So with the game over, pizzas and trays of cakes collected, we made our way to Mayshaw to meet the staff from Swansea and Bicheno. The Mayshaw health centre is a GP clinic with a 2 bed emergency treatment room attached to a 50 bed aged care facility. We are very grateful that they welcome our presence in their facility and that the local Gp’s are happy to travel and co-locate for the purpose of EMET education. We had 12 people in attendance from Swansea, Orford and Bicheno.
Michelle gave them a run down and explained that we would be doing simulations for this session. They were encouraged to buy into the simulations and live in the ‘suspension of disbelief’.
The first scenario we had was one of a distruaght mother who presented to the clinic with her one year old child who was choking on a piece of lego. Cue head tic… “Heeeelp! Little Jack is choking..(tic tic twictch).. he cant stop coughing but the Lego isnt coming out (twitch twitch)..
The GP and Nurse who were participating in this scenario were clearly very distressed at the prospect of a child with a compromised airway so all twitching was ceased and the scenario continued with helpful and supportive strategies to help them safely manage an obstructed airway and utilise their staff and equipment available. These scenarios are ones that we would find challenging and confronting in our big tertiary ED with aneasthetics and Paediatrics just a quick phone call away. It is always eye opening to see GP’s and Practice Nurses in rural areas play out these scenarios using their limited tools available. Realistically their nearest road ambulance is 50 minutes away, and air retrieval with call out time and flight would be approximately 30 minutes. That is a long time to be just a team of two in a remote setting with limited equipment. At the end of the scenario as part of the debrief we went throught the Australian Resuscitation Councils ‘The Choking child’ path way. Rest assured we also let them in on the joke re: head twitch, luckily they shared our humour.
Since Michelle had already traumatised the staff with everyones worst nightmare she thought in for a penny in for a pound, so scenario two was a multi-trauma with a young man, ATV crash into a tree with a tension pnuemothorax. The GP handled the situation well and came up with appropriate management plans – Michelle is a great facilitator, only ever giving away what is needed and supporting decisions and providing alternatives in the debreif stage. After talking through the insertion of a chest drain, and inspecting their equipment it became evident that they do not have some of the necessary tools required eg. forceps. The best out comes from our EMET sessions include the gain in knowledge and confidence from our participants, and also the opportunity for them to assess and familiarise them selves with their equipment and resources.
Scenario three was a teenage girl who was brought to the clinic by her mother post being kicked in the head by a horse. Initially conscious the patient rapidly detiorated and had a seizure. The staff were quick to recognise the Head Injury and raised intracracial pressure. This scenario was valuable in forcing them to think out side of the box to find neuro-protective measures with their limited drugs and equipment.
I think it is fair to say that the staff enjoyed the education session, were challenged and confronted by the scenarios and all took home some handy hints and tips. We always ask staff to compelte a feed back form post education and several people wrote that it was ‘uncomfotable and confronting but worth it’. As follow up we have provided laminated copies of the Choking child algorythm and a pair of forceps may have accidentally fallen into the envelope too – which if anyone develops a pnuemothorax, whilst holidaying near Swansea in summer, you can thank me for later.
This session was all wrapped up with a quick drive home where we spotted a Tassie Devil on the side of the road, not a bad ‘tic tic twitch’ days work.
Sarah has been an RN for 14 years, 10 of those in the RHH ED. After several years on the floor it felt like the right time for some project work, and what better way to do it than by stalking her husband, Juan, professionally – once known as the ‘sepsis’ couple, the Ascencio-Lane’s have now taken over the EMET portfolio. When not in the office Sarah is either under pressure in the Hyperbaric Unit, or under even more pressure at home caring for their three young boys.