Description: Get to the table By: Victoria Marcks Abstract: When dealing with surgical traumas, time is of the essence. Being able to perform quickly and efficiently in those high stress, life or death situations is something that comes with experience in the field. Novice nursing and surgical technician staff expressed concern with trauma cases inundated with health care professionals that did not have defined roles. The purpose of the "Get to the Table" project is to educate new and unconfident health care professionals through a mock trauma simulation to build upon their skills and teach them how to place individuals into roles; therefore the process will become more organized and efficient. As a team we can build on our trauma process by using simulations to providing fast and safe patient care to trauma victims when seconds matter. A multidisciplinary team was formed with our trauma clinical coordinator, our charge nurse, OR staff nurses, Surgical Technologists, a Trauma Surgeon, Surgical Residents, Anesthesia, and a simulation technician. As a team, we identified the areas of education with traumas and the staff. The idea originated that we should implement a simulation of a trauma in order to have the staff practice managing the patient and equipment in a high stress situation. The main goal being: become more organized and work together as a team in a quick and efficient fashion. The rationale for the multidisciplinary team versus only working with nursing staff is that everyone gains the opportunity to learn from each other, work hands on together, as well as making the simulation more realistic. As a team we assessed the areas of education needed with traumas. The areas of education needed were: policy with a hemorrhaging patient, using an auto transfusion machine (cell saver), defibrillator and crash cart use, trauma instrumentation for emergent thoracotomies, and the roles that everyone has during a trauma. In the four months leading up to the simulation, education was given to the nursing and surgical technician staff, in all these areas to prepare them for the simulation. The day of our simulation, during the pre-brief, the nursing staff was given a survey asking their thoughts on how well our facility can assemble for a trauma and how prepared they feel participating in one. The general consensus was uncertainty on resources and equipment, and that our facility could become more organized with traumas. The team simulated a gun shot wound (GSW) to the abdomen. A script was given to the Attending during the pre brief that he followed through out our simulation. The simulation script included patient ventricular tachycardia, emergently making a thoracotomy, and defibrillation of the patient (mannequin). We went with this scenario for a simulation because we identified emergent thoracotomies as a situation that requires improvement, as well as defibrillator use. The circulating nurse was also being judged on delegating to staff in the room, as well as organizational skills. The staff was delegated into roles in order to defuse some confusion. The simulation was carried out until the mannequin was defibrillated into a stable heart rate, and the Surgeon announced that the patient is now becoming stable. After the simulation was finished, we debriefed as a team to identify areas of improvement for the future. The nursing staff was given another survey after the debrief asking the same question as the pre-brief survey. Over all, they felt this was a notably beneficial practice to compliment working in a level one trauma center, and will better prepare them for trauma surgery. As health care professionals, we get better by repetition and practice. So why not practice trauma more? By doing these simulations more often, we can better equip our staff with the skills and confidence they need to get to the table as fast as possible, in an organized efficient manner.
