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Year : 2020  |  Volume : 15  |  Issue : 3  |  Page : 134-137
Simulation role in preparing for COVID-19

Intensive Care Department, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, Skills and Simulation Center, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia

Date of Submission26-Mar-2020
Date of Acceptance28-Mar-2020
Date of Web Publication10-Apr-2020

Correspondence Address:
Dr. Sara S Aldekhyl
Intensive Care Department, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, Skills and Simulation Center, King Abdullah International Medical Research Center, Mail Code: 1425, P.O. Box 22490, Riyadh 11426
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/atm.ATM_114_20

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During the current COVID-19 global pandemic, the major efforts are channeled toward containing and minimizing the spread and maintaining the healthcare providers' safety. One of the major aspects of effective infection control and prevention is healthcare team training and system troubleshooting. Simulation-based education appears to be a practical and flexible instructional design to achieve variable levels of knowledge, skills, and attitude training. In this paper, we aim is to provide a brief scheme on how simulation-based training can be employed in COVID-19 pandemic preparedness efforts. In addition, we will be sharing our multidisciplinary simulation experience in critical care at the National Guard Health Affairs, Saudi Arabia.

Keywords: COVID-19, National Guard Health Affairs, preparedness, simulation-based training

How to cite this article:
Aldekhyl SS, Arabi YM. Simulation role in preparing for COVID-19. Ann Thorac Med 2020;15:134-7

How to cite this URL:
Aldekhyl SS, Arabi YM. Simulation role in preparing for COVID-19. Ann Thorac Med [serial online] 2020 [cited 2023 Mar 24];15:134-7. Available from:

Since COVID-19 was declared as a global pandemic, the major focus of healthcare organizations sifted toward preparing healthcare systems to handle the inevitable COVID-19 burden at different phases and levels. According to the CDC guidelines, one of the major aspects of infection control and prevention is training and educating the healthcare team members.[1] Several instructional modalities are currently being utilized such as protocol dissemination, presentations, and online modules.[2] Over the past decade, simulation has emerged as a practical and timely tool to achieve predetermined levels competencies at either level of knowledge, skills, and/or attitudes in a highly authentic setting.[3] In addition, it is a modality that can be easily tailored to improve the healthcare system; from individual capacity building to process and system testing while identifying system latent safety threats and improving team behaviors.[4],[5],[6],[7]

During the past epidemics, simulation was successfully utilized for healthcare systems and professionals preparation. For example, simulation-based training (SBT) identified serious gaps in safety protocols at hospitals deemed ready for Ebola management.[8] Following the era of SARS, simulation-based airway management and cardiac arrest training programs were widely adopted to improve hard and soft skills of healthcare providers involved in care of patients with highly contagious diseases.[9],[10]

Currently, national and international healthcare institutions are sharing and regularly updating their simulation-based experiences. In addition, variable simulation governing bodies are providing frequently updated lists of simulation resources.[11] The most popular and heavily utilized example is the Toronto simulation-based multidisciplinary scenario created by the emergency department for the management of suspected COVID-19 case presenting with respiratory distress.[12] The Prince of Wales Hospital (affiliated with Chinese University of Hong Kong) conducted an in situ simulation at the intensive care units and operating theaters to familiarize their employees with the principles of airway management in suspected or confirmed COVID-19 infections.

   A Case Study for Simulation Preparedness Plan Top

The MNGHA has an established infection control program in place “Right Care, Right Now,” in addition to a series of updated guidelines and pathways for managing patients with suspected or confirmed communicable disease. COVID-19-specific protocols and guidelines are regularly being updated and disseminated to all employees.

In addition to a large simulation laboratory in the university, the Intensive Care Department at MNGHA has a three-room simulation laboratory with a control room, which is fully equipped by high fidelity mannequins and audio-visual equipment. The “point-of-care” laboratory enables early access to train residents, nurses, and respiratory therapist without significant impact of daily workflow.

Our simulation team identified some of the potential applications of SBT in the setting of COVID-19 preparation plan. These areas include infection control precautions, bed-side skills modification, team and resource management, and system latent safety threat identification. An example of each domain is provided in [Table 1].
Table 1: Potential applications of SBT in the setting of COVID-19 preparation plan

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We designed two simulation-based scenarios, based on our assessment of the biggest performance gap. The objectives of each covered two or more of the domains mentioned above. In our first multidisciplinary session, we focused on proper handling and management of newly presenting suspected COVID-19 case. This session basically addressed the entire patient flow experience, from the minute of emergency room presentation to the moment of securing a compromised airway in a negative pressure room. The second project was a series of multidisciplinary sessions tackling the appropriate use of specialized portable negative pressure chamber for transporting suspected/confirmed COVID-19 patients within and between healthcare institutions [Figure 1]. The trainees were allowed to deliberately practice until a minimum level of competency was achieved, resulting in high degree of satisfaction and improved confidence. Worth mentioning, these sessions received an encouraging feedback nationally and internationally upon social media dissemination through the hospital's formal accounts. Multiple requests were received to deliver these sessions at different departments and institutes. We are currently working on building SBT scenario bank to address additional aspects and areas with perceived gap. As an example, [Table 2] shows a simulated scenario for managing a suspected/confirmed COVID-19 case with respiratory and cardiac arrest.
Figure 1: Isopod transportation simulation-based training session

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Table 2: Multidisciplinary Simulation-Based Scenario

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   Our Recommendations Top

“Once you're in the midst of a severe pandemic, your options are very limited. The greatest good can happen with pre-planning.”

– Eric Toner, Senior Scholar, Johns Hopkins Center for Health Security.

Up to the moment this document was written, our region remains relatively less affected by the global pandemic compared to other countries, which leaves us with a great opportunity to educate our healthcare teams and identify the gaps in our protocols and algorithms to bridge them in a timely matter. SBT is an educational design that is feasible and adaptable to the dynamic policy changes at institutional or national levels. For example, personal protective equipment utilization during training sessions was modified to respect the current global shortage. The number of participants was kept to minimal each session in compliance with the crowd management policy. Moreover, multiple simulation modalities and techniques can be utilized to design a simulation experience that is tailored according time available, resources, educational objectives, and targeted stakeholders.

SBT does not necessarily require investments of money and technology to succeed. Basic training can be accomplished with the resources already present. When utilized and applied properly, even these basic training sessions can have a significant impact on the learners and the institution in which they are applied.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Infection Control: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). CDC. Available from: [Last accessed on 2020 Mar 22].  Back to cited text no. 1
Simulation Exercise. Available from: [Last accessed on 2020 Mar 22].  Back to cited text no. 2
Alanazi A, Nicholson N, Thomas S. Use of simulation training to improve knowledge, skills, and confidence among healthcare students: A systematic review. Internet J Allied Heal Sci Pract 2017;15:2.  Back to cited text no. 3
Kirschner P, van Merrienboer JJG. Ten Steps to Complex Learning: A New Approach to Instruction and Instructional Design. In: 21st Century Education: A Reference Handbook 21st century education: A reference handbook. SAGE Publications, Inc.; 2012. p. I-244-I-253.  Back to cited text no. 4
Dubé MM, Reid J, Kaba A, Cheng A, Eppich W, Grant V, et al. PEARLS for Systems Integration: A Modified PEARLS Framework for Debriefing Systems-Focused Simulations. Vol. 14, Simulation in Healthcare. Lippincott Williams and Wilkins; 2019. p. 333-42.   Back to cited text no. 5
Dubé MM, Reid J, Kaba A, Cheng A, Eppich W, Grant V, et al. PEARLS for Systems Integration. Simul Healthc J Soc Simul Healthc [Internet]. 2019;14:333-42. Available from: [Last cited on 2020 Mar 22].  Back to cited text no. 6
Patterson MD, Geis GL, Falcone RA, LeMaster T, Wears RL. In situ simulation: Detection of safety threats and teamwork training in a high risk emergency department. BMJ Qual Saf 2013;22:468-77.  Back to cited text no. 7
Phrampus PE, O'Donnell JM, Farkas D, Abernethy D, Brownlee K, Dongilli T, et al. Rapid development and deployment of ebola readiness training across an academic health system the critical role of simulation education, consulting, and systems integration. Simul Healthc 2016;11:82-8.   Back to cited text no. 8
Chen P-T, Huang Y-C, Cheng H-W, Wang C-C, Chan C-Y, Chan K-H, et al. Medical Teacher New simulation-based airway management training program for junior physicians: Advanced Airway Life Support New simulation-based airway management training program for junior physicians: Advanced Airway Life Support. 2009. Available from: [Last cited on 2020 Mar 22].  Back to cited text no. 9
Abrahamson SD, Canzian S, Brunet F. Using simulation for training and to change protocol during the outbreak of severe acute respiratory syndrome. Crit Care 2005;10:R3.  Back to cited text no. 10
Combined Statement on Models & Simulation and COVID-19 > The Society for Simulation in Healthcare. Available from: [Last accessed on 2020 Mar 22].  Back to cited text no. 11
Suspected COVID-19. EM Sim Cases. Available from: [Last accessed on 2020 Mar 22].  Back to cited text no. 12


  [Figure 1]

  [Table 1], [Table 2]

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