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Hospitals across the nation are preparing for possible nuclear warfare with North Korea.  In order for physicians and trainees to be ready for such a catastrophic event, we caught up with the University of BS who brought together the nation’s best administrators and medical educators to design simulation scenarios mimicking the hardships of triaging mass casualties.  We caught up with Richard Analson, head of the hospital admissions department, who shared with us the scenarios for this costly yet necessary session.

Scenario 1: Triaging with Efficiency

Five actors with different injuries arrive at the same time while alarms are beeping everywhere.  The physician must show that patients with no hospital card must get registered first before entering orders.  The physician must resist all urge to attend to these patients and must first make sure to and log in to the electronic records, enter the time of patient contact, the tests, the medications, the admission diagnosis and the orders.  Only then can they go to see the patient and ask for their insurance information.

Scenario 2: Admission Decisions

In this scenario, the physician arrives in the room with an nurse and a dummy.  The patient is bleeding and hypotensive.  The nurse is told to resist following any orders by the physician until the physician officially admits the patient.  At the five-minute mark, nurses may prompt the physician by asking the rarely used question “Are you admitting?”  Only then can proper resuscitation start which signals the end of the station.

Scenario 3: Communication

In this scenario, the physician must show empathy with an angry patient who’s been waiting 6 hours for a terrible back pain he’s been having for the past two years.  The actor is told to act unhappy and disappointed throughout the length of the 30-minute encounter.  The actor will then offer feedback by filling a patient satisfaction survey.

Scenario 4: Donning and Doffing

In this scenario, a physician must show proper donning and doffing before entering the room of a burn victim in pain with dropping O2 saturations and stridor that is known MRSA positive.  To make things challenging, the clean yellow jacket bin is empty and the trainee must run to find a clean one before entering.

After a full day of simulation, we spoke with Dale Eagerbeaver, a first-year ER resident.  He shared with us: “These scenarios felt so real!  My human nature pulled me towards going to the patients and trying to save their lives.  But then I had to remember, I’m a physician first and I can’t let my emotions blur my thinking.  I need to remain objective and prioritize what’s important: admission orders, insurance policies, patient satisfaction surveys and rigid institutional policies.  I went into medicine and ER to save lives and now, if and when Kim Jong-un decides to blast us with nukes, I’ll be ready to do just that!”

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