title: Using simulation for training and to change protocol during the outbreak of severe acute respiratory syndrome.
abstract: BACKGROUND
  During the 2003 severe acute respiratory syndrome (SARS) crisis, we proposed and tested a new protocol for cardiac arrest in a patient with SARS. The protocol was rapidly and effectively instituted by teamwork training using high-fidelity simulation.
  
  
  METHODS
  Phase 1 was a curriculum design of a SARS-specific cardiac arrest protocol in three steps: planning the new protocol, repeated simulations of this protocol in a classroom, and a subsequent simulation of a cardiac arrest on a hospital ward. Phase 2 was the training of 275 healthcare workers (HCWs) using the new protocol. Training involved a seminar, practice in wearing the mandatory personal protection system (PPS), and cardiac arrest simulations with subsequent debriefing.
  
  
  RESULTS
  Simulation provided insights that had not been considered in earlier phases of development. For example, a single person can don a PPS worn for the SARS patient in 1 1/2 minutes. However, when multiple members of a cardiac arrest team were dressing simultaneously, the time to don the PPS increased to between 3 1/2 and 5 1/2 minutes. Errors in infection control as well as in medical management of advanced cardiac life support (ACLS) were corrected.
  
  
  CONCLUSIONS
  During the SARS crisis, real-time use of a high-fidelity simulator allowed the training of 275 HCWs in 2 weeks, with debriefing and error management. HCWs were required to manage the SARS cardiac arrest wearing unfamiliar equipment and following a modified ACLS protocol. The insight gained from this experience will be valuable for future infectious disease challenges in critical care.
authors.affiliation: Department of Anesthesia and Division of Critical Care, University of Toronto, St, Michael's Hospital, 30 Bond Street, Toronto, M5W 1W8, Canada. Abrahamsons@smh.toronto.on.ca
authors.forename: Simon D
authors.initials: SD
authors.lastname: Abrahamson
authors.forename: Sonya
authors.initials: S
authors.lastname: Canzian
authors.forename: Fabrice
authors.initials: F
authors.lastname: Brunet
mesh_terms: D002170:Canada / Q000453:epidemiology; D003198:Computer Simulation; D003479:Curriculum; D004196:Disease Outbreaks; D004496:Education, Continuing; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D020407:Internet; D010564:Personnel, Hospital / Q000193:education; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology* / Q000517:prevention & control