Biomedical Engineering Reference
In-Depth Information
Patient 1, a robotic simulator, is severely intoxi-
cated with VHF, has a very high fever and profound
hemorrhagic shock, and despite all treatment dies 10
minutes after entering the ED. The presence of this
patient emphasizes the lethality of VHF.
Patient 2, another robotic simulator, is intoxi-
cated with VHF, is initially treated for fever and
hemorrhagic shock, and then proceeds along a
roller coaster of temperature spikes and circulatory
failure. Final prognosis depends upon treatment.
This patient emphasizes the intense vigilance and
extensive care required for successful treatment of
VHF (Figure 21.1).
Patient 3, a live actor, is intoxicated with VHF,
walks into the ED 5 minutes after start of scenario
with VHF oral and skin symptoms, is directed to
a chair and told to wait. This patient becomes
very anxious and disruptive just after observing the
death of Patient 1, spits blood (simulated) onto a
charge nurse, and should be restrained by students
and then removed from the room by the security
team. The incorporation of this patient into the
scenario emphasizes the potential of the walking
wounded to create fear-driven disruption and to
spread contamination (Figure 21.2). Redirection of
students' attention away from Patient 1 toward
Patient 3 allows for surreptitious transformation of
the dead Patient 1 into live Patient 4.
Patient 4, the now-reprogrammed robotic simu-
lator that was used for Patient 1, represents a 60-
year-old policeman with pre-existing respiratory
(asthma) and cardiac diseases (hypertension, coro-
nary artery disease). This patient is not infected
with VHF, but the described illnesses and the drugs
taken for those illnesses combined with fear make
the clinical presentation similar to that of Patient 2.
The inclusion of this patient emphasizes the diag-
nostic challenges of those bioterror agents that
produce signs and symptoms similar to those of
more common ailments.
Patient 5, a live actor, is a worried-well patient
who walks into ED 35 minutes after the start of the
scenario. This patient has no physical symptoms
at all but is screaming about being poisoned and
loudly and persistently demands to be treated. This
patient emphasizes the fear-driven disruption by
the worried-well and how their vast numbers at
21.7.2 Instructors' Teaching Objectives
Familiarization with diagnosis and treatments
of the wide-ranging types and overwhelming
numbers of patients generated by bioterror event.
Reminder that Standard Precautions in the ED are
always essential.
21.7.3 Students' Goals
Correctly care for all types of patients expected in
the ED during a bio-agent event.
Correctly identify unfamiliar agents.
Inform appropriate disaster managers of presence
of unusual agents.
21.7.4 Setting
Bays in the ED.
21.7.5 Participants and their Roles
during production
Students—play themselves
as
clinicians
and
provide diagnosis and treatment.
Actors—play patients
and clinicians guiding
scenario.
Simulation professionals—operate mannequins.
21.7.6 Simulation Resources and
Requirements
Extensive simulation professional preparation and
rehearsals.
Interactive robotic patient simulation devices.
Simulated ED facility with the appropriate clinical
equipment and supplies.
Audio/visual recordings of action in the ED for
review phase.
Debriefing arena for replay and analysis of ED
action.
21.7.7 Scenario Outline
The ED will see six different patients over 50
minutes. Of the five that enter the ED presenting
various signs and symptoms of VHF intoxication,
one will not be infected, and one will be “worried-
well.” The sixth will be a member of the ED that
neglects contact precautions.
