Human factors in theatres at any one time.
l How this would be accurately communicated and presented in an efficient and precise manner for those in the incident command centre.
l What equipment needed to be identified and protected, initially, to support ongoing patient care.
l Were staff all familiar with the evacuation routes that could be taken when moving a patient to another area mid-operation?
From this, materials were developed to create a document that could quickly detail where staff and patients were and the medical status of those patients, to enable the ICC to plan for evacuations, which could be tested in a live exercise. After the success of the tabletop exercise, CFRS were keen to engage in a live fire evacuation exercise. Smith et al (2011) describe a live fire exercise as a term originating from the military to describe training in a realistic scenario, utilising specific equipment in real time, alongside environmental adjuncts.7 In order to create realism and to establish
and test existing plans, the idea to undertake a live fire exercise was proposed to the Trust’s chief operating officer, the director of operations for surgery and the general manager for critical care, and a request was made to undertake the exercise on a clinical governance afternoon, within the elective theatre suite, with a fully establish multidisciplinary team of staff within the operating theatre and the hospital clinical site management team. This was agreed and the department was positively encouraged to proceed with the exercise by the senior management team. Gopee and Galloway8
describe that, with any project, it is vital to address and gain the support of senior Table 1. Aim and objectives for live fire exercise
Aim: To test the Trust’s ability and the theatre fire plan in responding to and managing a fire in the elective theatre suit.
Objectives: l To activate and communicate the Trust response within the local area.
l To initiate the Trust agreed command and control structure, and activate the appropriate incident control centre.
l Management of the incident to include the use of the joint decision-making tool, and share situation awareness.
l Recognise the need for and evidence correct record keeping.
l To provide an opportunity for multi-agency working, using JESIP principles.
l To allow area managers and Tactical Commander’s the opportunity for dynamic risk assessment.
l To exercise test media enquiries.
management from the earliest opportunity, so that, through initial engagement and development, all areas that could affect clinical care and operational capacity are addressed and issues rectified before proceeding, to prevent delay to the end project. Ethical consideration was undertaken. The objective proposal would only consist of staff employed by the organisation and members from the contributing organisations, and no patients were to be affected by this exercise. This included all pathways of patients through the department. Services to provide non- elective surgery must not be interfered with. All staff who were rostered for duty that day were contacted a month in advance to inform them that an emergency exercise was going to be undertaken, which would contain simulated smoke and distressing situations. Imaging and video would also be taken. All staff that wished not to participate were asked to contact the clinical coordinator for theatres in advance, so that they could be allocated outside of the designated exercise areas.
Joint meetings between all parties, both
internal and external, were undertaken – where appropriate objectives and scenarios were discussed to make the most of the unique opportunity (see Table 1 and 2). To create further realism within the scenario,
a smoke machine was utilised to simulate a poor visual environment. This is known as fidelity. Fidelity, as described by Lame and Dixon- refers to the extent to which simulation
Woods,9
reproduces the experience of the real-world situation it aims to replicate. Beaubien and Baker10
state that, to increase fidelity, it must
be developed and based on three dimensions: psychological, environment and equipment, each, in turn, affecting the choices made to meet the learning outcome of the exercise. Tun et al reports that all three dimensions of fidelity are essential to validate the scenario by creating an accurate representation of real-world stimuli
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