Last month I attended a real OD in the carpark at our GP clinic. The unresponsive man’s friends notified our reception that he had dropped and I attended, gave some basic airway support, IM nalaxone and then handed over to Victoria Ambulance. I attended that with my Conover-style everyday pack but other doctors were talking about what to do for another OD or multiple casualties, could the emergency trolley get there, how many people would we need – so I offered to organise an in situ simulation to explore these questions.
Props were syringes with some flash back blood in the hub, pharmacy bags and drug baggies.
The staff were all given warning – unexpected sim I do not feel would really work in the GP setting. I generally run these in the registrar teaching time so I know they are free and the supervisor teaching them. I then also block out the practice nurse for that first 30min of the day and notify the reception staff. I put up signs at reception and for this one in the car park around it “Medical Emergency Training” so no one is alarmed. As other people report about in situ simulation, patients are interested and respectful of you demonstrating skills upkeep in the usual clinical space.
Before hand, I provide a preamble to the staff about the focus of the scenario and some background. Opiate Overdose in the Practice. Then I write or adapt my running sheet as a reminder about manipulating the blue tooth speaker, monitor vital signs or other changes.
We ran the team through – two registrars, one GP supervisor, the practice nurse and myself as the simulation educator. A quick clean up and then debrief in the tea room saw us use the first 30minutes of the day very fruitfully.