Simulated Emergency Clinical Encounter

This week we had what I believe to be a unique experience among the naturopathic medical schools. We had a medical emergency during a follow-up visit with one of our simulated patients. I'm not aware of any other naturopathic med school that offers this intense experience for their students.

Dr. Ezra Cohen has set up our clinical training rooms with microphones, cameras and recording equipment to help us review and better understand our encounters with each simulated patient. These video records help both us, as students, and our faculty gain a better understanding of strengths and weaknesses of our interaction with our patients. Dr. Cohen warned us at the beginning of the trimester that we would have a simulated emergency at some point during the trimester. He also warned us that the cameras would be rolling to document the experience. The cameras were rolling, so to speak, as our follow-up visit began.

The follow-up visit started quietly. Our patient was an elderly female who had presented for persistent headaches. My team of naturopathic and chiropractic interns had completed the first office visit and initial intake with her the week before. We had come up with a good treatment plan for her that involved increased water intake, diet modification, a relaxing botanical tincture for the evening, along with some acupuncture and massage for her neck and shoulders to help with the headaches. This treatment plan was developed based upon many interactions with prescription drugs that our herbal tincture may or may not have along with our patient's daily activities, posture and goals for healing.

Well, as we were about 10 minutes into the follow-up visit with our patient, she started complaining of having difficulty breathing. As our patient began to clutch her chest and let us know she was dizzy, one of my team of Interns stepped beside the patient in her chair to steady her. Just as she was about to say another word, she grabbed her chest in a clenched hand and started to slump over in her chair! 

Another Intern stepped to her opposite side and as she slumped the two interns supported her and carried her to the examination table in the room, where they placed her in a "face-up" position lying down. I immediately exited the room to let Dr. Cohen know that we had an unconscious patient, who had clutched her chest while complaining of shortness of breath. I explained that I believed our patient was having a myocardial infarction (a heart attack) and asked Dr. Cohen to immediately call 9-1-1 (simulated, of course). 

Dr. Cohen called right away and I returned to the room. Upon my return, my teammates had started taking the patient's vital signs, were supporting her on the table to secure her from falling and both were talking to the patient to let her know that she was safe with her caregivers, emergency responders were on the way, and that her emergency contact had been notified. During this entire time our patient was alive, yet unconscious. After about five minutes, Dr. Cohen entered the examination room to declare the exercise complete.

Our team described what we would share with the emergency responders such as the patient's vital signs (with any differences before and after the incident), when they last ate, and current prescription drugs as well as a description of the patient's words, actions and the entire incident. This information is vital to the emergency responders' ability to care for a patient in an emergency situation.

Our patient suddenly "woke up" and was fine. She gave each of us excellent feedback on how the situation was recognized, handled by each Intern, and relayed to the first responders. Our simulated patients do an excellent job overall of discerning our actions, efforts and performances as Interns.

Thanks to Dr. Cohen and his efforts to ensure we are exposed to as many ailments, pathologies, life situations, and emergencies as possible, I feel that we will be better caregivers to our patients. After all, doctors (regardless of modality or specialty) are caregivers and as soon as we forget that we are dealing with a whole human being, then our capacity to be a "caregiver" diminishes. I am thankful for our professors at NUHS who teach us to be caregivers and not just a lens to focus on one pathology.