Critical care in the middle of nowhere – delivering evidence-based resuscitation in rural Queensland by designing an innovative simulation course

Mr Samuel Brookfield1

1Queensland Health, Brisbane, Australia

Rural and remote Queensland is one of the most challenging environments in which to provide emergency nursing care.  This presentation will provide a case study of an original simulation course designed to empower rural and remote health facilities to respond to high acuity presentations in a way that is evidence-based and patient-focussed.  The Charleville Hospital Emergency Simulation & Training (CHEST) course was implemented in 2016, in response to an identified need for more critical care training for medical and nursing staff.  Scenarios included advanced life support algorithms, intubation and ventilation, and complex trauma cases.  Throughout the process of writing, providing, and reviewing this course, several key observations were made.  The project governance structure was an essential foundation, indicating a necessity for senior medical and nursing support with facilities.  There were psychological barriers to overcome for participants unfamiliar with education and wary of assessment.  Multiple low-cost, communication-based strategies could be used to manage the limitations of simulation equipment.  The expected management of these patients as based on current evidence contradicted some participant’s ideas of best practice, providing many useful debrief points.  There were also many opportunities for inter-organisation collaboration, with some simulations involving Queensland Ambulance Service, and Telehealth services.  Finally there was the value of momentum, as more staff became aware of, and comfortable with, regular exposure to the learning environment.  The final simulation operated over multiple sites with a total of 30 participants and observers.  The core goal of the CHEST course is to contradict the idea that the tyranny of distance should be a barrier to evidence and training for emergency nurses.  The lessons learned from the experience of this pilot program provide valuable insight for other health services attempting to provide quality critical care in the middle of nowhere.


Sam is a registered nurse in the Royal Brisbane & Women’s Hospital Emergency Department, and a remote clinical educator in South West Queensland.  He has designed and implemented multiple emergency education projects in both tertiary and remote settings.  He has also completed clinical placements in Nepal and Kenya, and provided medical support along the Kokoda Trail.  Sam holds a Master of International Public Health, with a research dissertation on disaster management.  He is currently completing a PhD in the field of bioethics and drugs and alcohol, through the University of Queensland.