Dr. Elizabeth Hunt's program of simulation training prepares Hopkins medical teams to better handle emergencies

August 21, 2008|By Euna Lhee | Euna Lhee,Sun reporter

In the office of Dr. Elizabeth "Betsy" Hunt, words attributed to Louisa May Alcott hang on the wall: "I am not afraid of storms for I have learned how to sail my ship."

For Hunt, or "Dr. Betsy," as she likes to be called, her storms are pediatric emergencies and her ship is simulation.

As early as 1980, Hunt was preparing for emergency situations, either as captain of the safety patrol squad or as a lifeguard at the local pool. By simulating bus accidents and heart attacks, she recognized the value of a plan.

"I learned that if you do a little bit of work ahead of time, you can do so much better in an emergency," said Hunt, 40. This lesson carried over from her teenage years to her adult life as a physician.

In the pediatric intensive care unit at Johns Hopkins Hospital, Hunt regularly uses simulations to prepare medical students and staff for emergencies, such as cardiac arrests - when patients lose consciousness and stop breathing normally. Her research on resuscitation and critical care medicine led to her appointment as the first director of the hospital's Simulation Center in 2004, when she worked with engineers and architects to design and build the $5 million facility. The center opened its doors in March of this year.

"She really pioneered the teaching of CPR to our residents with very little support," said Dr. David Nichols, vice dean for education at the School of Medicine. "We kept track of the impact of her training along with actual [cardiac] arrests in the hospital, and over time she demonstrated that survival rates were getting better."

Hopkins is far from the first to construct a state-of-the-art simulation center. Since 1993, more than 660 centers have been built worldwide, including 436 in the United States, according to databases from the Bristol Medical Simulation Centre in the United Kingdom.

The University of Maryland Medical Center established one in 2006, and its director envisions collaborating with Hopkins to advance research in robotics and visualization.

"It takes a lot of individuals and resources to bring simulation in the training of doctors," said Dr. Adrian Park, head of general surgery at the medical center and director of the simulation center. "If we put our heads together, we can develop new modules and then evaluate their effectiveness in learning."

For Hunt, who earned her medical degree from Albany Medical College and her master's of public health and Ph.D. from Hopkins, simulation is all about improving teamwork, communication and multitasking skills. Recently, she spoke about her research and life experiences during an interview in her office. A colorful quilt of pictures covers a part of the wall, showing her in front of landmarks such as St. Basil's Cathedral in Moscow.

She says she first conceived the idea for her research when she was a fellow in pediatric critical care at Hopkins in 2002. When arriving on the scene of a cardiac arrest patient, she usually saw nurses and junior doctors rushing around the room.

And the patient? Unattended and forgotten, from her perspective. "It became very frustrating because this was happening too frequently," Hunt said.

Upon further investigation, she learned that this was unintentional behavior by medical personnel, who became distracted by the mayhem and emotion.

"I started to interview people and collect data on resuscitation, and I saw that we were asking too much from the first responders," Hunt said. "Instead of administering basic CPR, they would prepare the room for advanced life support, like getting the epinephrine and the defibrillator ready."

With colleagues, she staged mock drills, using life-sized child mannequins whose vital signs she can control, to see how quickly and effectively medical teams can treat trauma patients. In their research, they found that nearly all groups failed to properly stabilize seriously injured children.

As lead author of the studies, she published these findings in numerous journals, including Pediatrics, and suggested that the results probably apply to other hospital teams nationwide.

A spokesman for the American Heart Association said that Hunt now needs to tie her findings in the simulated setting to patient care.

"This critical gap for all simulation research is the challenge to relate what happens in simulations to what happens in real situations," said Dr. Vinay Nadkarni, associate director of the Center for Resuscitation Science at the University of Pennsylvania School of Medicine. "If providers learn and do well with simulated patients, does that really mean better outcomes for actual patients?"

For Hunt, the approach seems to be a matter of common sense. "I say, 'Practice on plastic first,' " she said. "Once students make mistakes, they have less of a chance making them the second time around, which may include real patients."

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