Safety Considerations for In-Person Simulations in the Covid-19 Era

As many simulation programs are making plans for September, when students may return to sim labs but physical distancing and other measures to minimize risks of virus spread are critical. This webinar reviews issues, processes, protocols, and other resources to reduce risks.

• View the recorded webinar
• PPT presentations: Darin Abbey, “In Person Sim in the Covid-19 Era” • Tara Fuselli,  “eSIM Lab Readiness Post COVID-19“
• Resources: Checklist: BCSN Protective Measures for Simulation in the Covid-19 Era and other COVID-19 Simulation Resources • AHS Operational Expectation Infection Control for Simulation • eSIM Consultant Resource and Signage

Preparing for COVID Via Simulation

On April 3rd, we were joined by simulation leaders from 4 Canadian hospitals to learn how they are using simulations to make care more efficient and safer for both patients and providers.

• View the recorded webinar

External Webinars

• Alberta Health Services – running system preparation simulations at hospitals around the province.
• SAIL sim centre at University of Illinois at Chicago – addresses adaptive sim centre policy changes for COVID, including using sim equipment for patient care and the safety of sim staff.

BC Simulation Network:

• COVID-19 Simulation Guide – Great for in-situ sim activities including planning, logistics, briefing, facilitation, debriefing and follow-up
• Checklist: Protective Measures for Simulation in the COVID-19 Era • Consignes et directives dans le contexte de la COVID-19 à mettre en place durant les exercices de simulation
• Checklist: Pre and post in situ simulation safety checklist

Dharamsi A et al. Enhancing Departmental Preparedness for COVID-19 Using Rapid Cycle in Situ Simulation. J Hosp Infect. 2020 Jun 12. doi:10.1016/j.jhin.2020.06.020

Brazil V et al. Translational simulation for rapid transformation of health services, using the example of the COVID-19 pandemic preparation. Advances in Simulation 2020; 5(9). doi:10.1186/s41077-020-00127-z

Chiu M et al. Physical health risks during simulation-based COVID-19 pandemic readiness training. Canadian Journal of Anaesthesia. 2020 June 5: 1-3. doi:10.1007/s12630-020-01744-y

Medical Education Editorial: “Strange Days” – on building scholarship into sim activities during COVID (thanks to IPSS for bringing this to our attention)

For Multiple Departments/Disciplines

The Ottawa Hospital, University of Ottawa and University of Colorado: Collection of 360º video simulation scenarios to assess and improve team preparedness for COVID in several contexts: emergency department; anesthesia; surgery; cardiac arrest; c-section; trans-esophageal echocardiogram; awake tracheotomy; CT scanning; newborn delivered of a COVID-19+ mother; cleaning an ICU isolation room; endoscopy.

Emergency & Critical Care

Simulation Canada: COVID in Community Hospital – adaptation of EM Sim Cases #1 for community hospital preparedness testing + in-situ sim planning guide

Simulation Canada: Respiratory failure in a patient with coronavirus – Patient presents to community hospital, needs PPE, isolation, intubation, resuscitation

EM SIM CASES: Several peer-reviewed cases:

• Suspected COVID-19 (1) – to test an emergency department’s readiness to respond to a suspected case
• Suspected COVID-19 (2) – a moderately unwell patient presents to ambulatory care
• STEMI with VF Arrest – unexpected cardiac arrest in a suspected COVID positive patient
• Out-of-Hospital Cardiac Arrest – patient arrives to ER after resuscitation by EMS

Montreal Jewish General Hospital (bilingual): Hypoxic COVID patient + code blue – English | Français – also includes videos

St. Emlyn’s (emerg med) Blog: Practical Exercise Without Casualties for possible coronavirus in the emergency department

Gold Coast Health Sim Service: COVID-19 in Emergency Room Needing Intubation – for system testing + PPE use

Gold Coast Health Sim Service: STEMI and VF Resuscitation of Patient with COVID Exposure – resuscitation while protecting selves

Operating Room

Life in the Fast Lane Blog: Airway Management in the Operating Room – from simulationists in Hong Kong; includes airway management reference poster

Obstetrics

Package of 4 Obstetrical COVID scenarios from Gold Coast Health Sim Service & The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (Antenatal Respiratory Distress; Uncomplicated Vaginal Birth; Respiratory Distress in Labour; Bradycardia and C-Section)

Center for Medical Simulation: Simulation Exercises for L&D, Labor, Cesarean Delivery in Cases with COVID-19

Pediatrics

Children’s Health Queensland: Nebulized Medication During COVID – includes clinical resources and reference poster

Children’s Health Queensland: HFNP Oxygen for children during the COVID-19 pandemic

National Level

WHO: Tabletop Simulation for national-level health authorities to strengthen existing plans, procedures and capabilities

Planning Advice:

Article from Vancouver simulationists on adding fluorescent powder to enhance simulations

COVID Virtual Patients:

CAN-Sim, CASN & Simulation Canada: FREE virtual simulation games on essential Covid nursing topics:

• Geriatric fluid volume deficiency
• Deteriorating patient
• Care of a ventilated patient
• Multiple organ dysfunction
• Running a code

FullCode: Fever and Cough After Travel (Case #83) – virtual sim case of high-risk for COVID
BodyInteract: Patient Suspicious for COVID-19 – 5 free virtual patient cases
Affinity Learning: Appendicitis in COVID-19 – protection, assessment and triaging of COVID-possible patient
Affinity Learning: Severe maternal illness in a pregnant patient with suspected COVID-19
MedicActiV: Create your own COVID virtual patient – free to author and distribute scenarios
PCS Spark: Suspected COVID Assessment by Telehealth

COVID Sim Scenarios:

EM SIM CASES: Protected Intubation in the Sim Lab
CAE Healthcare: COVID Scenario for Teams – includes diagnosis, isolation, personal protection, management and TeamSTEPPS strategies
Laerdal: COVID Resource Centre – includes free scenarios, tools and manikin hygiene information
Gold Coast Health Sim Service: COVID on Medical Ward – team communication, PPE, negative pressure room
NETEC (National Ebola Training and Education Center): Group Exercise Templates – written around Ebola preparedness but applicable to COVID

Critical Care & Ventilation:

University of Toronto: Quick ICU Training for COVID-19 – learning resources and reference materials for clinicians who are upskilling, renewing, or reviewing their knowledge and skill for redeployment
CAE Healthcare: Ventilator Use for COVID – Online course & virtual simulation
Xlung: Virtual ventilator – free during COVID

Videos

Mount Sinai Hospital: Instructional Video on intubating a patient with COVID
Montreal Jewish General Hospital (bilingual): Videos on code blue; hypoxemic patient; COVID workshop; grand rounds – English | Français
Université Paris-Est Créteil : Deux vidéos de formation sur la ventilation de patient porteur du COVID qui peuvent servir lors de vos séances
Université de Caen Normandie : Vidéo tuto sur l’extubation d’un patient Covid19 positif
Queen Mary Hospital, Hong Kong: Video of Simulation for COVID Intubation

E-Campus Ontario: Hand Hygeine interactive video (proper handwashing) and PPE Donning and Removal interactive video

CAN-Sim: Virtual Simulation Game on PPE selection, donning and doffing + learning management course for facilitators

Intensive Care Society: Staff Well-Being and Self-Care During COVID posters

NorSimS (France): Formez-vous aux bons gestes en vidéo – Habillage, déshabillage, intubation, plus

BMJ-STEL: Editorial on Sim & Tech to Prepare/Respond to COVID in China

SimGHOSTS: Advice and resources for Sim Operations during the pandemic

WHO Online Course: Emerging respiratory viruses, including COVID-19: methods for detection, prevention, response and control

Washington Post: Disease spread simulations in real time – shows impacts of quarantines and social distancing

We are maintaining a separate page to compile services and resources related to virtual simulations and running simulations at a distance.

With treatment guidelines evolving so rapidly, we will not attempt to stay on top of recommended practices. Other organizations offering vetted resources:

• Health Canada
• COVID-END – International consortium hosted in Canada to compile clinical evidence as it emerges
• Health Standards Organization / Accreditation Canada
• Canadian Nurses Association
• Royal College of Physicians and Surgeons of Canada
• Canadian Society for Medical Laboratory Science
• Canadian Society of Respiratory Therapists
• STARS Air Ambulance: Collection of clinical education resources including airway management guide and video tutorials

Some other websites offering simulation resource collections:

• Twitter #COVID19_Sim for to-the-minute commentary and resources
• WhatsApp COVID19_Sim discussion group
• Large collection of scenarios and resources from @jmrobertson at Harvard
• Simulcast Simulation Podcast – for podcasts related to COVID plus discussion forum and scenarios
• healthysimulation.com – several articles and COVID sim resource collection
• INACSL – COVID-19 and Virtual Learning Resource List
• Society for Simulation in Healthcare – more resource links and webinar list
• International Pediatric Sim Society – resources for pediatric sim