The Trial of Emergency Medicine Protocols In Simulation Sraining (TEMPIST) study

In the TEMPIST study we will evaluate the standard list of emergency guidelines in current use in Australia. The Handbook of Emergency Medicine Protocols has been designed as a cognitive aid for medical staff who have to manage medical emergencies that are both life threatening and time critical. Current protocols have been reformatted as simple, single step by step pathways, The content of the protocols has not been altered. Careful consideration has been given to the graphic design, text, diagrams and fonts used on each page, following consultation with experts from the aviation industry who design pilot manuals. Instructions are delivered in an easy to follow, step by step format designed to be read out loud during a resuscitation event. The TEMPIST trial will investigate the feasibility of using the Handbook Emergency Protocols during simulated medical emergencies. Objective: The aim of this study is to determine whether the use of the Handbook of Emergency Protocols leads to, or detracts from, the provision of correct care, in accordance with current Australian and New Zealand Resuscitation Committee guidelines. The research will be conducted in a high fidelity simulation laboratory. Study participants will be asked to manage four simulated emergency medicine scenarios. Groups of medical staff will be asked to manage four simulated emergency medicine scenarios. Groups will receive either the Checklist scenario or usual care. Each group will manage two scenarios with the emergency protocol handbook and two scenarios using only the wall charts and drug administration handbooks that are found in every Australian Emergency Department. Each group will perform each scenario only once, either with or without the emergency protocol handbook. The Groups will be randomly assigned, using a computer generated number table, to manage the emergency scenario, with or without, the Handbook of Emergency Protocols. Each group will be given a verbal prompt leading into the scenario and advised whether the protocol book will or will not be available. Each group will then be asked to manage the emergency scenario within the simulation laboratory. Each scenario will be conducted in the simulation laboratory with a set up designed to replicate a resuscitation bay in an Emergency Department. High fidelity manikins will be used and the room will contain standard patient monitoring and resuscitation equipment. The group being studied will be given a brief clinical prompt and then advised to proceed with the resuscitation. Initial observations (Pulse, BP, ECG rhythm, Oxygen saturation) will be exactly the same, each time the scenario is performed. A video recording will be made of the resuscitation effort. If a group fails to intervene in a timely manner, the simulated patient will be programmed to deteriorate clinically. Correct interventions will be reflected by improving clinical observations where relevant. Each scenario will be limited to a 15 minute duration. The four scenarios are: 1. Paediatric seizure 2. Adult pulseless ventricular tachycardia 3. Newborn resuscitation 4. Tricyclic antidepressant overdose. The patient will be a simulation manikin (Sim man 3G). The trial groups will be made up from doctors and nurses with a mixed level of emergency medical training. It is expected that use of the handbook will be at least as effective as current models of care. At the end of all 4 clinical scenarios, participants will be asked to fill out a questionnaire to evaluate their subjective experience of using the emergency protocol handbook and to try and identify potential hurdles to its adoption.