P3.Q332: “That Stuck With Me”: A Thematic Analysis of Medical Student Experience with Pediatric Death in a Simulated Mass Casualty Incident

Background: Multiple casualty incidents (MCI) have become commonplace in areas of conflict. High-fidelity simulation is used to prepare for such events. Operation Bushmaster is a simulated field exercise for students at the Uniformed Services University in preparation for a career in military medicine.
Current literature has shown that deployed healthcare providers routinely exposed to death are more likely to experience impaired mental health. Novice learners are even more vulnerable following the unexpected loss of a patient, especially if it’s a pediatric patient.
Previous studies of pediatric mannequin death have found learners can suspend disbelief and experience a similar, less intense, emotional reaction to actual patient death. It evokes self-reflection and allows learners to understand their responses to patient death.
Our study aims to understand the experience of students involved in the care of a pediatric death during a simulated MCI.

Methods: We conducted focus groups, using a grounded theory approach, for 10 medical/graduate nursing students involved in a simulated pediatric death at Operation Bushmaster. Transcripts were analyzed by three coders following Braun and Clarke’s six-phase analytical process to identify and define themes.

Results: Seven major themes were identified: (1) pediatric death was perceived to be more difficult; (2) pediatric casualties triggered a fear response that delayed critical actions; (3) simulated death provided a psychologically safe environment to understand one’s reaction to death; (4) participants perception of realism depends on simulation factors and participant factors, such as experiences, real-world events, and having a child; (5) debrief is necessary to mitigate the negative experience; (6) a brief pause followed by shared emotional experience can decrease the feelings of guilt; (7) the pace during this simulated MCI delayed the ability to emotionally process death.
Simulation allowed students to care for complex polytrauma patients within a controlled environment. The unexpected nature of pediatric death led to a perceived negative experience. However, the guilt resolved after shared peer experience, peer and faculty-led debriefing, and peer-led shifting of team roles, which allowed team members to process their experience and decrease the impact on future patient care.

Conclusion: Deaths on the battlefield are high-stress events for all medical providers, especially when it’s the unexpected death of a pediatric patient. The inclusion of pediatric combat casualties revealed significant knowledge gaps and a fear response that led to the delayed application of well-known trauma algorithms. Senior medical providers should be aware of the impacts of unexpected death on trainees and provide a thorough and timely debrief for all patient deaths in addition to resources for coping with patient death.

“The opinions and assertions expressed herein are those of the author(s) and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences or the Department of Defense.”