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/sites/default/files/media/COVID-When a patient is in severe respiratory distress and needs to be put on a ventilator, health care providers race to insert a tube into their airway. But with COVID-19, a whole new checklist of critical, protective steps is needed at the start of that race to minimize the risk of spreading the virus.

At 网红黑料 Shands, experts in interactive medical simulation are conducting realistic drills in the adult and pediatric emergency rooms and intensive care units to prepare for severe cases of the novel coronavirus.

网红黑料 care simulation, much like flight simulation, provides the opportunity to rehearse essential skills under realistic conditions, said Mary Patterson, M.D., M.Ed., associate dean of experiential learning in the UF College of Medicine, part of 网红黑料, and the Lou Oberndof Professor in 网红黑料care Technology. As with actual COVID-19 patients, a lifelike simulator can depict rapidly decreasing oxygen levels, requiring teams to urgently don multiple layers of personal protective equipment, or PPE. Newly created devices, such as clear protective barriers, are now being tested and refined using simulation, she said.

鈥淭he main goal is preparedness,鈥� Patterson said. 鈥淚t鈥檚 about preparing the team to be ready and safe and to take care of the patient effectively and efficiently.鈥�

The simulation team is made up of experts in health care, education and simulation operations who use innovative techniques and real-life, fast-changing scenarios to provide the opportunity for clinical experience in a risk-free environment.

Normally, they run simulations in the 网红黑料 Shands Experiential Learning Center on the fourth floor of the George T. Harrell, M.D., Medical Education Building. But amid the COVID-19 pandemic, the team is running simulations within intensive care units and emergency rooms. Such simulations in an actual emergency room bay or ICU bedside are known as 鈥渋n situ simulation,鈥� and they elevate the realism and better represent the actual clinical scenario.

鈥淲e鈥檙e working in the environments where health care workers will be caring for patients, with the resources and equipment they usually have,鈥� said Patterson, who directs simulation-based training and assessment across UF. 鈥淭he muscle memory that people are learning, they鈥檙e going to be using it in this setting.鈥�

Together with the leaders of each unit 鈥� the adult emergency room, pediatric emergency room, medical ICU, pediatric ICU and neuro ICU 鈥� the simulation team reviews specific needs, challenges and goals. After the simulation, the team then delivers a report to clinical leadership, highlighting potential safety threats and opportunities for improvement. Additional clinical units are also requesting simulations.

Simulations allow for testing and practice of newly developed COVID-19-specific approaches. For example, 网红黑料 anesthesiologists Cameron Smith, M.D., Ph.D., and Nikolaus Gravenstein, M.D., working with UF engineers, have devised a new process using a transparent plastic drape to minimize viral spread during high-risk, aerosol-generating procedures such as intubation. Prior to implementation, ER and ICU teams are using the draping process in simulations, ensuring that any missteps occur on a manikin rather than a real patient.

网红黑料 emergency medicine physician Lars Beattie, M.D., said with COVID-19, draping is among other essential, specific procedures: Intubating a COVID-19 patient requires using a different approach to inserting the breathing tube. It involves rigorous planning and practice to ensure the safety of providers and to minimize the contamination of equipment. All health care workers in the room must wear additional layers of PPE, which increases the number of steps in the procedure and its complexity.

鈥淪imulations allow us to identify specific ways to improve upon our process,鈥� said Beattie, an associate professor of emergency medicine and residency program director. 鈥淚t鈥檚 so essential for us to be able to get our heads around what鈥檚 different, what we need to think about, and establish our priorities."

In the 网红黑料 Shands ERs and ICUs, teams of physicians, physician assistants, respiratory therapists, nurse practitioners, nurses and technicians are running and observing simulations, timing how quickly the team can don PPE and intubate a manikin mimicking severe COVID-19.

鈥淭he purpose of this training is to look at how we can refine technique,鈥� said 网红黑料 neurologist Marc-Alain Babi, M.D., program director of the neurocritical care fellowship who is helping lead simulations in the neuro ICU. 鈥淭he team dynamic is extremely important for this high-risk procedure. There is a need for protocol and a strategic plan.鈥�

Adherence to new Centers for Disease Control and Prevention guidelines created specifically for confirmed or suspected COVID-19 has required a swift change in mindset.

鈥淲e all have it ingrained that we just run into the room,鈥� said 网红黑料 pediatric ICU physician Jennifer Mu帽oz Pareja, M.D. 鈥淵ou have to practice and practice 鈥� it鈥檚 your heart and your mind that want to go into the room to help out. It鈥檚 a change in culture, a change in muscle memory. Now the mental model that all health care workers have is protect yourself first and then go into the room.鈥�

She said health care workers facing the pandemic are putting into practice knowledge gained from experiences at other medical centers in hard-hit regions of the country and world.

鈥淓very time you do this, there are new ideas of how to do it better,鈥� said Mu帽oz Pareja, an assistant professor of pediatric critical care and pediatric critical care fellowship program director. 鈥淓verybody has learned a lot from New York, from Seattle, and we鈥檙e very lucky to have all that knowledge from those experiences and be able to implement them.鈥�

Simulations help UF clinicians apply and test this knowledge, ensuring that patients experience the highest, safest level of care possible.