JGH Zoom presentation on treating COVID-19 patients draws over 500 participants from Quebec hospitals

Emergency Medicine Simulation Team trains more than 160 staff for real-life care of COVID-19 patients

In the best-attended Medical Grand Rounds ever at the JGH, more than 500 healthcare professionals from across Quebec recently viewed a webinar presentation on treating acutely ill COVID-19 patients, delivered by members of the hospital’s Emergency Medicine Simulation team.

Held on April 6, the Medical Grand Rounds were presented by Dr. Errol Stern, Dr. Haran Balendra and Dr. Kamy Apkarian, in coordination with the Department of Medicine, headed by Dr. Ernesto Schiffrin, the JGH’s Physician-in-Chief.

Demand for attendance at the webinar was so great that the Zoom session quickly exceeded the 500 people who were expected from McGill University and Quebec hospitals.

Screenshot from a JGH video: A manikin is used to simulate a COVID-positive patient who needs to be intubated for extreme hypoxia (low blood oxygen saturation).

The presenters discussed the unique features and treatment of COVID-19 patients, while outlining how simulation exercises have provided physicians, nurses and respiratory therapists with lessons that can be put into practice in experiential, real-life situations.

Using simulation exercises, Dr. Stern and his colleagues have also trained more than 160 healthcare providers in the JGH Emergency Department to treat COVID‑19 patients who have a variety other medical problems or conditions.

The presentation is available on the JGH website for medical providers who could not attend the session or would like to examine its content more closely.

“The value of medical simulation is its benefit as an educational tool,” says Dr. Stern, Director of the JGH Emergency Medicine Simulation Program. “The debriefing after the simulation exercise gives facilitators helpful insights into the reasons why staff behaved as they did.

“By better understanding their frame of mind, we can have an open discussion and agree on the best way to maximize the safety of our personnel, while achieving the best care for COVID patients.”

A COVID-19 simulation training session with (from left) Hajar Al Hoqani, an Emergency Medicine resident; Linda Marchand, an Emergency Department nurse; and Dr. Julia Bernard, an Emergency physician and member of the Emergency Medicine Simulation Team.

The simulation sessions have also brought about systematic changes, explains Dr. Stern, who is an Associate Professor of Emergency Medicine at McGill University. “One such improvement involved the medical supplies that were being taken into the isolation rooms of COVID patients.

“Previously, larger carts, containing various supplies that might possibly be needed, were wheeled into the rooms. But afterwards, many unused items had to be sterilized or even thrown away, because they had become contaminated.

“As a result of a simulation exercise, a substantial number of smaller bundles of supplies has been created, so that only the necessary items are brought into patients’ rooms.”

Simulation tabletop exercise sessions were held on Feb. 17 to review the plans and procedures of professionals in numerous departments.

This was followed, a week later, by a multi-disciplinary simulation exercise, in which a COVID-19 patient—played by an actress feigning illness—was treated in the Emergency Department and transferred to Intensive Care. This helped ensure that CIUSSS staff were properly prepared for the arrival of actual patients who had been infected with the coronavirus.

In mid-March, two simulation scenarios related to COVID-19 were created by the Emergency Medicine Simulation Team (Dr. Apkarian, Dr. Balendra, Dr. Julia Bernard, Melanie Sheridan, Dr. Stern and Dr. Madelaine Yona). These were recorded and posted on the JGH EM Simulation COVID website.

The first video features a COVID-positive patient who has suffered a cardiac arrest just after being brought by Urgences Santé to the Emergency Department. To protect staff, the video shows how the patient’s airway must be secured during cardiopulmonary resuscitation, so that no droplets from the throat can contaminate the environment.

The second video involves a COVID-positive patient whose blood oxygen saturation is low (hypoxic) even though he seems healthy and is breathing nearly normally (“silent” hypoxia). Ultimately, the patient needs to be pre-emptively intubated (placing a tube in the trachea) to avoid a rushed or “crash” intubation, which is a high-risk procedure with greater likelihood that the coronavirus will contaminate the healthcare providers.

Both videos also advocate strategies for effective team communication, which becomes more complicated when staff wear personal protective equipment and use walkie-talkies. Despite these obstacles, the healthcare team’s leaders frequently summarize the health status of their patients, while sharing valuable information with team members inside and outside the isolation room.

According to Dr. Stern, these exercises are valuable tools for coping with new or complex medical situations, and they serve as helpful adjuncts for effectively improving care.

“By examining the actions of the multi-disciplinary medical team and the responses of the healthcare system, we can keep pace with our evolving environment and effectively deliver the care the patient needs,” he says.