I am thinking about purchasing the ACLS scenario package for SimMan.  I think the price is rather steep, having looked at the simplicity of the programmed scenarios, however the related material with objectives etc. is very helpful for our new instructors.  And to be honest, I am too busy to start programming all of these, so the price may be worth the convenience.

Has anyone out there used them?  Any feedback?

Also, I can't even order off the Laerdal Canada website.  And the US website has an increased price (approx $4100) compared with the prior price.  What is going on with the price increase?  Anyone from Laerdal care to comment/help?  (Bruce????)

Thanks

Randy

 

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Randy Wax, MD, MEd, FRCPC
Medical Director, Program for Resuscitation Education and Patient Safety (PREPS)
Mount Sinai Hospital, Toronto, Canada
Assistant Professor, Critical Care,
University of Toronto
rwax@mtsinai.on.ca
http://www.mshpreps.org

Hi Randy,

The ACLS scenario package was developed and validated in conjunction with the American Heart Association to provide a complete curriculum integration solution for SimMan users to teach 2005 guideline compliant ACLS. The package includes 31 preprogrammed scenarios, the ACLS Instructor and Provider Manuals, and other comprehensive supportive materials.

The introductory pricing offer has expired but I would suggest that even at $4100 (approximately $125 per scenario) this is excellent value. I will be happy to put you in contact with your local Territory Manager so that you can continue a discussion on pricing and ordering processes, and I will contact you offline to follow up.

 Once again, many thanks for your comments and contributions to the Discussion Forum.

 All the best,

Bruce     

Hi Randy and Bruce,

I agree that the price seems a little high but I don't have the time to program all the scenario's into practice, training and testing situations.  I would also be very cautious about the fact you have to follow the guidelines exactly with no real wiggle room from what I have done on the computerized ACLS program (which drives me crazy because I want to order several things all at once). 

My facility is looking at starting a live ACLS program for the 5 hospitals and the other clinics we have along with allowing others to take the class as well.  I would much rather buy the program than do it from scratch and make a mistake.

 Also, SHS is going to be partnering with a Med School out of Calif soon and I am looking at doing a lot more simulation on a very different level than I have been doing.  The next few years are going to be very different and go by very fast!

 Dani

I want to throw in my opinion. We have the ACLS scenarios and they are awesome. They are so easy to use. I agree with Dani about writing the scenarios. It would take too much time for me to try to match. We used them straight out of the box without any prep work, and they worked perfectly. The comments made during the scenarios are very helpful for the students as well. Even though the price is steep, I think that they are well worth the money!

- Jason

Jason,

Does the ACLS package go into the Advanced ACLS at all?  We have an ED Dr that is wanting to do more of the Advanced ACLS instead of the Basic ACLS for his crew.  Right now I am writing the scenarios but if they are already in this pack I won't need to do this and can just wait for it to arrive and go from there.  I have my fingers crossed but not holding my breath...

Dani

Well folks, I went ahead and ordered the package. We used it for an ACLS Instructors course and a 2-day new provider course.

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Randy Wax, MD, MEd, FRCPC
Medical Director, Program for Resuscitation Education and Patient Safety (PREPS)
Mount Sinai Hospital, Toronto, Canada
Assistant Professor, Critical Care,
University of Toronto
rwax@mtsinai.on.ca
http://www.mshpreps.org

Hi Dani,

The ACLS scenarios start off very basic (one shock to recovery, learning to pace, etc...) Then they build on that knowledge. They proceed up through MegaCode. In the MegaCode the students will have to apply a couple different algorhythms to successfully rescue the patient. My favorite scenario is the VF3, where the patient has pain like he has never had before. The students try to talk to him, but if you watch the monitor you can see the increasing ST segment before he goes unconscious into VF. I think that any physician at your facility will be pleased with these scenarios.

Randy,

I appreciate your input on these scenarios as well. You are right, they are not perfect. Like you said, I would not want to try to build these scenarios from scratch. One of the things I like about these scenaros is that they are AHA approved/formulated. This is important to me because we are trying to have everyone learn the same ACLS protocols; no matter where in the world you learn it or use it. I agree the scenarios were worth the money.

Have a great day,

Jason

Randy and Jason,

Thanks so much for the input!  I really appreciate it.  It looks like the ACLS live program will be happening so they will purchase the program for Sam.  Sounds like I will have lots of work for a long time!

Thank you again,

Dani

Hello, all.  My name is Aaron Acton, and I have been reading through these forums for almost a year now, getting myself up to speed in using SimMan at our hospital.  Right now we have five adult sims we are using for our ACLS classes and two baby sims we are preparing for PALS classes.  We also have purchased the ACLS pre-written scenarios as part of a joint research project between our hospital and our local University to study retention of information between static and dynamic courses. 

I agree with Randy on some of his observations - several of the scenarios don't flow the way I would expect them to, either leading to a treatment not part of the scenario (which almost always happens - the students don't always follow the script) or a patient outcome that does not seem warranted happens.  I cannot change the scenario programming during the research but I am making many notes for modifications after the research project is done.

Jason-

Are you by any chance Bloomington Hospital in Indiana?  Just curious.  I am in Indianapolis.  It sounds like you use your support materials as they were intended - as lesson maps per se, following them through in order.  We have taken the material and applied it to the AHA lesson maps instead in order to facilitate our research.  Can you clarify that point?  I'm curious as to the efficacy of a different agenda path.

Now, for my two cents on the ACLS scenarios.  I am a part-time programmer so creating the scenarios is easy and fun for me - the graphical interface makes things easy and challenging because my actions are limited to those pre-programmed choices.  I sometimes find myself wanting to make things happen differently to accomplish a particular effect.  My concern with the ACLS scenarios is that I feel they do not use trends/handlers to allow some ease in programming.  The scenarios seem to be programmed with certain paths that have to be followed - and while I understand this is what the scenarios are validating, I feel the simulation could be more realistic if trends were applied to medications and oxygenation.  The scenario I am thinking of in particular is the Stable Narrow Complex Tachycardia.  Laerdal used frame changes to facilitate the asystole and recurrent SVT when a trend would have handled it easier, and once written, the trend can be used in any scenario rather than have to be programmed in using frames each time.  It feels like there is wasted possibilities.

I am working with our group to write trends for all possible medications, and then tie them to handlers, that way any time a scenario uses a certain medication, that handler and all it's appropriate responses are already written.  I am hoping this will simplify programming for the rest of our staff.

 

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Aaron Acton EMT-P
Simulation and Disaster Education
Emergency Response Training Institute
Clarian Health
Indianapolis, Indiana

I agree with you 100%.  When we had our initial training, we were told that while linking actions and responses through frames may seem to make logical sense, especially since we are used to using algorhythms, that that format was actually very limiting and you had to go down that path consistantly and heaven forbid the student didn't follow the program to the letter or got things out of order.  He recommended 1 frame scenarios where you build handlers to manage the possible interventions.  Then you can have not only the physiologocal response, such as the asystole with adenosine built in as a trend, but also the statement of whether or not it ws a correct step and the rationale for taking that step.  I think that it makes it easier for the operator as well.  I feel like I need to have printouts of the scenarios when they are linked boxes, just so they know how it is supposed to run. 

  My question is- if this is the best way, why did my co workers who were trained last month not even get that info? Why are all the Laerdal scenarios not built that way?  It's a little frustrating. I would love to see what you come up with, I had a hard time with the adenosine handler in mine and I'm still not 100% satisfied with it.  

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Barbara K. Ratliff RN, BSN, MBA
Baptist Health Montgomery, AL
Institute for Patient Safety
and Medical Simulation
Simulation Specialist

Aaron,

I am in Bloomington, Indiana. Where in Indy are you? I would love to come see your lab sometime. I have never seen any other lab and would love to see how you work in yours. E-mail me at jking@bloomingtonhospital.org if this is possible.

As far as the med-surg scenarios go... I start out as they are written, but once I have run it a few times, I see where the students tend to go. I then change the objectives accordingly. I think the scenarios provide good frame work for teaching. The instructors never seem to mind, because any time you run the scenarios, there is always teaching that can be done.

- Jason

Barbara,

There are a couple of issues with writing a program as a single frame and then using handlers and trends for creating changes. While this approach works very well for many scenarios, treatment that requires very specific steps (such as an ACLS algorithm) will not work as well. For example, embedding everything into a single frame and relying on the handler to initiate action would not allow the program to differentiate that giving an antiarrhythmic before the vasopressor in a VF cardiac arrest was not the correct step.

 

The handler will also force you into using a single debriefing comment for the event. While this might not be a problem in some cases, in others it could be an issue. An example would include giving a medication before starting CPR in a cardiac arrest. The handler would only know that the event occurred, it would not know if it was in the proper order. Therefore, you could not write a debriefing comment that indicated this was a correct action because of the possibility that the student performed the event out of sequence.

 

There are ways to get around this using handlers and trends but it creates a highly complex program and will increase the workload on the instructors. You could create a duplicate set of handlers for all events with one set being the event was done correctly and in the right order and the other set is used when the event is out of order (with debriefing comments to match). Of course this doubles the programming required and forces instructors to navigate through the event menus looking for right or wrong responses to each event.    

 

As I have mentioned to some others on this topic string, handlers and trends could have been more extensively used in the ACLS scenarios but would not have been a substitute for all events. As the primary author of the product, I agree that the programming is a bit simplistic. That was primarily a function of these scenarios being written very early in our center’s programming history (around 2004) right as we were getting our first SimMan. Our initial training did not include a lot of work on handlers and trends, so when they were developed we just went with what we knew. While we updated the programming to reflect Guidelines 2005, we did not change the core of the programming as it was functioning very well for us (These scenarios have been run over 20,000 times in our center). Another issue was a similar scenario program for the ALS simulator. As you may know, the VitalSim scenario builder does not have handlers or trends. As a result, the two sets of scenario programs looked very similar.

 

Dave Rodgers

Hi Everyone,

Barbara, you mentioned the Adenosine handler and I didn't care for it either.  When I have used Adenosine in real life, the heart stops for several seconds and then comes back hopefully in a slower Sinus but often in what it was in and you need to give the 12 mg dose.  The handler does not stop the heart at all.  I'm glad that I was able to check it out before I just used it.  I very seldom use anything without trying it. 

 Now about programing, I am using a lot more trends to make the scenarios flow better.  I like the fact that it looks real on the monitor and things move along in a natural progression instead of jumping from a HR of 80 to 130 in 2 seconds.  I have made my own trends up using Laerdals as the base and have learned to label them more general like HR inc 15 over 30 sec.  This way I can use them wherever I want.  If you have several things that need to change at the same time, just make sure that you have all your parameters checked and then you can have everything move together.  It has become a lot of fun and the facilitators love the fact that it is so seamless. 

I do print out the final scenario boxes with all of their links as I do put that on the VS boxes in the scenarios.  In that way someone else could run the computer if I were not available that day by following all of the links and the scenario template we use.  

I guess this doesn't really fit the topic of the ACLS stuff but I am also a little concerned about them as well - just ask Jason - as we will be starting a live class this fall and I still have questions and no software.

Thanks for listening (reading),

Dani

I made my own adenosine handlers- Adenosine 6mg has an unsuccessful trend where the patient returns to their SVT and the 12mg has a successful trend that returns the patient to 120s and then gradually down to the 100s- they work- it was just hard to create.  It took several tries to realize that the drop in HR has to be sudden and Very brief.  Try my SVT scenario on the download page, although I've probably worked on it a lot since then.

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Barbara K. Ratliff RN, BSN, MBA
Baptist Health Montgomery, AL
Institute for Patient Safety
and Medical Simulation
Simulation Specialist

David-

It is good to hear from you.  If I understood your post correctly, you are one of the original authors of the Laerdal software.  I would like to say thank you, and they are good scenarios. 

 Barbara -

I have also been told that a single frame scenario with everything done with trends and handlers is a better way to do scenarios, but from my experience (meaning trial and error *grin*) I have found the best way is to use a combination of frames and handlers.  Your trends can be used when moving between frames, or as handlers, but I like to use the handlers for non-critical actions.  In other words, in a scenario I'm wanting to focus on cardioversion of SVT, I would have the adenosine handler running but without breaking the rhythm - always returning to SVT.  This gives the appearance that the drug is given, helps the students prepare for the effects of the drug, but also incorporates the critical thinking of 'What do I do when this doesn't work?'  In a second scenario, almost identical but focusing on the adenocard, I would not use the handler, but use the trend when changing frames and allowing the drug administration to be the movement in the scenario.  I like to use handlers for the interventions that aren't part of the main focus but they add realism to the scenario.

Thank you all for your replies.  These forums do help very much.

Aaron

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Aaron Acton EMT-P
Simulation and Disaster Education
Emergency Response Training Institute
Clarian Health
Indianapolis, Indiana