gms | German Medical Science

Introduction: Procedural sedation and analgesia is an integral component of the skill set of the modern Emergency Physician, employed to enable a broad range of medical procedures to be tolerated by patients without undue pain or suffering. It is practised on a daily basis, to varying degrees and using varying techniques and drugs, in all UK Type 1 Emergency Departments (which have resus room facilities). It is important to note that procedural sedation is a form of anaesthesia, covering a continuum from anxiolysis through to (but not including) general anaesthesia. For it to be practised both effectively and safely it is vital to approach procedural sedation broadly as one would general anaesthesia, with a similar process of planning, pre-assessment and checks.

Objectives: To develop an infrastructure that delivers high quality sedation and has provision for training and teaching both ED medical and nursing staff built-in.

Materials & Methods: Emergency Medicine Registrars working in areas of the Emergency Department where conscious sedation is performed (the resuscitation room) were the participants in the procedural sedation simulation training. Prior to the training session, the participants read the Royal College of Emergency Medicine (RCEM) Procedural Sedation in Adults Clinical Audit 2015-2016. Their theoretical knowledge and experience were both then assessed in the following categories: previous sedation experience, knowledge of drug pharmacokinetics, number of previous rapid sequence intubations, management of common sedation complications, knowledge of equipment and presedation assessment and familiarity with departmental protocols and policies. They were then allowed to demonstrate 3 supervised procedural sedations using a high fidelity mannequin (SimMan3G) and rate their experience. Mean participant rating of the educational session was 4.75 (1=poor, 5=excellent).

Result: 10 Emergency Medicine Registrars participated in the training. Mean participant rating of the educational session was 4.80 (1=poor, 5=excellent).

Conclusion: Simulation provides an effective method for teaching procedural sedation in the Emergency Department to eligible Emergency Medicine Registrars. Further objective theoretical testing of knowledge is planned for the future in the form of an online module for self-assessment. However simulation provides an excellent constructivist method to assess practical skills.