N.C. Paramedic Competition Scenario Challenge Emergency Responders with High-Fidelity Simulation

The initial dispatch was for an unknown emergency, with law enforcement en route. Law enforcement arrives on scene and finds one patient with a gunshot wound to the right leg with arterial hemorrhaging. 

The background story, explained only to the audience, is that a woman and her boyfriend are looking to steal a baby. They identify a woman who is 8.5 months pregnant, and drug her with tramadol.

The pregnant patient passes out and, while in the bathtub, they forcefully cut the baby out of her abdomen by C-section. 

They initially think the baby is dead and place it in the sink. The boyfriend then decides he wants no part of this. There is an argument and he shoots his girlfriend—who is wearing a body harness with a prosthetic pregnant abdomen—in the leg. He leaves, and is a not at the scene when responders arrive. Cue the teams to enter the scenario.

When the competing team arrives, they find a law enforcement officer (LEO) who has cuffed the female with the gunshot wound in the den near a chair. She is psychotic and continually asks for her baby. 

The team starts immediate care on her and LEO leaves the room to clear the rest of the house. 

About 30 seconds later, LEO calls for assistance in the bathroom and the team enters to find the mother and baby. Mother is drugged with tramadol and needs at least two rounds of Narcan and has to be removed from the tub, which is full of blood.

She also needs hemorrhage control and resuscitation for her traumatic C-section. She succumbs to her wounds as teams treat her.

The baby is hypoxic and bradycardic and needs aggressive care. Blood sugar is 15. 

At two minutes into the scenario, another LEO and two EMTs arrive on scene. At 10 minutes into the scenario, if the team did not apply a tourniquet to the leg, the first patient (the would-be mother with the gunshot wound) becomes hypotensive and unresponsive. 

All but one team failed to apply the tourniquet within that time frame. 

The baby died if teams did not aggressively resuscitate her rapidly. The total time of the scenario was 12 minutes, and teams had their hands full the entire time.

Cadaver Simulation

This is the second year that the N.C. Office of EMS has partnered with the Center for Innovative Learning at Wake Med Hospital to use their high-fidelity simulators. For the mother in the bathtub, a Wake Med cadaver simulator was used to add a realistic component to the competition.

On the Saturday before the competition, the six competing teams had the opportunity, if they chose, to meet with Wake Med’s staff and judges to practice with simulators (except, of course, for the cadaver simulator) to become familiar with them. There were a variety of simulators used in that session, but the teams did not get a glimpse of the cadaver sim until the actual competition. 

As you can imagine, the shock factor was high when they first entered the scenario.

The winning team, Jose Butron and Josh LeCrone from Surry County EMS, was announced at a banquet at  Emergency Medicine Today 2016, held Sep. 30–Oct. 5. The 43rd annual conference was presented by the North Carolina Office of Emergency Medical Services and provided valuable opportunities for education in both emergency medicine and disaster preparedness.