title: Managing a surgical exsanguination emergency in the operating room through simulation: an interdisciplinary approach.
abstract: OBJECTIVE
  Operating room (OR) emergencies, such as fire, anaphylaxis, cardiac arrest, and exsanguination, are infrequent, but high-risk situations that can result in significant morbidity and mortality. An exsanguination scenario involving a pregnant trauma patient in the OR was developed for surgery residents with the objectives of improving overall team performance when activating an emergency response system, identifying a team leader, initiating an exsanguination protocol, following advanced cardiac life support guidelines, and recognizing the mother as the first patient.
  
  
  METHODS
  During 6 months, 171 OR staff members of the Hospital of the University of Pennsylvania participated in a prospective study in which randomly selected groups of surgery residents, anesthesia residents, and perioperative nurses were trained in a simulated exsanguination and cardiac arrest emergency. Upon arrival to the simulation center, groups of trainees were assigned to a simulated OR equipped with a SimMan 3G (Laerdal, Norway) and a session moderator. The scenario started with a pregnant patient in hemorrhagic shock, bleeding from a carotid injury, ultimately leading to cardiac arrest. Each group did an initial "cold" simulation without any prior training or knowledge of the scenario, followed by a didactic training session, and ending with a "warm" simulation.
  
  
  METHODS
  Penn Medicine Clinical Simulation Center at 1800 Lombard Street, Philadelphia, Pennsylvania.
  
  
  RESULTS
  Among 156 participants, 50% reported understanding their role in an OR exsanguination emergency pretraining, compared with 98% who understood it posttraining (p < 0.001). For activation of the exsanguination protocol, 50% understood how to do it pretraining, compared with 98% posttraining (p = 0.004). The time needed to complete 8 clinically significant tasks was documented pre- and posttraining, with a statistically significant improvement in all tasks.
  
  
  CONCLUSIONS
  The results of this simulated exsanguination emergency demonstrate that team training using a high-fidelity mannequin is an effective way to train OR personnel, on how to manage exsanguinating traumatic patients in a high-risk surgical emergency.
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Natalia Martinez
authors.initials: NM
authors.lastname: Acero
authors.forename: Gregory
authors.initials: G
authors.lastname: Motuk
authors.forename: Josef
authors.initials: J
authors.lastname: Luba
authors.forename: Michael
authors.initials: M
authors.lastname: Murphy
authors.forename: Susan
authors.initials: S
authors.lastname: McKelvey
authors.forename: Gretchen
authors.initials: G
authors.lastname: Kolb
authors.forename: Kristoffel R
authors.initials: KR
authors.lastname: Dumon
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Resnick
mesh_terms: D004630:Emergencies; D058734:Exsanguination; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007396:Internship and Residency; D009873:Operating Rooms; D011247:Pregnancy; D011446:Prospective Studies; D013043:Specialties, Surgical / Q000193:education*