O44 Simulated case-based peri-mortem ceasarean section in the emergency department: a new multidisciplinary training tool

• Published in: BMJ simulation & technology enhanced learning Vol. 3; no. Suppl 2; p. A31
• Main Authors: Ward, C, McGregor, L, Marshall, H, Blain, F
• Format: Journal Article
• Language: English
• Published: 01.11.2017
• ISSN: 2056-6697
• DOI: 10.1136/bmjstel-2017-aspihconf.65

IntroductionCases requiring a peri-mortem c-section to be performed are amongst the most daunting faced by ED staff. The situation can arise in any department, regardless of on-site specialty presence or available expertise. Following such a case presenting to our DGH Emergency Department overnight, with no on-site obstetric/neonatal services, it was identified that there had been five similar cases throughout Scotland in the last 18 months. Despite awareness of the indications for peri-mortem c-section, the skills required, both technical and non-technical are rarely taught. There are currently no simulators in the UK that this can be demonstrated on. Therefore, in collaboration with the Scottish Multiprofessional Maternity Development Programme (SMMDP), an opportunity to develop a new way of learning was identified, involving the development of an appropriate mannequin.Project DescriptionFollowing our real-life case debriefs and significant event report, learning points were highlighted. These included technical and non-technical skills, whilst feedback from related simulation courses agreed that although c-section is the advised management, there is a lack of teaching regarding the correct technique, indicating a need for wider reaching and alternative methods of teaching. Using a multidisciplinary team and professional filming crew, a high fidelity simulated scenario was filmed at the Scottish Centre for Simulation. The film follows a seemingly healthy 31  year old, 33 weeks pregnant patient who becomes unwell at home and calls 999. Initially she appears well, walking into the ambulance, but on arrival quickly decompensates, suffering a cardiac arrest. Footage follows the patient from ambulance arrival on scene, highlighting the importance of a pre-alert and team preparation pre-arrival, to the patient leaving the ED. A specially designed simulated uterus was used to highlight the recommended surgical technique for C-section, alongside ongoing resuscitation of the pregnant patient and the delivered neonate.OutcomeAs a new way of learning, we have produced an educational video of a simulated scenario highlighting the approach to a collapsed pregnant patient, including the recommended technique for peri-mortem c-section in the ED. This can be used as a multi-disciplinary training tool and an adjunct to currently available simulation courses. The video is designed to be realistic, not scripted, intimidating or ‘textbook’, in order to encourage other EDs to identify and relate to this potential scenario. Specifically we aim to demonstrate that this scenario although daunting, can be effectively managed anywhere, at any time, including in more rural or remote EDs with limited onsite specialty expertise.