AUSMAT members continually work on maintaining their readiness for any number of health emergencies. In a unique shift from traditional methods, Melissa Taylor, a Clinical Nurse and Midwife Consultant at the National Critical Care Trauma and Response Centre (NCCTRC), in collaboration with Dr Jason Sly, Nurse Midwife Lynice Wood, and Dr Andrew Brewin from Royal Darwin Hospital, have recently introduced an innovative and low-cost method for training healthcare professionals in managing early pregnancy bleeding and peri-mortem caesarean section (PCS) procedures.
The PCS is an extremely rare but potentially life-saving procedure for both mother and baby, performed when the mother is in cardiac arrest or has suffered severe trauma. Recognising its importance, the procedure has been incorporated into the AUSMAT Surgical Team Course curriculum. In breaking away from conventional training models, Ms Taylor has introduced an unconventional yet effective training tool - watermelons and rockmelons.
The statistics behind the PCS speak to its rarity and urgency. In the United States of America alone, cardiac arrests during pregnancy occur at a rate of 1 in 30,0001, with a portion of these leading to dire consequences that could be prevented by swift surgical intervention. Yet, the opportunities for healthcare professionals to practice this time-sensitive procedure are scarce.
Enter an innovative solution inspired by: The Gravid Watermelon: An Inexpensive Perimortem Caesarean Section Model by Dr Paul Valencia and Dr Danielle Turner-Lawrence. The publication provided detailed instructions on how to transform a watermelon into a surrogate for the female uterus in PCS simulations and it was the catalyst for incorporating fruit-based simulations into the Surgical Team Course.
“The rockmelons were used as a model of the uterine cavity to practice and train with new equipment in the treatment of early pregnancy bleeding and incomplete miscarriage in the austere environment, " Ms Taylor explained.
"Early pregnancy bleeding and miscarriage can be a life-threatening event if a woman haemorrhages, often requiring urgent surgical intervention and an anaesthetic to remove retained products of conception. In the austere environment this can prove challenging if a theatre is not available or a woman presents to the EMT before the surgical capability has been built,” she added.
Participants of the AUSMAT Surgical Team Course also trialled the Ipas Manual Vacuum Aspiration (MVA), a low-cost and effective method for treating early pregnancy bleeding and miscarriage. This handheld device eliminates the need for general anaesthesia, power, or suction and can be used with a local anaesthetic while the woman is awake.
“To simulate the procedure, the rockmelons were filled with ultrasound gel and food dye to simulate retained products of conception, the Ipas MVA proved to be easy to use and effective in removing the products from the model uterus,” Ms. Taylor noted.
By utilising materials commonly found in supermarkets and hospital emergency departments, participants engaged in a hands-on learning experience that delved into the intricacies of performing surgery in austere environments.
The course highlighted managing obstetric emergencies, a critical skill set for responding to disaster and health emergencies. Participants were confronted with a variety of urgent maternal health scenarios, from emergency caesarean sections to complex vaginal deliveries and the dangers of post-partum haemorrhage and retained placentas.
Understanding the gravity and rarity of the procedures, Ms Taylor’s training approach balanced the seriousness of the topic with an element of levity. “The participants are comfortable performing procedures in their familiar hospital environments with high-tech equipment,” she said.
“The course gave them the opportunity to adapt their skills for challenging environments, where they might face life-threatening obstetric emergencies with unfamiliar equipment. In such situations, there may be no power, suction, or limited oxygen until an EMT field hospital is established. This is precisely why the AUSMAT Surgical Team Course is essential – to prepare healthcare professionals for these challenging scenarios,” explained Ms Taylor.
Feedback from one of the course participants reflected the success and impact of these innovative training methods. “The hands-on experience with the fruit-based models was unexpectedly effective. Not only did it provide us with a clear understanding of the procedures in a simplified manner, but it also encouraged us to think creatively in resource-limited settings. This approach to learning is not just innovative but also deeply practical and memorable. It definitely enhances our ability to handle real-life emergencies with more confidence and skill,” they said.
“This is the first time I have been involved in the faculty of the AUSMAT Surgical Team Course and it was a lot of fun. I have been a Nurse and Midwife for 18 years, teaching and education has always been a passion of mine, sharing our knowledge and making learning fun ensures that knowledge is consolidated,” reflected Ms Taylor.
The course included participants from both remote and rural communities across Australia and the Asia-Pacific region. By adopting the gravid watermelon training model, Ms Taylor has not only made advanced medical training more accessible but also empowered participants to enhance their capabilities in their home communities. This approach is pivotal as it enables participants to impart their newly acquired skills to colleagues, further expanding the capacity for emergency medical care within their local healthcare systems.
References:
1 Montufar-Rueda C, Gei A. Cardiac arrest during pregnancy. Clin Obstet Gynecol. 2014;57(4):871-881. doi: 10.1097/GRF.0000000000000075
Carla Yeung
Communications and Digital Engagement Officer