In 2014, as in 2013, the SMACC conference arguably ended where it all began, in the roots of resuscitation, with clinical teams coming together to resuscitate and compete against the challenges of knowledge, skill, attitude and relationships. We joined in a celebration of those most challenging of times when circumstance, pressure, illness, injury and time conspire to test us. However, as the mega-budget had been entirely blown on the opening ceremony (nice touch chaps) it seems that real patients were in short supply so Simulation ruled the day in the form of SimWars.
The Intensive Care network have now released the video and podcast of the event on the Gold Coast. Head over there to learn more and/or watch the video below.
What the Hell is SIMWARS?
OK, for those of you living under a rock for the last few years SIMWARS is competitive resuscitation without much of the nice feedback that you might expect on your average training course. WAR is dirty, mean and real…. And let’s face it, the resus room is too. We are all using sim in training these days so why not add a competitive element to it and place a challenge down to find out who is the best at resuscitation. Seems a good idea in principle, you just need people crazy (Ed – or desperate) enough to agree to perform a testing scenario in front of several hundred people.
The rules vary from competition to competition but in essence teams of resuscitators are challenged with a clinical scenario that is usually somewhat unusual. There will be elements to challenge them clinically and there will inevitably be elements to challenge crew resource management. Human factors play a key part in achieving the goals of the resuscitation and there is no doubt that if you agree to take part you will be tested.
Teams are scored on their all round ability to control the situation, manage the chaos and to achieve the goals of resuscitation (i.e. keep the patient alive until the buzzer sounds).
What happened at #SMACC2013?
In Sydney, teams from around the world (well St.Emlyn’s, Sydney HEMS and North Shore ICU) met in battle with each team facing an unfamiliar scenario. St.Emlyn’s (British) treated a brown snake bite, Sydney HEMS a calcium channel blocker OD, and North Shore ICU got a ‘fresh’ trauma patient. Basically, everyone was immediately shunted well outside their comfort zone to add pressure… As if performing a sim, on stage, in front of >600 people and live streamed on the internet required more pressure! Sydney HEMS abseiled from the ceiling, North Shore came on in camouflage clothing and St.Emlyn’s had a nice cup of tea and a sing-song round the old joanna before taking the stage, and to be honest we needed it. It was arguably one of the most stressful experiences I’ve ever had. Partly because of the event but mostly because of my awesome, but somewhat ‘independently active’ team of Iain Beardsell, Natalie May and Alan Grayson.
It doesn’t matter who won.
(Ed – no, seriously it does: it was like getting the ASHES back, but best not mention that)
The history books state that the St.Emlyn’s team were victorious largely due to the fortuitous management of a penile snakebite. In all honesty we were helped greatly by the Sim centre staff and from LITFL info up on the big screen (accessing FOAM resources is actively encouraged at SMACC SimWars).
For St.Emlyn’s it was an amazing culmination of a truly life changing trip to SMACC. All of us on stage that day, indeed everyone I know who has travelled from the Northern Hemisphere to SMACC, has come back a changed clinician, inspired by the mix of medicine, education and entertainment – MedUTainment if you like. We had arrived to be made welcome as long lost friends and returned as victors on the field of play. It was an amazing moment.
Sydney HEMS flew in from on high, but were challenged by the massive calcium channel blocker OD. A really tough call with ABC issues on the background of some serious toxicological complications.
The North Shore ICU team had a tough trauma case and were taken out of their comfort zone with a trip to the ED, the undifferentiated patient and the challenges of finding the life threatening issues at the right time, in the right order and with the right therapies. It was a tough one!
All good SIM should have a debrief and we had a debrief that will stick in the mind for some time. How would you like to get feedback from Oli Flower, Roger Harris, Vic Brazil, Scott Weingart and Cliff Reid? It’s the stuff of nightmares (Ed – yep, still having nightmares…), but although tough and entertaining it was great. It made us laugh and that’s no bad thing. We did get some Pendleton’s rules (you know, the **** sandwich) although on this occasion there wasn’t a great deal of bread, but that was OK. This was entertainment with a message and if you’re prepared to get up on the stage then you must expect that sort of thing. Let’s face it, every panel needs a Simon Cowell (aka Roger D Harris 😉 ).
We were lucky enough to win the prize and to take OSCAR to the bar for a celebratory beer.
The return of SIMWARS at SMACCGold
2014 brought SIMWARS to the Gold Coast and a change of venue meant a change of style. In 2013 we took a team to Australia. That allowed us to train in advance and to hone our resuscitation skills as a tightly knit team for months before SMACC. In reality we didn’t do that, we went to the Opera bar in Sydney the week before instead, but the point was that we COULD have trained if we wanted to, but that’s not a reality in clinical practice. Flash teams are the norm and resuscitationists need to work with strangers whose strengths and weaknesses are unknown or at best presumed. Jon and John decided to create flash teams in 2014 taking 2 people from 6 of the entries to form three teams of 4 persons guided by a Jedi master. The three Jedi Masters were Weingart, Reid and (for reasons of presumed kindness) myself.
So it was that Carley, Reid and Weingart, (the latter two who sat in judgement in 2013) found themselves on the floor of the arena as participants before the SMACC masses.
The Flash teams were announced at the start of the week and we had a matter of days to meet, greet and train our teams before the denouement on Friday afternoon. So it was that Naomi, Bryan, Tim, Liz and myself came together to try and practice resus using only our imagination and a SMACC bag.
To be honest I have no idea what the other teams did. I know what we did. Firstly I went out and bought light sabres and T-shirts. All teams need a sense of identity and I think this helped. Scott brought really cool T-shirts from the states, I found some in TARGET….. win to Weingart there I think.
Training was harder than we thought. When you enter SIMWARS it feels like a bit of jape, but as the time approaches and the impostor syndrome rises it becomes real. It’s not so much that you want to win, it’s just that you’re desperate not to lose. On the matter of training I would caution any future participants as to where to train. Apparently it’s not a great idea to train in the middle of the lunch queue. Ever wondered what would happen if you had a fit at a conference of resuscitationists? Would thousands come to help? Well we decided to try… And ‘apparently’ the conference staff were not totally happy with this… And ‘apparently’ it was a really stupid idea… And apparently it’s really dangerous, and apparently you really should tell the catering staff that you’re going to do this and apparently someone will call an ambulance, and apparently Cliff will come in at the end (cos he is awesome like that and has a magnet implanted within him that attracts him to any significant resuscitation event – though incidentally a little bird tells me that Cliff’s team had a similar incident when he pretended to be hypoxic outside the ladies’ toilets).
Anyway, that training did tell us that the team was capable of performing in front of an audience so all was sweet and lovely, although Tim remained focused on the use of suppositories (probably after listening to John Hinds in the Cricolol debate).
So what happened?
Watch the video to see what went well, what did not go so well and of course think about who won 🙂
The awesomeness starts at around about 53 minutes.
WATCH THE VIDEO HERE
Three challenging scenarios, and some tough decisions to make by the teams and the coaches.
- Bryan (Bubba) Jordan from Sydney HEMS
- Naomi Pallas
- Tim Leeuwenburg from Kangaroo Island docs
- Liz Barrett
- The secret code word ‘Grilling my Corn’
Everyone on the team contributed, everyone made suggestions, everyone communicated and checked communication. They all led, followed, listened and made a difference. As I say at the end, my contributions were limited on the stage, they were simply the best.
So what’s the point?
A good question. Is this education? Is it entertainment? Is it clinical practice? Well, yes and no to all of these. SimWars clearly has flaws. Educationally it has issues and there is a real risk of public embarrassment, but despite that it’s really good to have fun, and I believe that it’s vital that those who talk a good game are willing and able to put themselves on stage in front of the world so that they too can experience the stresses, benefits and cautions that our juniors experience in our local simulations.
We also discovered and explored how flash teams work, how distractions can really affect performance and that when you are on stage it’s tough!
Most of all though, as we always say at St.Emlyn’s:
Enjoy your Emergency Medicine