This is the 33rd #WILTW

A few weeks ago we ran a simulation day for the doctors and nurses in our department. It was successful (in terms of perceived value) and hopefully over time we will be able to demonstrate “outcome” based improvement.

One of my favourite quotes from the day was:

“I’ve learnt a lesson here. But I won’t go home + beat myself up (well, not too much) as at end of the day no patients harmed”
#TeamPaedED

— Damian Roland (@Damian_Roland) December 18, 2014

Simulation (whether high or low fidelity) has a great deal to offer medical education. Those critical of an increasing reliance on simulation to balance deficits in experience would highlight that demonstrated behaviours may not match those in the clinical workplace. They argue there is nothing like the real thing.

This was really brought to life over the holiday period when I drove off a junction on a busy motorway to be confronted by this

We were the fourth car on the scene. There were no emergency services present but a number of cars had followed us off the motorway so we did not appear to be in immenint danger of being hit from behind (although this was a potential risk as more cars came off the slip road). I got out of the car to get a closer look at the lorry. The passengers of the first car that had stopped were on the phone to the police. The passenger of the second car had got out of his car and was trying to ascertain if there was anyone in the lorry. I told this person I was a doctor and he appeared visibily relieved. I probably didn’t feel as nervous as I should have done as there then followed a sequence of events in which I learnt a great deal about pre-hospital care (my thanks to Dr. Ben Teasdale, the clinical director of our department who has a special interest in pre-hospital medicine, for gently pointing out some of the mistakes I made.)

A summary of my key learning:

1. Hospitals are safe places.

2. Roadside vehicle accidents are not.

3. Inadequate experience of (2) and too much experience of (1) leaves you cognitively disadvantaged.

4. Point 3 is a polite way of saying unconsciously incompetent.

5. Because of point 4, and not being able to ascertain how unwell driver of the vehicle may have been, led me to climbing up onto the lorry to see into the cockpit.

6. It is very, very, difficult to set diesel alight. This was a good thing for me as there was diesel spilling out of the diesel tank (1).

7.  If you sound like you know what you are talking about, but potentially don’t, either people humour you or believe you. I am still unsure as to what the ambulance and fire services made of me 😉

While I can’t share all that happened for reasons of confidentiality I certainly learnt from the experience without anyone coming to harm. InitiallyI was going to title this post: “Nothing beats the real thing”. While that may be true had I encountered a scenario like this in any of my pre-hospital or hospital training I may well have done things differently. You need no clinical training to realise getting on top of a crashed lorry is potentially a dangerous thing to do, but if you are unsure of the how well a person is, at the time just waiting is not easy. Simulation provides a great way of demonstrating many things, the pros and cons of action versus inaction for one, in a way that no-one will get hurt.

What have you learnt this week? #WILTW

(1) Please see comment below about my original school boy error on this post which has now been corrected!