In response to a recent post to the Society of Simulation in Healthcare’s Open Forum by Jill Mackey-Feist, Simulation Educator at Samaritan Health Services, asking to hear from others who had experience providing Massive Transfusion Simulations within a multidisciplinary team approach, CMS’ Dan Raemer responded:
We have been conducting massive transfusion cases in our simulations at the Center for Medical Simulation and Mass General Hospital for several years now. The important components are (1) finding or making an appropriate surgical or OB model that simulates massive hemorrhage in a plausible manner, (2) involving everyone in the situation, and (3) insuring psychological and simulation safety. We have mostly made our own models such as tumors that rapidly bleed with simulated blood as regulated from the control room. The model must include several sources of bleeding that are difficult to reach surgically. There are a number of “tricks” that can be used to ensure that the quantity of blood that appears in suction canisters and on lap-pads and drapes is enough to impress surgeons or obstetricians used to dealing with hemorrhage. Sometimes this requires an enormous amount of blood!! Having all of the typical resources (electrosurgery, balloon devices, hemostatic agents, blood warmers, etc.) to deal with blood loss readily available is important so as not to frustrate the participants. We try to create cases where everyone is involved. For example, having frequent phone calls with the blood bank about delays in providing blood, minor antibody issues, verification of ID can ensure that team communication issues will arise during the case and be discussed during a debriefing. Third, we think it is important for psychological safety not to put the team into a situation where they feel that the massive hemorrhage is a result of their incompetence. We usually bring the team into a situation where someone (an actor), another surgeon or a trainee has gotten into trouble and has asked the team for help. We almost always have the patient survive even if they have gone into PEA arrest from the hemorrhage. As will all simulations, making sure that everything used, including the blood, is labeled “Not for Human Use, Simulation Only” is critically important. Standardized waterproof labels can be obtained at Foundation for Healthcare Simulation Safety. I would be happy to discuss further if you would like to contact me directly.
Founded in 1993, The Center for Medical Simulation (CMS) was one of the world’s first healthcare simulation centers and continues to be a global leader in the field. At CMS the focus is on communication, collaboration, and crisis management training in order to develop skills and teamwork behaviors that are best learned actively under realistic conditions. Since it first opened in 1993, CMS has trained thousands of participants in its innovative and challenging programs. Contact CMS at firstname.lastname@example.org