Using simulation for training and to change protocol during the outbreak of severe acute respiratory syndrome

Phase 1 was a curriculum design of a SARS-specific cardiac arrest protocol in three steps: planning the new protocol, repeated simulations of this protocol in a classroom, and a subsequent simulation of a cardiac arrest on a hospital ward. Phase 2 was the training of 275 healthcare workers (HCWs) using the new protocol. Training involved a seminar, practice in wearing the mandatory personal protection system (PPS), and cardiac arrest simulations with subsequent debriefing.Simulation provided insights that had not been considered in earlier phases of development. For example, a single person can don a PPS worn for the SARS patient in 1 1/2 minutes. However, when multiple members of a cardiac arrest team were dressing simultaneously, the time to don the PPS increased to between 3 1/2 and 5 1/2 minutes. Errors in infection control as well as in medical management of advanced cardiac life support (ACLS) were corrected.During the SARS crisis, real-time use of a high-fidelity simulator allowed the training of 275 HCWs in 2 weeks, with debriefing and error management. HCWs were required to manage the SARS cardiac arrest wearing unfamiliar equipment and following a modified ACLS protocol. The insight gained from this experience will be valuable for future infectious disease challenges in critical care.Severe acute respiratory syndrome (SARS) is a newly identified atypical pneumonia that can be life threatening. Attention was drawn to the disease in February 2003 when a physician and subsequently 12 other hotel guests staying in a hotel in Hong Kong became ill [1]. One of these hotel guests returned to Toronto, Canada, died on 5 March 2003, and became the index case for Toronto. The Morbidity and Mortality Weekly Report published a description of the SARS outbreak on 21 March 2003 [2]. The SARS virus seemed to be highly contagious in the hospital setting. A case report suggested that intubation of patients produced a high risk for transmission of SARS to healthcare workers (