8. Have a transport plan in place. Make post-stabilization transport plans
part of the simulation. It's crucial that every surgery center have a
transport plan in place before an MH episode happens, and that every-
one knows the transport plan. Depending on how far away you are
from the receiving facility, I recommend that the anesthesia provider
accompany the patient in the ambulance along with a sufficient
amount of dantrolene. He should be able to give reports to the receiv-
ing facility en route and continue to administer dantrolene, if needed.
9. Keep track of who's trained and who isn't. The Joint Commission recom-
mends that you do simulations once a year. But if turnover is high or
you have a lot of new people coming into your facility, keep it in mind
and consider increasing the frequency of your drills to get new staff
up to speed.
10. Rotate between scheduled drills and unscheduled ones. If your purpose
is to educate, then you want drills to be scheduled. If your purpose is
to assess readiness, you want them to be a surprise. I think it's a
great idea to rotate between scheduled and unscheduled drills, and
to have one of each every year. That will obviously be more time-con-
suming than one drill a year, but it will also be more effective.
11. Have contingency plans. Keep in mind that the people you train
might not be the people who are there if an episode happens in the
middle of the night. Those are things that need to be discussed and
planned for. Whom are you going to call or page? Are you going to
bring people in from home or not? Contingency plans should be
part of the simulation.
OSM
9 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A R C H 2 0 1 6
Dr. Shukry (mshukry@childrensomaha.org) is the chief of anesthesia at
Children's Hospital in Omaha, Neb., and an associate professor in the
Department of Anesthesiology at the University of Nebraska Medical Center.
