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Readied for Reality

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An EMS crew arrives for the start of their shift and begins a required vehicle inventory. Suddenly, their radio screams to life: “Team Red, respond to an unconscious person.”

The team responds to a motel where they find an unconscious male in his 30s. Initial patient assessment reveals that he’s breathing and has a pulse. Nearby, there are multiple beer cans, an empty bottle of insulin and a diabetic log showing an increasing blood glucose level over the last several days. The patient is placed on oxygen, an IV is established, and blood glucose levels are checked.

The patient is loaded into the ambulance and transported to the nearest emergency department where the crew gives a hand-off report to the receiving physician. The team then puts their ambulance back in service and writes a report.

The “call” just described wasn’t an actual incident, but a structured, pre-planned simulation that students participate in during the HealthONE EMS Paramedic Education Program.

A Realistic Approach
The program’s simulations are designed to run in real time, with all assessments and treatments performed as if students were responding to an actual call. Students are assigned jump kits, which they are responsible for maintaining. If they run a call and are missing an item from their kit, they must manage the call without the missing item.

Simulation rooms, or “environments,” include a bar and night club, restaurant, garage, bathroom, living room and three bedrooms. The areas around the school—our parking lot, bike trail, fitness center and a motel—are also used for simulation environments. A stationary ambulance is built into the wall in a classroom, and a functioning ambulance sits in the parking lot.

Patients are played by students from other programs and by high-tech, wireless pediatric and adult manikins.

Each simulation is designed with primary learning objectives in mind. The objectives for each simulation are taken from the National EMS Education Standards and include everything from learning how to run a pediatric arrest and interact with parents, to determining if a patient is able to refuse care.

Answering the Call
On simulation days, the environments are carefully set up. Alcohol is spilled, TVs are turned on, fake vomit is tossed onto tables and clothes, and fake blood is splattered across the floor. Patients are moulaged, and all manikins are made ready to “perform,” monitor, record and respond to the participants’ every move and patient care action. Sounds and odors are also replicated whenever possible.

Initial simulations are run with teams of four to five paramedic students. Later simulations are run with teams of two to three students, and then finally with just one paramedic student and two EMT-B students.

Teams are “dispatched” via radio. They then respond to their assigned environment and begin the call. The expectation is that students will run the call exactly as they would a real call.

Several of the environments are monitored by cameras or one-way mirrors so the instructor isn’t in the room. As a result, students quickly learn that they can’t simply turn to the instructor for help. If instructors have a safety concern, they will interject, otherwise they allow the simulation to proceed to completion.

All communication with dispatch or the hospital is carried out via portable radio or cell phone. This includes notifying dispatch of transport and destination, as well as contacting medical direction for medication orders or refusals. This adds to the student experience and injects realistic learning lessons into the scenario.

When needed, students move patients to one of the ambulances and transport their “patient.” In the stationary ambulance, transport is simulated and patients are taken to the emergency department (ED) simulation room in the school.

Patients in the functioning ambulance are transported to an actual ED, where ED staff take a hand-off report and give students immediate feedback about the care provided.

Students then complete patient care reports on their laptop computers with custom software and submit them electronically for review. The patient report, turnover of patients to ED staff, and follow-up administrative documentation and electronic charting are all very valuable parts of the educational and operational process.

After the call, instructors guide a debriefing designed to review the incident, educate the participants and the instructors, and maximize the opportunities for education and personal improvement. It also allows for administrative and operational improvements to be made not only to the simulation program, but also to how we deliver service in the field.

Students are evaluated in their roles as team leader and team member. The debriefing begins with the team leader identifying what went well on the call, as well as what they would do differently in future similar patient encounters. This is probably one of the most memorable and educational aspects of the simulation experience.

Most importantly, if a serious error was made during the exercise, no actual patient is ever affected and the team doesn’t suffer significant emotional distress or disciplinary action.

Conclusion
In today’s EMS classroom, assessing and managing a patient’s needs, many of which are life-threatening, must be placed in the hands of students so they can experience the processes for themselves, not just listen to a lecture or watch a slideshow about them.

Our structured simulations and the debriefings conducted in conjunction with them allow students, faculty and EMS system managers to discover how students might respond during an actual event and make important adjustments to training, operational and administrative practices.

When problems arise, staff can remediate the student, evaluate the educational program and simulation aspects, and make changes as necessary prior to the student’s internship.

Students participating in these simulation “experiences” report that they feel more confident entering the internship phase of the program and find the realistic situations are invaluable in preparing them for the real and unpredictable world of EMS.

Disclosure: The author has reported no conflicts of interest with the sponsor of this supplement.

This article originally appeared in an editorial supplement to the September 2010 issue of JEMS as “Readied for Reality: HealthONE EMS’ Paramedic Education Program offers a realistic approach to training.”



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