Glenn is an Emergency Department RN who has basically seen it all through his fifteen years of practice. One day, a teenager is rolled into the trauma bay in cardiac arrest after a horrific car crash. Despite the team’s best efforts, the resuscitation fails and the teenager dies. Afterwards, Glenn is shaken and wants to talk. The trauma team leader organizes a debrief but doesn’t seem like she knows what to say, and there’s a lot left unsaid. Glenn can’t get the case out of his mind for the rest of the shift and doesn’t know who to talk to.
In Emergency Medicine, unexpected tragedies are an expected part of our specialty, and a skilled debrief session can be as important for the team as the patient care delivery itself. This Feature Educational Innovation (FEI), titled “Critical Incident Stress Management – TASK Defusion” on May 15, 2015 and answers the question: “Can we develop a practical debriefing tool to help structure team debriefing after a critical incident?” A PDF version is available here. A CAEP cast is available here.
- Introduction – discussion of who is present, roles and expectations of debriefing.
- Management Phase – covers important topics in medical case management, answers questions from the team about why and how decisions were made.
- Reaction Phase – asks team members to share their reaction to the situation. For example: “If you had the power to erase one single aspect, without changing the outcome, what would you most want to eliminate from this experience?”
- Teaching Phase – Assure that stress is a normal reaction to an abnormal event. Give basic strategies for coping, such as:
- Talk to people
- Eat and sleep normally
- Do something nice for yourself
Although the workshop has only been performed once, the resident feedback was excellent. They found the session very practical and useful. We intend to survey the residents in a year to see if they are actually using the tool in the “real world.” We are also developing an app that leads a facilitator through the debriefing process.
Can you give us examples of the best and the worst debriefing sessions you have experienced? What made them good or bad?
More About the CAEP FEI
This post was originally authored for the Canadian Association of Emergency Physicians (CAEP) Feature Educational Innovations project sponsored by the CAEP Academic Section’s Education Working Group and edited by Drs. Teresa Chan and Julien Poitras. CAEP members receive FEI each month in the CAEP Communiqué. CanadiEM will be reposting some of these summaries, along with a case/contextualizing concept to highlight some recent medical education literature that is relevant to our nation’s teachers. [bg_faq_end]