From a training tool to a scientific research engine: a simulation study showed that life-saving maneuvers remain effective even with personal protective equipment. The results, published at the height of the pandemic, were cited in the international ILCOR guidelines, influencing cardiopulmonary resuscitation practices. This confirms that simulation is not just training, but a research laboratory for improving patient safety.
In 2018, during the last months of my specialization in Emergency Medicine, I was attending the Operations Center in Venice Mestre and looking out the window at the rubble that the NBCR and USAR unit of the Fire Department uses for their exercises. I had also participated in some of their exercises involving dressing and undressing and moving a stretcher with a patient. The exercises in the gym were quite tiring and complex! I had many questions: had they done other exercises for other procedures? What were the procedures for a patient in cardiac arrest? If I had been part of the rescue team, would we have had time to undress and then resuscitate him? Wasn’t it better to stay dressed and start the massage? But how tiring would it be? How effective would it be? What about placing a venous access?
I had shared all these questions with colleagues and friends from the control center and from my specialization. “Come on Giulia, when do you think we’ll ever dress like this for a biological or chemical emergency?” Others, however, had taken the questions I had asked myself seriously and we had started to plan a study that would at least partially answer these doubts. But how do you measure the effectiveness of cardiac massage? How do you measure the timing of placing a venous access, an intraosseous access or a drain? Or a tourniquet?
And I, a devoted and enthusiastic simulation facilitator, suggested using our simulators because they are equipped with sensors to measure the depth and speed of chest compressions, but they could also detect the complete closure of the artery when placing the tourniquet, etc. In short, our simulators were finally useful for research as well, and not just for training healthcare personnel!
We therefore read the guidelines for randomized controlled trials in simulation (Checklist: Simulation-based Research Extensions for the CONSORT Statement), prepared the protocol, studied the simulation days in detail and between August and September 2019 we enrolled 36 participants and randomized them into the intervention and control groups [procedures with vs without (procedures with personal protective equipment (PPE)].
Table 1 shows the procedures performed and the different methods and simulation models used
We were writing the article when the COVID 19 pandemic began, and at that moment I thought that we were really using those PPEs and that we were – unfortunately! – also performing all the procedures described in the study. Fortunately, some results of our research work, at least as far as cardiopulmonary resuscitation was concerned, comforted us. In particular, the fact that cardiopulmonary resuscitation could be performed while wearing PPE without compromising its quality, while other tasks requiring greater dexterity could be significantly compromised by PPE.
Finally, after months of hard work, even during the pandemic, with very tough shifts in the emergency room, we managed to publish the study.
And then… a few months ago I received a text message. One of many. But this one notified me of a new citation. Curious, I looked up who had cited our article. Ebbena was 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. How exciting! I thought my hard work had paid off! Being mentioned in ILCOR‘s work means that your article is really influencing scientific progress and, consequently, contributing to the well-being of patients! I felt proud. We who studied something that seemed rare but then turned out, alas, to be possible and terrible, namely the biological emergency of COVID 19. And also proud of the power of simulation! Simulation is still very often seen as a tool only for education and training (or as a “game”, the “doll doctor” because “patients must be saved for real, not just played with as dummies!”). Simulation that is really useful, simulation that becomes a laboratory for scientific research with the ultimate goal of improving patient safety!
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