Where to Begin

The Republic of Moldova identified a desire to strengthen emergency and trauma care given its proximity to the war in Ukraine. We utilized in-situ simulation (ISS) as a rapid tool to assess the current trauma management practices in a tertiary care Emergency Department. We conducted three simulations, utilizing peer-reviewed scenarios, over the course of one day. Emergency Department teams managed the simulated patient according to their usual practice, involving General Surgery, Orthopedics, and Neurosurgery consultants. The ISS identified challenges in clear leadership, established roles, and team communication to ensure situational awareness and prioritization of interventions for patient resuscitation. Other patient care findings included no availability of mass transfusion protocols and inconsistent approach to secondary ATLS survey. Overall, we found ISS to be an effective method of assessing the current state of trauma care and identified areas on which to focus our initial efforts during the formation of a trauma Team.