emergency trauma management course course instructor manual … · 2019. 11. 27. · as an etm...

ETM Instructor Manual © ETM 2019 1

EMERGENCY TRAUMA MANAGEMENT COURSE

COURSE INSTRUCTOR MANUAL

Version 1. 2019


Table of Contents

Introduction to instructing on ETM Course ....................................................................... 4

Pre course information .................................................................................................... 4

Instructor portal and ETM trauma manual log in detail ........................................................................................... 4

Instructor Training/Mentoring .................................................................................................................................. 4

Signing up to instruct on a course............................................................................................................................. 4

Faculty confirmation ................................................................................................................................................. 5

Cancellation ............................................................................................................................................................... 5

Instructor entitlements ............................................................................................................................................. 5

Instructor timetable/Course information ................................................................................................................. 5

Pre course preparation ............................................................................................................................................. 5

Course start and finish times .................................................................................................................................... 5

Flights to and from course locations ......................................................................................................................... 6

Car travel to and from course locations ................................................................................................................... 6

Accommodation ........................................................................................................................................................ 6

Reimbursement for travel expenses ......................................................................................................................... 6

Prepaid Visa cards ..................................................................................................................................................... 7

Course Entertainment ............................................................................................................................................... 7

Role of the course coordinator ................................................................................................................................. 7

Instructor Profiles/ETM website ............................................................................................................................... 7

Course content ................................................................................................................ 9

Day 1 ............................................................................................................................................................... 9

Pre-arrival briefing 08.00 – 08.20 ............................................................................................................................. 9

Morning Lectures ...................................................................................................................................................... 9

Small Group Procedures ........................................................................................................................................... 9

Afternoon Lecture ...................................................................................................................................................10

Scenarios 1.1 ..........................................................................................................................................................10

Testing: Airway and Chest Decompression OSCE ...................................................................................................11

Day 2 ............................................................................................................................................................. 11

Morning Lectures ....................................................................................................................................................12

Small Group/Procedures .........................................................................................................................................12

Afternoon Lecture ...................................................................................................................................................13

Scenarios 2.1 ...........................................................................................................................................................13

Scenarios 2.2 ...........................................................................................................................................................14

Day 3 ............................................................................................................................................................. 14

Morning Lectures ....................................................................................................................................................14

Small Group Procedures .........................................................................................................................................14

Scenarios: 3.1 ..........................................................................................................................................................16

Final testing .............................................................................................................................................................16

Post Course MCQ and Feedback .............................................................................................................................16

Final summary .........................................................................................................................................................16

General information .......................................................................................................17

Assessment..............................................................................................................................................................17

Debriefing and Feedback ........................................................................................................................................17

APPENDICES ...................................................................................................................19

Appendix A: ETM Course Assessment Policy (Updated Feb 2019) ........................................................................19


Appendix B: Instructor Scenario Debriefing Tool....................................................................................................29

Appendix C: ETM Simulation Prompts ....................................................................................................................31

Appendix D: Instructor FAQs ...................................................................................................................................32

Appendix E: The Nurse Observer role .....................................................................................................................34

Appendix F: Manikin use and handling ...................................................................................................................36

Appendix G: Equipment setup ................................................................................................................................38

Appendix H: Sample Instructor Timetable ..............................................................................................................40


Introduction to instructing on ETM Course

ETM Instructors are responsible for the delivery of course content at each course. There are currently over 190 faculty members on the ETM database. Instructors are selected based on criteria related to trauma and/or education experience as well as their ability to conduct themselves in a positive, pro-active and professional manner whilst teaching on the course.

Instructors come from many medical specialties including Emergency Medicine, Pre-hospital and Retrieval, Intensive Care, Anaesthetics and Rural General Practice.

Our course Instructors are the glue that holds ETM Course together and we thank you for being involved in what is widely known as the most up-to-date, practical and relevant trauma course for medical practitioners who care for the seriously injured.

Approximately 16 courses are held around Australia and NZ each year. Each course includes:

• a maximum of 24 participants

• a maximum of 4 x Nurse Observers (Refer to Appendix B for information about the nurse observer role)

• a maximum of 8 Instructors, including 1 course director

• 1 x course coordinator and; over 350 kg of course equipment!

Pre course information

Instructor portal and ETM trauma manual log in detail

All Instructors will receive log in details for the ETM Instructor Portal and the online trauma manual. If you

have forgotten your password, you are able to reset your password. Please contact our administration

team at [email protected] if you require assistance resetting your password.

Instructor Training/Mentoring

ETM Instructors are not required to attend an instructor training course. Unlike other courses, we don’t run a dedicated “train the trainer” model. We have an extensive set of instructor resources on our instructor portal including teaching plans, videos, scenario demos and more.

We also send out an instructor timetable before each course which includes links to teaching plans and other resources you may need to teach on the various course sessions.

New Instructors are paired with an experienced faculty member for the first 2 courses and actively mentored throughout each course. Mentors will train new instructors and provide feedback as required.

Signing up to instruct on a course

To sign up to instruct on a course, please visit the online instructor portal, click on the link to your preferred course and complete the form. Once you’ve signed up for a course, you’ll receive an automatic confirmation email. You’ll then receive an Instructor timetable and all final accommodation and course information 2 - 3 weeks prior to each course.

Please note: In the interest of supporting local trauma networks, preference will be given to local faculty for the Far North QLD, Broome, Darwin and NZ based courses.

If you’re interested in instructing on any of these courses, please sign up anyway and we will contact you to confirm final course faculty 3 months prior to the course commencement date

mailto:[email protected]


Faculty confirmation

With the exception of the Far North QLD, Broome, Darwin and NZ based courses, you can assume that your place on faculty is confirmed once you’ve signed up for a course. On occasion, we may contact you to advise if your selected course has been oversubscribed with faculty.

Cancellation

If you have signed up for a course and are unable to attend, please let us know as soon as possible so we can fill your place.

Instructor entitlements

As an ETM Course instructors, you are entitled to the following:

• $250/day or $800 for all 3 days via prepaid visa card

• Instructor level access to the ETM Course online manual

• Access to the ETM Instructor portal – includes teaching plans, slide presentations, the instructor manual, equipment demo videos and more.

• A gourmet instructor dinner on the Saturday night (partners welcome)

• Flights (Single return economy) and accommodation & taxis to/from airport for interstate instructors

Instructor timetable/Course information

The instructor timetable will be emailed to instructors 3 weeks prior to course commencement. The

timetable includes links to teaching plans and other resources required to teach on the various course

sessions.

All other course, venue and accommodation information will be included in this email.

Pre course preparation

There are several things you can do to prepare to instruct on the ETM Course, especially if you haven't

taught on a course before.

• Log into the Instructor portal and; o Read the instructor guide o Watch the videos on the instructor video page, in particular the scenario and debriefing

videos

• Review the relevant sections of the ETM Course Manual (you will have unlimited access to the manual while you are an ETM Instructor)

Instructors are required to prepare for their allocated sessions in advance. If you are not comfortable

teaching or lecturing on a session that you have been allocated, please advise the course director prior to

the course.

Course start and finish times

If committed to 1, 2 or 3 course days, we ask instructors to stay for the full duration of the day, unless

approved by the course director in advance. Instructors are expected to help set up and pack away their

stations.

http://etmcourse.com/instructor-videos/http://manual.etmcourse.com/


Flights to and from course locations

ETM instructors are required to organise all travel to and from course locations. Depending on the course

location, ETM may decide to book instructor flights in advance (e.g. NZ, Darwin). If ETM decides to book

long haul instructor flights, you will be notified 3 months prior to the course.

ETM will reimburse a standard, return economy airfare when instructors are on an interstate/overseas

course.

Car travel to and from course locations

Local instructors will be reimbursed for parking at or near the course venue.

For distances over 50km, ETM will reimburse car travel to and from the course on a km basis according to

ATO guidelines. The 2019 - 20 income year rate is 0.68 cents per kilometre.

Accommodation

Interstate instructors or instructors who live more than 50 kilometres from the course venue may request

accommodation.

Instructors requiring accommodation must indicate preferred check in and check out dates on the

instructor sign up form.

ETM will book all accommodation in advance, in a standard room for the duration of the course up to a

maximum of 3 nights. If flights are not available on the last day of the course, additional accommodation

will be covered by ETM where we are informed in advance.

If an interconnecting room for family members is required, ETM will pay the full amount and you be

invoiced for the difference between a one and two bedroom suite.

If an extended stay is required for personal reasons, any additional accommodation, room charges or

upgrades must be payable by the instructor and will need to be settled directly with the hotel prior to

check out.

If you would prefer to book your own accommodation, ETM will reimburse you for up to 3 nights’

accommodation at the same rate as the hotel in the course location. Please contact ETM to confirm the

hotel rate on each specific course.

In most cases, breakfast is included in your stay. If it is not included, you are entitled to up to $30 to cover

this meal.

Reimbursement for travel expenses

In order for us to reimburse your expenses as quickly as possible, please complete the online instructor

reimbursement form once the course is completed.

• Reimbursements will be made on presentation of a correctly dated receipt and tax invoice,

including the ABN of the service provider

• Credit card/EFTPOS payment slips/statements alone will not be accepted. Claimable items include:

o Taxi fares: home to/from airport

o Taxi fares: to/from course venue/hotel/destination airport.

o Airport parking (Maximum 4 days)

https://www.ato.gov.au/Business/Income-and-deductions-for-business/Deductions/Deductions-for-motor-vehicle-expenses/Cents-per-kilometre-method/https://www.ato.gov.au/Business/Income-and-deductions-for-business/Deductions/Deductions-for-motor-vehicle-expenses/Cents-per-kilometre-method/


o Flights to and from course location

o Daily breakfast on course days (if not provided at accommodation) up to $25 per day

• Reimbursements are made for ETM Instructor expenses only. Family expenses are not redeemable

and will be deducted from any claim.

Prepaid Visa cards

Prepaid Visa cards will be distributed by the coordinator and activated on the first day of the course. Please

contact +61 3 8672 5945 or [email protected] if your card does not appear to be activated. To check

the balance of your pre-paid Visa card, please visit https://uchoose.mycardplace.com/cholder/

Please note the expiry date on your card. Cards are valid for only 12 months.

Card rates are as follows:

• Single course day: $250/day

• 2 course days: $500

• Full course: $800

Course Entertainment

Friday night drinks: At the conclusion of Day 1, all participants and instructors are invited to attend social

drinks and bar food. Instructors are not obligated to attend but it provides a good opportunity for

attendees to talk in a relaxed environment.

Saturday night Instructor dinner: Instructors and partners are invited to attend a dinner on Day 2 of the

course.

Role of the course coordinator

While instructing on a course, the course coordinator is your go-to person for all things related to set up,

equipment, the venue, security, spare parts, participant feedback, computers and presentation set up.

The coordinator role includes but is not limited to:

• Venue, room and presentation set up

• Ensuring equipment and assessment paperwork is in allocated rooms

• Meeting and greeting course attendees and instructors

• Direct candidates and faculty to allocated rooms

• Ensure sessions are kept to time limits

• Providing instructors with 5-minute warnings prior to the end of each session/lecture/scenario

• Liaising with venue management, catering and security staff if required

• Liaising with ETM Head office

You will be given the course coordinator’s contact details prior to each course. Please contact the course

coordinator if you are running late or are unable to attend a course day due to an emergency.

Instructor Profiles/ETM website

We have had many requests (from instructors and participants) to provide instructor/faculty bios on our

the ETM website.

If you haven’t already done so, please complete the Instructor Profile form here.

mailto:[email protected]://uchoose.mycardplace.com/cholder/https://form.jotform.com/70458192843967


Having a profile on the ETM website will add to your "street cred" in the trauma world and makes it easier

for other instructors, course directors, course co-ordinators and participants to identify you on a course.

(Please note, if you don't supply a photo of your choice, we will scour the internet and find one ourselves!).

If you would like us to amend, update or remove your profile at any time, please contact us at [email protected] .

mailto:[email protected]


Course content

Day 1

Pre-arrival briefing 08.00 – 08.20

Please arrive before 0800hrs on Day 1 of the course if you are teaching that day, to allow for a pre-course

briefing, as well as introductions to the course director and other instructors on the course. The course

director will brief you on any anticipated problems or changes to the timetable.

Morning Lectures

08.20 – 10.20

The course coordinator will ensure that all rooms have been set up in advance for the small group

procedures.

There are lectures in the morning, which will allow instructors who haven’t been to the course before to

spend an hour or so familiarising yourselves with the layout and equipment.

• 0800 – 0820: Welcome and Introductions

• 0820 – 0850: Trauma reception and resuscitation - Lecture and Interactive sessions

• 0850 – 0920: Airway - Lecture and interactive session

• 0950 – 1020: Breathing/Chest trauma - Lecture and interactive session

Small Group Procedures

10.35 – 12.35

On Day 1 there are 4 concurrent small group sessions of 30 mins each. The groups rotate through each

station. Our coordinator will give you a 5-minute warning when it’s time to wrap up, and a final signal

when the time’s up. As soon as the 30 mins is up, please discharge your group to the next station, as even

a couple of minute delay accumulates and means a shorter lunch break.

If candidates have burning questions, encourage them to seek you out at the break.

• Initial Assessment

The aim of this is to get candidates to run through their initial assessment of a trauma patient. They

will have had a lecture on this and seen a video and will have a handout. There will be 2 manikins

in the room, the instructors should do a demonstration assessment, and then split the group in half

(3 candidates with 1 manikin & 1 instructor). This will allow time for questions/explanations. The

afternoon scenario involves them doing an initial assessment on their own, detecting one life threat

and managing it, but the aim of this station is simply to go through the motions of the assessment,

without any management/treatment.

• Airway 1

The group should be split in half. Half (3 candidates) will do basic airway manoeuvres (as per the

teaching plan), and half will do intubation with MILS/cricoid. Each candidate should have a turn,


and at around the 15-minute mark, they swap to do the other skill.

• Chest Decompression

Quickly go over the indications. Then use skeleton manikins to demonstrate insertion technique.

The group will split in two, half with each instructor, and each have a turn doing finger

thoracostomy, and ICC insertion.

The second skill is securing the ICC using the tube/board model. Demonstrate the techniques, and

then each candidate should have a go tying the tube in.

Lastly demonstrate how to tape the ICC to the connector/atrium drain tube.

• Circulation: IV/IO Access

Half the group will do rapid infuser insertion on the vein models, and half will do EZY-IO insertion

on the bone models. At the halfway mark they’ll swap and do the other skill.

Afternoon Lecture

13.50 – 13.45

• 1315 – 1345: Haemorrhage and shock Lecture and Interactive session

• 1345 – 1400: Scenario demo

Scenarios 1.1

14.00 – 15.30

Please refer to the Instructor portal for further information on scenarios including:

• Example scenario running sheets

• Trolley set up

• Scenario demonstration videos

• Sim Mon Set up guide

All of the scenario running sheets for the course follow the same format, with a summary, a list of life

threats, the objective/s of the scenario, and the clinical information and progression of the case. There is

also a list of props at the bottom.

All scenarios used on the course are available on the Instructor Portal.

An example of the Scenario assessment sheet is available here.

Day 1 scenarios are straightforward, and involve the candidates performing an initial assessment on their

own, with a fellow candidate assisting. The goal is to do an initial assessment, detect one life threat, and

manage it.

1. The overall aim of the scenarios is to set the candidates up to succeed. It is a learning opportunity,

not a test.

2. If they are doing something really dangerous that would kill the patient, pause the scenario, ask

them to summarise the case, what they think is wrong with the patient, and enquire about their

thought processes that led to that conclusion. They may require guidance as to correct

interpretation of findings or signs and should be re-started in the scenario on the right trajectory.


3. If they leave a major part of the assessment out (e.g. they skip “Breathing”), pause the scenario and

ask them to go back and do it.

4. X-rays and FAST scan images are available as props.

5. As we aren’t teaching FAST formally, you can hand them the FAST images and tell them “here’s the

FAST scan result, it’s negative/positive”.

6. Similarly, they can have a go interpreting the x-rays which should be fairly obviously normal or

abnormal, however if they are struggling, you can tell them the result.

Instructor roles during scenarios

There will be 2 instructors in each scenario, one should man the iPad/provide patient

responses/vocalisations, and one should run the scenario, and direct candidates about

findings/investigations and direct the flow of the scenario.

The monitor instructor needs to keep an eye on things, and in some cases, if certain interventions aren’t

happening, you may need a pre-arranged signal with the other instructor to know when to start making

the obs on the monitor deteriorate (or improve if certain interventions do happen!)

Participant roles

Participants will be allocated a scenario on the running sheet. They are expected to engage in the scenario,

to actually do stuff rather than just standing back and saying what they’d do, and some may need some

gentle encouragement to get their hands on the manikin.

One way to encourage this is to tell them “do it, while saying out loud what you’re doing.”

Testing: Airway and Chest Decompression OSCE

1530 – 1545

There will be a testing station on airway management and chest decompression at the end of Day 1. The

manikins and chest decompression skeletons will be used for this.

Testing will be run in 4 simultaneous rooms, with 2 instructors in each.

Each participant will do the same test. It will involve a short case synopsis, institution of basic airway

manoeuvres and intubation of the manikin, then finger thoracostomy on the skeleton model

The coordinator will stick the SCE outside each room. Participants will read the SCE before commencing

the test.

View the Day 1 testing assessment sheet here.

Those who fail (fail criteria will be on the sheet), can have a re-test immediately with a different instructor

pair. If they fail a 2nd time, they are permitted to have one more go on the last day.

Day 2 Day 2 starts with lectures, again, which will give the new instructors time to familiarise themselves with the

space/equipment.

https://www.dropbox.com/s/trmbaosa7fum7bg/DAY%201%20TEST%20AIRWAY%20DECOMPRESSION.docx?dl=0https://www.dropbox.com/s/trmbaosa7fum7bg/DAY%201%20TEST%20AIRWAY%20DECOMPRESSION.docx?dl=0


Morning Lectures

08.20 – 10.00

• 0820 – 0920: Traumatic Brain Injury and Abdomino-Pelvic Trauma interactive session

• 0920 – 1000: RRM: Teamwork in Trauma Resuscitation

Small Group/Procedures

10.15am – 12.15

As per Day 1 there are 4 concurrent small group sessions of 30 mins each. The groups will rotate through

each station.

1. Airway 2 (Difficult Airway)

This station moves on from the initial basic airway station to cover difficult airway management.

The main aim is to get people to work through this sequence:

Skills for this station are:

• LMA insertion • Needle & surgical cricothyrotomy using the scalpel/finger/bougie technique.

2. Devices

The goal of this session is to run through the indications for, and application of two common

devices, the pelvic binder and the Donway or CT6 splint.

PLEASE NOTE:

➢ If using the CT6, the manikin requires a pair of shorts/pants to stop the groin strap

disappearing into the gap between the thigh and the torso!

➢ The 2 instructors should demonstrate the application of the pelvic binder. There is a video

of this in the online manual.

➢ One instructor can demonstrate the application of the CT6.

➢ Like most of the stations, probably best to split in two, with 1 instructor/3 candidates for

each skill, & swap halfway.

3. Resus Room Management


In this station, we go over the idiosyncrasies of working with “teams” in the ED, what a “flash team”

is, and how to function in one.

We also cover team leader skills and get them to practice some of the techniques that they’ll need in the scenarios later on.

For example:

• Managing multiple simultaneous tasks

• Role allocation

• Closed loop communication

• Shared mental model

4. Traumatic Cardiac Arrest & ED Thoracotomy

This session will cover a simple algorithm for management of traumatic cardiac arrest, using some

case examples on PowerPoint slides as discussion prompts. Candidates will then be shown a couple

of videos of ED thoracotomy, and a “plus/delta” critique will be undertaken of the videos that will

serve to illustrate the indications for and correct technique for ED thoracotomy.

Afternoon Lecture

13.00 – 13.15

• 1300 – 1315: Scenario demo

Scenarios 2.1

13.00 – 13.15 (35 Minutes each)

There are two rounds of scenarios on the afternoon of the 2nd day, with afternoon tea in between.

Each participant will act as team leader once in each round, and take turns acting in other team member

roles, including:

• Airway doctor

• Assessment doctor

• Procedures doctor

NB: If a nurse observer is attending the course, please include in the scenario in their capacity as a nurse.

The scenarios will be different from day 1, in that candidates will be taking on the role of team leader and

will have 3 assistants to act as airway doctor, assessment doctor, and procedures doctor.

There is a video demonstration shown first. The scenario demonstration videos are available on the

instructor area of the ETM Website.

They will be expected to stand at the foot of the bed, and undertake the following actions:

• Role allocation • Closed loop communication • Shared mental model


whilst simultaneously coordinating the assessment and management of the patient. Their team members

will be doing the assessment and management and feeding back their progress to the team leader.

Prompts in the form of photos and x-rays will be used and given to the team leader/shared with the group.

They should still follow the standard A/B/C/D/E approach, and the scenarios will only contain

injuries/pathology that have been included in the preceding sessions.

Feedback

A key aim is for candidates to come away with the ability to track multiple simultaneous events, use closed

loop communication, and use a shared mental model by periodically summarising the A/B/C’s, and

announcing no more than the next 3 actions/steps for the team.

Should a candidate be clearly struggling, pause the scenario, and ask them to summarise the situation/case

for you, and then summarise the status of the A/B/C/D/E’s. This will achieve one of the goals above.

Then ask them what they think needs to happen next and guide them to the correct path to take. You can

then re-enter the scenario by asking them to summarise the A/B/C/D’s and giving the next set of

instructions to the team.

Scenarios 2.2

15.15 – 17.00 (35 Minutes each)

Participants are taken through a 2nd set of scenarios.

Day 3

Morning Lectures

08.00– 08.30

• 0800-083O: Mechanism/patterns of injury Lecture/interactive session

• 0830-0900 : Neck Injuries Lecture & Interactive session

Small Group Procedures

1. Transport/retrieval

This session is a small group discussion, with a PowerPoint presentation.

There is a case discussion, so use the whiteboard, and nominate a member of the group to act

as scribe. Ask the group to supply headings and points to cover in the planned retrieval and

facilitate the discussion.

2. Radiology

This session involves going through the A/B/C method of chest & pelvic x-ray interpretation,

using a pre-prepared PowerPoint presentation and a handout. There are also some CT scans in

the presentation. These are embedded as movies. Hover the mouse over the movie and you will

see the progress bar. Once the movie has played once, you can use the mouse to slide the

progress bar back and forth to scroll through the CT.


3. Spinal Trauma: This session involves participants splitting into 2 groups. It may be more

efficient timewise to demo both skills first to the whole group and then split into two.

1 instructor/3 participants will size & fit cervical collars, and the participants are encouraged to

wear them for a few minutes to see how uncomfortable they are! 1 instructor/3 participants will

clear a cervical spine using the Canadian C-spine/NEXUS criteria.

Please note:

As this station involves “strangers” touching each other, please keep a close eye on people whose

technique may be bit “too gentle”, caresses rather than directed spinal palpation, or whose hands

may stray below the C7 spinous process, particularly if the person being palpated is female.

Unfortunately, this is not a joke. We do not want any complaints of inappropriate touching, and I

want the instructors to keep a very formal tone to this part of the session.

Please ask all participants, in particular all female participants, if they are OK to have other group

members touch them. If they hesitate at all, are wearing loose or revealing clothing, ask a different

group member to act as the patient.

If people feel funny about having their neck palpated, they don’t have to be a mock patient. Just

get someone else in the group to do it.

The log roll component should be done in the last 5 minutes USING A MANIKIN. DON’T LOG ROLL A

PARTICIPANT – for the aforementioned reasons relating to touching.

One person at the head, 3 people doing the roll, one doing the spinal examination, and the last

person to roll up the sheet and push it under the manikin.

4. Lateral Canthotomy

This session includes a PowerPoint/Video, facilitated discussion and the completion of a lateral canthotomy and inferior cantholysis on a manikin. Please allow 5 minutes prior to the session for set up. A link to the set-up video can be downloaded from the instructor timetable. A one page quick set up overview is available here and a laminated version can also be found in the kit. You will require a laptop and a copy of the lateral Canthotomy PowerPoint presentation. The PowerPoint, teaching plan and video can be downloaded directly from the Instructor timetable. If you have any trouble downloading the files, all documents are saved on an USB key which is included in the lateral canthotomy kit.

The Lateral canthotomy kit contains 3 heads and 3 masks so if you have 6 people in your group,

divide the group into 2 people per testing station.

The key concepts of this procedures include:

• Lateral canthotomy and inferior cantholysis is a sight-saving procedure

• It is easy to overlook or miss the need/indications for this procedure

• The commonest cause of orbital compartment syndrome is retro-bulbar haematoma from trauma

https://www.dropbox.com/s/1cqwx4u3zk9aj6t/Lateral%20Cathotomy%20setup%20instructions.docx?dl=0


Scenarios: 3.1

This will run the same as scenarios 2 and 3, but the patients will be sicker, and have multi-system injury.

The same rules apply as per previous scenarios.

Final testing

This will be in the form of a single hybrid-SCE type station, which will mimic the FACEM exam SCE style. It

will involve a written scenario that they get 2 minutes to read, a couple of questions from the examiner, a

procedure, and an interpretation of an X-ray or CT scan.

There will be a straightforward marking sheet, and clear pass/fail criteria.

Candidates who fail can have a re-sit with a different question and different examiners.

If they fail the final OSCE, they fail the course. Participants who fail the course will not receive a post

course certificate.

Post Course MCQ and Feedback

During the testing period, participants complete ETM/RACGP/ACRRM and ACEM feedback and also sit a

concurrent post-course 20 question MCQ.

If a participant fails the MCQ, an instructor will be asked to go through the incorrect questions with the

participant. If the participant fails a subsequent time, they will be given the opportunity re-do the MCQ

following the course. This will be followed up by ETM admin staff.

Final summary

Participants will be asked to stay at the venue until everyone has completed their assessment, as there is a

final summary/thanks.

Instructors are asked to be in the lecture theatre during the final wrap up.


General information

Assessment

(See Appendix A – ETM Assessment Policy)

Even though the scenarios are not “tests”, you will be asked to make a judgment about whether the

candidate performed the initial assessment reasonably correctly, if they had minor troubles, or if they

were completely hopeless. For those that really struggle, we ask that you provide an explanation, and we

will discuss it at the instructor meetings to see if we can find ways to assist the candidate to improve

during the rest of the course (e.g. doing a repeat scenario in the lunch break).

Formative and summative assessment is used on the ETM Course.

Debriefing and Feedback

Refer to Appendix B – ETM Instructor Debrief Tool and Appendix C – ETM Simulation Prompts

All instructors have been selected based on their proven ability to sensitively and constructively provide

feedback to participants.

Instructors should lead the debrief and focus it on the nominated participant, not on the other participants

in the group.

Please be aware the participants will have varying levels of experience with simulation and feedback. You may need to carefully gauge their ability to process feedback in an educationally positive way.

Beware of asking open ended questions to the group (such as “what did everyone else think?”) which may lead to unintentional criticism that other group members may feel is constructive but may not be interpreted as such by the recipient.

Feedback is a contentious issue in medical short courses, and by virtue of the format, we are unable to dedicate enough time to feedback.

Some instructors will have formal training in giving simulation/scenario feedback and some won’t. It’s a nuanced area, that can be done really poorly on medical short courses.

The model we’ve chosen to use is the Plus/Delta model. Plus = what was good Delta = what would you change

This involves drawing a table on the whiteboard, with a plus symbol over one column, and a delta symbol

over the other. You then ask the candidates what they think they did well and note it in point form in the

plus column and ask them what they’d change if they could do the scenario again. You should aim to get

at least 2 or 3 points on each side. Then pick one or two points from the board that you as the instructor

think are the most salient, or carry important learning issues, and use these as a starter for a discussion.


The idea is to drill down a bit into the candidates thought processes, to see what their frames of reference

were for making certain decisions, to positively reinforce and build on them if they worked well, and to

redirect or help them reconstruct them if they were missing, dysfunctional or inaccurate.

It is not intended to be overly critical of clinical specifics; rather it is a chance for a guided reflection on the

thought processes that led them to making certain decisions during the scenario.

+ Δ

Followed the ABCD model

Detected pneumothorax

Decompressed chest quickly

Forgot to re-fasten the collar

Slow to get IV access

Exposure incomplete

Good questions to ask to initiate the discussion are:

“I noticed you did ___X____ (action) when you ___Y___ (plus/delta point), I’m wondering what your

thought processes were that lead you to that action”.

E.g. “I noticed that you checked the monitor a few times and read out the sats as they were dropping

before you picked up the pneumothorax, I’m wondering what your thought processes were that lead you

to do that?

“Can you tell me what you were thinking when you did __X__”

You can then go back to some theory to help fill in knowledge gaps, or even better, ask them (now that the

heat’s off) to think back and try & come up with the answers. But remember, it’s not a knowledge test, if

they don’t know, tell them!

At the end of the discussion, ask THEM to come up with TWO take home lessons that they will apply in

their next shift at work.

Please do not make judgemental comments, critical statements or engage in a monologue about what

you think they did right/wrong. The scenarios are not about you judging them, or what you think. You

are there to facilitate their learning.

As the instructor, you only know what you saw them DO, you don’t know what they were thinking or why

they were thinking it, so you can’t make inferences about this. This is a hard concept for many medical folk

to get, as we are trained, and honed to be “problem solvers” and diagnosticians.

However the goal of the plus/delta technique is to get the candidate to talk about what’s important to

them, and for the instructor to show true curiosity about their thought processes, to reinforce positive

elements, and if they were really bad, ask THEM to come up with different ways to approach the problem

that may have a more positive outcome.

This is the crux of what’s called “learner centred learning”, and as sceptical as some people may be about

it, it’s a strong educational modality


APPENDICES

Appendix A: ETM Course Assessment Policy

(Updated Feb 2019)

ETM COURSE ASSESSMENT

The objective of this policy is to provide a framework for the design, delivery and implementation of

assessments during the ETM course. This policy aims to identify responsibilities and accountabilities for

assessment decisions and processes, and guarantee that assessment practices are transparent,

consistent and fair.

Assessment is designed to contribute to high quality learning by participants, and to allow for quality

assurance and the maintenance of high academic standards. ETM’s approach to assessment practice is

guided by the following principles designed to enhance the learning experience and achievement of

learning outcomes:

• Assessment and feedback are designed to align with effective learning and teaching and enhance participant engagement and achievement

• Assessment design and practice assists participants to develop their critical thinking skills, capacity for evaluative judgement and/or demonstrate practical competence to a required standard

• Assessment is based on informative and transparent criteria, validity and measuring achievement against learning outcomes

• Assessment is designed to ensure academic integrity of attainment of learning

• Assessment is designed to be fair, valid, reliable and achievable

• Assessment design and practice enables constructive and timely feedback to participants to help them make judgements about the quality of their learning

To successfully complete the ETM course participants must:

Attend all scheduled course sessions

Actively participate as Team Leader in four simulated trauma scenarios

Actively participation as Team Member in four simulated trauma scenarios

Receive no more than two (2) “F” marks on formative assessments

Achieve a mark equal or greater than in the following summative assessments:

o Day 1 OSCE (pass mark 17/20) o Day 3 OSCE (pass mark 16/20) o Day 3 Post Course MCQ (pass mark 16/20)

Participants who do not satisfy all of the above criteria have not successfully completed the ETM course.

The pre-course MCQ is formative assessment and does not contribute to course grades. Its aim is to

identify “at risk” participants who may find the ETM course challenging. Typical reasons for poor

performance on the pre-test include, limited theoretical preparation i.e. inadequate reading of pre-course


material or limited exposure to clinical management of trauma patients. Participants with a score of 15/20

or below are to be identified to the course director on day 1 of the program. For more information, please

see Section 1.5 At risk participant.

Certificate of completion

“Certificates of completion” are issued to participants who satisfy all of the above criteria. “Certificate of

attendance” are NOT be issued to participants who attend the course but are unsuccessful in meeting the

criteria outlined above.

Participants who require proof of attendance are to contact the ETM Administrative Team in writing. A

document affirming the participant’s attendance to all theoretical and practical sessions will be issued.

The document will:

• be emailed directly to a relevant third party (e.g. employer) at an employer-identifiable email address (documents will not be sent to personal or non-employer-identifiable email addresses).

• be mailed to the requesting participant via standard post; documents will not be emailed directly to participants.

Any requests for documentation of proof of attendance outside of these criteria will be declined.

CPD point allocation:

• RACGP CPD points will NOT be allocated to participants who fail the course.

• ACRRM PDP points WILL be allocated to participants irrespective of a pass or fail. (Providing the participant has attended all 3 course days)

• ACEM CPD points WILL be allocated to participants irrespective of a pass or fail. (Providing the participant has attended all 3 course days).

COURSE ATTENDANCE CRITERIA

Acceptable reasons for non-attendance at ETM course sessions include (i) illness of the participant (or

immediate family member) or (ii) compassionate leave. Under exceptional circumstances and at the

discretion of the ETM Education Committee, a participant who does not meet these criteria may be given

the opportunity to undertake a make-up session. Attendance at a make-up session must take place within

12 months of original course.

Attendance at all simulation scenario sessions is mandatory; non-attendance will result in failure of the

ETM course. Make-up simulation scenarios sessions are not available. Participants will not be issued a

certificate of completion or attendance and are not eligible to attend make up sessions.

Non-attendance at more than one (1) lecture or more than one (1) small group session (i.e. one two-hour

block: 4 x small group/procedure stations); will result in failure of the ETM course. Participants will not be

issued a certificate of completion or attendance and are not eligible to attend make up sessions.

* Exceptions may be made on Day 2 for participants who have completed the Day 2.1 and Day 2.2

simulation scenarios as team leader who need to leave early for personal or family reasons. This is at the

discretion of the Course Director.


MAKE-UP ATTENDANCE

To be eligible to attend make up session, participants must not have missed more than:

One lecture

OR

One small group session (i.e. one two-hour block: 4 x small group/procedure stations)

Attendance at a future course to meet attendance criteria is dependent on course availability and at the

discretion of the ETM Administrative Team. All reasonable efforts to accommodate requests for make-up

sessions will be undertaken.

To qualify for make-up session, participants must attain a pass mark on all completed formative and

summative assessments. Participants are to attend a single course—not multiple courses—to cover missed

theoretical and practical content. No additional charge is associated with make-up sessions.

SUMMATIVE ASSESSMENT

There are three (3) summative assessments on the ETM course. Summative assessments are undertaken

on day 1 (OSCE) and day 3 (OSCE & MCQ) of the ETM course.

To be successful participants must:

Receive a grade of 17 or higher on the day 1 and 16 or higher day 3 OSCE

Receive a grade of 16 or higher in the MCQ


Day 1 OSCE

Ideally, the participant undertakes reassessment prior to close of the program on day 1. However, the

Course Director may offer day 1 OSCE re-testing on day 2 or 3 of the program.

After remedial teaching, the participant will meet with the Course Director or delegate to undertake

reassessment. Two examiners must be present during the retesting. If the participant correctly answers

enough incorrect questions to receive a pass mark, they pass the OSCE and are able to continue on the

course. The participant is identified as at risk; see Section 1.5: At risk participant.

If the participant is unable to answer incorrect questions correctly, they fail the course and are not issued

with a completion certificate. However, the participant may request a certificate of attendance if they

meet criteria outlined in Section 1.1 and 1.2.

DAY 3 OSCE:

Day 1 OSCE

PASS Score ≥17 Continues on ETM course

FAIL Remedial teaching

& resit

PASS - continues ETM program

*identified as at risk participant

FAIL - can continue program but wil NOT be issue with certificate of

completion, can sit day 3 OSCE

Day 3 OSCE

PASS ≥ 16 If passes MCQ issued

certificate of completion

FAILRemedial teaching

& resit

PASS - if passes MCQ issued certificate of

completion

FAIL - wil NOT be issued with certificate

of completion


After remedial teaching, the participant will meet with the Course Director or delegate to undertake

reassessment. Two examiners must be present during the retesting. If the participant correctly answers

enough incorrect questions to receive a pass mark, they pass the OSCE and are able to continue on the

course. If the participant is unable to answer incorrect questions correctly, they fail the course and are not

issued with a completion certificate. However, the participant may request a certificate of attendance if

they meet criteria outlined in Section 1.1 and 1.2.

Day 3 MCQ

Participants will meet with the Course Director or delegate to discuss incorrect answers on the MCQ. If the

participant correctly answers enough incorrect questions to receive a pass mark, they pass the course and

are issued with a certificate of completion. If the participant is unable to answer incorrect questions

correctly, they fail the course and are not issued with a completion certificate. However, the participant

may request a certificate of attendance if they meet criteria outlined in Section 1.1 and 1.2.

FORMATIVE ASSESSMENT

There are seven (7) formative assessments during the ETM course. These occur on day 1, 2 and 3 of the

ETM course. Formative feedback and assessments of participants’ performance is to take place during

small group sessions and simulated trauma scenarios. Participants will receive a rating by instructors of

either: fail, borderline, pass, potential instructor. Please see rubric.

Formative assessments do not contribute to course grades; it provides an opportunity for participants to

improve their performance prior to summative assessments. Formative assessment also assists in

identifying “at risk” participants. The course director or delegate will offer participants scoring multiple

borderline marks or fail marks remediation.

Feedback to participants should enable them to monitor their progress towards the course learning

outcomes, and to determine where improvements can be made to improve their learning. Participants are

to be provided with constructive feedback as soon as practicable in all small skills sessions and trauma

scenarios.

Day 3 MCQ

PASS ≥ 16 If passes day 3 OSCE issued certificate of

completion

FAILRemedial teaching

& resit

PASS - if passes MCQ issued certificate of

completion

FAIL - wil NOT be issued with certificate

of completion


Participants cannot solely pass or fail the course based on formative assessment results; however,

progression through the summative assessment is dependent upon the successful completion of formative

assessment. To be issued with a certificate of completion, the participant must have no more than two (2)

fail marks on formative assessments.

To pass simulated trauma scenarios on day 2 & 3 of the course participants MUST:

✓ Succinctly synthesise the trauma case to the trauma team ✓ Demonstrate clear role allocation ✓ Use effective communication to delegate tasks ✓ Demonstrate closed loop communication ✓ Shared their mental model ✓ Correctly identify life threats and manage according to evidence based principles/best practice ✓ Demonstrate the ability to maintain self-control in the simulated clinical setting under stressful

conditions.


CRITERIA FAIL BORDERLINE PASS POTENTIAL FACILITATOR

Communication & teamwork

Trauma management

Uses lay language and requires

extensive structured guidance to

communicate with team.

Shows minimal understanding of

trauma management.

Does not detect life threats &

implements incorrect management

Major omissions or actions likely to

result in harm

Rude, dismissive or argumentative

with team members/instructors

Not receptive to feedback

Uses some discipline specific language

and requires limited guidance to

exchange information with team

Shows limited understanding of

trauma management

Detects some but not all life threats

Requires occasional prompting for

correct management

Heavily reliant on team

Receptive to feedback

Communicates professionally

using discipline specific

language and demonstrates a

satisfactory understanding of effective

communication

Shows adequate understanding of

trauma management

Detects all life threats

Correct management

No/minor omissions


Communicates professionally to

negotiate and assert own

values while respecting the

contribution of others

Shows advanced understanding of

trauma management

Confident, organised approach

Positively interacts with team


Problem-solving & critical

thinking

Utilises a basic structure to understand

clinical data and manage trauma

patient

Utilises a structured format to

synthesise and analyse clinical

data and manage trauma patient

Utilises critical thinking and works

collaboratively to synthesise, analyse

and produce innovative and creative

solutions to manage trauma patient

Utilises sophisticated critical

thinking and analysis to initiate

evidence-based trauma management

Planning and management Demonstrates limited use of reflective practice to organise information

establish and develop team leader role

Demonstrates minimal use of

reflective practice to organise

information, establish and develop

team leader role

Effectively organises information using

self-determined structures and

applies reflective practice to

develop team leader role

Uses reflective practice to

articulate visions, goals and

innovative strategies to

develop team leader role and


Effectively manage team.

Initiative Requires extensive guidance to manage a trauma patient, lacks a

structured approach

Requires some guidance to manage a

trauma patient, at times implements

structured approach

Performs the role of team leader

competently, requires no prompts to

manage patient.

Demonstrates intuition and insight

during simulation. Performs the role of

team leader confidently and

competently, requires no prompts to

manage patient.

Use of equipment /

technology

Skills session

Limited ability to uses technology and

resources to find and generate

Information /data.

Participant demonstrates

• minimal participation during skills sessions

• significant knowledge gaps

• Unable to demonstrate skills/knowledge taught in session despite feedback

• Disruptive or rude behaviour

• Poor response to feedback (e.g. argumentative, lacks insight)

Uses technology and resources

with some degree of guidance to

find generate information /data.


• Limited participation during skills sessions

• Minimal knowledge gaps • Able to demonstrate

skills/knowledge taught in session post feedback

• Distracting or intrusive to other group members – fixed ideas

Shows a high degree of sensitivity and

proficiency in the application of

technology and resources to

generate information/data.


• Active participation

• Answers questions

• Able to demonstrate skills/knowledge taught in session

• Receptive to feedback & new ideas

Shows a complete

understanding and appropriate

mastery in choice of technology

and resources to generate

information /data


• Extensive knowledge

• Positive interaction with group

• Willing to teach other group members

• Receptive to feedback & new ideas

28

AT RISK PARTICIPANTS

1. As soon as problems or concerns regarding a participant’s performance and/or behaviour appear, the Course Director or delegate will raise them with the participant.

2. The participant will be given clear evidence or examples to demonstrate that their performance and/or behaviour is unsatisfactory.

3. Remedial/corrective teaching will take place to ensure that the participant possess the necessary knowledge, skills and behaviours to implement trauma management as per best practice guidelines.

4. Ongoing contact and daily feedback on performance by the faculty is to occur whilst the participant is “at risk”.

5. If it appears that the participant has reached the agreed expectations, then the “at risk” process will come to an end and the participant will pass the formative assessment. The participant will continue to be closely monitored by the faculty for the remainder of the course.

6. If it appears that satisfactory progress has not being made, the participant will be awarded an unsatisfactory grade for their formative appraisal. Dependent on the outcome of the summative assessment the participant will pass or fail the ETM course.

7. Participants cannot solely pass or fail the course based on formative assessment results; however, progression through the summative assessment is dependent upon the successful completion of formative assessment. To be issued with a certificate of completion, the participant must have no more than two (2) fail marks on formative assessments.

COMPLAINTS & GRIEVANCES

ETM is committed to providing participants with an education of the highest possible quality;

as such, we welcome participant feedback. In the event a participant encounters a difficulty

or concern and believes he/she has been treated unfairly during the assessment following

steps should be followed:

The participant is to outline their concerns and/or issues with objective data in a constructive

manner. The email will be sent to the ETM Education Committee and:

a) State the ground(s) for appeal/grievance b) Provide relevant evidence relating to the ground(s) for appeal/grievance c) Where available, attach relevant documentation d) Clearly state the sought outcome

The ETM Program Director or delegate will respond in writing within 7 (seven) working days.

29

Appendix B: Instructor Scenario Debriefing Tool

Advocacy-Enquiry Model

Post-scenario phases:

Reactions to scenario

• Clear the air, take a breath!

• Review the facts of the case (can ask participant to summarise)

• Set the stage for addressing learning objectives via debrief/feedback

Understanding

• Explore what happened, unpack frames through advocacy–inquiry (see below)

• Apply good judgment and teach, moving participants to new understanding or skills

• Generalise lessons learned to real situations

Summarise

• Review lessons learned

• Discuss take-away lessons learned that will can applied in future events

Participants frames are comprised of their pre-existing knowledge assumptions and feelings

Frames drive actions.

Actions produce clinical results in the simulation scenarios

The aim is to uncover the participants internal frame, and help them reframe internal

assumptions/feelings, and take new actions to achieve better results in the future.

30

The idea is not to pass judgement on their actions, but to be a “cognitive detective” and

explore, with genuine curiosity, the knowledge, feelings and assumptions that lead them to

perform certain actions.

i.e. Do not to simply tell participants what they did wrong, and what the right thing to do

would have been. Instead, uncover their frames, get them to analyse/reflect on their

actions, and get them to re-frame and come up with solutions.

ADVOCACY: is a type of speech that includes an objective observation about, and subjective

judgment of, the participants actions.

EXAMPLES: (what you saw, observed or noticed, and the effect/consequence)

“I saw that when you detected the pneumothorax, you stopped to decompress the

chest, rather than complete the initial assessment, which delayed you finding the

pelvic fracture”

“I noticed that when the patient deteriorated, you advised the team to prepare the

patient to go to CT, but the team seemed hesitant to do this, which caused some

confusion and delay”

“When you decided to intubate, I heard the team tell you that the patient was

hypotensive, but you proceeded to administer the RSI drugs and the patient

deteriorated after that”

INQUIRY: is a genuinely curious question that attempts to illuminate the participant’s frame

in relation to the action described in the instructor's advocacy.

EXAMPLES: (aim is to discover the participants frames & rationale for their action/s)

“What was going through your mind at that stage”?

“Tell me what was going on for you at that point”?

“Tell me more about that” (repeat/drill down to uncover more)

(Notice the absence of the word “why”! i.e. don’t simply ask “why did you do that”?!).

This should draw out a reflective response from the participant.

Can follow this up with a prompt to re-frame their thoughts:

“If you were faced with this same situation again, how might you approach it?”

“How might you approach a similar case/situation next time”?

“If you were to manage this case again, would you do anything different”?

31

Appendix C: ETM Simulation Prompts

32

Appendix D: Instructor FAQs

What is the ETM Course? The Emergency Trauma Management Course is a new medical short course, designed by Emergency Physicians to teach Emergency Medicine practitioners "how we really manage trauma in the ED".

Who is the target audience? The target audience for the course is Emergency Registrars. However, we hope that FACEMs with an interest in improving their trauma skills, and folks from other specialties (including Anaesthetics, ICU and Surgery) as well as Rural and Remote GP's will be attending.

How many participants are there on each course? A maximum of 24 participants and 4 nurse observers can attend each course. Participants are divided into 4 groups (6 participants and 1 nurse observer per group)

Is ACEM Involved? Lots of people have asked us "so who's running this, the College?". The short answer is "No. Currently ACEM is not involved.”

Who owns the ETM Course? Andy Buck is the director and sole owner of Emergency Trauma Management Pty Ltd, the company that owns the ETM Course.

Is the ETM online manual kept up to date? Several guest authors have generously written chapters for the manual. The manual is reviewed and edited by qualified trauma experts, as well as by education experts to ensure the content is valid.

What is the educational philosophy behind the ETM Course? The main educational principles we are using to guide the design of the course include Learner Centered Learning and Experiential Learning, as well as some of the more traditional concepts of adult learning. We have incorporated some Instructional Design methods into our processes as well.

What can I do to prepare for the course? There are several things you can do to prepare to instruct on the ETM Course, especially if you haven't taught on a course before.

• Read the instructor guide

• Watch the videos on the instructor video page, in particular the scenario and debriefing videos

• Review the relevant sections of the ETM Course Manual

We not only want instructors to be good teachers on our courses, but we hope to provide them with skills they can take back to the workplace and use in their day to day teaching. ACEM has defined "Scholar" as a core competency, and we hope to provide

http://etmcourse.com/instructor-videos/http://manual.etmcourse.com/

33

instructors with some knowledge and skills that will help them achieve this role - mainly with regard to teaching competency:

Source: http://www.acem.org.au/media/publications/FEH03_v01_Fellowship_Curriculum__Mar-06_.pdf

Can I claim CME for instructing on ETM Course? As a course instructor, you are eligible to claim 22 hours teaching time. Please contact us at [email protected] if you require a letter to confirm that you have instructed on ETM Course.

mailto:[email protected]://etmcourse.com/wp-content/uploads/2013/04/FACEM_scholar_competencies.png

34

Appendix E: The Nurse Observer role

Trauma nursing requires a specialised body of knowledge and skills. In order to implement

optimal care, nursing management of the trauma patient is founded upon a framework of

technical competencies and critical thinking skills.

A maximum of 4 nurse observers can attend each ETM Course.

Nurse Observers pay $550 including GST to attend, so as paying participants, they must be

actively included in course activities as set out below.

PRE-COURSE

• Manual access: The nurse observer will receive access to the ETM online manual.

• Online lectures: The nurse observer is required to view the online lectures prior to

course attendance

INVOLVEMENT DURING THE COURSE

Small Group sessions

The Nurse Observer should be included in small group discussion sessions.

If the course is at capacity (i.e. 6 participants per group), the Nurse Observer may not be

able to participate actively in the RRM/dominos session but should be included in the

discussion.

Procedure sessions

The Nurse Observer will observe procedural session. At the discretion of the instructors,

time permitting and depending on equipment availability, the Nurse Observer may be able

to actively participate in procedural skills practice.

Scenarios

The Nurse Observer will be able to actively participate in the simulation scenarios. The

course director who delivers the scenario-demo should mention that the groups that have a

nurse observer will be able to actively participate in the scenario and they should be made

use of!

During the simulation scenarios, the Nurse Observer will be attached to one pair of

instructors and stay in one room for each round of scenarios. This way they will get to

participate in each scenario 3 times (or 6 cases in total).

Instructors must pre-brief the Nurse Observer prior to commencement of the scenario,

including:

35

• Simulation case details

• Roles/responsibilities

• Debriefing will be focused on team leader

The opportunity for debriefing the Nurse Observer after the end of the scenario round (after

the last group has finished) should be offered.

Nurse will act in a confederate role and only attend duties as directed by the Team Leader.

Examples of duties that can be allocated to Nurse Observers include:

• Attaching monitoring

• IV access

• Drug administration

• Assistance with intubation (airway nurse role) or other procedures

• Wound management

• Extra duties as deemed necessary by Team Leader

If the Nurse Observer would prefer to sit-out and just observe the scenarios, this should be

facilitated by the instructors.

ASSESSMENT

Pre and post course MCQ’s

The nurse observer is required to complete the pre and post course MCQ’s. If a pass mark is

not obtained for the post course MCQ, the course director must personally review incorrect

answers with the Nurse Observers and facilitate the opportunity to provide correct

responses.

OSCE’s

Nurse Observers are not required to sit the OSCE station. Therefore, on day 1 the Nurse

Observers can leave early if they desire.

FEEDBACK

Nurse Observers should complete a post-course feedback form.

CERTIFICATE

The nurse observer will be provided with a certificate of 22 hours attendance at the

completion of the course. In order to be awarded the certificate, the nurse observer must

attend all timetabled teaching sessions of the program.

36

Appendix F: Manikin use and handling

Laerdal Manikins are used on ETM Course. Manikins can be intubated but you can’t see

chest rise/fall. They are fairly flexible and sturdy but can’t have any procedures done on

them except airway management. Monitor leads can be attached to the ECG dots on their

chest.

Tips for procedures

IV access can be done by taping the IV/RIC to the arm/leg

• IO can be done by taping the IO to their leg/arm (Some scenarios involve not being

able to obtain standard IV access and they’ll have to resort to RIC/IO insertion).

• ICC insertion can be done by taping the ICC to the side of the manikin’s chest

Handling

Please note that manikin handling is strictly at two-person task.

Out of Box

1. Remove manikin legs from the box

2. One person should stand on either side of the box

3. Remove manikin chest plate

4. Facing the manikin hips, each person should kneel next to

the box

5. Grasp the chest cavity with the hand closest to the box,

and lift the manikin arm with the remaining hand

6. Co-ordinate the lift

7. Lift with your legs, ensure the mannequin is held close to

your body and your back is straight

8. Place mannequin on table

Room to Room

1. Remove manikin chest plate

2. One person to stand at the end of the table, between

manikin legs

3. One person to stand at the side of the table, next to

manikin chest

4. Slide manikin down the table, to allow the person at

the end of the table to grasp both legs

5. The person at the side should grasp the edge of the

chest cavity

6. When ready, co-ordinate the lift and carry manikin to required location

37

Lifting manikin into box

• Remove manikin legs

• With manikin torso on the table, one person should

stand on either side and face mannequin hips

• Remove the chest plate

• The hand closest to the table should grasp the edge of

the chest cavity

• The remaining hand should hold the manikin arm

• Lift manikin off of the table

• Move manikin toward box

• With manikin over the box, lower yourself by bending your knees and straightening

your back

• Slowly lower the manikin into the box

38

Appendix G: Equipment setup

NB: The coordinator will ensure that the equipment is set up in the allocated room.

Session Equipment

Small Group/Procedures Day 1

Room 1

Initial Assessment

INITIAL ASSESSMENT BOX

1) Mannequin x 2 2) Trestle table x 2 3) iPad x 2 (2 x red) plus iPad stands

Room 2

Airway 1: Basic manoeuvres and Intubation

AIRWAY 1 Box

• TruCorp Mannequin head

• Mannequin x 1

• Trestle table x 2

Room 3

Chest Decompression

CHEST DECOMPRESSION Box

• Mannequin with chest cut out plus foam/skin inserts


Room 4

Circulation: IV/IO Access, RIC

CIRCULATION/VASCUALR ACCESS Box

• Trestle tables x 2


Room 1 Human Factors/Teamwork/RRM • Domino bags x 4 - 6 dominoes in each bag

Room 2

Airway 2: Difficult Airway

• AIRWAY 2 Box

• TruCorp Mannequin head

• Mannequin x 1


Room 3

Devices: Pelvic Binders, Donway

• Mannequin x 2


• Pelvic binder x 1

• CT 6 x 2 (In small back and blue bags)

Room: Lecture theatre

Traumatic Arrest and ED Thoracotomy

• Projector

• Laptop with slideshow loaded

• Finichietto rib-spreaders (in CT6/Vortex/thoracotomy

box)


Lecture room

Trauma Radiology

• Projector


39

Room 1

Spinal Trauma: C-collar, Log Roll

• Collar – Stiff neck Sets x 2 (blue zip-up bags)

• Mannequin x 1 (may need a 2nd – check with instructors)

• Trestle table x 1 (or 2 if 2 mannequins used)

Room 2

Transport and Retrieval

• White board and makers (Projector no longer required)

Room 3

Lateral canthotomy

• Lateral canthotomy box

• Projector


Scenario 1, 2, 3, 4 (Days 1, 2, 3)

Each scenario room needs:

• Mannequin x 1

• Trestle table x 2 for mannequin and equipment

• iPad x 2 (1 x red, 1 x black in each room)

• IV Pole

• Scenario assessment sheets

• Instructors will bring Scenario folders/x-rays

40

Appendix H: Sample Instructor Timetable

ETM Inst ruc tor

Timetab le Melb

March 2018.xlsx

Introduction to instructing on ETM CoursePre course informationInstructor portal and ETM trauma manual log in detailInstructor Training/MentoringSigning up to instruct on a courseFaculty confirmationCancellationInstructor entitlementsPre course preparationCourse start and finish timesFlights to and from course locationsCar travel to and from course locationsAccommodationReimbursement for travel expensesPrepaid Visa cardsCourse EntertainmentRole of the course coordinatorInstructor Profiles/ETM website

Course contentDay 1Pre-arrival briefing 08.00 – 08.20Morning LecturesSmall Group ProceduresAfternoon LectureScenarios 1.1Testing: Airway and Chest Decompression OSCE

Day 2Morning LecturesAfternoon LectureScenarios 2.1Scenarios 2.2

Day 3Morning LecturesSmall Group ProceduresScenarios: 3.1Final testingPost Course MCQ and FeedbackFinal summary

General informationAssessmentDebriefing and Feedback

APPENDICESAppendix A: ETM Course Assessment Policy (Updated Feb 2019)Appendix B: Instructor Scenario Debriefing ToolAppendix D: Instructor FAQsAppendix G: Equipment setupAppendix H: Sample Instructor Timetable

emergency trauma management course course instructor manual … · 2019. 11. 27. · as an etm...

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