A pilot session was carried out in July 2012 incorporating an initial assessment by ED staff, airway management by anaesthetists with handover and continuing care undertaken by the plastic surgery and burns trainees. Nursing staff from the ED were also involved to increase the fidelity and multi-disciplinary approach to training.

An assessment tool has been developed allowing for real-time video tagging of acceptable and unacceptable practice by consultant specialists. This is then incorporated into the video debrief. Work will continue to validate this method of assessment with the aim of providing a new tool for formative and eventually, summative assessment.

EMSB

The Emergency Management of Severe Burns (EMSB) course was developed by the Australian and New Zealand Burn Association with the intention of improving the quality of care that burn patients receive

The course is delivered via a manual, a series of lectures, skill stations, interactive discussion groups and simulated moulage cases. To complete the course, participants must pass written and clinical moulage assessments.

It is aimed at medical and nursing personnel who may come in to contact with burn care in any setting and emphasises the benefits of universally applied, protocol driven care2.

The course was adopted by the British Burn Association in 1997 and is now a requirement for all UK plastic surgery trainees; the course is also commonly attended by doctors, nurses and other professionals from pre-hospital and emergency care3.

Further information on EMSB can be found online:

http://www.britishburnassociation.org/emsb

http://www.anzba.org.au

SIMULATION

Simulation has been a focus for research into critical event management training since the 1950s, with early work in particular focussing on the management of cardiac arrest. Early forms of simulation included anaesthetised animals; technology has since progressed, particularly in the last decade, to provide us with realistic equipment such as the manikins used at the Lancashire Simulation Centre (LSC)4,5.

Developments like high fidelity Human Patient Simulator (HPS) systems have increased the educational impact of simulation6,7. Key elements of the increasing level of fidelity that can be achieved with simulation include dynamic physiological changes in response to scenario progression8, auscultation of heart and lung sounds, and airways which are suitable for intubation6,9,10.

Simulation training that focuses on the management of rare events is both intuitively important and desirable11 thus it can be best applied to situations where a diverse team of personnel are required to effectively manage complex or infrequent occurrences, as is the case with severe burns.

Modern pressures such as shortened training, as well as an emphasis on patient safety and accountability have meant that new assessment methods for surgical and procedural skills have had to be developed12. Simulation training and evaluation of performance is one way we can enhance modern training and assessment within the confines of restricted training time.

SIMULATION SUITE

The LSC development was lead by consultant emergency physician Mrs Jackie Hanson. The suite has two full time, and two part-time staff. They facilitate simulation training for postgraduate and undergraduate trainees as well as allied healthcare professionals within the area and to a wider audience through courses.

The manikins in use at LSC are METIman pre-hospital and METI PediaSIM (CAE Healthcare, Saratoga, FL). The adult manikin is completely wireless and therefore portable, the paediatric manikin is tethered by a large umbilicus that provides data output.  The manikins are made up by the centre staff to provide visual context to a range of scenarios; centre staff are trained by METI in simulation makeup techniques.

More information can be found online:

http://www.meti.com/products_ps_metiman_prehosp.htm

EPIDEMIOLOGY OF BURNS, AND THE NBCR

A recent estimate calculated that major burns leading to death, or a hospital stay exceeding 72 hours, occurred at a rate of 4.7 per 100,000 per year in the UK13. 

The National Burn Care Review 2001 was commissioned by the British Burns Association as a result of evidence that UK burns services were “disorganized, fragmented, inadequate, and inequitable from a patients’ perspective”. 

Following their review, a number of key recommendations were put forth:

1. National clinical management and referral guidelines were developed to include a new way of classifying those with burn injuries as well as suggesting the development of national education programmes, such as EMSB.

2. All inpatients with burns were to be treated by specialists

3. The UK Burns service was restructured to have National Burn Injury Referral Guidelines and stratification of patients to Burn Facilities (BF), Burn Units (BU), and Burn Centres (BC).

4. Burn Centres must have dedicated critical care departments for the provision of burns care

5. Continuing care of patients with a burn injury was mandated as part of burns services to ensure that every patient had access to specialist functional, aesthetic and psychological rehabilitation.

6. All of the units BFs, BUs, and BCs were connected to one another in local networks to ensure seamless care for patients

7. Research and analysis into burn injuries and their management was commissioned

8. Improved data gathering and information analysis of burn injuries was suggested

The LSC is one of the most advanced facilities of its kind within the UK. The study was devised in consultation with the LSC staff, and scenario scripts were developed according to a standard template. The scenarios were devised with a panel of experts and referenced the most recent published works on burn care management.

Several areas of burns management including assessment and initial management of major (>10% total body surface area) burns, escharotomy, inhalational injury, toxic shock syndrome, and paediatric burn injuries were incorporated into the pilot sessions.

Fig 2. METI PediaSIM manikin with burn make-up detail to left forearm.

FEEDBACK

The simulation suite staff are experienced at facilitating video aided, trainee-led debrief at the end of each scenario.

Good quality feedback, as mandated by Ericsson, is seen as an essential component of skill acquisition and improvement¹⁴; a learner who reflects on feedback can integrate insights from experience into later action¹⁵. Feedback is seen as a key feature of simulation-based learning, being associated with a reduction in skill-decay over time¹⁶.

Participant feedback was taken immediately after the session. The following questions were asked:

1.    Was the content suited to your educational requirements?

2.    Were the topics covered in sufficient detail?

3.    Is this your first experience of human patient simulation?

4.    The use of human patient simulation enhanced my learning experience

5.    This session has enhanced my ability to manage acute severe burns?

6.    My daily practice has been enhanced by this session

7.    The lectures/presentations enhanced my learning experience

8.    Instructors ability to provide real world experience?

9.    Instructors ability to respond appropriately to questions?

10. Instructors knowledge of subject matter?

11. Instructors presentation abilities?

12. Overall rating of Instructors/Facilitators

13. Professionalism of staff at the Simulation Centre?

14. Were the classrooms comfortable and conducive to learning?

15. Was the standard of the equipment appropriate to this course?

16. Were you satisfied with the refreshment facilities?

17. Overall rating of the course?

18. Would you recommend this course to others?

19. Should simulation training be incorporated into plastics and burns curriculum and formal training?

NB// Yes was coded for by Yes, Strongly Agree and Agree depending upon whether the responses used a Likert scale or were simply yes and no results. Simlarly No was used to represent No, Disagree and Strongly Disagree.