Our institution has developed an IPE initiative which aims to prepare students for practice. In the past, the medical school has led a disaster simulation, but only included their medical students. Through conversations it was clear collaboration between nursing and medical faculty could provide a positive learning experience for students from both programs. Thus, a team was formed to develop a disaster simulation for both disciplines. Due to the large-scale simulation, the team conducted two to three planning meetings for five months leading up to the event. The learning objectives for the experience focused on developing communication skills, prioritizing patient care in a large-scale disaster, and working in a multidisciplinary team. Also, the objectives followed the National Disaster Life Support Foundation (2014) DISASTERTMparadigm, including detection, incident command, safety and security, assess hazards, support, triage and treatment, evacuation, and recovery.
For this project, the multidisciplinary team utilized a template adapted from the National League for Nursing (2018) designed to guide simulation activities in the school of nursing. The prebriefing and debriefing was co-lead by a faculty member from the medical school and one from the nursing school. Both were well-versed in best practices for simulation, according to International Nursing Association for Clinical Simulation and Learning (2018) Standards of Best Practice: SimulationSM. In addition, both were considered experts in disaster management and training. Prebriefing included a description of the learning objectives, expectations of participants. A fiction contract and ground rules were also established. Next, faculty introduced the scenario, which includes a college transit bus that loses control, collides into a group of pedestrians heading to a college football game, catches fire, and then explodes sending large amounts of debris into the crowd. After prebriefing, students were instructed to go to their stations for the simulation. The majority of students were assigned to the simulation lab, which was set up to be a mock emergency department (MED). Faculty facilitators from nursing and medicine were present to guide students to their positions. Several students were sent to the green space outside the school of nursing to be involved in the triage process.
Once everyone was prepared to begin, 48 actors served as patients and began to make their way into the triage area. These actors were assigned roles and moulaged to make the experience more realistic for students. Medical and nursing students worked with faculty facilitators to triage the patients. Once they were stabilized, the students transported patients to the MED in the simulation lab. Patients entered the MED and were placed into the appropriate rooms depending on the severity of their injuries. Some were transported to the trauma bays while others were assisted to a fast-track zone. Several patients had severe injuries requiring IVs, foley catheters, ABGs, suturing, intubation, and/or resuscitation. When a patient required a task/procedure, students would go to the task trainer area, which was set up in the middle of the MED. Faculty facilitators would assist students as they started IVs, intubated, placed chest tubes, or completed other required tasks.
Towards the end of the scenario, three of the patients with the most severe injuries went into cardiac arrest and required CPR. Students and facilitators worked together to run the codes and provide the needed care for these patients, which had then been switched to high-fidelity manikins. In addition, another patient was pregnant and emergently delivered a baby during the scenario via high-fidelity manikin. The medical students delivered the baby and transferred care of the newborn to the nursing students. The nursing students guided the mother as she provided skin to skin contact after delivery. The disaster scenario lasted about an hour, then all students and facilitators went back to the large lecture hall for debriefing. The simulation was repeated four times to accommodate the 350 nursing and medical students.
Debriefing was led by the same nursing and medical faculty that guided prebriefing. The Promoting Excellence and Reflective Learning in Simulation (PEARLS) combined method to debriefing was incorporated (Eppich & Cheng, 2015). These faculty discussed the scenario, the process of triage, transportation of patients to the MED, and the process of caring for multiple patients with limited resources. The debriefing process encouraged students to reflect on the experience, what went well, and what could be improved in future practice. Students verbalized it was a positive experience and they were surprised how much they learned from students from the other discipline.
In today’s society, it is vital students in health professional programs be equipped to work in a multidisciplinary team as well as be prepared for potential mass casualty situations. Even though development of this simulation was time consuming and execution required numerous faculty, the results were extremely positive. The experience provided a safe environment for students to learn to effectively collaborate and communicate in a disaster or high-stress situation.