As part of my rehab program to cure my PTSD following #SimWars in Australia, (Ed – which we won), snakes and a rather challenging Roger Harris sandwich I was invited to take part as a judge for the London SimWars contest held at the Royal Society of Medicine on the 16th July 2013. As far as we know this may even be the first UK EM SimWars!
So three teams entered the competition and well done to all of them for being prepared to get up on stage and give it a go. It takes guts and confidence (and hopefully some skill) to do this, and many others would not be prepared to do it….., and after this there may be more or less, I’m not sure 😉
So three teams
- NE London
- SE London
- NW London
- SW London were conspicuous by their abscence…..
Case 1. NW London (St.Mary’s) were first up with a rather challenging patient who had been stabbed in the neck with a tension pneumothorax and an expanding neck haematoma. A tricky one with a critical airway and chest problems that were hard to differentiate.
Case 2. SE London (Kings) got an Australian BBQ enthusiast with minor burns but an underlying medical condition (sepsis). That’s a tricky one but they managed to get there in the end with the team working well.
Case 3. NE (The Royal London) got a 28/40 pregnant women with intrabdominal bleeding following trauma. Again this was a tough one. Was the blood in the peritoneum or the Uterus??? Difficult decisions about treatment, referral and transfer.
So what did we learn? As a judge it’s easy to be hyper-critical from the comfy seats, resting back and observing what went well and also what did not go quite to plan, but that’s not the real world where the luxury of sitting back and observing rarely if ever exists. The teams did well under stressful conditions with lots of really useful learning points that are worth reiterating. There were a few themes that struck me across all three teams at some point (these are general comments not about each individual team or leader).
- As Cliff Reid told us at SMACC2013. Be liked, and if possible be good looking. You can get away with one of these ( if you can only manage one your patients will appreciate the first).
- Communication is vital in the resus room and we saw great examples of the team confirming and checking that information was passed correctly.
- We saw how the use of first names and directed tasks to individuals really works.
- We saw how regular mini summaries really help the team focus on their tasks and bring them back together.
- We saw how time spent in preparation, that involves predicting potential future events can be really helpful (great situational awareness in the preparation phases).
- We saw some great examples of the team leader listening and valuing the comments of the team.
Stuff to think about.
- Checklists for intubation in the ED – maybe it’s because I’m trying to introduce this locally, but we saw how the lack of a checklist can potentially lead to trouble.
- ‘Somebody’ is not a real person. Asking ‘somebody’ to do stuff won’t get it done.
- When information is contradictory it’s really difficult to deal with. It needs to be listened to and registered by the team leaders.
- Make sure the BP is cycled regularly (caught me out in Oz this one).
OK – Who won then??
It was honestly very close and the four judges, myself, Tim Coates, Tim Harris and Nicola Jakeman had different winners, it was that tight on the marking schemes. We used the TEAM assessment tool for simulation which served it’s purpose well. After adding the scores up, submitting them to a metanalysis and some Bootstrapping…… (Ed – I know you just added up the rankings!) the NE London team came out on top. The scoring was incredibly close though with the top two teams having equal scores but slightly different rankings which is how the Royal London came out on top. So well done to them.
All in all a really fantastic addition to a short conference and I’m really looking forward to seeing this in the UK again. Thanks so much for the invite and a massive thanks to everyone who put huge efforts into putting this and the rest of the conference together.
As I’m not a London chap, if any of the team names are wrong let me know and I’ll sort it. There is also talk that the event was filmed…., if that’s the case let’s see it up on the internet soon so that I can post a link here 🙂