Sept. 25, 2024 — “I need help, someone call 911!” the clinician’s voice boomed from the patient exam room.

“Calling 911,” another voice confirmed, as a third member of the care team arrived on the scene with an oxygen tank and emergency response cart equipped with an automated external defibrillator, or AED, bag valve mask, and essential medications.

After connecting the sticky panels of the AED to the patient’s bare chest, the team got to work performing chest compressions and administering shocks until emergency services arrived.

Even though the patient in this scenario was an interactive mannequin and in no real danger, adrenaline remained high as staff members from the University of Florida College of Medicine’s Center for Experiential Learning and Simulation demonstrated the steps UF Health clinical faculty and staff should take should they encounter an emergency in one of their clinics.

The UF College of Medicine recently led a series of emergency response workshops and simulations throughout UF Health’s internal medicine clinics in Gainesville, aimed at ensuring outpatient clinicians are up to date on best practices and feel comfortable using equipment in the event of a patient emergency.

Dianne Goede, M.D., the associate chief of quality and patient safety in the Division of General Internal Medicine and medical director of UF Health Internal Medicine – Medical Plaza, said the workshops led by the Center for Experiential Learning and Simulation, or CELS, team began approximately a year and a half ago, after they ran simulations at all three UF Health internal medicine clinics in Gainesville: Medical Plaza, Springhill, and Kanapaha, to determine opportunities for emergency response improvement.

“These are situations the faculty and staff will not typically encounter very often,” Goede said. “Having regular practice in our clinics with our clinic’s emergency equipment and protocols keeps everything fresh in our minds, improving our response performance in a real crisis.”

It takes about eight minutes for emergency services to arrive at the scene of a call, Goede said, so any delay in getting a patient the help they need can be deadly.

About a dozen practitioners cycled through three practice stations during a September workshop at the Kanapaha clinic to rehearse administering chest compressions, using a manual ventilator, and operating an AED. Several teams also completed a separate real-time emergency simulation under observation of CELS staff to uncover pinch points and knowledge gaps.

“This is a great opportunity for different types of providers, from nurses to medical assistants and physicians, to work with one another as they would during an actual scenario,” said Eric Rosenberg, M.D., the College of Medicine’s associate dean for continuing medical education. “That’s not how these groups undergo their training, so it’s nice to be able to provide that option.”

Mannequins connected to tablets during the workshop allowed participants to get immediate feedback on the amount of air delivered to the lungs with the manual ventilator and the quality of the chest compressions they performed, ensuring they were well-paced and the appropriate depth.

While emergency simulations are often conducted in hospital settings, the use of simulation training in outpatient, or ambulatory, settings is unique. College of Medicine faculty and CELS staff members will present a workshop about UF’s ambulatory emergency training at the International Meeting on Simulation in Healthcare in Orlando in January 2025.

­During a patient simulation held at the Medical Plaza clinic, a patient named “Hans” complained of trouble breathing, and his vitals showed low blood pressure. With Center for Experiential Learning and Simulation team members nearby, the medical assistant taking down the patient’s information called for help from a nurse and physician in the hallway. Together, they placed Hans, a mannequin, onto the floor of the patient exam room. The group then connected an AED to his chest and administered CPR, breaths, and shocks for nearly eight minutes before he began coughing and breathing properly again.

Senthil Meenrajan, M.D., an associate professor in the Division of Internal Medicine and the physician on duty at the clinic during the simulation, said the drill was a great learning experience.

“When there’s many people involved, the dynamic is always going to be a little different, but the constant is the equipment,” he said. “I trained with a slightly different set of panels and slightly different-looking equipment, but that’s the part of CPR that can easily be addressed ahead of time to prevent any gaps in care. Even a few seconds of delay can make a difference.”