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About FernoSim NEW FORMAT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Team Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Registration and Entry Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Code of Conduct, Liability and Model Release . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Team Check-Ins & Sequestering NEW PROCESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Permitted Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Equipment Supplied by FernoSim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

BSI and PPE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

The FernoSim Competition Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Scoring of the Final Competition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Awards Ceremony . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Procedural Guidelines & Tips for Simulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Key Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Reference Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Contents

Social MediaJoin us on social media! Follow us on Facebook, Instagram, Twitter or YouTube for news, tips and behind-the-scenes fun and share your own stories in the lead up to the competition.

The official hashtags are #FernoSim and #SPAIC2018

Ferno Australia Paramedic Sim Challenge

FernoSim

@FernoSim

Ferno Australia (FernoSim Playlist)

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NEW IN 2019!We’re trialling a new Challenge format in 2019, so that:

• Multiple teams from each Uni Campus can enter FernoSim and• We can include more Teams in FernoSim without starting a Waiting List.

Read section ABOUT FERNOSIM CHALLENGE NEW FORMAT on page 4 to learn more.

Important DatesDATE TIME DESCRIPTION

Monday 9th September 2019 12 Noon AEST Last day to submit Entry Forms

Thursday 3 October 10:00 am - 15:00 FernoSim Preliminary Challenge @ QUT Kelvin Grove

Evening (on social media) ANNOUNCEMENT: Teams progressing to FernoSim Finals

Friday 4 October Afternoon Student FernoSim Challenge Finals @ QUT Kelvin Grove

Saturday 5 October Lunch @ Conference (TBC) Awards & Announcement of Student #FernoSim winners

Please note: Event timings may be subject to change depending on venue requirements and logistics

Useful ContactsFernoSim Registrations Ces Thomson FernoSim@ferno.com.au +61 (0)411 601 202

FernoSim Challenge drug protocols Colin Allen FernoSim@ferno.com.au +61 (0)417 745 576

Fees

All teams must complete and return the Application Forms and return it to FernoSim. A complete application comprises a fully filled-in registration form and payment of entry fee.

Student FernoSim Challenge AUD $100 per team of up to four

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Introduction

OBJECTIVESFerno Australia and Team Australia EMS are all for promoting paramedic excellence. The objective of the FernoSim Challenge is to provide a fun and challenging educational experience for student paramedics to put into practice the academic and practical skills learnt at university.

The FernoSim, unlike other EMS competitions, is not designed to test a team’s ability to recite assessment protocols or achieve “points” for doing the right things. We believe that teams signing up to compete feel confident that they excel in assessment and patient care, and that their team members can complete assigned tasks at a rapid, but efficient pace.

ABOUT FERNOSIM CHALLENGE NEW FORMATWe normally have more teams entering than we can cater for. So in 2019, we are introducing a two-stage FernoSim so more teams can be included. This means multiple teams from each university campus can now register without being wait-listed.

• Stage 1: FernoSim Preliminaries - ALL TEAMS will participate in three separate Skill Challenges on 3rd October 2019. • Stage 2: FernoSim Final - The TOP 8 highest-scoring teams will proceed to the FernoSim scenario-based final on 4th October.

FERNOSIM PRELIMINARIES - 3RD OCTOBER 2019Each team will participate in the Preliminary Challenge which comprises three Skill Challenges and will be based on a selection of any three topics from the list below. Teams will be scored on their performance and competency. The eight teams with the highest scores will proceed to the FernoSim scenario-based Final on Friday afternoon.

1. Airway2. Cardiac3. Drug Calculations4. Paediatric5. Patient Assessment6. Patient Packaging

FERNOSIM FINAL - 4TH OCTOBER 2019The Student FernoSim Final is a high-fidelity 15-minute, scenario-based event that tests each team’s ability to manage multiple patients with varying illnesses or injuries in front of a large audience of their peers. The Competition focuses directly on each team’s ability to:

• Communicate and work as a team; • Gain control of a scene including conducting a thorough scene and hazard assessment; • Patient and crowd control; • Zero in on each patient’s illness or injury and manage each condition in a complete, compassionate and efficient manner.

FernoSim rules and regulations are designed to ensure standardisation in team and on-site operations plus administration of the FernoSim, operated by the FernoSim organising committee. To ensure consistency with the rules and regulations, only the designated FernoSim Coordinators are permitted to render an interpretation of the rules and regulation, officially address team concerns or make on-site operational/administrative decisions.

Team Composition• An eligible team comprises three paramedic students enrolled in a recognised University. One team member must be

designated as the team leader.• A fourth (alternate) paramedic student may be registered with a team and substituted in the event of illness or injury of one

of the three primary team members or other reason acceptable to FernoSim officials. • Qualified paramedic graduates, physicians and physician assistants are not eligible for this competition. This is a student only

event.

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Registration and Entry FeeAll teams must complete and return the Application Forms and return it to FernoSim. A complete application comprises a fully filled-in registration form and payment of entry fee. Each team registration is $100 per team of up to 4 students. The fees contrib-ute towards the cost of staging the FernoSim.

Code of Conduct, Liability and Model ReleaseAll participating team members and alternates must sign and return by email a waiver containing the following:

• Participation Agreement & Liability Release Form • Code of Conduct Form • Permission & Photo Release Form

NOTE: Failure to complete the waiver, or failure to abide by the principles and practices outlined in the waiver, will result in a team or team member’s disqualification without any refund.

UniformsBecause this is a high-profile event, all team members are required to wear either their clinical placement uniforms or a team competition uniform while competing in FernoSim.

Team Check-Ins & Sequestering NEW PROCESSOnce your registration has been accepted and confirmed, further updates and schedules will be communicated to teams via their nominated Main Contacts. Each Main Contact is expected to relay received communications from FernoSim to their team members.

Thursday 3 October: FERNOSIM PRELIMINARIES The FernoSim Preliminary Challenge will comprise three skill stations which will be run concurrently at QUT Kelvin Grove campus. Each team will be provided with a time and place to check-in, and then escorted to the location of the three skill stations.

Friday 4 October: FERNOSIM FINALTeams will be provided with a time and location to check in for the Finals. All team members will be required to present official, current university certification cards at check-in.

During the FernoSim Final all competing teams will be sequestered in the Team Sequestering Area while not competing to ensure the secrecy of the scenario details.

After competing in the Competition, teams will not return to the Sequester Room. A sequestering officer will be responsible for gathering and securing all of the teams’ gear and equipment so they may attend the remainder of the FernoSim Challenge as a spectator if they wish to do so.

During Sequestering:

• No cell phones or communications/messaging/email/web access devices are allowed in the Team Sequestering Area nor are they to be carried by team members during competition phases.

• Restroom breaks will be supervised by a FernoSim staff member to prohibit competitors from conversing with individuals who have seen or competed in the event.

• Team members waiting to compete who are found using a cell phone, communicating or engaging in conversation relative to the competition while outside the Sequester Room will be disqualified from the competition and may cause their team to be disqualified.

• Light snacks and beverages will be available to sequestered competitors.

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Provision of Restricted Information to Other Teams or Team Members• A lead judge will coordinate the movement of teams throughout the competition to maintain security of the event and a

recommended timeline.

• Individual team start times for the competition will be determined randomly by the FernoSim Coordinator.

Permitted EquipmentNo portable equipment may be carried on the competitor’s body or in/on the competitor’s uniform during the competition, with the exception of:• A stethoscope• Patient contact gloves • Eye protection • Pen • Blank or ruled notepad and/or clipboard• Trauma scissors • Penlight and/or flashlight.

This includes, but is not limited to scene ID vests, IV/IO catheters, rescue airways laryngoscopes or laryngoscope blades. All medical supplies will be provided in kits to each team.

Review or reference “cheat sheets” will not be allowed in the competition. Examples include printed or electronic field drug guides, quick reference drug calculations or formulas, radio report summary cards, and any other material that would provide an advantage to the competing team.

Equipment Supplied by FernoSimThe following equipment will be provided on site and therefore FernoSim teams are not required to bring these items.

EQUIPMENT QUANTITY NOTESMonitor / Defibrillator / Pacer / SpO2/Capnography capable 1 Physio Control LifePak 12s, or

LifePak 15s

Oxygen Unit 1

CPAP Unit with O2 adaptors 1 complete unit

Long spine board, straps head device 1

Cervical collars - adult & child sizes (adjustable collars acceptable) 1 full set

Bag-valve mask with connective tubing 1

Thermometer (oral, digital or rectal) 1

Glucometer 1

Pulse oximeter (may be integral to cardiac monitor) 1

Suction device with suction tubing and catheters/han-dles capable of oropharyngeal and endotracheal 1

Safety goggles or face shield 1 per team member

Sharps container 1

Kits/Bags of equipment to include drugs, IV supplies, airway devices, ET tube holders, trauma dressings etc. 1 1 full kit per team will be given prior to

commencing the scenario

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Gloves and other body substance isolation personal protective equipment

Sufficient for each team member

Masks not necessary because of interfer-ence they may cause with communica-tion between a competitor and Ferno-Sim judges

ETCO2 device 1

Laryngoscope handle and blades 1 adult & 1 paediatric handle Video laryngoscopes not permitted

Triage tags and MCI (first arrival) vests/supplies

20 triage tagsMCI Vest to ID ‘EMS’ com-mander/leaderand Triage person

Medications Teams should carry and be prepared to use ALL of the following medications, or the Australian equivalent.

• Adrenaline• Aspirin• Box Jelly Fish antivenin• Cefiriaxone• Glucagon• Glucose Gel• GTN• Methoxyflurane• Midazolam• Morphine Sulphate• Naloxone• Ondansetron• Oxygen• Paracetamol• Salbutamol• Sodium Chloride• Water for injection

NOTE:1. All drugs on this list or the Australian equivalent will be carried by a competing team regardless of whether their university

system carries and uses the medication. Teams will be judged on their ability to render care and administer drugs that can correct specific problems.

2. Teams can use a drug that performs the same actions as another on this list but must have all of these drugs with them.3. All drugs will be properly labeled with name, dosage and date of expiration. 4. Kits/bags will be packed and checked by FernoSim Crew to ensure that all drugs in this list are present.5. If your State system or University uses a drug considered to be equivalent/comparable to any of these medications, and

you have concerns that no drug(s) on this list are equal in action to your specific medication(s) in question, you must notify

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FernoSim by email (fernosim@ferno.com.au) no later than September 21st 2019 of:

• The drug(s) in question• The drug(s) on the above list that it will be used in place of• The indications for its use• The contraindications of its use• How the drug is carried (precharged syringe, vial or ampule).

Body Substance Isolation (BSI) and Personal Protective Equipment (PPE)• Competitors must don all necessary BSI/PPE equipment just prior to the start of the scenario.• Mask protection is not necessary due to interference with communication between competitors and judging staff.• All sharps used during the scenario must be disposed of in a puncture-resistant container comparable to those available in

the health-care setting.• Failure to safely discard a needle or catheter will result in team disqualification.

The FernoSim Competition ProcessThe competition will be conducted in a special FernoSim arena.

Finalists must be present at the designated Sequestering/Lock Down Room on Friday 28th September at a time to be confirmed. Team competition order will be determined by a random drawing. Each team will be given a time slot and sequestered during the competition.

The competition will involve all teams performing in front of an audience and multiple judges in a 15-minute scenario. One team member must be identified as the team leader. Competitors will be briefed on the scenario when they are brought into the arena area to compete.

Each team will be judged on their overall ability to communicate with each other, assess and treat all patients involved in the scenario, request appropriate agencies or resources (if applicable) and successfully complete the maximum amount of skill and treatment objectives for the incident in 15 minutes.

Each team will be presented with multiple patients with varying levels of acuity. Competitors will be expected to effectively assess each patient, properly intervene and competently overcome scenario-based challenges.

Competitors competing in the scenario should practice performing assessments and treatment options as outlined in the assigned reference materials . In addition, recommended team preparation includes practicing all of their skills . Since clinical proficiency and timely intervention are key components of the scoring process, every competitor should be prepared well in advance .

Scoring of the Final CompetitionScoring for the Competition will place an emphasis on each team’s ability to assess and treat multiple patients efficiently and effectively in the 15 minutes timeframe. As with any Competition, the decision of FernoSim’s judges in assessing penalties, and the overall ranking will be final and not subject to debate or challenge.

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Awards CeremonySaturday 5 October - time to be advised .

ALL TEAMS accepted to participate in the Competition will assemble in uniform at a time to be confirmed during SPAIC conference to be properly recognised for their training and participation in the competition.

The winning teams including team Alternates, will then be announced at this time.

Procedural GuidelinesTo ensure continuity of judging, guidelines for performing BLS and ALS skills will be presented to each competing team. All team members will be expected to be familiar with proper performance of each skill.

TIPS for Simulation

• Remember the basics! Practice, practice, practice until they are second nature. This will help you when under severe stress.

• Each competitor will need to verbalise assessment, procedure or treatment information to gain the appropriate points. For example, don’t just insert an IV into a manikin arm. Verbalise each step while you’re doing it so the judge can not only see but also hear that you’ve inserted the needle at the proper angle, looked for a flash of blood, lowered the needle angle and advanced the catheter without the needle.

• Competitors cannot assume that what they see is precisely what is intended. Some diseases and/or injuries will not appear exactly as they would in a true scenario so ask a Feedback Judge.

A feedback judge will provide any information that the team requests but will not voluntarily offer information without solicitation. Direct questions must be asked for specific information. E.g. “I am inspecting the chest. What do I see?” is a well phrased question vs “How does the patient look?” which doesn’t allow the judge to divulge details.

• When performing skills, competitors must actually do the procedure from start to finish on the manikin provided. If the skill cannot feasibly be performed, the competitor will need to state each step of the skill.

Example: Pleural decompression• I am locating the site in the second intercostal space midclavicular.• I am cleansing the site with iodine.• I am inserting a two-inch 14-gauge angiocatheter along the 3rd rib.• Is there a release of air?• I am connecting a 3-way stopcock to prevent air from entering the pleural space while allowing a means for air escape.• I am immobilizing the catheter as I would an impaled object.

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Key skillsTo assist teams in practicing for the competition, key skills are outlined below to provide a basis for standardisation. Each is outlined in general terms and not meant to be a definitive reference point. Consult the referenced textbooks for a step-by-step guide to performing interventions.

Basic Airway Management (This skill will be performed on a manikin):

• Verbalize to the judge what equipment is selected to obtain full credit for the intervention.• Ventilate the patient as deemed necessary by conditions present. Size and insert an airway adjunct (NPA, OPA, etc.) as

indicated by the scenario.• Verify proper placement and airway patency.• Continue to provide ventilations at appropriate rate and depth.• For nebulizer use, properly assemble the device, connect it to oxygen and insert the proper dose of medication into the unit.• For non-rebreather mask use, inflate the bag prior to placing it onto the patient.• If indicated and chosen for use by a team, succesfuuly assemble, set and deliver treatment via a CPAP device.• During the competition, the team will be considered ineligible if they do not successfully clear an obstruction and/or

inadequately control the airway within 5 minutes of their arrival, as defined by the start of the scenario stop watch.

Intravenous/Intraosseous Access (Perform the intervention as outlined in the textbook references):

• Determine the need for the intervention and select the proper supplies.• Correctly attach the solution set to the IV bag of choice using aseptic technique.• Determine insertion site and relay that information to judges. Cannulate the vein or bone using proper technique.• Dispose of sharps into proper containers. Failure to properly dispose of a catheter (e.g., exposed needle lying on the ground)

will result in team disqualification.• Assess for IV/IO patency using accepted techniques. The feedback judge will state, “IV/IO is patent” when the skill has been

correctly done.• Employ a pressure infuser and set the flow control wheel to the proper measurement to administer the desired amount of

fluid.

Administering Medications (Perform the intervention as outlined in the textbook references):

• Select the proper drug to be administered. You cannot administer the wrong medication. For example, if you pick up epinephrine, you cannot say that it is diphenhydramine and/or administer it as diphenhydramine. If a team member does so, intentionally or accidentally, the team will be disqualified.

• Select the appropriate injection site and cleanse/prep it accordingly, using actual aseptic technique.• Administer the correct dose (to be verified by judge).• Assess for patient changes.• Dispose of sharps into appropriate container. Failure to properly dispose of a catheter (e.g., exposed needle lying on the

ground) will result in team disqualification.

Electrical Interventions (Perform the intervention as outlined in the textbook references):

• Determine the need for electrical intervention—pacing, cardioversion or defibrillation.• Prepare all equipment necessary for intervention.• Properly place the paddles/patches.• Verbally and physically clear all people from the patient prior to discharging paddles/patches.

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Reassess for changes in patient status and need for additional therapy. Pleural Decompression (Perform the intervention as outlined in the textbook references):• Determine the need for the intervention.• Verbalize the proper insertion site.• Prepare all necessary equipment.• Secure the catheter to the patient in a safe and secure manner. Reassess for changes in patient status.

Immobilizing the Spine (Perform the intervention as outlined in the textbook references):

• Determine the need for the intervention.• Hold manual C-spine stabilization and apply a cervical collar.• Properly secure cervical collar in place.• Properly lift or logroll the patient as indicated by patient condition.• Completely secure the patient to the backboard via at least three straps.

Fracture Immobilization (Perform the intervention as outlined in the textbook references):

• Determine the need for the intervention.• Assess distal pulse, motor, sensation and capillary refill before and after splinting.• Apply traction (if indicated for a femur fracture) unless a life threat is present that does not justify extra time necessary for the

application of a traction splint.• Realign injured extremity as deemed necessary, particularly if no pulse is detected or is reported absent by a judge.• Secure the extremity to the splinting device.

Wound Care (Perform the intervention as outlined in the textbook references):

• Determine the need for the intervention. Information will need to be obtained from the feedback judge to determine the severity of the injury.

• Control external bleeding using direct pressure, elevation, pressure points and/or tourniquet(s) as deemed appropriate.• Apply dressings and bandaging as needed.• Secure the dressing in place.• Assess distal pulse, motor, sensation and capillary refill once bandage and dressing are in place.

Newborn Delivery (Perform the intervention as outlined in the textbook references):

• Prepare the patient and area for delivery.• Assemble equipment as deemed necessary.• Deliver the baby using the manikin as a simulated mother and child.• Cut the umbilical cord in two places no closer than 4 to 6 cm from the infant.• Perform any necessary interventions to resuscitate the baby.• Perform post-delivery care on both mother and baby.

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Cardiopulmonary Resuscitation (Perform the intervention as outlined in the current American Heart Association [AHA] Guidelines):

• Determine the need for the intervention. A manikin will be used that will allow for proper rate and depth of compressions.• Perform CPR as indicated in the 2013 AHA Guidelines.• Reassess as indicated.

Initial Assessment:• Determine if the airway is open by questioning the feedback judge.• Assess for breathing.• Assess for circulation.• Determine the initial level of consciousness using the AVPU scale.• Expose and examine for life threats and/or bleeding.

Detailed Examination:• Inspect, auscultate, and palpate as needed for all aspects of the examination.• Verbalize what you are assessing throughout the entire examination. Use of mnemonics, such as DCAP BTLS is acceptable;

however, you must tell the judge what each letter stands for the first time you use this abbreviated version.• You must actually examine the body parts as you go. In other words, telling the feedback judge that you are listening for

breath sounds while the stethoscope dangles around your neck will not result in points or information.

Patient Triage

• Determine the need for the triage of more than one patient.• Place a color-coded triage tag on each patient with the proper priority selected for each patient based on the resources

available to you.

Triage scoring will be based on the following injuries/conditions presented on clearly notated cards attached to patients/manikins:

RED (First priority patients you feel could survive for at least 30 minutes if removed, treated and sent to a definitive care facility)• Unconscious• Burns with airway/respiratory involvement• Open chest or abdominal wounds (regardless of size or depth) = potential for internal bleeding• Uncorrectable airway or respiratory problem• Uncontrollable external hemorrhage• Pneumothorax, tension pneumothorax, hemothorax or hemopneumothorax• Shock (Signs of significant depletion of blood volume)• Emotionally uncontrollable patients (that you need to have removed from the scene to maintain the safety and control of the

scene)• Complex medical problems (impending cardiac arrest, chest pain, pregnant patient who is traumatized to any extent)• Fracture of both femurs (potential to lose 1500 cc of blood internally)• Fractured extremity with pulse absent (even when manipulated)

YELLOW (Second priority patients you feel could survive for at least 60 minutes if removed treated and sent to a definitive care facility)• Burns not affecting the airway• Conscious head injuries• Spinal injuries (No dyspnea present)• Moderate blood loss (signs of shock not present)

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GREEN (Third priority patients you feel could survive for at least 90 minutes if removed treated and sent to a hospital or other treatment facility.)• Minor injuries• Minor fractures• Walking wounded (with minor injuries and no RED or Yellow indications/conditions)

BLACK (Individuals that are deceased on scene, or those you do not feel could survive for more than 10 minutes after you triage them even if sent to a hospital immediately.)• Mortally wounded multi-systems trauma patients• Agonal respirations• Pulses and respirations absent during your first contact with them• Decapitated

Re-triage any inappropriately tagged (prioritized) patients you find on arrival of your

crew. This may consist of a triage tag/color-coded triage indicator in place or a patient located on an inappropriately colored triage tarp.

Criteria for Induced Hypothermia

• ROSC not related to blunt/penetrating trauma or hemorrhage• Temperature after ROSC greater than (>) 34 C degrees• Blind Insertion Airway Device (BIAD) or ETT in place and patient not able to follow simple commands

Procedure guidelines• Perform neurological exam• Assess temperature• Apply ice packs to groin and axilla (Minimum of 4 ice packs to be applied: at least one in each area)• Administer cold saline bolus (30 mL/kg) to maximum of 2 liters• Reassess temperature:• If temperature is < 33 C, discontinue cooling measures• If temperature is > 33 C and the patient is shivering, administer a paralytic (Etomidate, ketamine or benzodiazepine are

acceptable).

Reference materialThe following textbooks will be used in the selection and scoring of the scenarios:

• Brady’s Paramedic Care Principles & Practice, Second Edition, Brady Publishing;

• Basic & Advanced Prehospital Trauma Life Support (PHTLS), 5th Edition, NAEMT, published by Mosby/JEMS Publishing.

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NOTES

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NOTES