A FRCEM station on MedMock, start to finish

You have just taken handover of the Emergency Department at 18:30. Walk me through your immediate priorities and how you are going to create capacity in Resuscitation in the next four minutes.

My immediate priority is clinical safety for the incoming Priority 1 paediatric airway emergency arriving in four minutes while maintaining safe oversight of the four critically ill patients already in Resuscitation. To create a Resuscitation bay immediately, I will look at Bay 3—the post-ROSC STEMI awaiting cath-lab transfer—and Bay 1—the intubated trauma patient going to CT. I will call the cardiology coordinator immediately to confirm whether Bay 3 can move straight to the catheter lab right now with the transferring team; if the lab is ready, that frees Bay 3 within minutes. Simultaneously, I will prepare the paediatric airway equipment and call the on-call consultant anaesthetist, ENT registrar and paediatric registrar to assemble in Resuscitation BEFORE the five-year-old with stridor and drooling arrives, as this is a time-critical suspected epiglottitis or severe croup airway emergency where we must keep the child calm on the parent’s lap and avoid distressing examination or cannulation.

How will you deploy your medical and nursing team across Resuscitation while that paediatric pre-alert arrives?

I will maintain helicopter oversight as the EPIC—Emergency Physician in Charge—rather than becoming task-fixated in a single bay. I will allocate my senior ST5 or ST6 registrar and an airway-competent doctor to Bay 4—the 19-year-old in status epilepticus—with a clear trigger that if seizures continue after the second-line anticonvulsant load, they proceed to rapid sequence induction with ICU support. For Bay 1, I will ensure a trained airway transfer doctor and trauma nurse accompany the intubated patient to CT with full monitoring. For Bay 2, the septic shock patient on peripheral vasopressors, I will task a middle-grade doctor with central venous access or continuing protocolised peripheral vasopressor monitoring while I escalate directly to the ICU consultant to expedite bed clearance. I will personally greet the incoming five-year-old with stridor alongside the anaesthetic and ENT seniors.

Once the paediatric airway emergency is stabilised, how do you address the seven holding ambulances and the 22 patients waiting in Majors?

Seven holding ambulances represent high unassessed clinical risk in the ambulance corridor. With the Nurse in Charge and Ambulance Hospital Liaison Officer, I will ensure a senior clinician performs rapid Rapid Assessment and Treatment—RATing—on every holding crew within 15 minutes of arrival so time-critical sepsis, stroke, chest pain or fracture analgesia is never delayed in the back of an ambulance. To create flow out of Majors and release ambulance offloads, I will run a rapid 10-minute board round with the Majors doctors to identify patients waiting only for a senior review, blood review or specialty referral decision, pull specialty registrars down to see referred bedsides promptly, redirect ambulatory pathways to Same Day Emergency Care, and escalate departmental crowding to the hospital Silver Tactical Commander and Site Manager under our Full Capacity Protocol.

And what will you do about the foundation doctor in Majors who is distressed after being shouted at by a relative?

Staff welfare and psychological safety are an immediate consultant responsibility. As soon as Resuscitation is safe, I will ask the Majors senior nurse or middle-grade to cover the foundation doctor’s active patients so she can step off the floor into a quiet room for a supportive debrief and a break. I will check she is physically unharmed, listen to what happened, and go myself with the Nurse in Charge to speak to the relative—Addressing the underlying clinical delay or concern calmly while setting a clear, firm boundary on acceptable behaviour toward staff, involving hospital security if there is any ongoing aggression. Before the end of the shift I will ensure the incident is logged on Datix and follow up with the foundation doctor and her educational supervisor.

Thank you. That is the end of the station.