The Simulated Simulation:



Imagine this:


A case crashes through the door with five minutes notice.

What do we do?


We prepare for the worst and hope for the best.

Yup. Contingency planning. It's what we do best!


So if thing go pear shaped?


Stop right there!

We're already half-prepared!


And OF COUSE things are going to go pear shaped.

It's a SIM, after all.


Now read on!




So A has rushed into the room and assembled all the gear for the induction, and all is well.


L has primed the lines and has the cannulation tray, the Art line stuff and the central line trolley including the ultrasound ready to go.


B has primed the Level 1, and has a trolley set up with a fresh fluid balance chart, a contaminated waste bag and some extra fluids ready for the rush, and has a dedicated phone and the number for the blood bank.


Hopefully a pre-patient debrief has been undertaken, so that everyone knows who the leader is, what the projected plans are, and tweaking of the set-up has been done accordingly:


What drugs?

What tube?

Reminder re the critical Bleeding protocol?


Then the patient arrives and everyone swings into action!

To watch, it is poetry in motion. Pride provoking.

The teams swing into full-blown activity, purposeful, watchful, focussed.

Brains are already working to maximum capacity, flowing with the fluxing demands of the situation.


Then God speaks through the voice of the Sim-Master, and all hell breaks loose!


Can't intubate, can't ventilate!


Can't get a bigger IV line in, and the 22 guage is looking in danger!


We need the C-Mac, the difficult intubation trolley, the thingumy that connects to the whatchumacallit, the crico-thyrotomy set.....

We need a central line, but can't get to it because the airway team is struggling.....

We need the intraosseous cannulation set....




We need the Defib trolley, chest compression, shock, adrenaline.....


With a team already maxed out, who is going to help with the added workload?

Look up.

Is the Code button pressed?

And who are all those extra people in the room?

R is there.

SA arrives.


And look at all those people standing at the foot of the bed wanting to help but unsure of how they can.


NOW we're cooking! 


There is a theatre technician, maybe two!

There is a surgical team including a couple of nurses and a couple of surgeons.


And with the Code alarm, a heap of people arrive;



And suddenly the problem is not....

Not enough people in the room, but....

Too MANY people in the room!


And with it, challenges to communication structures, problem solving, critical thinking and task allocation.


Often we think that the problem is knowledge.


As true as this may be, the more real problem is....


Getting things done on the ground!




Below Ten Thousand

An international collaboration

Empowering clinicians in safety culture