For the first time, the Semmelweis Simulation Center hosted an ATLS (Advanced Trauma Life Support) course, which ensures the care of seriously injured patients based on a protocol and curriculum standardized in 40 countries. The training program has been available in Hungary since 2006, and it was the 52nd occasion that the theoretical and practical course held in mid-October was offered in Budapest. On the closing day of the program, we accompanied the instructors behind the scenes and the students through the key stages of the final examination required to qualify as an orthopedic traumatologist.
At 6:00 a.m., an experienced and well-knit team is unpacking into the rooms of the Semmelweis Simulation Center in Ernő Street. They are equipping four rooms of the hospital’s trauma care unit with the necessary tools to treat four different cases. The briefing of the ‘victims’, who are also experienced in acting out the symptoms of each medical condition, has also started. This year, Semmelweis University has hosted the ATLS course for the first time, which is compiled, supervised, and updated every four years by the American College of Surgeons, says Dr. Tamás Bodzay, Director of the Department of Traumatology and President of the Hungarian Society for Traumatology, which supervises the training in Hungary.
Tünde, who joined the team in 2016, is applying lifelike, cinematic makeup to the injured to be treated by the examiners. “Before the exams, we always discuss with her what scenarios will be included in the exam practice and later in the exam, and where, what kind of wound or bruise should be applied on each ‘patient’,” says Dr. Tamás Bodzay. Students receive the English-language course manual one month in advance, and then eight instructors teach 16 students during the 2.5-day course. They practice the life-saving maneuvers that, if performed in the right order, will significantly enhance the survival of the given cohort of patients, adds Dr. Tamás Bodzay.
The mock patient Tünde is working on is an aspiring actor, so he is accustomed to makeup and, being the child of a traumatologist, he is no stranger to healthcare, either.
A stab wound in progress. Advanced practice nurse István Popof has been playing the injured in different scenarios featured in ATLS courses for six years. In his experience, the body of knowledge, the approach, and practical steps of treating serious injuries, which are learned here, are also useful in his everyday work as an intensive care nurse at the Dr. Manninger Jenő Traumatology Center in Budapest and as an ambulance nurse. The curriculum enables the participants to become skilled in the basic steps and know-how related to patient trauma positions and preparation, psychic guidance, oxygen therapy, preparing the equipment, wound treatment, and other manual techniques, adds István.
The final result that the examinees will face. As the training is based on an American franchise, a significant part of the curriculum focuses on the treatment of penetrating injuries – stab and gunshot wounds – while in Hungary blunt force trauma and fractures are more typical. Adhering to the ABCD points of the primary survey prescribed in the curriculum will establish the routine of what needs to be assessed and performed for each injury to treat and stabilize the patient in 15 minutes so that they can be transported to a larger hospital or the designated ward within a hospital. The practical exam is successful if the doctor has performed the interventions in the correct order and refers the patient alive to a larger hospital, says Dr. Tamás Bodzay.
Last briefing before the students’ arrival on the course of the exam and the scenarios. Half of the eight instructors are affiliated with Semmelweis University; seven participants of the 52nd Hungarian ATLS course are also in the university’s residency training program, and three are employed by the university. This training has been available in Hungary since 2006, initially in Szeged, but since 2016, it has also been offered twice a year in Budapest. Since 2013, the course has been compulsory for the specialist examination in orthopedic traumatology, it is a compulsory elective subject in emergency medicine, and a course recommended by the professional committees in anesthesiology and intensive care in other Hungarian universities. As a result, interest in the course has been soaring, with a waiting list of several years. Some of the current participants originally applied in 2018.
Finishing touches before the exam.
On exam day, half of the students start with the English-language written exam, while the other half of them wait in pairs at the entrance of the four situation rooms. Those starting with the practical exam part will take two mock exams, first as participants and then as observers, followed by the real exam.
Before seeing the patient, the doctors are briefed by the paramedics on the circumstances of the case, the nature of the injuries, and the patient’s vital signs. From this point, it is their responsibility to keep the ‘patient’ alive.
“Come on, it hurts,” wails the dazed ‘patient’, ripping off his ventilator mask, as his doctor is trying to find out why his vital signs are deteriorating.
The contribution of allied health professionals is also essential during the exams.
If necessary, students can also request an imaging test and may order further examinations and interventions based on the results. From next year on, the new monitor system of the Simulation Center will also be available for the courses, just like the immediate student feedback system for the theoretical training part.
Then the examinees within the pair swap places, with the observer becoming the doctor in the test exam.
On some occasions, the mock patients give such lifelike performances that instructors need to gently remind the examinees in exam fever not to intubate the patients.
Relief after the third, real practical exam. Then students swap with the team that has taken the written test. Both the written and practical exams need to be passed to obtain the qualification.
The highlight of the day: announcing the results and receiving the certificates. Based on their performance during the training and exams, several candidates are invited by the instructors to the upcoming train-the-trainer course.
On the way to the specialist exam.
Melinda Katalin Kiss
Translation: Judit Szabados-Dőtsch
Photos by Bálint Barta – Semmelweis University
