Crash testing the dummy: a review of in situ trauma simulation at a Canadian tertiary centre

Background: In situ trauma simulations allow for the trauma team and emergency department to practise team dynamics, resuscitation and logistics in a safe environment. The goal of this investigation was to show the feasibility of an in situ trauma simulation program at a Canadian level 1 trauma centre. Methods: We performed a retrospective review of in situ simulations (maximum 20 min, followed by a 10-min debriefing session) at a level 1 trauma centre from 2015 to 2017. Errors were categorized according to the National Patient Safety Agency risk assessment matrix by 3 independent raters and assigned consequence scores (assessing potential harm) and likelihood scores (assessing the likelihood of potential harm). A risk score was calculated as the product of the mean consequence and likelihood scores. Errors per simulation and the number of simulations required for error resolution were recorded. Results: We reviewed 8 in situ simulations and identified 54 errors, of which 7 were related to medications, 20 to equipment, 21 to environment/staffing and 6 to training. The mean consequence score was 2.85/5 (standard deviation [SD] 0.75, intraclass correlation coefficient [ICC] 28%), indicating minor to moderate harm. The mean likelihood score was 2.82/5 (SD 0.55, ICC 41%), indicating unlikely to possible. The mean risk score was 8.42/25 (SD 3.19, ICC 43%). One error (2%) was low risk, 23 (43%) were moderate risk, 26 (48%) were high risk, and 4 (7%) were extreme risk. Conclusion: In situ trauma simulations are feasible in a Canadian centre and provide a safe environment to identify and rectify errors.