Police Foundations, Paramedics, Nursing, Social Service Workers

5

IPC

Police Foundations, Paramedics, Nursing, Social Service Workers

Joanne Smith (Simman 3G)

A 911 call is placed by a female complaining that her boyfriend has beaten her up. She reports that he has fled the scene and she wants to speak to the police.

Com centre’s dispatch:

We have a 911 call to 4715 Highway 101 East, Apartment 2, South Porcupine. Female calling requesting assistance as she is fighting with her husband. Husband may have left the scene. We have no name at this time or information on weapons.

Two officers are dispatched to the scene. Upon arrival, the officers knock on the door and get no response. Due to the fact it was a 911 call and there is no response at the door this allows the officers to enter the residence without a warrant to check on the well being of the people inside. The officers enter the residence searching the residence not knowing if there is anyone there with a weapon or if anyone is in need of assistance and they have to act accordingly. The officers find the victim lying on the couch, not responding to them. There are open and empty alcoholic beverages in the kitchen and living room. The living room has furniture displaced and turned over, broken picture frame in the corner of the room. The victim has obvious signs of injury to the head, neck, and arms. There is ID (wallet) with the following driver’s license info:

Joanne Smith

4715 Highway 101 East, Apt 2

South Porcupine

DOB: August 3rd, 1982

The police call for paramedics to come to the scene.

Officers’ call to com centre:

This is officer______

North Bay Com, we have found an unresponsive female. We need an ambulance dispatch at 4715 Highway 101 East, Apt 2, South Porcupine. The husband as fled the scene.

Dispatch call to paramedics:

We have a 911 call from police officers to 4715 Highway 101 east, Apt 2, South Porcupine. Officers requesting assistance with an unresponsive female.

Upon arrival to the scene, the paramedics find the victim unresponsive to touch and voice. They get a report from the police officers.

Following are the findings they should find:

She does flex to painful stimuli

Her eyes are closed and her pupils are 3+

VS: BP 170/80, HR 122, R 32, T 37.9, O2 Sat 95% on RA

Skin & Colour: NML

Lung sounds: good A/E bilaterally, no adventitious sounds

Heart rate: tachycardic and regular, no extra sounds

Abdomen: soft, no bruising/swelling present, BS in all 4 quadrants

No evidence of incontinence

Odours of products of fermentation present

Large hematoma over the right temple

Bruising right lateral side of neck, upper arms

Crepitus, swelling and bruising felt over right forearm

Radial pulses present and equal bilaterally

Good cap refill bilaterally

Pelvis stable

No evidence of injury to lower limbs, pulses present and equal bilaterally

Unknown re: allergies and medications

Client is collared and immobilized on transfer board by the paramedics.

Officer’s call to com centre:

We have found mail with the name of Joanne Smith and Doug Smith of 4715 Highway 101 East, Apt 2, South Porcupine. Can you run a 10-29 CNI record check.

Com centre: 10-4

Ambulance call to dispatch:

We have an unresponsive female with a GCS of 3 en route to ER. Please patch us through to ER.

The client is transferred to ER by paramedics accompanied by a police officer while the 2nd officer maintains scene security Report given to ER nurses. Paramedics complete their paperwork in “ER”.

Com Centre to Officer ______

No wants or warrants but there is a history of domestic violence calls at this residence in the past 2 years. No firearms involved or registered to either subject. Joanne Smith has a history of drug use.

Police officers come back to obtain the “status report” and continue with the next step in their investigation. They may ask “is there a possibility she could die?”

VS on admission in ER

VS: BP 176/62, HR 106, R 30, T 37.7, O2 Sat 96% on 2 L/NP

Orders in ER

Call RT to Intubate

IV NS 75 cc/hr

STAT head CT scan

STAT BS

STAT portable CXR and wrist X-ray

CBC, lytes, BUN, creat, BS, G&S, ETOH level, drug screen

Foley catheter to straight drainage with urometer

STAT ECG

Tests results

Hb 14 g/dL

Hct 46%

Na 144 mmol/L

K 4.6 mmol/L

Cl 98 mmol/L

BUN 60 mgl/dL

Glucose 5.4 mmol/L

Stat BS 5.6 mmol/L

ETOH: 20 mmol/L

ECG: Sinus tachycardia

Head CT: acute subarachnoid hemorrhage

CXR: negative

Wrist x-ray: # ulnar

Admission orders

Admit to CCU

OR prep for craniotomy and evacuation of blood clots

Neuro VS q 15 minutes

Cardicac monitoring

IV 0.9% N/S at 75 cc/hr

I & O

Mechanical ventilation

Splint Rt wrist

Ortho consult

Zantac 50 mg IV now and q8h (supplied 50 mg/2 ml vial)

Send 1 bag of 5% N/S to the OR with client

ABGs STAT

Keep O2 sats >95%

HOB at 30o

Dilantin 1 g IV now followed by 300 mg IV OD (supplied 50mg/ml in a 5 ml vial)

Glucometers QID

Tylenol 650 mg PR to maintain T ≤36.5 o C (supplied 650 mg per suppository)

VS to be programmed

No voice/moaning commands

BP 186/60, HR 62, R 22, T 38.2 O2Sat 92% on vent

Patient decerebrate posturing

Orders received

Mannitol 250 cc IV STAT (supplied premixed IV bag)

Send client to OR STAT

If students don’t seek STAT orders, program simman to start seizing (will do on the fly)

Orders received

Ativan 4 mg IV push STAT (supplied 4 mg/ml vial)

If students do not intervene appropriately, I want to click on the fly the next frame to go VSA.

VSA programming:

Vfib

no BP/HR/R

Post Mannitol event

BP 166/84, HR 56, R 28

Improvement in posturing

Needs

Apartment

·  Empty alcoholic bottles

·  Broken picture frame (without the glass……..)

·  Furniture displaced, perhaps a chair or two upside down/on side

·  Take out food wrappers here and there

·  Percocets in a little baggy on counter

·  Fake knife (Dollarama) on floor, no blood stains on knife

·  Baseball bat

·  Wallet

Mannequin

·  Dressed with swelling and ecchymosis over right temple

·  Bruising over right lateral side of nick and upper arms

·  Crepitus and bruising over right forearm

·  Disheveled

·  Tear in sleeve shirt

·  Smelling of ETOH (perhaps put a bit on clothes not to ruin the mannequin….)

Equipment

Overall:

·  Video/audio recording (system) and laptop

·  Clipboards

·  2-way radios

·  Photocopies:

o  Readiness for Interprofessional Learning Scale (RIPLS) pre and post copies

o  Interdisciplinary Education Perception Scale (EIPS) pre and post copies

o  Brookfield’s Classroom Critical incident questionnaire

·  Booking of lab and apartment

Police:

·  Police foundation documentation memo books

·  Two way radios

·  Gun belt and student uniform

·  Evidence bags

·  Gloves

Paramedics:

·  Paramedic ambulance call report ACR

·  Stretcher, transfer board, cervical collar, ambulance if insurance allows use, if so, have them go around educational institution to simulate transportation

·  First response kit, Flynn kit, Back board kit

·  2-way radios

·  2nd Zoll monitor for ER setting

·  Uniform

Nursing:

·  Students with stethoscope, wearing own scrubs

·  CPS

·  IV NS/tubing

·  IV start equipment (students who are certified can start the IV)

o  Alcohol swabs

o  Tourniquet

o  Opsites

o  Angios

o  tape

·  Lab reqs and lab results

·  ER charting

·  Foley catheter with urometer drainage bag

·  Catheterization trays and mannequin lubricant

·  Narrative charting

·  GCS graph

·  I & O sheet

·  Ventilator

·  Intubation equipment (laryngoscope blade, ETT (pick size that will fit the mannequin), stylet, ambubag, O2 tubing, flow meter with nipple, ETT holder and mouthguard)

·  O2 equipment i.e. mask, tubing, NP

·  Cardiac monitor

·  Zantac IV

·  5% NS

·  Dilantin IV

·  Tylenol PR

·  Glucometer

·  VS equipment

·  Mannitol IV

·  Ativan IV

·  MARs

·  Gown

·  Stretcher sheet

·  IV pumps

·  Tensor bandage and wrist splint

·  2nd Zoll monitor with cable and stickers (from paramedics)

·  Penlight

·  Sterile gloves, various sizes

·  Electrical extension cord

Social Service Worker Students

·  Observer and recorder role looking at communication, interaction, and exchange of information

·  Clipboards

·  Tool for documentation of observation

Physician

·  Require someone to role play of physician in order to provide telephone orders, if not available. Set up stage where physician is off unit perhaps in ICU or attending a code.

·  If medical student available, may participate in this simulation, adding another discipline to this activity

Respiratory Technologist

·  If available, RT students may also participate in this activity

February 2015 for SIMOne Submission