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Table of Contents
Year : 2020  |  Volume : 10  |  Issue : 1  |  Page : 4-8

Operating room trauma simulation: The St. Luke's University Health Network experience

1 Department of Surgical Services, St. Luke's University Health Network, Bethlehem, Fountain Hill, Pennsylvania, USA
2 Department of Surgery, St. Luke's University Health Network, Bethlehem, Fountain Hill, Pennsylvania, USA
3 Department of Surgery; Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Fountain Hill, Pennsylvania, USA

Date of Submission11-Feb-2020
Date of Acceptance21-Feb-2020
Date of Web Publication9-Mar-2020

Correspondence Address:
Dr. Stanislaw P Stawicki
Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA 18015, Fountain Hill, Pennsylvania
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJCIIS.IJCIIS_17_20

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How to cite this article:
Marcks V, Hayes K, Stawicki SP. Operating room trauma simulation: The St. Luke's University Health Network experience. Int J Crit Illn Inj Sci 2020;10:4-8

How to cite this URL:
Marcks V, Hayes K, Stawicki SP. Operating room trauma simulation: The St. Luke's University Health Network experience. Int J Crit Illn Inj Sci [serial online] 2020 [cited 2023 Mar 21];10:4-8. Available from: https://www.ijciis.org/text.asp?2020/10/1/4/280227

   Introduction Top

The maintenance of readiness is an important component of care optimization for the critically injured trauma patient. This applies to the individual, the team, and the system levels. Evidence shows that there may be a correlation between trauma volumes and effective trauma team readiness and that there may also exist a relationship between clinical outcomes and the number of patients treated during a specific period of time.[1] Simulated cases, especially those featuring realistic, high-fidelity scenarios, have the potential to materially enhance trauma team readiness, retention of process-specific skills, and knowledge, in addition to improving the critical thinking ability.[2],[3],[4],[5] To help enhance our trauma team's functional readiness in the emergency operative setting, we set out to design and implement an operating room (OR) trauma simulation (ORTS) exercise. The aim of this simulation exercise was to identify the key opportunities to further optimize our existing OR trauma procedures and performance.

   Operative Trauma Simulation Scenario Top

Case simulation summary

Level A Alert (e.g., highest acuity) is called for a trauma patient who presents after sustaining a gunshot wound to the abdomen. He is unstable, is promptly brought to the OR, and massive transfusion protocol is called due to rapidly deteriorating patient condition. The attending trauma surgeon then decides to prepare for emergency thoracotomy, including open cardiac massage and direct application of internal defibrillation pads. In the meanwhile, the patient responds to less invasive resuscitative maneuvers, the thoracotomy is aborted, and the surgeon proceeds with the original plan to perform an exploratory laparotomy.

The setting

The simulated case scenario took place at the University Hospital OR (St. Luke's University Hospital, Bethlehem, Pennsylvania, USA).

Key components and structure of the process

The overall ORTS process is simple but requires excellent operational integration due to ongoing primary OR activities. The overall exercise takes anywhere between 30 and 50 min, depending on the completion time for each of the preplanned phases [Figure 1]. The list of exercise participants, including their respective roles, is provided in [Table 1]. The ORTS is designed to evaluate the skills and system-based aspects specific to emergency OR trauma cases [Table 2]. Within this framework, each learner is exposed to predefined goals, objectives, and skills [Table 3]. A deliberate preparation process [Table 4] and simulation set-up process [Table 5] takes place before the exercise commences. The simulation itself is highly structured [Table 6] and incorporates a formal skills assessment grid, complete with postexercise debrief [Table 7]. Sample photos from the simulation exercise are provided in [Figure 2].
Figure 1: Allocated exercise time, including Pre-brief (5 min); Simulation (15–30 min); and Debrief (10–15 min); with an anticipated total time of 30–50 min

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Table 1: Required participants of the current trauma simulation exercise

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Table 2: Summary of broadly defined categories of skills and systems-based aspects of the current trauma simulation exercise

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Table 3: Summary of specific goals, objectives, and skills the learner should be exposed to and acquire as a result of this exercise

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Table 4: Synopsis of participant preparation for the trauma simulation exercise

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Table 5: Trauma simulation setup

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Table 6: Sequence of events during simulation

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Table 7: Formal skills assessment

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Figure 2: Photos from the current operating room trauma simulation exercise. (Left) Team of participants performing a procedure on mannequin; (Right) cell saver device

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   Discussion Top

Simulation is one of the most important tools to achieve and maintain readiness in trauma scenarios, especially when dealing with the less commonly encountered patient who is in extremis. Among the cornerstones of effective trauma response is the right combination of team coordination, communication, and collaboration. Without these three components, an organized trauma response is bound to have inherent inefficiencies, and patient outcomes may suffer as a result.[6],[7],[8]

Barriers to implementing effective simulation include low fidelity/lack of realism, inadequate logistics, insufficient time, financial consequences of “nonproductive” time, intimidating or stressful environment, and fear of being judged/critiqued.[9] Of importance, without institutional commitment to high-quality simulation, critical processes used in emergent scenarios may suffer when put to the real-life test. Previous research suggests that lower-than-usual trauma volumes, even for very busy trauma centers that experience a “temporary slow-down,” may result in worse outcomes during such slower periods.[1] Consequently, fostering some form of “mission readiness” may be beneficial to ensure that appropriate levels of critical thinking and cognitive skills, along with technical competency, are maintained [Table 7].[10],[11],[12],[13]

Simulated scenarios, especially high-fidelity ones, promise to provide an effective platform for the maintenance of readiness, especially in the context immediately relevant to this commentary.[10],[11],[13],[14] In addition, simulation-based training may also be beneficial in provider confidence building and patient safety promotion.[13],[15],[16],[17] These concepts take on further significance and depth when considered in the inter-professional environment of modern trauma practice, where large and intricately interconnected teams are required to perform highly coordinated, complex task sequences in patient-centered fashion.[18],[19],[20]

In conclusion, the current report of our institutional experience with ORTS provides a readily implementable framework for other, similarly structured institutions. Following exercise completion, the majority of participants identified a number of opportunities for improvement, at personal, team, and institutional levels. Consequently, we recommend other trauma centers (and institutions where similar experiences may be of value) to consider this approach to maintaining readiness, especially across “mission-critical” areas of team performance.


The authors would like to acknowledge the following trauma simulation participants, in alphabetical order: Kenda Bartholomew, James Cipolla MD, Katelyn Getz RN, Abigail Gotsch MD, Kathryn Kelley MD, Ryan Kennedy, Kyle Rice RN, Christopher Sellers RN, Charlene Stackhouse RN, Kaylin Stratton RN, Julia Tolentino MD, Doreen Young RN.

   References Top

Stawicki SP, Habeeb K, Martin ND, O'Mara MS, Cipolla J, Evans DC, et al. A seven-center examination of the relationship between monthly volume and mortality in trauma: A hypothesis-generating study. Eur J Trauma Emerg Surg 2019;45:281-8.  Back to cited text no. 1
Ackermann AD. Investigation of learning outcomes for the acquisition and retention of CPR knowledge and skills learned with the use of high-fidelity simulation. Clinl Simul Nurs 2009;5:e213-22.  Back to cited text no. 2
Goodstone L, Goodstone MS, Cino K, Glaser CA, Kupferman K, Dember-Neal T. Effect of simulation on the development of critical thinking in associate degree nursing students. Nurs Educ Perspect 2013;34:159-62.  Back to cited text no. 3
Maneval R, Fowler KA, Kays JA, Boyd TM, Shuey J, Harne-Britner S, et al. The effect of high-fidelity patient simulation on the critical thinking and clinical decision-making skills of new graduate nurses. J Contin Educ Nurs 2012;43:125-34.  Back to cited text no. 4
Bowers C, Cannon-Bowers J. Cannon-bowers, Cognitive Readiness For Complex Team Performance, in Teaching and Measuring Cognitive Readiness. Boston, Massachusetts: Springer; 2014. p. 301-23.  Back to cited text no. 5
Cant RP, Cooper SJ. Simulation-based learning in nurse education: Systematic review. J Adv Nurs 2010;66:3-15.  Back to cited text no. 6
Sohn VY, Miller JP, Koeller CA, Gibson SO, Azarow KS, Myers JB, et al. From the combat medic to the forward surgical team: The madigan model for improving trauma readiness of brigade combat teams fighting the global war on terror. J Surg Res 2007;138:25-31.  Back to cited text no. 7
Miyasaka KW, Martin ND, Pascual JL, Buchholz J, Aggarwal R. A simulation curriculum for management of trauma and surgical critical care patients. J Surg Educ 2015;72:803-10.  Back to cited text no. 8
Savoldelli GL, Naik VN, Hamstra SJ, Morgan PJ. Barriers to use of simulation-based education. Can J Anaesth 2005;52:944-50.  Back to cited text no. 9
Nithman RW, Spiegel JJ, Lorello D. Effect of high-fidelity ICU simulation on a physical therapy student's perceived readiness for clinical education. J Acute Care Phys Ther 2016;7:16-24.  Back to cited text no. 10
Lasater K. High-fidelity simulation and the development of clinical judgment: Students' experiences. J Nurs Educ 2007;46:269-76.  Back to cited text no. 11
Kim JY, Kim EJ. Effects of simulation on nursing students' knowledge, clinical reasoning, and self-confidence: A quasi-experimental study. Korean J Adult Nurs 2015;27:604-11.  Back to cited text no. 12
Cherry RA, Ali J. Current concepts in simulation-based trauma education. J Trauma 2008;65:1186-93.  Back to cited text no. 13
Moran ME, George R. Past Present and Future of Simulation in Trauma, in Statpearls. Treasure Island, Florida: StatPearls Publishing; 2019.  Back to cited text no. 14
Aggarwal R, Mytton OT, Derbrew M, Hananel D, Heydenburg M, Issenberg B, et al. Training and simulation for patient safety. Qual Saf Health Care 2010;19 Suppl 2:i34-43.  Back to cited text no. 15
Smith SJ, Roehrs CJ. High-fidelity simulation: Factors correlated with nursing student satisfaction and self-confidence. Nurs Educ Perspect 2009;30:74-8.  Back to cited text no. 16
Samawi Z, Miller T, Haras MS. Using high-fidelity simulation and concept mapping to cultivate self-confidence in nursing students. Nurs Educ Perspect 2014;35:408-9.  Back to cited text no. 17
Pemberton J, Rambaran M, Cameron BH. Evaluating the long-term impact of the trauma team training course in Guyana: An explanatory mixed-methods approach. Am J Surg 2013;205:119-24.  Back to cited text no. 18
Bainbridge L, Nasmith L, Orchard C, Wood V. Competencies for interprofessional collaboration. J Phys Ther Educ 2010;24:6-11.  Back to cited text no. 19
Baker C, Pulling C, McGraw R, Dagnone JD, Hopkins-Rosseel D, Medves J. Simulation in interprofessional education for patient-centred collaborative care. J Adv Nurs 2008;64:372-9.  Back to cited text no. 20


  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]


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