It’s the skills we don’t use often that we need to practice to keep sharp. For EMS providers, that includes treatment knowledge and skills for patients in ventricular fibrillation (v fib). Unfortunately, there’s no quick fix to keeping these skills honed: It requires repeated, hands-on training, specifically, simulation-based training.
“EMS has a long history of using simulation training, whether it’s pulling a manikin out of a car or practicing CPR,” points out Geoffrey T. Miller, EMT-P, associate director of research and curriculum development at the Gordon Center for Research in Medical Education at the University of Miami. “Now we’re starting to refine what we’re doing with that training to achieve a higher outcome.”
The benefits of simulation-based training are two-fold: providers who practice hands-on skills will remember them more clearly than if they received only classroom instruction, and their skills can be checked as they learn. “The trainer can see the decision-making process two or three levels deep; they can follow the train of thought through troubleshooting,” says Paul Phrampus, MD, director of the Peter M. Winter Institute for Simulation, Education and Research (WISER) in Pittsburgh. “Written tests don’t do this. Take intubation, for example. In an immersive simulation, you can check those skills as well as decision-making skills. Can the provider walk into a room, assess the situation, make decisions and then correctly perform intubation?”
Dr. Phrampus and other experts offer these five tips for effective simulation-based training on v fib skills:
1. Keep it simple. “Sometimes when people are starting out with simulation training, they think they need to set up the complete situation, starting with the 9-1-1 call,” says Dr. Phrampus. “But instead of doing this, which takes a long, long time, look at the impact you want to focus on, and then simulate that little piece of it. This way you can do a simulation in 10 minutes and then debrief for 10 minutes.”
2. Keep it brief. “We can use simulations for periodic skills assessment,” Dr. Phrampus continues. “Instead of coming in for a classroom review and sitting for an exam, the provider can come in once a year, maybe, and do a 15-minute simulation and get feedback on it.”
3. Do it often. While the minimum standard for re-training in ACLS skills is two years, skills that are not used often, such as treatment of v fib patients, should be refreshed more frequently. “Something we now know from studies of learning resuscitation skills is that there is about a 30% loss of skill and knowledge about 180 days after training,” says Miller. “The things we don’t do often are the skills that get lost, and those of course are the things that must be assessed and evaluated.”
4. Spend smart. Although high-tech manikins that respond to treatment are great assets, they are not the important part of simulation-based training. “If a program gets $300,000, most would ask, ‘How can I get the most high-tech manikins for this money?’ What they should be thinking is the best way to train,” advises Dr. Phrampus. “Buy one manikin and spend the rest on developing a curriculum, training trainers and then training the most people possible.”
5. Use top trainers. Make sure the professionals who are training and assessing your people are good. “The most important aspect of the training is the instructor, who needs relevant medical knowledge and, more importantly, training in how to instruct other people,” stresses Ran Rubinstein, EMT-P, chief instructor at the Israel Center for Medical Simulation. “We give a lot of attention to training our trainers, and all of our instructors are required to undergo an in-house instructor course.”
If your department doesn’t have the resources for ongoing simulation-based training in treating patients in v fib, look around. Dr. Phrampus predicts that most EMS providers will soon have access to simulation training with high-tech manikins through community colleges, universities or stand-alone EMS programs. Meanwhile, Miller and others continue to research how and how often such training should be done, in hopes of making time spent with simulations more effective and ensuring providers’ skills stay sharp.