Our CT3 ED doctor took the helm and performs a primary survey:

<C> No sign of catastrophic haemorrhage

A: No C-spine concerns, groaning in pain

B: No wounds/injuries to chest, saturating 100%, equal air entry, slight tachypnoea 35/min

C: Tachycardia at 100 breast per minute, hypertensive 150/60mmHg, CRT 2s centrally, pink right foot, CRT 3s

D: GCS 15/15, initially alert but becoming confused, no signs of head injury

E: Knife sticking out lateral right thigh, no visible bleeding or oozing, no haematoma felt, temperature 36.0°C. Full top-to-toe performed. Underside of patient yet to be examined.

With security in the background, whilst also surrounded by medical staff, I start to feel more unwell and struggle to answer the doctors questions. The pain is making me sweaty and I almost throw up (those acting lessons pay for themselves).

“Give oxygen 15L/min non-rebreathe mask. Two wide bore IV cannulas please. Remember group and save! What’s the blood gas? Put out a major haemorrhage call and a trauma call.” “Shall we give fluids?” “No, let’s give tranexamic acid, and prepare blood.” “M, can you team lead… I’m going to reassess an A to E. We also need to check underneath him for injuries.”

Further help arrives in the form of a paediatric surgical SpR, a porter, a radiographer, nurse in charge, doctor in charge etc. Helpfully, the sliding glass bay doors assist with crowd control. A handover is given and just as the surgeon begins to reassess… the simulation is over. Everyone is invited into the room. It’s time to discuss!

The Debrief

This simulation drew departmental attention. With participants and observers gathered we began to revisit the scenario, being careful to be sensitive to people’s needs.

The context

Sadly paediatric stabbings are on the rise. Notoriously, London is seeing record numbers. Statistics there suggest victims are male (97%) coming from deprived areas (73%) with most stabbings occurring after school (4pm-6pm) minutes away from their homes (within 5km) (Vulliamy et al. 2018). Here in Leicester too we regretfully are seeing cases. As a paediatric doctor, honestly, I would have had no clue what to do! Indeed, this brings us to the first of our learning objectives…