FIRE SIMULATION Preparing for disaster can prevent it.

One morning per week, we open our ORs 1 hour late so select surgeons, anesthetists and nurses can gather in our 22,000-square-foot clinical simulation center and review what to do in an emergency. We run 2 to 4 simulated ORs at each session, and assign members from each group to an unknown scenario. At the flash fire simulation, an alcohol-based prep on the neck of a patient (well, a mannequin) who's having a cervical lymph node excised catches fire, and the team performs various mitigation steps.

Simulation, a better way to train
In the 2 years we've been doing this, we've trained more than 500 employees in up to 4 OR emergencies:

• fire/alcohol prep safety,
• anaphylaxis,
• exsanguination/cardiac arrest, and
• respiratory difficulty/neck hematoma after neck surgery.

In this era of increasing complexity in our ORs, simulation provides an exceptional opportunity to move learning away from the live patient setting and increase preparedness for emergencies in advance of their occurrences. For each training topic, we divide trainees into OR teams. They participate in a "cold" simulation, attend a didactic/debriefing session and repeat the original simulation (now "warm"). Measured outcomes include participant self-assessments, pre- and post-quizzes, and the time to complete pre-defined mitigation steps.

Does simulation training work? The numbers suggest so. All OR teams completed more essential steps in less time in "warm" versus "cold" scenarios (p< 0.05), with nearly all participants feeling more comfortable with their roles in an OR emergency after training. Preliminary data also show that, as similar emergencies have taken place in our ORs, the vast majority of staff who've been trained in the particular scenarios during team training feel their training better prepared them to handle the real-life emergencies. Team training reduced the number of, and time to perform, crucial emergency response steps during the OR simulations. Participants across the board believe the training has been useful for their job performances, and fun. Most importantly, team training improved team preparedness, role and procedural awareness, and clinical outcomes during actual OR emergencies.