Complimentary scenarios for COVID-19 preparedness

This scenario presents a 55-years-old male presenting in the emergency room with fever, coughing and generally feeling unwell. He returned from travel in an endemic area for COVID-19 1 week ago. The front desk has prioritized him to immediate examination and isolation.

The participants are expected to prepare equipment, don PPE, assess patients and triage to home quarantine, educate patients, communicate effectively with interprofessional team, escalate standard precautions for all patients and safely dispose of equipment and PPE.

Learning objectives:

• Recognize the suspected patients early and rapidly
• Apply appropriate source control
• Apply routine Infection Prevention and Control (IPC) for all patients
• Collaborate and communicate with the health care facility’s IPC infrastructure
• Apply standard precautions according to presumed diagnosis at all times
• Perform a primary assessment of a patient with a suspected acute respiratory infection
• Distinguish between severe acute respiratory infection and acute respiratory infection
• Obtain specimen for laboratory test according to safety procedures
• Triage the patient according to the general principles for patients with suspected COVID-19 infection
• Obtain patient history on personal and work relations
• Advise patient on home quarantine
• Coordinate safe patient transfer
• Doff PPE according to procedure

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Scenario overview (Word) 

This scenario presents the expected arrival of a 71-years-old male with suspected COVID-19. The patient called the healthcare triage call center, with high fever, coughing, chest pain, and respiratory difficulty. 9 days ago, he met with his son who has now been tested positive for 2019-nCoV. The patient has a history of diabetes 2 and chronic liver disease.

The participants are expected to prepare equipment, don PPE, assess patient, administer supplemental oxygen, obtain a venous blood sample, order bedside x-ray, and triage to admission on either Intensive Care Unit (UCI) or monitored acute respiratory department, educate patient, communicate effectively with interprofessional team, escalate standard precautions for all patients and safely dispose of equipment and PPE.

Learning objectives: 

• Apply standard precautions according to presumed diagnosis including appropriate PPE
• Apply routine Infection Prevention and Control (IPC)
• Ensure all equipment ready and available
• Recognize the suspected patient early
• Collaborate and communicate with the health care facility’s IPC infrastructure
• Distinguish between severe acute respiratory infection and acute respiratory infection
• Perform a primary assessment of a patient with severe acute respiratory infection (SARI)
• Start immediate treatment of respiratory distress and infection
• Alarm the Hospital IPC coordinator of suspected COVID-19
• Verbalize escalated standard precautions for spouse and front desk
• Obtain adequate samples and diagnostics for SARI according to safety procedures
• Triage the patient according to the general principles for patients with severe acute respiratory illness (SARI)
• Educate patient on personal standard precautions and plan of care
• Coordinate safe patient transfer to receiving department
• Handle contaminated equipment according to procedure
• Doff PPE according to procedure

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Scenario overview (Word)

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Made in partnership with IngMar Medical.

This scenario presents a 71-years-old male with suspected COVID-19 already admitted to the Emergency Department. The patient was admitted to 1 hour ago and is waiting for an Intensive care bed.

The participants are expected to assess and recognize deterioration in the patient's respiratory condition. They should appropriately increase ventilatory support while maintaining appropriate respiratory precautions., and recognize the need for intubation and ventilator support.

Learning objectives - After the simulation, the participants should be able to:

• Perform a primary assessment of a patient with severe acute respiratory infection (SARI)
• Change the non-invasive support to maximize the patient’s effort
• Express the need for intubation of the patient to stabilize respiration
• Perform intubation of the patient in a timely manner
• Connect the patient to a ventilator
• Contact the Intensive Care Unit to discuss possible transfer using patient advocacy
• Doff PPE according to procedure

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Scenario Overview (word) 

ASL 5000 Lung models for use with these scenarios

Made in partnership with IngMar Medical.

This scenario presents with a 71-years-old male with suspected COVID-19 who was admitted from the Emergency Department with Severe Acute Respiratory Infection (SARI). Over 4 hours ago he was transferred to the Intensive Care Unit in an isolation bay.

The participants are expected to assess the patient's work of breathing, identify respiratory dyssynchrony, perform respiratory interventions and recognize the need for sedation to maximize the ventilation for the patient. The participants should communicate with the patient and follow isolation protocols including donning and doffing PPE for contact precaution.

 
Learning objectives: 

• Apply standard precautions according to presumed diagnosis including appropriate PPE
• Perform a primary assessment of a patient with severe acute respiratory infection (SARI)
• Improve ventilation by changing ventilator settings
• Discuss concerns with the team in relation to increased respiratory dyssynchrony
• Provide sedation to the patient
• Reassess patient to evaluate the effect of treatment
• Doff PPE according to procedure

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Scenario overview (Word)

ASL 5000 Lung models for use with these scenarios

Made in partnership with IngMar Medical.

This scenario presents a 71-years-old male with diagnosed COVID-19, who was triaged from the Emergency Department and transferred to the Intensive Care Unit in an isolation bay two days ago.

The participants are expected follow isolation protocols, including PPE for contact precaution. They should assess the patient’s saturation status, discuss proper respiratory treatment and recognize the need for turning the patient into a prone position. The participants should delegate roles, utilize closed-loop communication and successfully turn the sedated and paralyzed patient in one movement.

NOTE: This scenario contains an optional alternative partway with accidental extubation of the patient while turning him to prone position. The participants should then recognize the unintentional emergency incident and act immediately by reversing the patient to supine position, apply cricoid pressure, reintubate the patient and reconnect to a ventilator.

Learning objectives: 

• Apply standard precautions according to presumed diagnosis including appropriate PPE
• Perform a primary assessment of a patient with COVID-19 respiratory infection (SARI).
• Realize the need to turn a patient into prone position
• Verify sedation and paralysis prior to changing the position of a patient
• Delegate roles and communicate with team members to move a patient in one movement
• Perform turning of a sedated and paralyzed patient while on a ventilator
• Doff PPE according to procedure

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Scenario overview (Word)

ASL 5000 Lung models for use with these scenarios