Objectives & Background A paediatric code red (massive haemorrhage) call is rare but when it does happen, it needs to be performed correctly. In our major trauma centre, our adult emergency department (ED) teams have regular code red calls and have thus fine-tuned the process. We used a series of in-situ high-fidelity simulation to improve how we practically managed a paediatric code red in our ED.
Methods A paediatric code red trauma scenario was delivered using high-fidelity simulation. 3 sessions were delivered over 9 months in our paediatric ED with immediate debriefing of the team and observers.
Results There were >20 members of the multidisciplinary team (MDT) at each session. The key concerns identified from debriefing were acted upon. These included.
▸ Communication: problems in the bleep system were identified. One key change is that the radiology registrar now holds a bleep to attend these calls. There is poor network coverage in the hospital for mobile phones and there is now an on-going discussion about the need for more portable phones. The team members on the switchboard list were identified and amended to be specific for a paediatric call.
▸ Team work: aide memoires with key tasks for each of the paediatric trauma team member were adapted from the adult cards
▸ Equipment: a mobile paediatric code red trolley was commissioned by the anaesthetic team to address the repeated questions about which trauma lines were available for younger children.
▸ Training: gaps in knowledge for the MDT were acted upon, including increased frequency of Belmont training for the paediatric nurses. The general paediatric doctors now have a trauma specific workshop to understand their roles and trauma terminology included in their regular teaching program.
▸ Major issues were reported via our DATIX system which helped efficiently deliver on some of the changes. Action and learning points were communicated with the leads for all the relevant departments via email. Debriefing sessions also gave the MDT an opportunity to identify different members of the team and open doors for other discussions.
Conclusion The simulation and debriefing sessions were key to identifying gaps and in improving the process of managing a paediatric code red by our trauma teams. We worked successfully with our simulation department and these sessions have been set up to continue running to ensure all new teams will benefit from managing this rare event and to continue to fine-tune the process.
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