Determining surgical surge capacity with a hybrid simulation exercise.

Autor:	Blimark M; Centre for Disaster Medicine, University of Gothenburg, Gothenburg, Sweden.; Centre for Defence Medicine, Swedish Armed Forces, Gothenburg, Sweden., Robinson Y; Centre for Disaster Medicine, University of Gothenburg, Gothenburg, Sweden.; Centre for Defence Medicine, Swedish Armed Forces, Gothenburg, Sweden., Jacobson C; Sahlgrenska University Hospital, Gothenburg, Sweden., Lönroth H; Centre for Disaster Medicine, University of Gothenburg, Gothenburg, Sweden.; Sahlgrenska University Hospital, Gothenburg, Sweden., Boffard KD; Centre for Disaster Medicine, University of Gothenburg, Gothenburg, Sweden.; Sahlgrenska University Hospital, Gothenburg, Sweden.; Milpark Hospital, University of the Witwatersrand, Johannesburg, South Africa., Lennquist Montán K; Centre for Disaster Medicine, University of Gothenburg, Gothenburg, Sweden.; Department of Global Public Health, Karolinska Institute, Solna, Sweden., Laesser I; Sahlgrenska University Hospital, Gothenburg, Sweden., Örtenwall P; Centre for Disaster Medicine, University of Gothenburg, Gothenburg, Sweden.; Centre for Defence Medicine, Swedish Armed Forces, Gothenburg, Sweden.; Sahlgrenska University Hospital, Gothenburg, Sweden.
Jazyk:	angličtina
Zdroj:	Frontiers in public health [Front Public Health] 2023 Oct 16; Vol. 11, pp. 1157653. Date of Electronic Publication: 2023 Oct 16 (Print Publication: 2023).
DOI:	10.3389/fpubh.2023.1157653
Abstrakt:	Background: To help test and improve surgical surge capacity, mass casualty incident (MCI) exercises generate valuable information. Both large scale table-top exercises (TTX) and full-scale exercises (FSX) have limitations if you want to test an organisation's capability and structure. A hybrid exercise incorporating the advantages of TTX and FSX is a possible way forward, but is no standardised exercise method, yet. This study aims at evaluating the exercise results to determine the feasibility of a hybrid TTX/FSX exercise for an organization's capability and structure. Methods: A hybrid MCI simulation using moulaged figurants and simulation cards was designed, where the emergency department of a level 1 trauma centre receives 103 casualties over 4 h. After registration and triage, all casualties are expected to be resuscitated in real time and are transferred for further treatment inside the hospital (radiology, operating theatres, intensive care unit (ICU)/postop and wards). When reaching operation theatre, ICU or ward, figurants are replaced by simulation cards. Observers ensured that those procedures performed were adequate and adhered to realistic times. Use of resources (materials, drugs etc.) were registered. Primary endpoint was average time spent in the emergency department, from time of arrival, to transfer out. Secondary endpoints were related to patient flow and avoidable fatalities. Results: The hospital managed to deal with the flow of patients without collapse of existing systems. Operating theatres as well as ICU and ward beds were available at the end of the exercise. Several details in the hospital response were observed that had not been noticed during previous TTX. Conclusion: FSX have a valuable role in training, equipping, exercising, and evaluating MCI management. Hybrid simulations combining both FSX and TTX may optimise resource utilisation and allow more frequent exercises with similar organisational benefit. Competing Interests: KLM has copyright to the MacSim simulation system used in this study. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2023 Blimark, Robinson, Jacobson, Lönroth, Boffard, Lennquist Montán, Laesser, and Örtenwall.)
Databáze:	MEDLINE
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