On the 10th & 11th of February the Newcastle upon Tyne Hospitals Trust ran a multi-disciplinary, multi-stage exercise to practice and evaluate the effectiveness of procedures for providing peri-partum and neonatal care to a patient with a viral haemorrhagic fever. The exercise, titled “Moulin Rouge”, followed on from work done by the Royal Free Hospital, London, which conducted an exercise using a Trexler-based method of isolation and care in 2024. The Infectious Diseases (ID) team at Newcastle simulated a PPE-based care model to explore the relative challenges and benefits as compared against the Trexler model.
The scenarios progressed through 4 phases: Level 2 (HDU) and antenatal/maternal care, acute deterioration requiring intubation, caesarean section/post-partum haemorrhage/hysterectomy, and neonatal resuscitation.
Newcastle Hospital’s Simulation team were invited into the exercise from the early planning stages to ensure that the simulated elements would not interfere with the realistic progression of events and practice, whilst also being clear and understood by the large audience observing the exercise both within the Trust and around the country.
The caesarean section was likely to be a focal point of the exercise, as it was the cause of the large haemorrhage of infected blood and the need for hysterectomy and would be under a great deal of scrutiny. They developed an abdominal insert for the Laerdal SimMom manikin, based on work on a ‘peri-mortem c-section task trainer’ presented at ASPiH 2024 by the ADAMGel team from Brighton Hospitals. This insert recreated the tissue layers and neonate, allowing the obstetrician to conduct the caesarean section and allow the gynaecologist perform a hysterectomy in order to stem the bleeding. Further modifications were made to SimMom to simulate the high 4.5 litre blood loss required by the scenario.
The scenarios took place primarily in the Royal Victoria Infirmary’s High Level Isolation Unit. It was therefore necessary to provide a robust audio-visual solution to ensure that everyone observing would be able to participate in the debrief sessions after each scenario. The Sim team used a Tricaster production systems from the newly refurbished Freeman Simulation Centre that allowed for high-quality, multi camera video and audio production on location that could be streamed via YouTube. Remote and local participants would watch the scenarios live via YouTube, then conduct the debrief discussions in person at Peacock Hall, RVI and over Microsoft Teams.
For those interested, the scenarios are still available to view in full here: https://youtube.com/playlist?list=PLWbdI0d-XMT4DaNKjFDjWPKG9TJf7C5xu&si=TC7BmXw4Qfq-tumk
Feedback on the day and following the exercise was overwhelmingly positive, with observers saying how immersed they felt during the c-section scenario in particular. The scenarios prompted a great deal of valuable discussion during the debrief and at the HCID National Network meeting later that week.
The exercise was hailed as a great success:
“Thank you for running and hosting the excellent simulation this week […] We have all learnt a great deal from the exercise and […] have majorly helped in the development of the NHS experience and resilience.”
Joan Ward Senior Highly Specialised Services Commissioning Manager – NHS England
Article produced by Thomas Hayes - Workforce Development Officer - The Newcastle Hospitals NHS Foundation Trust
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