Comparing the stress response using heart rate variability during real and simulated crises: a pilot study

Area of Science:

• Medical Education
• Physiology
• Emergency Medicine

Background:

• Medical personnel face significant stress during emergency responses.
• Reduced heart rate variability (HRV) is a known indicator of physiological stress.
• The stress-inducing potential of crisis simulation versus real emergencies is not well-understood.

Purpose of the Study:

• To compare changes in heart rate variability (HRV) in medical trainees during simulated and real medical emergencies.
• To determine if crisis simulation can elicit a comparable psychophysiological stress response to actual clinical events.

Main Methods:

• A prospective observational study involving 19 resident physicians.
• Real-time HRV measurement using a 2-lead heart rate monitor over 24-hour critical care shifts.
• Data collection at baseline, during crisis simulation, and during real medical emergencies (57 observations).

Main Results:

• All HRV metrics demonstrated expected changes in response to stress.
• Significant differences in HRV metrics (SDNN, RMSSD, PNN50, LF, LF:HF) were found between baseline and simulated emergencies.
• No statistically significant differences in HRV metrics were observed between simulated and real medical emergencies.

Conclusions:

• Crisis simulation effectively elicits the same psychophysiological stress response as actual medical emergencies.
• Simulation provides a safe environment for practicing essential skills while inducing realistic physiological stress.
• Simulation is a valuable tool for preparing medical trainees for the demands of emergency medicine.