Sims and models in EM

The group that I work for as an emergency physician publishes a quarterly newsletter. I guess they are pretty strapped for contributors. So dire is their need for articles they asked me to write something. They even let me pick the topic!

So I thought it might be interesting to write a short review of modeling and simulation in emergency medicine. The audience are practicing emergency physicians – real world doctors pretty far removed from the shadow of the ivory tower. If possible, the article should be entertaining and relevant for practising EM doctors. Also, it should be short. They don’t have the column space or patience for my usual verbose ramblings.

The famous (in EM circles) Joe Lex hosted a Speakers’ Corner at the ACEP (American College of Emergency Medicine) meeting in San Francisco in 2002. He gave an open invitation for speakers to give short talks on the last day of the conference. As you know, only the most hardcore conference attendees stick around for the last
day. Only the most masochistic of these would sit through unsolicited talks. Happily, I had a very nice group of doctors attend my talk, which was an introduction to modeling and simulation, and a short discussion of how and where these techniques were being applied within the field of emergency medicine.

The talk and PowerPoint presentation was very well received. In fact, I had hoped that I might be in the running for the Speakers’ Corner award. As of yet, however, no reward, plaque, or check has been forthcoming. If I did indeed win that award, perhaps someone could let me know? I am starting to think I did not win.

Modeling and simulation have been used for the following:

1. modeling flow through the emergency department – recent work has used barcodes and RF tags to literally track patients’ progress through the department and its ancillary areas in an attempt to streamline throughput

2. simulation training – residents as well as nursing and other staff are using more and more types of simulation in training scenarios. One program has a manequin that is hooked to a monitor that students practice ACLS (advanced cardiac life support) with. It responds to treatments (meds) with changes to vital signs and presentation, and proceedures such as direct laryngoscopy, endotracheal intubation, central line placement, and CPR can be performed on it.

Some recent articles that have appeared in the emergency medicine literature include the following:

EMS helicopter crashes: what influences fatal outcome?
Ann Emerg Med. 2006 Apr;47(4):351-6. Epub 2006 Jan 19.

Analysis of ambulance transports and diversions among US emergency departments.
Ann Emerg Med. 2006 Apr;47(4):317-26. Epub 2006 Feb 17.

Effects of hospital closures and hospital characteristics on emergency department ambulance diversion, Los Angeles County, 1998 to 2004.
Ann Emerg Med. 2006 Apr;47(4):309-16. Epub 2006 Feb 3.

Cognitive versus technical debriefing after simulation training.
Acad Emerg Med. 2006 Mar;13(3):276-83.

Prediction of pulmonary embolism in the emergency department: the revised Geneva score.
Ann Intern Med. 2006 Feb 7;144(3):165-71.

Bottleneck analysis of emergency cardiac in-patient flow in a university setting: an application of queueing theory.
Clin Invest Med. 2005 Dec;28(6):316-7.

Using queueing theory to increase the effectiveness of emergency department provider staffing.
Acad Emerg Med. 2006 Jan;13(1):61-8. Epub 2005 Dec 19.

Emergency physicians’ fear of malpractice in evaluating patients with possible acute cardiac ischemia.
Ann Emerg Med. 2005 Dec;46(6):525-33. Epub 2005 Jul 14.

Disaster modeling: medication resources required for disaster team response.
Prehospital Disaster Med. 2005 Sep-Oct;20(5):309-15.

Modeling the emergency ambulance pass-by of small rural hospitals in Victoria, Australia.
J Rural Health. 2005 Fall;21(4):367-71.

Artificial neural network models for prediction of acute coronary syndromes using clinical data from the time of presentation.
Ann Emerg Med. 2005 Nov;46(5):431-9.

Simulation for assessing statistical methods of biologic terrorism surveillance.
MMWR Morb Mortal Wkly Rep. 2005 Aug 26;54 Suppl:101-8.

Forecasting medical work at mass-gathering events: predictive model versus retrospective review.
Prehospital Disaster Med. 2005 May-Jun;20(3):164-8.

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