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Managing Emergencies in Primary Care A Resource pack for running simulationsDr. Eric Britton MD MPH MRCGPProgramme Director ST ǯ London Deanery 2 Introduction: Primary Care Emergencies London Deanery 2010 Introduction: The purpose of this resource pack is to provide Programme Directors and Trainers with a means of preparing GP Specialist Trainees ;^d͛ƐͿ to deal with emergency situations in the primary care setting.The London Deanery has recognised that acute emergencies are rare in primary care and it ispossible that a ST will not have the opportunity to contemporaneously experience an emergency inwhich to learn and practice skills during the GP portion of their training; therefore not fulfilling amajor part of the RCGP Curriculum. ^ŽŵĞŵĂLJĨĞĞůƚŚĂƚƚŚĞ^d͛ƐǁŝůůŐĞƚƐƵĨĨŝĐŝĞŶƚ experience in managing acute emergencies during thesecondary care portion of their training, but there are several reasons why it is felt that specifictraining for the primary care setting is essential. With the expansion of training in GP from 12 to 18 ŵŽŶƚŚƐĂƚƚŚĞĞdžƉĞŶƐĞŽĨƐĞĐŽŶĚĂƌLJĐĂƌĞƚƌĂŝŶŝŶŐ͕^d͛ƐǁŝůůďĞĞdžƉŽƐĞĚƚŽĨĞǁĞƌŽƉƉŽƌƚƵŶŝƚŝĞƐƚŽ experience acute emergencies due to the lower prevalence in primary as opposed to secondary care.Moreover, with the move to create secondary care posts located predominantly in outpatientdepartments or in future poly-clinic type facilities, the opportunity for emergency care experiencewill be decrease even more over the full scope of GP training.However, the most important reason for the creation of this resource pack is the problem of context ͘dŚĞĐŽŶƚĞdžƚŝŶǁŚŝĐŚŵŽƐƚ^d͛ƐŽďƚĂŝŶĂŶĚƉƌĂĐƚŝĐĞƚŚĞƐŬŝůůƐĨŽƌƉƌŽǀŝĚŝŶŐĐĂƌĞ for acuteemergencies, e.g. ALS, PALS etc., is in the bosom of the hospital network; a network where a team of similarly trained and practiced professionals are present with resources, e.g. defibrillators, venflons,emergency medications etc., close to hand. Moreover, the teams get to practice with someregularity these skills on real cases.In contrast in primary care, although the materials are usually available and maintained just in case asituation should arise, these skills are rarely used. Moreover, the supportive practitioners (nurses,receptionist and fellow clinicians), although receiving yearly training; may wait years before they getto practice their skills on a real case. Furthermore, the ST, being transplanted from the relativelystandardized and familiar context of the hospital or outpatient department to a new and much morevariable primary care setting, will be disoriented and relatively isolated if confronted with a patienthaving a life threatening event. Finally, many ST ͛ƐǁŚŝůĞŚĂǀŝŶŐƉĂƌƚŝĐŝƉĂƚĞĚŝŶƚŚĞƉƌŽǀŝƐŝŽŶŽĨ emergency care will never have taken the responsibility for directing the care, being the leadclinician during the emergency.Although knowing what to do intellectually, practicing their skills in a non-hospital setting is verydifferent on a qualitative level. Assumptions shared by a team of hospital practitioners who dealwith emergencies on a daily basis are not present. The ST will need to be clearer in what they areasking for, instructing inexperienced colleagues in moments of heightened emotional tension clearlyand exactly. In addition they may need to improvise, not following the standard algorithms, due to alack of materials available. The scenarios in this resource pack have been structured to providerealistic situations in primary care. They have been trialled with a 2 focus groups ŽĨ^d͛ƐǁŚŽƌĞƉŽƌƚ that it was not the knowledge that was difficult but the setting and feeling of being more alone andunsupported that was important in the role plays. 3 Introduction: Primary Care Emergencies London Deanery 2010 ŽƚŚƐĞƚƐŽĨ^d͛ƐƚŚŽƵŐŚƚƚŚĂƚƚŚĞŽƉƉŽƌƚƵŶŝƚLJƚŽƉƌĂĐƚŝĐĞďĞŝŶŐŝŶĐŚĂƌŐĞĂŶĚŵŽƌĞĂůŽŶĞǁĂƐĂŶ invaluable experience. In addition, feedback from programme directors, actors acting as role playersand physicians who are experienced in both primary care and emergency medicine were canvassedto ensure that these scenarios were realistic and pertinent to the objectives of the exercise.It is hoped that this resource pack will provide a means of providing experience of emergencies inthe primary care context and thus provide more confidence to allow better provision of emergencycare ďLJ^d͛Ɛ over their GP careers. These scenarios do not replace basic training in BLS, ALS, or PALS. <ŶŽǁůĞĚŐĞŽĨƚŚĞƐĞƐŬŝůůƐŽŶƚŚĞƉĂƌƚŽĨƚŚĞ^d͛ƐŝƐĂƐƐƵŵĞĚ . These scenarios intend to build on thosebasic skills through experiential application. 4 Objectives Primary Care Emergencies London Deanery 2010 Objectives 1. To provide experience of common Primary Care Emergencies that although common are ƌĂƌĞĞŶŽƵŐŚƚŚĂƚ^d͛ƐŝŶƚƌĂŝŶŝŶŐŵĂLJŶŽƚĞdžƉĞƌŝĞŶĐĞƚŚĞŵĚƵƌŝŶŐƚŚĞŝƌƚƌĂŝŶŝŶŐ͘ 2. dŽƉƌŽǀŝĚĞW͛ƐͬƚƌĂŝŶĞƌƐǁŝƚŚ suggested materials to run a seminar addressing Primary CareEmergencies in total or in part.3. To provide a flexible series of case scenarios so that they can be re-used in the same sessionor repeated within a 3 year cycle.4. To provide a list of available or easily obtainable resources for the staging of a seminar.5. Scenarios are to allow for the ST toa. Use knowledge already knownb. Practice clinical skills necessary to treat the patientc. Practice decision making, negotiation, and use of services in a safe but realisticsituation.d. Refine leadership skills in an emergency situatione. Reflect on the communication skill required when dealing with patients andcolleagues in these situations.6. BLS with AED training, PLS, & ALS should be addressed under a different venue but itsprinciples are assumed to be used and understood in these scenarios
