Case Studies

Learn how Rainer Stens used Scoop to help fire chiefs and EMT leaders simulate patient handoffs in mass casualty incident training

During a mass casualty incident (MCI), first responders are trained to self-organize and create distinct staging areas as rapidly as possible. They need clearly marked zones for victim triage, treatment and transportation in order to provide the greatest good for the greatest number of people.

Yet despite this universal order of operations, the process of assessing and moving patients from the incident site to triage and beyond (the 'patient handoff') is still chaotic, stressful and imperfect. To prevent errors, everyone from frontline responders to the specialized teams that arrive later must strive to communicate key data points about each patient as concisely and directly as possible. 

To this end, Rainer Stens, a training consultant who specializes in emergency, risk and crisis management, developed a special program for MCI training exercises that focuses on the patient handoff. Designed for use by fire stations in Germany, Stens' program gives station chiefs a structured way to train firefighters and EMTs in both the clear exchange of critical patient information and efficient multi-team coordination during high-pressure MCIs. His tool of choice for the train-the-trainer was Scoop.

Scoop as a metaphor for patient handoffs in complex, high-stress situations

With Scoop, teams must work together to lift a ball from the ground and transport it into a bucket or basket using a plastic shovel-like tube they control with strings (the Scoop). It looks easy, but the balls can readily fall out unless the team carefully coordinates their movements.

In Stens' adaptation, the balls represented MCI victims, while Scoop itself served as a tangible metaphor for the complexity and challenge of patient handoffs.

"We prepared an activity on the topic of handover point using Scoop, which the managers were later to put into practice themselves when conducting training with their teams back at their bases," he explained.

Stens staged the activity in the apparatus bay of a fire station. He set three Scoops on the floor approximately 30 feet apart, then used temporary spray paint to outline three zones of a mass casualty - the hazard zone, the patient triage area and the hospital.

In the hazard zone, he inserted common 'landmarks' such as streetlights, hydrants and planters, then scattered nine foam patient-balls throughout the scene (three red, three yellow and three green). He wrote a random number next to each ball and carefully recorded all these 'patient details.'

Stens then laid down a tarp between the hazard zone and patient triage to serve as a transfer area.

Beyond the hospital, he placed three buckets in matching colors at a distance from each other. Next to the buckets was a flip chart with three columns labeled red, yellow and green.

Bringing a concept to life with hands-on practice

Stens started the lesson in an adjacent room by discussing key handover concepts, then walked participants to the bay to introduce the hands-on activity.

"Your focus so far has been on the patient treatment handover points and the flow of patients within the treatment processes," he explained. "To make these processes and the associated challenges visible, I have prepared an activity for you."

He divided the group into three teams of 10-14 people, then assigned each group to a zone and outlined their responsibilities, one group at a time.

The first group was in charge of the hazard zone. Their challenge was to use the Scoop to transport the nine patients scattered around the zone to the triage area managed by the second group. They had to record exactly where each patient was found (ie. by the streetlight) and the number written next to them.

Stens led the second group to the tarp between the hazard zone and triage, and explained, "You work in the patient triage area within the markers. Group one will bring you patients of different categories in the form of colored balls. They will be dropped off here. You will be given information about the patients, which one of you should record. If you receive several patients, please triage them according to the urgency of treatment from red to yellow to green."

"Then transport the patients to the next marker in accordance with their priority. At this point, you are to transfer the ball-patients from tube-to-tube to the following group along with the information you have received," he continued.

The third group was charged with taking the patients to a suitable medical facility. Using a tube-to-tube transfer, they would accept patients from group two, then transport them to buckets that corresponded with their colors. The patient data had to be included.

"As soon as you have done this," Stens explained, "write down the related information on the flip chart."

Stens used a staggered start with each group to mirror realistic conditions and the activity began. The participants worked diligently until all the patients arrived at the hospital, and the activity ended.

Relating the experience to traditional MCI training

Following the challenge, Stens led a reflection that deliberately focused on the participants' experiences of success to foster self-awareness and self-reflection. He asked the following questions:

1. What went well?
2. What can we improve?
3. What do we not have that we need to be even better?
4. What would we do the same way again next time because it worked or was a factor in our success?

"We discussed the metaphors of the learning situation and their relevance to the actual task of providing patient care with the aim of making the experience useful for the participants as they prepared to apply it to their own on-site training programs."

Some of the attendees were not able to appreciate the experiential nature of Sten's program right away. "The use of training tools as surrogates for an actual exercise was an unusual form of learning for this specific group," he wrote. "However, the feedback after further workshops and after repeated practice by all of the units showed continuously improved performance."

 

About the trainer

Rainer Stens is a German training consultant who specializes in emergency, risk and crisis management, and the winner of the 2016 METALOG Training Award.

Connect with Stens on LinkedIn.