Group Challenge

Chaos Tasks

Setting

Groups unaware of scenario start.

Explosion 1 -  committee member runs from hut shouting there has been an attack on a humanitarian camp nearby. There has been an explosion and 2+ (depending on groups size) are stuck indoors – 1+ injured. Committee member explains that people in camp are VIPS and must be kept alive at all costs (despite their music taste) and that the attack is likely by a terrorist organisation that are working to destabilise the region and undo all that the humanitarian group have helped with.

Part 1

Group given 3 minutes to organise themselves into 2+ A-E teams. Committee member hands out roles to team at random via paper slips:

- Team Leader

- Medic

- Competent Helper (Traitor – do not reveal to other team mates)

- Competent Helper

- Head/Scribe

- Extra competent Helper as required to meet numbers

Group taken to hut. Inside the hut shows signs of explosion – furniture and items thrown everywhere, Rammstein/heavy metal playing excessively loud.  1+ (depending on group size) casualty covered in fake blood, on floor, screaming.

1 other VIP panicking at other side of hut.

- Casualty 1a: X1 catastrophic bleed. Arm lost – requires tourniquet – blood loss = dizzy, cant walk or collapse – needs evac

- Casualty 1b (if needed) - X1 leg fracture + Massive right pneumothorax – requires splint + drain – can’t walk = needs evac

See patient sheet for Hx and Obs

Teams given 4 mins to manage casualties.

Explosion 2 heard. Panicking VIP now injured. Explosion damages teams’ ears – all members given ear plugs to inhibit communication.

- Casualty 2: X1 Major bleed from wound on thigh + Pelvic fracture due to trauma. Requires compression bandage and pelvic binder – can’t walk = Evac

Teams to continue A-E until both are ready for evac – one on stretcher, one on tarpaulin or other improvised method.

Traitors can interfere with management during this part

See mark sheets for Part 1

Part 2

The explosion damaged a chemical tank releasing an irritant into the air, that and the smoke and dust has impaired the vision of the group.

Blindfolds/scarves etc given to each member of the team apart from Team Leader – Ear plugs remain in.

Those carrying the stretcher/tarpaulin are blindfolded and team leaders have to direct the team through a treacherous route using communication skills to a safe evac point as directed by committee member.

Teams have 15 minutes to reach complete course and reach safe zone

Part 3

Teams to remove blindfolds and ear plugs

Committee member tells groups that heli-evac will arrive in 10mins but new intel suggests that the attack was an inside job and that the terrorists have infiltrated the humanitarian group. One member of each team is a traitor and is trying to eliminate the VIPs – Teams have to keep their patient alive and stable whilst trying to work out who is a traitor.

At this point, nearby locals/reporters have arrived due to the commotion and run interference with the teams by asking questions, panicking etc.

Teams must reassess VIP in safe zone, whilst addressing interference and trying to identify traitor. Casualty becomes gradually more unresponsive regardless of management/traitor interference.

Teams have 10 minutes.

If traitor sabotages patient treatment e.g. loosens tourniquet/pelvic binder/removes O2/sats probe etc etc. and this goes unnoticed for a total of 8 minutes (part 1 + part 3). Patient deteriorates and dies – Traitor wins.

If teams maintain patient for 10 mins AND sabotage time remains below 8 mins – Teams win.

Teams to then try to identify traitor.

See deterioration sheets for obs

Traitor’s role

- Traitor must act as a competent helper but discretely sabotage management during all parts of the scenario.

- During part 1 after good management applied to patient – committee examiner must time any period where management is undone by traitor. 5 mins max achievable in part 1.

- During part 2 if teams don’t complete course in given time limit – plus 1 minute to traitor time. Ignore any sabotaged management during this part.

- During part 3 committee examiner must time any period where management is undone by traitor.

- Once 8 minutes in reached, inform team that VIP is dead.

-

Key points:

- Teams must give an observation where possible before receiving patient obs e.g must calculate committee casualty heart rate before being told patient’s scenario heart rate in all parts of scenario.

o This is to help actually practice skills

- Committee casualties must be as convincing as possible – Oscars not awarded but pretend like they would be.

- Teams start each part at the same time and given instructions as a group + given time to ask questions before each part begins.

Scenario requirements

- 2-3 committee casualties

- 2-3 Committee examiners

- 1-2 Committee interferers

- Role slips

- Patient info

- 2-3 stop watches/phone stop watches

- 2 complete kit bags

- 1-2 tourniquet

- Pelvic binder

- Traction splint

- Fake blood

- T-shirts for fake blood (casualty 1a)

- Leggings for fake blood (casualty 2)

- Stretcher + tarpaulin

- Ear plugs

- Scarves plus blindfolds – Or just keep eyes closed if required.

- Big speaker

- Some fantastic acting skills

Casualty 1a – Part 1

Name + age can be made up by casualty.

P/C

- Amputated right arm due to explosive trauma + Catastrophic blood loss

S+S

- Very pale and sweaty

- Terrified

- Intense pain

- Tachypnoeic

- Feels dizzy + faint

PMH – Nil

Allergies – Nil

Medications – Nil

Last ins + outs – normal breakfast + juice at 8am. Bowls open shortly after. No vomiting.

Answer any other questions with contextually relevant answers

Obs

A: Alert responds to voice and pain

B: RR: 25 – improves slightly on O2/analgaesics – remains at 25+ if traitor interferes with mask or O2

O2: Can’t get a reading – 95% if tourniquet applied and fluids given – Can not get reading if traitor interferes with tourniquet or fluids

Trachea central. Percussion normal. Auscultation normal. Chest expansion symmetrical but quick and shallow.

C: PR: 152 – improves slightly if tourniquet applied/Fluids given/wound dressing/analgaesics – 152+ if traitor interferes with management

BP: 85/61 – improves to 87/62 with effective tourniquet, 96/64 with fluid – remains at 85/61 with traitor interference to fluids or tourniquet

Periph cap refill: can’t get – if effective tourniquet + fluids = 5 seconds

Central cap refill: 5 seconds – improves to 3 seconds with effective tourniquet and fluids

Heart sounds normal

D: All normal

E: Mild cuts and bruises all over, missing right arm, gash on right leg with some blood loss.

Casualty 1b – Part 1

Name + age can be made up by casualty.

P/C

- Massive right pneumothorax

- Right leg fracture

S+S

- Breathless

- Sweaty

- Terrified

- Intense pain in leg

- Feels dizzy + faint

PMH – Nil

Allergies – Nil

Medications – Nil

Last ins + outs – normal breakfast + juice at 8am. Bowls open shortly after. No vomiting.

Answer any other questions with contextually relevant answers

Obs

A: Alert responds to voice and pain

B: RR: 28 – improves slightly on O2/analgaesics/ chest drain – remains at 28+ if traitor interferes with mask or O2 or chest drain/1-way dressing

O2: 89% - improves to 94% if on O2 – remains at 89% if traitor interferes with O2 or chest drain/1 -way dressing

Trachea deviated to left. Percussion normal left, hyper-resonant right. Auscultation normal left, no air sounds right. Chest expansion asymmetrical (reduces right) + quick and shallow. Open wound on right side.

C: PR: 125 – improves slightly if analgaesia/O2 given – remains 125 if traitor interferes with management

BP: 128/79 – lowers slightly when on O2 – remains at 128/79 with traitor interference to O2/mask/drain/1-way dressing

Periph cap refill: 2 seconds

Central cap refill: 2 seconds

Heart sounds normal

D: All normal

E: Mild cuts and bruises all over, guarding of right thigh, incredibly painful to touch and move.

Casualty 2 – Part 1

Name + age can be made up by casualty.

P/C

- Major bleed on left thigh – open wound

- Pelvic fracture

S+S

- Sweaty

- Terrified

- Intense pain in leg and hips

PMH – Nil

Allergies – Nil

Medications – Nil

Last ins + outs – normal breakfast + juice at 8am. Bowls open shortly after. No vomiting.

Answer any other questions with contextually relevant answers

Obs

A: Alert responds to voice and pain

B: RR: 24 – improves slightly analgaesics/proper wound dressing/Pelvic binder – remains at 24+ if traitor interferes with analgaesics/wound care/Pelvic binder

O2: 97% - improves to 98% if on O2 – remains at 97% if traitor interferes with O2 or mask

Trachea central. Percussion normal. Auscultation normal left. Chest expansion symmetrical + quick and shallow.

C: PR: 132 – improves slightly if analgaesia/O2/Fluids/Pelvic binder given – remains 132 if traitor interferes with management

BP: 105/71 – Increases if fluids given/pelvic binder – remains at 105/71 with traitor interference to fluids/pelvic binder

Periph cap refill: 4 seconds – improves with pelvic binder/fluids

Central cap refill: 2 seconds

Heart sounds normal - fast

D: All normal

E: Mild cuts and bruises all over, guarding of left thigh and hips, incredibly painful to touch and move.

Casualty 1a – Part 3

S+S

- Very pale and sweaty

- Terrified

- Intense pain

- Tachypnoeic

- Feels dizzy + faint

Answer any other questions with contextually relevant answers

Obs

A: Alert responds to voice and pain – Gradually deteriorates through confusion, delirium and unresponsive

B: RR: 22 – maintained if on O2/analgaesics – Increases to 28+ if traitor interferes with any management – higher is traitor time is close to 8 mins

O2: 95% if tourniquet applied and fluids given – Can not get reading if traitor interferes with any management

Trachea central. Percussion normal. Auscultation normal. Chest expansion symmetrical but quick and shallow.

C: PR: 135 – maintained if tourniquet applied/Fluids given/wound dressing/analgaesics – 152+ if traitor interferes with management. Higher if traitor time close to 8 mins

BP: 95/67 - maintained with effective tourniquet and fluid – 73/56 with traitor interference to management. Lower if traitor time close to 8 mins

Periph cap refill: 5 seconds – can’t get

Central cap refill: 4 seconds – 6 seconds if traitor interferes with management

Heart sounds normal

D: All normal

E: Mild cuts and bruises all over, missing right arm, gash on right leg with some blood loss.

Casualty 1b – Part 3

P/C

- Massive right pneumothorax

- Right leg fracture

S+S

- Breathless

- Sweaty

- Terrified

- Intense pain in leg

- Feels dizzy + faint

Obs

A: Alert responds to voice and pain– Gradually deteriorates through confusion, delirium and unresponsive

B: RR: 22 – maintained on O2/analgaesics/ chest drain – increases to 28+ if traitor interferes with management. Higher if traitor time is close to 8 minutes.

O2: 94% - maintained if on O2 – drops to 85% if traitor interferes with management. Lower if traitor time close to 8 mins.

Trachea deviated to left. Percussion normal left, hyper-resonant right. Auscultation normal left, no air sounds right. Chest expansion asymmetrical (reduces right) + quick and shallow. Open wound on right side.

C: PR: 120 – maintained if analgaesia/O2 given/chest drain correct – increases 136+ if traitor interferes with management. Higher if traitor time close to 8 mins.

BP: 125/75 –maintained when on O2 – increases slightly with traitor interference to management

Periph cap refill: 2 seconds

Central cap refill: 2 seconds

Heart sounds normal

D: All normal

E: Mild cuts and bruises all over, guarding of right shin, incredibly painful to touch and move.

Casualty 2 – Part 3

P/C

- Major bleed on left thigh – open wound

- Pelvic fracture

S+S

- Sweaty

- Terrified

- Intense pain in leg and hips

Answer any other questions with contextually relevant answers

Obs

A: Alert responds to voice and pain – Gradually deteriorates through confusion, delirium and unresponsive

B: RR: 22 – maintained on analgaesics/proper wound dressing/Pelvic binder – increases to 27+ if traitor interferes with analgaesics/wound care/Pelvic binder. Higher if traitor time close to 8 mins

O2: 98% - maintained at 98% if on O2 – drops to 96% if traitor interferes with management.

Trachea central. Percussion normal. Auscultation normal left. Chest expansion symmetrical + quick and shallow.

C: PR: 125 – maintained if analgaesia/O2/Fluids/Pelvic binder given – increases to 139 if traitor interferes with management. Higher if traitor time close to 8 mins

BP: 105/71 – maintained if on fluids/pelvic binder – drops to 91/68 with traitor interference to management. Lower if traitor time close to 8 mins

Periph cap refill: 3 seconds – can’t detect if traitor interfered with management

Central cap refill: 2 seconds – 5 secs if traitor interfered with management

Heart sounds normal - fast

D: All normal

E: Mild cuts and bruises all over, guarding of left thigh and hips, incredibly painful to touch and move.

Patient 1a Mark Sheet

Area

Criteria/Comments

Danger

Catastrophic   bleed

Are dangers   noted?

Time taken to   apply tourniquet (quicker the better):

Airway

Checked?

Attempted   communication/introduction with patient?

Frequent   Reassessment?

Breathing

RR checked?

Expansion   checked?

Percussion   checked?

Auscultation   checked?

O2 sats   checked?

Trachea   checked?

Chest exposed?

Frequent   Reassessment?

Circulation

PR checked?

Auscultation   checked?

BP checked?

Cap refill   peripheral and central checked?

Frequent   Reassessment?

Disability

AVPU?

Glucose?

Pupils equal   and reactive?

Temperature?

Frequent Reassessment?

Secondary   survey/ exposure

Is head to   toe examined for breaks, bruises and bleeding?

Is patient   adequately protected from elements?

Frequent   Reassessment?

Management

Life-saving   – (are they acted on as soon as they are found? If not, when?)

Tourniquet

Celox

Trauma   bandage

Fluids

Other:

O2

Analgesia

Communication/reassurance   to patient + Patient handling

Team   Communication

Good/clear   communication with each other?

Team-work

Clear roles +   organisation

Patient 1b Mark Sheet

Area

Criteria/Comments

Danger

Catastrophic   bleed

Are dangers   noted?

Airway

Checked?

Attempted   communication/introduction with patient?

Frequent   Reassessment?

Breathing

RR checked?

Expansion checked?

Percussion   checked?

Auscultation   checked?

O2 sats   checked?

Trachea   checked?

Chest   exposed?

Frequent   Reassessment?

Circulation

PR checked?

Auscultation   checked?

BP checked?

Cap refill   peripheral and central checked?

Frequent Reassessment?

Disability

AVPU?

Glucose?

Pupils equal   and reactive?

Temperature?

Frequent   Reassessment?

Secondary   survey/ exposure

Is head to   toe examined for breaks, bruises and bleeding?

Is patient   adequately protected from elements?

Frequent Reassessment?

Management

Life-saving   – (are they acted on as soon as they are found? If not, when?)

Chest   drain/1-way dressing

Oxygen

Other:

Analgesia

Communication/reassurance   to patient + Patient handling

KT splint   adequate

Team   Communication

Good/clear   communication with each other?

Team-work

Clear roles +   organisation

Patient 2 Mark Sheet

Area

Criteria/Comments

Danger

Catastrophic   bleed

Are dangers   noted?

Time taken to   apply tourniquet (quicker the better):

Airway

Checked?

Attempted   communication/introduction with patient?

Frequent   Reassessment?

Breathing

RR checked?

Expansion   checked?

Percussion   checked?

Auscultation   checked?

O2 sats   checked?

Trachea   checked?

Chest   exposed?

Frequent   Reassessment?

Circulation

PR checked?

Auscultation   checked?

BP checked?

Cap refill   peripheral and central checked?

Frequent   Reassessment?

Disability

AVPU?

Glucose?

Pupils equal   and reactive?

Temperature?

Frequent   Reassessment?

Secondary   survey/ exposure

Is head to   toe examined for breaks, bruises and bleeding?

Is patient   adequately protected from elements?

Frequent   Reassessment?

Management

Life-saving   – (are they acted on as soon as they are found? If not, when?)

Pelvic binder

Tourniquet

Fluids

Other:

Analgesia

Communication/reassurance   to patient + Patient handling

Compression   bandage

Team   Communication

Good/clear   communication with each other?

Team-work

Clear roles +   organisation