Lennquist (Sweden) as Course President and Dr Boris Hreckovski (Croatia) as Co-President. The course was combined with a course in Medical Response to Major Incidents (MRMI) organized by ESTES (European Society for Trauma & Emergency Surgery). After a preparatory course for instructors, the 25 instructor candidates took roles as instructors at the MRMI-course, supported, supervised and evaluated by an experienced international senior faculty.
Figure II:1
Debriefing of instructor candidates (yellow waistcoats) before group training.
Figure II:2
Two of the senior faculty members, Bob Dobson from the London Ambulance Service (UK) and Captain Heather Hancock, MD/Surgeon, US Air Force, San Antonio(USA).
Figure II:3
Sten Lennquist and Heather Hancock in action.
Figure II:4
The first step of instructor- training is to set up the simulation model. A hospital is built up.
Figure II:5
The preparation includes staffing of the hospital with staff on duty of different categories. The different wards are located in the bottom of the boards.
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It also includes loading with simulated “non-disaster patients” who are normally there before the alarm, occupying emergency department, surgery, intensive care unit and wards.
Figure II:7
Preparing of times for arriving staff of different categories with different intervals after possible activation of the disaster plan.
Figure II:8
Instructor candidates train the participants in the MRMI-course in primary and secondary triage in groups, supported and supervised by senior faculty. The aim with this group training is to prepare the participants for the simulation exercises. The training includes the whole chain of the Major Incident Response: Scene, primary and secondary triage, transport, in-hospital management and performance, coordination and command on hospital - and regional level.
Figure II:9
The simulation exercise has started: The first triage team deals with casualties trapped on scene with given times needed for extrication. Decision has to be made what to do or not to do on scene, and with which priority.
Figure II:10
Secondary triage and decision making with regard to treatment on scene: If the trainee decides to indicate treatment of any kind, patient and staff are “frozen” during the time it takes to do that treatment in reality: See timer around the neck of the instructor.
Figure II:11
The load of casualties is heavy: 400 injured and dead after terrorist attack. The injuries are from a real scenario, which makes the exercise realistic.
Figure II:12
High pressure on the transport officer who has to utilize ambulances and helicopters optimally, and also distribute the patients correctly between hospitals in communication with the different hospitals via the Regional Command Centre: Sending patients requiring immediate surgery to a hospital without immediately available theatres will result in mortality.
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Patients arrive to the hospitals, new triage and distribution to available “Major Incident Teams” at the Emergency Department. Also at this position, real times: A blocked team is a blocked team.
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Utilization of diagnostic procedures as CT, which has to be restrictive in this situation, is illustrated.
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Utilization of surgical theatres. Again, real times for all procedures. Need of qualified staff is illustrated.
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Available staff, depending on degree of alert. How to handle incoming staff in a big hospital can be a problem in itself, requiring attention and preparation.
Figure II:17
Instructor candidate controls and registers in-hospital management and performance using prepared protocols as a base for the later careful evaluation.
Figure II:18
The Hospital Command Groups are, as in reality, located on another floor than the hospital departments, requiring telephone communication and also equipped with radios. The same is valid for the Regional Command Centre.
Figure II:19
Evaluation of all patients who died after arrival of medical teams, related to both Revised Trauma Score (primary condition) and Injury Severity Score (final diagnosis). Potentially avoidable mortality as well as complications (= result of the performance) is carefully evaluated.
Figure II:20
Instructor candidates are trained to lead evaluation under supervision of senior faculty. This is an important part of the exercise: What can be improved, and how? The participants are given a second chance with two consecutive whole-day simulation exercises, which illustrates how decision making and performance really can be improved by training.