Background: 
Pain interventions are frequently performed in remote sites where there are inherent difficulties when providing resuscitation. In St Helens' NHS Trust, UK, a need to improve safety was identified. To do this, the environment was tested with standardised MDT simulations to unearth latent errors in the system. We also conducted a survey to ascertain the extent of this issue in Mersey Deanery, UK.
Methods:
Three high fidelity simulations were run twice by the hospital simulation team in the radiology suite during morning lists between 2017-18. Three simulations were tested: anaphylaxis, local anaesthetic toxicity and cardiac arrest. A full MDT was present: consultant, operating department practitioner, healthcare assistant and radiographer. The environment was unadapted. Structured video-assisted debriefs were then conducted. The scale of the problem in Merseyside, was determined with a survey of the 8 other Merseyside hospitals.
Results: 
A number of key issues were identified: an absence of emergency drugs, a radiology table not suitable for immediate chest compressions and an inability to use the wall mounted oxygen port. This led to the institution of an equipment checklist, drugs bag, metal table support and freestanding oxygen cylinder. The survey of local departments highlighted 3/7 performed procedures in remote sites, 1/7 hospitals run simulation, 2/3 of those with remote sites do not. 6/7 of respondents thought that simulation would improve safety and all advocated a checklist.
Conclusions: 
We have found in-situ simulation particularly advantageous for testing systems, processes and uncovering latent errors and knowledge deficits in remote environments.

MULTIDISCIPLINARY TEAM (MDT) SIMULATION IN REMOTE SITE PAIN THEATRES