Practiss - Welcome

Code White

This scenario is meant for hospital staff to practice running a code white in their facility. Designed with the Wilson Memorial General Hospital in mind, it includes policies at that hospital and broader guidelines. It should be modified or edited to suit your facility.

The woman presents to the hospital lobby yelling out her daughter's name and gets herself into the ER lobby. When a nuse greets her she is not able to be verbally de-escalated. When the physician arrives she escalates further swearing and threatening and pulls out a kitchen knife. She wants to be taken to her daughter. She is disheveled, highly agitated, and not able to be redirected. Staff will need to work with police to de-escalate the situation.

Ensure that you have coordinated with the police officers that will be attending the simulation beforehand, and that you are all on the same page in terms of expectations for one another and the procedures to be followed

Goals and Learning Objectives

Technical/Equipment Recommendations

Supporting Roles and Scripts

Role

Description (Role, Behaviour, Key Moments, Script)

Aggravated patient

You are a 39 year old bipolar woman with a daughter who is currently in your husband's custody. Your daughter was recently hospitalized for pneumonia and discharged a day or two later - she is currently in Thunder Bay visiting her grandma. You arrive at the hospital under the delusion that your daughter is still at the hospital and that the hospital is lying to you about where she is. You become increasingly agitated and violent as the scenario rolls on.

Stage 1

You confront the nurses at the nurse's desk, demanding to see your daughter. You are angry and convinced that the nurse is lying to you when she says that your daughter is not here
- Example phrases:
  - "Take me to my daughter! I know she's here!"
  - "I know he's telling you to hide her from me"
  - "You're lying!"
  - "Stop looking at me like I'm fucking crazy!"
They will attempt to verablly de-escalate the situation with you, but you are having none of it. You grow increasingly frustrated and angry.

Stage 2 - Physician enters

When the physician enters, you get much more agitated. You pull out your kitchen knife and threaten both the physician and nurse
If the physician and nurse don't immediately leave the scene within 90 seconds, you attempt to take the nurse hostage to force the hospital to bring your daughter to you

Stage 3 - Police Arrive

Everyone has left, leaving you alone in the ER. You're still agitated and yelling for them to bring your daughter
The police come, and eventually they convince you to drop your weapon
When they attempt to sedate you, if they don't give you a ketamine injection (so if they administer haloperidol or Ativan) then it doesn't work and you remain aggressive

Stage 4 - You take the Nurse Hostage

You grab hold of the nurse and threaten to cut her with your knife.
This one will take some artistic license from you, as how this situation resolves will likely be very different in different settings. Go with what you think seems appropriate as a place to end the scene

Moulage and Scenario Set-Up

Printable Supporting Documents (Will also be accessible at relevant Scenario Stage)

Note: While prepping for your simulation, don't forget to prep for the debrief. Become comfortable with your chosen framework, review your objectives. For additional debriefing resources, see our Resources page.

Credits:
Original Author: Eliseo Orrantia
Date: March 7 2023

Prebriefing

A good prebriefing is an essential component of running effective simulations, as it sets the stage for everything that comes after it^1-3. An effective prebrief will create a safe container for learning, and in doing so, help participants feel more comfortable pushing their limits, sharing their thoughts and feelings, and buying into the experience. In turn, this will enhance engagement, participation, and learning. To that end, the prebriefing process needs to cover a lot of information^1-5, which can make it daunting to novice or non-expert facilitators. To help, we have consulted the relevant literature and put together a prebrief guide to ensure that you have the tools you need to run an effective pre-briefing session.

Throughout the pre-brief, it is important that you convey your commitment to respecting learners and their perspective^2-4, and establish and maintain the simulation as a safe space for learning^1,4,5.

Prebrief Guide (Sample Phrases in Italics)

Welcome and Introduction

Orient to Basic Logistics

Clarify Objectives

Review the Evaluation Structure for the Day

Clarify Expectations

This could be a good place to pause and ask learners if they have any additional expectations, fears, comments, or questions about the topic for the day.

Establish Confidentiality

Establish the Fiction Contract

Explain and Assign Roles

Go over Logistical Details

Orient to the Environment

Ask for questions!

References

1. Rudolph JW, Raemer DB, Simon R. Establishing a safe container for learning in simulation: the role of the presimulation briefing. Simul Healthc. 2014 Dec;9(6):339-49. doi: 10.1097/SIH.0000000000000047. PMID: 25188485.

2. Leigh G, Steuben F. Setting Learners up for Success: Presimulation and Prebriefing Strategies. Teaching and Learning in Nursing. 2018; 13(3):185-189. https://doi.org/10.1016/j.teln.2018.03.004

3. Lecomte F, Jaffrelot M. Chapter 33 - Prebriefing and Briefing. Clinical Simulation. 2019; 2nd ed.; 471-482. https://doi.org/10.1016/B978-0-12-815657-5.00034-6.

4. INACSL Standards Committee (2016, December). INACSL standards of best practice: Simulation^SMFacilitation. Clinical Simulation in Nursing, 12(S), S16-S20. http://dx.doi.org/10.1016/j.ecns.2016.09.007.

5. Simon R, Raemer D, Rudolph J. Rater's handbook for the Debriefing Assessment for Simulation in Healthcare (DASH) Rater Version. 2009. http://www.harvardmedsim.org/debriefing-assesment-simulation-healthcare.php.

The Situation

It is 8am. A 39 year-old woman with known bipolar disorder presents to the hospital lobby yelling out her daughter's name and gets herself into the ER lobby. She has recently gone through a separation from her husband, who has been given custody of their 11 year-old daughter to this woman's inability to manage her mental illness. She is under the delusion that her daughter (who was recently hospitalized for pneumonia) is still being kept in hospital and that the hospital is lying to her. The daughter has actually been sent to visit her paternal grandmother in Thunder Bay to give her a bit of a rest and recuperation holiday and to get away from her unwell mother. The father has not let the mother know where the daughter is. She is angry, seems disheveled, and is not able to be redircted.

Physical Exam
Cardio:	Neuro:
Resp.	Head & Neck:
Abdo:	MSK/Skin:
Other:

1. Aggravated patient

The previously described woman makes it into the ER and confronts the lone nurse at the nurse's desk. The ER is empty except for a mother and her 13 year-old son in the eye room who got a twig injury to his eye while ice fishing the previous evening. The ER physician is currently on their way to the hospital to start their shift

The woman is angry, and yelling out her daughter's name.

Expected Learner Actions	Modifiers	Triggers
Assess threat and identify risk level Attempt verbal de-escalation in a calm voice Identify what the woman wants Follow hospital procedures for summoning assistance Ensure that help is on the way	De-escalation attempted ⇒ No impact	2-5 minutes ⇒ 2. Physician Arrives

2. Physician Arrives

The physician arrives. The woman becomes much more agitated and pulls out a kitchen knife and begins threatening both the physician and nurse.

Expected Learner Actions	Modifiers	Triggers
Assess threat and ID situation as high risk Get other patients to safety Call Code White Call Police Initiate local Code White protocols Leave the scene within 90 seconds Begin developing and verbalizing plan Assign specific tasks to nurse Team Leader communicates with individual Gives specific plan details to team members, ie. where exactly to exit room Ensure team members are ready	Physician arrives ⇒ Woman becomes more agitated	Team leaves within 90s ⇒ 3, Police Arrive Team fails to leave in time ⇒ 4. Hostage

Expected Learner Actions

Modifiers

Triggers

Assess threat and ID situation as high risk
Get other patients to safety
Call Code White
Call Police
Initiate local Code White protocols
Leave the scene within 90 seconds
Begin developing and verbalizing plan
Assign specific tasks to nurse
Team Leader communicates with individual
Gives specific plan details to team members, ie. where exactly to exit room
Ensure team members are ready

Physician arrives ⇒ Woman becomes more agitated

Team leaves within 90s ⇒
3, Police Arrive

Team fails to leave in time ⇒
4. Hostage

3. Police Arrive

The police arrive and take over the scene. All staff are gathered outside the ER doors, and no sounds can be heard from within. The patient is hiding in the trauma room behind the O2/vacuum stack.

The police eventually convince the woman to drop her weapon

Expected Learner Actions	Modifiers	Triggers
Organize staff to keep patient from exiting the ER Allow police to take control of scene Chemical restraint admin - IM Ketamine 5mg/kg administered to woman Apply physical restraints	Haloperidol/Ativan administered ⇒ No impact, patient remains agitated and alert	Team sedates and restrains patient ⇒ End and go to debrief

Expected Learner Actions

Modifiers

Triggers

Organize staff to keep patient from exiting the ER
Allow police to take control of scene
Chemical restraint admin - IM Ketamine 5mg/kg administered to woman
Apply physical restraints

Haloperidol/Ativan administered ⇒ No impact, patient remains agitated and alert

Team sedates and restrains patient ⇒
End and go to debrief

4. Hostage!

The woman grabs the nurse by her hair/arm and pulls them towards her. She is threatening to cut the nurse if you do not bring her her daughter.

Expected Learner Actions	Modifiers	Triggers
Back off from physical confrontation Work with police to control situation Administer chemical restraint - IM Ketamine 5mg/kg (500mg max) Administer physical restraints		Team administered physical and chemical restraints ⇒ End and go to debrief

Debriefing

Choosing a Debrief Framework:

A good debrief has been identified in the literature as the most important part of a successful simulation experience. If you're a novice or inexperienced facilitator, use this table to help you choose which debrief framework you want to use, just tap the button on their name and you will be directed to the appropriate aids or scripts. While we recommend the PEARLS framework, take a look to see if there may be another that is a better fit for your situation.


	Time	Facilitator Level	Prep Time	Scenario Type	Flexibility
PEARLS (Our Favourite)	Moderate	Novice	Moderate	Any	High
GAS	Short-Moderate	Novice	Low	Short w/ Clear Objectives	Low
Team Dynamics	Moderate	Novice	Moderate	Any, esp. Team-focused	Moderate
SHARP	Very Short	No experience	None	Any	Low
Diamond	Short	Novice	Low	Low number of non-technical skills	Low
Plus-Delta	Very Short	No experience	None	Any	Moderate
Debriefing w/ Good Judgement	Moderate-Long	Novice	Moderate	Any	Moderate

PEARLS Debrief Framework

(To learn more about this debriefing framework, visit our page on Debriefing resources)

If you need help with debriefing Crisis Resource Management skills, check out this infographic from Isaak & Stiegler: View Infographic

Phase	Objective		Task		Sample Phrases
1. Setting the Scene	Create a safe context for learning		State the goal of debriefing; articulate the basic assumption		“Let’s spend X minutes debriefing. Our goal is to improve how we work together and care for our patients.” “Everyone here is intelligent and wants to improve”
2. Reactions	Explore feelings		Solicit initial reactions and emotions		“Any initial reactions?” “How are you feeling?”
3. Description	Clarify Facts		Develop a shared understanding of the case		“Can you please share a short summary of the case?” “What was the working diagnosis? Does everyone agree?”
4. Analysis	Explore a variety of performance domains: Decision making Technical skills Communication Resource utilization Leadership Situational Awareness Teamwork		See bottom of guide for details on the analysis phase		For each item to be debriefed: 1. Preview Statement: (to introduce topic) “At this point, I’d like to spend some time talking about [insert topic] because [insert rationale]" 2. Pick Analysis method + Analyze: (see below for more info on each method) a. Learner Self-Assessment b. Focused Facilitation c. Provide information 3. Mini Summary: (to summarize discussion of topic) *“That was a great discussion. Are there any additional comments related to [insert here]”* Phase Wrap-up: "Any outstanding issues or concerns before we start to close?"
5. Application or Summary	Identify take-aways		Can be learner- or instructor-centered		Learner-centered: “What are some takeaways from this discussion for our clinical practice?” Instructor-centered: “The key learning points for the case were [insert learning points]”
Analysis Phase Details
Choose an analysis approach (Different approaches can be used for different topics within the same analysis stage):
Approach		Objective		Sample Phrases
Learner Self-Assessment Time: Short/Moderate Performance Domain: Cognitive/Technical Rationale Evident: Yes/No Facilitator Experience: Low		Promote reflection by asking learners to assess their own performance		“What aspects were managed well and why?” “What aspects do you want to change and why?”
Focused Facilitation Time: Moderate/Long Performance Domain: Cognitive/Behavioural Rationale Evident: No Facilitator Experience: More experience required, can be difficult		Probe deeper on key aspects of performance, uncover mental frames guiding performance		Use Advocacy-Inquiry Method Advocacy: "I saw [observation], I think [your point-of-view]” *"I noticed [observation]* I liked that/I was concerned..." Inquiry: “How do you see it? What were your thoughts at the time?”**
Provide Information Time: Short Performance Domain: Cognitive/Technical Rationale Evident: Yes Facilitator Experience: Low		Teach to close clear knowledge gaps as they emerge and provide directive feedback as needed		“I noticed[behaviour]. Next time you may want to consider [suggested behaviour], because [rationale]”

PDF from debrief2learn.org: Here
Visual Guide: debrief2learn.org
Alternative Script: Here
Originally Created by: Bajaj K, Meguerdichian M, Thoma B, Huang S, Eppich W, Cheng A. The PEARLS Healthcare Debriefing Tool. Acad Med. 2018, 93(2), 336.

GAS Debrief Framework

(To learn more about this debriefing framework, visit our page on Debriefing resources)

If you need help with debriefing Crisis Resource Management skills, check out this infographic from Isaak & Stiegler: View Infographic

Phase	Goal	Actions	Possible Scripts
Gather (Listen) 25%	Actively listen to participants to understand what they think and how they feel Identify what occurred during scenario	Elicit emotional state	*How do you feel?*
		Request narrative(s)	*How do you think it went?* *Can you tell me what happened?*
		Request clarifying or supplemental information	*Can anyone add anything to that account?*
Analyze (Guide Reflection) 50%	Provide feedback on performance Facilitate participant’s reflection on and analysis of their actions and systems issues Investigate basis for performance gaps	Review accurate record of events	*I noticed…*
		Report observations (correct and incorrect steps) Ask questions to reveal participant thinking	*I noticed…. What was the thought process behind….* *When….happened, I saw….What do you think…..* *I saw…I think….How do you see it?*
		Stimulate reflection and provide redirection	*Tell me more about…* *How did you feel about….* *I understand, but tell me about X aspect of the scenario*
Summarize (Help gather Conclusions) 25%	Facilitate identification and review of lessons learned	Identify positive aspects of session (participants)	*What are two things that you thought were effective or went well?*
		Discuss behaviours that require change	*What do you think are some areas you/your team need to work on?*
		Summarize session	*In today’s session, we….* *Going forward, we should….*

References/Adapted From:

Phrampus P.E., O’Donnell J.M. (2013) Debriefing Using a Structured and Supported Approach. In: Levine A.I., DeMaria S., Schwartz A.D., Sim A.J. (eds) The Comprehensive Textbook of Healthcare Simulation. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5993-4_6
Baily K (2019) Gather – Analyze – Summarize: The Simple GAS Method for Healthcare Simulation Debriefing (w/ Quick Template). www.healthysimulation.com/18874/gas-debriefing/

Team Dynamics Debrief Framework

(To learn more about this debriefing framework, visit our page on Debriefing resources)

If you need help with debriefing Crisis Resource Management skills, check out this infographic from Isaak & Stiegler: View Infographic

Instructions:

Use the table below to guide your debriefing (Example phrases provided in plain text)
Observe and record elements of team dynamics
Identify 2 or 3 elements of team dynamics to discuss per debriefing section

Actions

Gather

Analyze

Summarize

Closed-loop communication

Orders acknowledged and confirmed when given
Orders announced when executed

Clear Messages

Team members speak clearly
Orders are questioned when doubt exists

Clear Roles

All team members have appropriate roles
Roles are reallocated when appropriate

Knowing one’s limitations

Calls for assistance
Seeks advice when appropriate

Knowledge Sharing

Sharing information between team members
Asks for ideas and suggestions

Constructive Intervention

Identifies priorities
Questions colleagues who make mistakes

Reevaluation and Summarizing

Reevaluates patient
Summarizes patient condition and treatment plan

Mutual Respect

Speaks in a professional, friendly tone of voice
Provides positive feedback

Student Observations

Can you describe the events from your perspective?
How did you think your treatments went?
Can you review the events of the scenario?
What could you have improved?
What did the team do well?

Instructor Observations

I noticed that [insert action here]
I observed that [insert action here]
I saw that [insert action here]

Done Well

How were you able to [insert action here]?
Why do you think you were able to [insert action here]?
Tell me a little bit more about how you [insert action here]?

Needs Improvement

Why do you think [insert action here] occurred?
How do you think [insert action here] could have been improved?
What was your thinking while [insert action here]?
What prevented you from [insert action here]?

Student-led Summary

What are the main things you learned?
Can someone summarize the key points made?
What are the main take-home messages?

Instructor-led Summary

Let’s summarize what we learned….
Here is what I think we learned….
The main take-home messages are….

References/Adapted from:

Cheng, A MD, FRCPC; Rodgers, DL. EdD; van der Jagt, É MD, MPH; Eppich, W MD, MEd; O’Donnell, J CRNA, MSN, DrPH (2012) Evolution of the Pediatric Advanced Life Support course, Pediatric Critical Care Medicine. 13(5). 589-595 doi: 10.1097/PCC.0b013e3182417709
American Heart Association Team Dynamics Debriefing Tool. 2011. https://ahainstructornetwork.americanheart.org/idc/groups/ahaecc-public/@wcm/@ecc/documents/downloadable/ucm_488325.pdf

SHARP Debrief Framework

(To learn more about this debriefing framework, visit our page on Debriefing resources)

If you need help with debriefing Crisis Resource Management skills, check out this infographic from Isaak & Stiegler: View Infographic

Before Case

Set learning objectives
What would you like to get out of this case?

After Case

How did it go?
What went well? Why?

Address Concerns
What did not go so well? Why?

Review learning points
Were your learning objectives met for this case?
What did you learn about your clinical/technical skills?
What did you learn about your teamwork skills?

Plan ahead
What actions can you take to improve your future practice?

Framework from:

Imperial College London (ND). The London Handbook for Debriefing: Enhancing Performance Debriefing in Clinical and Simulated Settings. www.imperial.ac.uk/media/imperial-college/medicine/surgery-cancer/pstrc/lw2222ic_debrief_book_a5.pdf

Diamond Debrief Framework

(To learn more about this debriefing framework, visit our page on Debriefing resources)

If you need help with debriefing Crisis Resource Management skills, check out this infographic from Isaak & Stiegler: View Infographic

Diamond Debrief: Sample Phrases

Description

“So what happened?...and then what happened next?”

Continue asking until confident that the details of the scenario have been raised by the learners

“Let’s not judge our performance now, let’s just focus on what happened”

Transition

“This scenario was designed to show…”

“Let’s address technical and clinical questions. What is the protocol for…?”

“How do we normally deal with this clinical situation?”

“Everyone ok with that?”

Analysis

“How did that make you feel?” To participants, then group

“Why?” Then use silence

“How did you/they do that exactly?”

“Why did you respond in that way? “ or “Why did you take that action?”

“It feels like…was an issue. Did it feel like that to you?”

What I’m hearing from you is…is that correct?”

“This is part of…” (identify the non-technical skill/human factor)

“We refer to that as a human factor or non-technical skill, which means…”

Transition

“So, what we’ve talked about in this scenario is…”

“What have we agreed we could do?”

Application

“What other kinds of situations might you face that might be similar? How are they similar?”

“How might these skills we discussed play out in those situations?”

“What are you going to do differently in your practice going forward?”

Underlying Principles

Description

Reinforce a safe learning environment.

Situate the debrief in the shared and meaningful activity that occurred.

Keep the focus dispassionate—discuss what happened but avoid focus on emotions.

Listen for emotional responses but resist the temptation to discuss emotions.

Make sure everyone shares the same understanding of what happened.

Transition

Transition into analysis by clarifying any technical and clinical issues

Analysis

Spend most of your time in Analysis.

Deconstruct behaviours into specific actions, and explore what happened in detail.

Ask about affective responses and validate them.

Analyze and interpret the activity by applying appropriate frameworks or lenses (such as non-technical skills, or the clinical context surrounding the scenario).

Keep discussion positive, and avoid the temptation to focus on “strengths and weaknesses”.

Reflect responses back, allowing participants to amend or augment.

Transition

Transition into Application by reinforcing learning.

Application

Focus on moving from the specifics of the scenario to the more general world of practice.

Break behaviours down into specific actions.

Explore the other kinds of situations that these might apply to.

Ask what participants will do differently in their practice.

Adapted From: Jaye P, Thomas L, Reedy G (2015). 'The Diamond': a structure for simulation debrief. The Clinical Teacher 12(1). 171-175. onlinelibrary.wiley.com/doi/full/10.1111/tct.12300

Plus-Delta Debrief Framework

If you need help with debriefing Crisis Resource Management skills, check out this infographic from Isaak & Stiegler: View Infographic

Pluses:

Things that are working first
Items that the individual or team wants to build on
Ex: What went well?

Deltas:

Opportunities for improvement things that can be changed so that the individual team might become more effective
Should be specific, within the realm of possibility
To be reviewed and acted upon
Ex: What would you do differently next time?

Plus (+)	Delta (∆)

References:

Klair MB (2000). The Mediated Debrief of Problem Flights. in Facilitation and Debriefing in Aviation Training and Operations (1st ed). Routledge. www.taylorfrancis.com/chapters/mono/10.4324/9781315255576-12/mediated-debrief-problem-flights-key-dismukes-guy-smith
ACPS Quality Tools: Plus/Delta (ND). fhop.ucsf.edu/sites/fhop.ucsf.edu/files/custom_download/ACPS_Plus_Delta_Template.pdf

CODE WHITE SITUATION In a Code White situation the roles and responsibilities of all staff involved are as follows:

1. Staff Initiating the Call - Staff involved in situation or first staff member to come upon the scene:
• Identify that a situation exists requiring immediate assistance.
• Ensure own and co-worker safety (e.g. need to leave area until sufficient resources are available to restrain or remove an aggressive individual).
• Follow procedure outlined by the organization for summoning assistance.
• Direct other staff as necessary to reduce stimulation in the area (removing all clients, visitors from area, reducing noise levels by turning off radios/tvs, vacuum cleaners, etc.).
• Have client’s record or chart available if possible.
• Provide information to the Code White Team Leader about the situation, action taken and action required.
• In the event medication is to be administered ensure medication orders have been received, medication has been prepared and is ready.
• In the event the client is to be placed in seclusion, ensure the room is ready to receive the individual.
• Prepare restraints if necessary.
• In the event that additional help is required (e.g. Police) ensure that the call has been placed and that help is on the way.
• Assist Team as directed by Team Leader.

2. The Code White Team: Roles and responsibilities assigned to each team member will vary depending on the team size, skills of each member, the needs of the client and the location of the crisis.
    TEAM LEADER ( Team Leader selected as per organization’s protocols for designation of Team Leader):
    • Assesses the situation. • Calls for additional resources if required (e.g. Police).
    • Acts as the spokesperson for the team and the ONLY PERSON TALKING unless a spokesperson is delegated by Team Leader. guidelines: code white response.
    • Obtains information about the situation from the staff and what is expected of the team: i. reason for Code White call ii. details of current situation iii. name of acting out client iv. history of past incidents if appropriate and interventions that have worked in past v. any pertinent medical information vi. mental status vii. intervention needed (e.g. medication, removal to seclusion, etc) vii. location of client ix. additional information that may be pertinent (could include pertinent medical/nursing orders, committal status)
    • Develops intervention plan to ensure enough resources are available to safely carry out plan.
    • Identifies team members (confirms all have been trained).
    • Informs and directs team members about the plan of action, including approach to be used, type of intervention and how each member will exit from room.
    • Ensures safety of team by having all team members remove items such as watches, glasses if not safety glasses, pens, ties, pagers, scissors, stethoscopes or name tags, etc.
    • Ensures personal protection equipment (PPE) such as gloves are available for team use.
    • Assigns team members to specific tasks/positions.
    • Ensures all members including staff are ready before taking action (medication is ready, room is prepared, etc).
    • Communicates with acting out individual.
    • Directs intervention plan to completion (may administer, if appropriate, or delegate medication administration).
    • Ensures defusing/debriefi ng takes place as soon as possible following the incident and that staff know about and are able to access all available support if necessary (including CISM).
    • If an injury occurs to a team member ensures member seeks proper first aid.
    • Ensures appropriate documentation is completed as per organization’s protocols.

TEAM MEMBERS: Team responds in a co-ordinated manner under the direction of the Team Leader and
    • follows instructions of Team Leader.
    • understands intervention plan.
    • remembers that the Team Leader is the only person speaking at the time of interaction with the client.
    • carrries out tasks assigned by Team Leader and any other additional tasks as needed such as: i. crowd control ii. clearing area of hazardous objects iii. supporting other team members iv. preparing restraints
    • informs Team Leader if unable to perform assigned task (e.g. if recently injured and unable to take a restraining position).
    • removes personal items which could be damaged or cause injury.
    • listens for “cue to action” and move in on signal or if escalation occurs.
    • immobilizes limbs as directed.
    • secures client until instructed by Team Leader to release him.
    • assists in escorting client or with restraining or applying restraints such as four point restraints.
    • reports any injuries sustained during procedure.
    • assists with documentation as necessary.
    • participates in debriefing.

Phase	Purpose	Process	Sample Phrases
Reactions	Allow learners to express emotional reactions to simulation Provide facts underlying simulation	Ask for emotional reactions	*How are you feeling?* *What are some initial reactions to what just happened?* *So, in that scenario…*
Analysis	Uncover the ideas, thought processes, and other factors that lead to a learner behaviour (uncovering “frames”) Help learners find ways to improve	1. Observe an event or result. Comment on the observation. 2. Advocate for your position	*I saw that… I think…* *I noticed that…To me…* *I saw…I’m concerned that…*
		3. Investigate basis for learner’s thinking that led to the observed event or result	*What do you think?* *Why do you think that happened?* *How do you see it?* *What was the thought process behind….?*
		4. Close the gap through discussion and didactics	*I hear…. What would it take for you to do this next time?* *How could we do this differently next time?* *I think a few good ideas that came up were…* *I’d like to say a little bit about…from my experience/literature*
Summary	Distill lessons learned from debriefing Invite reflection on the experiences as a whole	Ask learners to summarize their takeaways, what went well/what could be done differently Summarize session and learning	*What are some takeaways from today?* *What went well today? What would you do differently next time?* *In today’s session, we….* *Going forward, we should…*

Code White

Scenario Overview

Scenario Info:

Prebriefing:

Scenario Stages: (Toggle) Educational

Debriefing:

Clinical Pearls:

Code White

Prebriefing

The Situation

1. Aggravated patient

2. Physician Arrives

3. Police Arrive

4. Hostage!

Debriefing

PEARLS Debrief Framework

GAS Debrief Framework

Team Dynamics Debrief Framework

SHARP Debrief Framework

Diamond Debrief Framework

Plus-Delta Debrief Framework

Debriefing with Good Judgment Framework