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Practicing Medicine

Practicing Medicine

To ensure patients receive the best emergency treatment as quickly as possible, a simulation center in Parsippany takes acute and intensive care to the next level

During a recent visit to The Medicines Company’s facility in Parsippany, I was there as a figure on a stretcher was rushed through glass doors and the emergency medical technician hurriedly shared with us everything he knew so far: The patient just had a motor-vehicle accident. He’s a kayaker and was heading to a training session to prepare for a solo trip across the Atlantic. He wasn’t wearing a seatbelt and since the accident has been having chest pains. As the emergency department (ED) staff gather around to cut off his clothes and check his vital signs, detecting elevated heart rate and blood pressure, we learn that the injured party is 64-year-old Addison Bookwalter. Oh, and there’s one more detail: Mr. Bookwalter is a dummy, packed with sensors that react to procedures and administered medications in real time. We are, after all, at a high-tech independent simulation center, where “everything is real but the patients,” explains Mike Young, chief learning officer at The Medicines Company.

Here, those learning about acute- and intensive-care products and procedures have the luxury of being able to play with time. “We can stop and teach as we go along,” Young says. “The patient’s not going to die.” It’s well known that preventable human error leads to an unconscionable number of hospital deaths each year—with figures ranging from 98,000 annually according to a 1999 Institute of Medicine report to as many as 440,000 a year in a 2013 study in the Journal of Patient Safety. Combating these statistics, simulation centers that offer healthcare professionals a chance to hone their skills before inheriting all the risk that comes with time-sensitive environments are an invaluable asset. Such learning centers have been cornerstones of academic settings for years, but now independent healthcare firms like The Medicines Company, a provider of solutions in acute cardiovascular care, surgery and perioperative care, and serious infectious-disease care, are going out on a limb to provide the optimal setting to educate those using their portfolio of products—and several states are offering vital support. The Medicines Company’s simulation center, in fact, received up to 50% of its funding from the state of New Jersey.

Many ED doctors who have spent long days and nights training in their academic institutions’ own simulation centers agree that independent simulation centers—that can improve patient outcomes and help healthcare professionals work together more effectively—are a step in the right direction for the future of medicine. Simulation centers can be “hugely valuable in training physicians in complex medical cases and also for training teams to work together as a dynamic unit,” says Darria Long Gillespie, national spokesperson for the American College of Emergency Physicians and an ED doctor at Northside Hospital in Atlanta, Georgia. “Patients are so different, and nobody follows the classic case that you read about in textbooks. You can read books on how to treat a human, but only once you start will you realize what you don’t know, and when it comes to human lives, there’s a lot less room for error.” Kevin Rodgers, president of the American Academy of Emergency Medicine and professor of clinical emergency medicine at Indiana University, says that in high-tech areas of medicine where complex situations quickly unfold, having a group cater to a narrow and very specific scope at an independent simulation center could help curtail the rate of medical error, when taught properly. Michael Bain, CEO of Qualified Emergency Specialists, in Cincinnati, Ohio, adds that since physicians-in-training have residency-hour restrictions that cap how long they are allowed to work in a hospital over a certain period of time, “there’s more of a need today for simulation centers that provide training in time-sensitive, specialty situations and offer hands-on experience on anything from administering an IV to treating a cardiac arrest situation.” According to Young, while hours spent at a simulation center based at a hospital would count towards the residency restriction, time spent at an independent simulation center would not.

At The Medicines Company, we quickly administer an IV in Bookwalter, give him oxygen and begin brainstorming a list of possible diagnoses, ranging from anxiety and stress to pulmonary embolism and aortic dissection. We call for labs, aiming to rule out as many scenarios as possible with the fewest number of diagnostics. We request an electrocardiogram, run some blood tests and take chest x-rays. We find a blockage in an artery on the right side of his heart.

Immediately, the catheterization lab begins to prepare for Bookwalter, where he’ll undergo a percutaneous coronary intervention (PCI) and likely receive a stent to open his blocked artery. In the lab, we administer a cocktail of drugs through an IV, including Kengreal, to protect against the body’s natural responses to the procedure and potential life-threatening complications like stent thrombosis. We then guide a wire into his radial artery, peering closely at the monitor displaying an internal, 2-D view of the wire to help direct us. When we cross the culprit lesion, the patient reacts with a sudden drop in blood pressure. Suddenly, he’s showing signs of cardiac arrest and coronary spasm, which requires defibrillation and a cocktail of drugs to stabilize.

As the PCI wraps up, Bookwalter’s condition is not improving and he continues to complain of severe back pain. We palpate his abdomen and feel a pulsatile mass. A bedside ultrasound reveals an abdominal aortic dissection, in which the largest artery branching off the heart has torn, and he’s swept away to the operating room for another procedure.

In the OR, Jason Campagna, senior vice president, health science, surgery and perioperative care for The Medicines Company, says it’s imperative to place a graft inside his aorta quickly and avoid the risk of it bursting and him dying on the table. We just started major abdominal surgery, and while we watch the blood accumulating near the incision and check the monitor showing his vital signs, we’re told we cannot put a clamp across his aorta until we reduce his blood pressure significantly. So we administer Cleviprex, an antihypertensive, in hopes of rapidly lowering his blood pressure. “This is usually when the room stands still,” Campagna says. “When you need to manage this level of complexity and have blood pressure drop significantly in a matter of minutes, there’s really not a lot of room for error.” Campagna reminds us that we have to remain aware that “very quickly—on a dime—things can change.” Fortunately, our patient’s blood pressure comes down, the procedure goes as well as can be expected and we replay the various possible scenarios and outcomes aloud, analyzing our actions and deliberating on what else we could have done.

“Everybody’s got that patient that kept them up at night,” Ryan Scott Bardsley, director of education and translational research at The Medicines Company, explains, just before we hang up our lab coats and call it a day. “Here, we try to break down the walls and expose those vulnerabilities so they’re not repeated in the future.” Clearly, in this safe space, where art meets science and medicine meets the movies, the simulation center provides an intimate look at the way emergency treatment is evolving in the here and now, while helping to ensure that real-life patients receive the best emergency care when time is of the essence.

Illustration by Greg Betza

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