On February 17th, 2020, after the early version of the ED COVID-19 protocol had been drafted, the JGH Emergency Medicine Simulation Team assisted in hosting a table-top simulation exercise. Many different departments and services were involved in this event.
Thereafter, on February 24th, 2020, we ran an in-situ simulation in the Emergency Department in collaboration with our Intensive Care colleagues. https://jghnews.ciussswestcentral.ca/detailed-plans-reviewed-to-ensure-jgh-is-ready-for-coronavirus-patients/
These two simulation exercises allowed our Health Care Providers to become more familiar with the COVID-19 protocol in an experiential manner and allowed us to identify latent system errors that lead to amendments to our procedures and training.
The JGH EM Sim Team has been working diligently since March 13th preparing and delivering educational material and simulations sessions.
Our efforts have concentrated on the care of the “silent” hypoxic COVID patient and the nuances regarding the COVID Code Blue patient. After reviewing the literature, the JGH ED protocol developed by Drs. Marc Afilalo and Paul Brisebois, conferring with ED Nursing, ICU, ID, IPC RT and Pharmacy, the JGH EM Sim Team produced two scenarios, an educational PowerPoint, a pocket guide TBA, two videos of our dry-run scenarios, and a hands-on workshop.
Our workshop, developed and coordinated by Dr. Julia Bernard, consists of:
- Task training: Airway management including use of Video Laryngoscopy, IO insertion and
- Simulation & Debriefing of two scenarios (Hypoxic COVID Patient & Protected Code Blue).
As of April 6, the Team with the particular help of Ms Melanie Sheridan, ED Clinical Nurse Specialist, we have trained 37 ER physicians, 131 nurses and 7 Emergency Medicine Residents in workshop simulations; the feedback has been excellent. Many are attributing the Simulation Workshops to their excellence of care delivered to the acutely ill ED COVID patient while ensuring Health Care Provider (HCP) safety.
Please refer to the presentation below: Considerations for the Unstable COVID patient in the ED created by Drs. Kamy Apkarian & Haran Balendra with the help of Dr. Madelaine Yona.
Also refer to the 2 videos titled Caring for the “silent” Hypoxic COVID ED Patient and Caring for Code Blue COVID (+) Patient.
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Errol Stern MDCM, CHSE, FACEP, FRCP, CSPQ
Emergency Department, Jewish General Hospital
CIUSSS du Centre-Ouest-de-l’Île-de Montréal
Associate Professor, Faculty of Medicine
Department of Emergency Medicine, McGill University
Director, JGH Emergency Medicine Simulation Program
JGH Emergency Medicine Simulation Team
Dr Kamy Apkarian; Dr Haran Balendra; Dr Julia Bernard; Ms Melanie Sheridan;
Dr Madelaine Yona
Jewish General Hospital
3755 Côte-Sainte-Catherine Rd., Suite H-197
Montréal, QC H3T 1E2
Resuscitation and Cardiac Arrest
- Schwartz et al. 2013. Can J Cardiol 29(1): 117-121
Medical Association Guidelines
Critical Care Literature
International Organization Guidelines
In-Patient Management Guidelines
Provincial / Federal Guidelines
Crisis Resource Management
- http://www.royalcollege.ca/rcsite/ documents/practice-performance-innovation/optimizing-crisis-resource-management-improve-patient-safety-team-performance-e.pdf