A simulated disaster provides a roadmap for rescue

Approximately 80% of all medical errors are due to misunderstandings. One high-risk area is handoffs between healthcare providers such as paramedics and nurses.

“When a disaster occurs, it is critical to have a clear chain of command where everyone clearly understands their roles and responsibilities,” said Kris Caudill, a student in the Fire and Emergency Response Administration program at Metropolitan State University of Denver.

Caudill will assume the role of incident commander for a simulated carbon monoxide leak on November 16 at MSU Denver. It is part of an applied interprofessional education program comprised of Denver Health’s EMS training program and the university’s nursing and FERA programs. The goal is to reduce misunderstandings and improve patient care, potentially helping to reduce deaths due to medical errors.

Scott Heiss, an associate professor at FERA and retired training director for Denver Fire Station 28, is coordinating the effort as part of his National Response course at the Emergency Management Institute.

“Whether an engine manufacturer is called to a dumpster fire or a multi-story high-rise building, every incident needs a dispatcher – that’s where it all starts,” Heiss said.

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The challenge, he added, is that too often responders are first exposed to the intricacies of incident response at the scene.

“This opportunity gives students the opportunity to work hands-on with other agencies and disciplines to see how to properly utilize the system they encounter at work,” Heiss said. “It’s an invaluable experience for them.”

Mark Whitright, principal instructor of Denver Health’s EMT school at MSU Denver, shared this sentiment and pointed to terminology confusion as a potential factor in patient handoff errors.

“Is it a stroller, a carrier or a stretcher? “What exactly does ‘triage’ mean in this situation?” he asked. “The more we can emphasize the importance of communication integration, the better we can provide our patients with the best possible care.”

After scenario carbon monoxide detection and emergency responder classification, simulated patients are handed over to nursing students in the newly opened Gina and Frank Day Health Institute Interprofessional Simulation and Skills Laboratory (Sim Labs).

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Mary Tucker, DNP, director of Sim Labs, used the pandemic as an example of why the interprofessional approach is critical to formulating a public health response strategy.

“An exercise like this is important to help our students understand how healthcare professionals interact with each other and how students can learn from mistakes in a safe environment,” Tucker said.

Caudill, a former Air Force medic, found herself accepted into the FERA program after running to help a friend whose house had caught fire. Experiencing the care and competence of the first responders proved to be a continuation of their mission.

“I saw what the fire department was doing and that confirmed it for me,” she said. “You see people on their worst days and try to make a difference.”

In the role of operations commander, she will use a framework called a “strategy prompter” — essentially a flowchart for setting up the command post and then dividing tasks into a clear, coordinated chain of command to establish priority areas.

It follows the response protocols established by the National Incident Management System, which Heiss describes in detail in his FERA course. NIMS was founded in the 1980s to fight fires in the Arizona wildlands and rose to prominence after the terrorist attacks of September 11, 2001, when then-President George W. Bush ordered first responders to establish a common language in mass rescue and recovery efforts. The format is still widely used today, including for planning events in Denver such as the 2008 Democratic National Convention and the National Western Stock Show.

Heiss says one of the keys to its effectiveness is maintaining simplicity at scale: Even as a scenario grows, each individual responder never speaks to more than five others at the same time, streamlining logistics to prevent misunderstandings.

That doesn’t mean mistakes will never happen. But with coordination and scenario training, Caudill and these real lifesavers work to ensure they don’t happen when lives are at stake.