You arrive on a crowded scene to find an elderly patient on the floor with CPR in progress. Your pulse is pounding. All eyes are on you and your partner. You begin to assess and treat the patient, trying to remember everything you were taught in the classroom. Your hands shake as you reach to open the ALS bag.
Most of us can relate to this situation, but it’s not a typical emergency scene because instructors are nearby taking notes and controlling the simulation manikin you’re “treating,” while a camera sends a live video feed to your peers in a classroom at another location. The encounter is also being recorded for later critique.
Yes, this is a simulation, but to the student, it seems like the real thing. This type of simulation is one of many being utilized today at the National EMS Academy (NEMSA).
At NEMSA, a partnership between Acadian Ambulance Service and South Louisiana Community College, the use of simulation permeates the entire curriculum. Students are challenged with realistic simulations that allow them to make and learn from mistakes before being pushed out into the real world.
The dedicated environments at NEMSA’s Lafayette (La.) campus are set up for a multitude of realistic simulation activities and are equipped with a camera that feeds video back to a remote classroom so classmates and faculty members can watch the activity.
The medical director can also view the simulation exercise if an employee is struggling with a particular patient care issue. This remote transmission helps reduce the Hawthorne effect and provides a better sense of how the medic will perform when no one is watching.
NEMSA uses simulation in various scenarios to depict incidents that students may encounter once they’re out in the real world. Below, we discuss a few key scenarios.
Airway Management: The difficulty in obtaining clinical sites for endotracheal intubation has created the need for simulation to provide supplemental intubation training, which is just as effective as live intubations, according to recent studies.
At NEMSA, the medical director runs students through scenarios that call for airway management. The student is observed as they proceed through the decision-making process and the actual tasks necessary to secure and maintain a patient’s airway. Because of the high level of fidelity, realistic anatomical features of the simulator and immediate feedback, intubations performed during the simulation “count” toward the required number of clinical experiences.
Ambulance Module: Students are required to move and load their patient into the ambulance for a 10-minute “ride” to the hospital. This provides the participants with a sense of reality while working alone in the small patient compartment and in prioritizing their activities during transport. The simulation also allows new hires to practice safe lifting and stretcher operations in a controlled environment. Two cameras catch the action from different angles and allow for later critique and coaching opportunities.
Emergency Room: The medical director often plays a role of the receiving physician in the emergency room portion of the simulation. Students can communicate with the physician via radio for treatment orders and give reports when handing off the patient.
This interaction between the students and medical director is invaluable in preparing them for their role outside the classroom. It’s also an excellent way to involve the medical director in the training program and helps create a bond between medical director and student.
Mystery Customer: In order to evaluate medic performance in the field, the Acadian Ambulance Quality Improvement (QI) Department has developed what we call Mystery Customer Encounters. Modeled after the mystery shopper concept, ambulance crews are dispatched to an “emergency scene” at a residence unfamiliar to them.
On arrival, they are confronted with an actual patient who, in reality, is a trained performer playing the role of a patient. The crew has no idea the response is a simulation until just prior to transport. The entire event is monitored from another room on hidden camera by the QI team.
OS 101: The Operations Supervisor 101 class (OS 101) is a supervisory prep class developed by Acadian Ambulance. It was developed because in many cases, promotion to a supervisory position doesn’t always involve the training needed to help employees adjust to their new role.
OS 101 was therefore designed to utilize simulations to help new and seasoned supervisors work through different challenging scenarios by role playing with trained actors. The live video feed is projected into the classroom, and all participants watch how each simulation is handled.
A full debriefing follows each scenario. The mix of novice and seasoned supervisors allows everyone to learn from the experience.
The practice of simulation in training is becoming more and more common in programs across the country. At NEMSA, the commitment to the use of simulation as a training, evaluation and feedback tool is evident in all activities, and will continue to play a greater role as new technologies become available.
Disclosure: The authors have 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 “Training at the National Level: The National EMS Academy offers a variety of simulation scenarios.”