Journal of Surgical Simulation 2018; 5: A: 1 - 1

Published: 11 September 2018


Oral presentation

Special Issue: Code Red - the movie: a multi-perspective simulation scenario of traumatic major haemorrhage management

WGP Niven, WJ English, NA Davies, AE Weaver and R Tallach
Corresponding author: WGP Niven, Homerton University Hospital NHS Foundation Trust, Homerton Row, London, E9 6SR, UK. Email:


Background: The management of major haemorrhage in trauma is a complex process that requires a focused, disciplined and multidisciplinary approach. The Code Red protocol developed at the Royal London Hospital in 2008 is an effective means of managing such patients that combines a structured, step-wise approach with pre-defined roles for the nurses and doctors involved in the patients’ care. In the context of perennially high staff turnover, there are issues with communicating and embedding the technical and non-technical skills in new trainees unfamiliar with the high stakes, time-critical decision making that is involved in Code Red management.

Aim: To develop a high-fidelity simulation of the Royal London Code Red Protocol in order to facilitate an expedited learning experience for doctors and nurses involved in Code Red management.

Methods: We recruited a broad selection of doctors, nurses and practitioners from the following departments: Emergency Medicine, Surgery, Orthopaedics, Theatres, Radiology, Anaesthetics and the Transfusion Service to form a quality improvement group. The group analysed, critiqued and refined the existing Code Red protocol and then developed a simulation scenario based on the updated protocol. The fidelity of the simulation was enhanced by carrying it out in the designated Code Red bay of the resuscitation room, the use of a professional actor as the patient, and real blood products. We used two GoPro cameras and Google Glass on the participating clinicians to gain as many perspectives as possible on the simulated scenario. 

Results: The simulation scenario was carried out in the early morning of Saturday 20 May 2017. The footage was adapted into a series of 10 min videos for each of the pre-designated Code Red roles, and initially used at Trust induction in August 2017. Since then the videos have been put on the Virtual Medics, and YouTube platforms. Whilst we have not gathered any formal feedback on this simulation, we plan to further refine the videos over the next induction cycle and then conduct a further qualitative study to measure the educational impact of these training videos on new trainees. 

Conclusions: High fidelity simulation using multiple, simultaneous perspectives represents an exciting, integrated and potentially valid learning experience for medical and nursing trainees.


Virtual Medics. (2017, October, 15). Code Red #TransformTrauma. Retrieved from


Code Red; major trauma; simulation; high fidelity; major haemorrhage

Additional Information

This presentation was given at the 7th Annual Homerton Simulation Conference: Novel thinking and new technology in healthcare and education, Homerton University Hospital, London, UK, on 7 December 2017.

Conflicts of interest: none declared.