View a video interview with James Logan below this article.
Believing that the best way to train is through realism, Lt. James Logan, BPS, IC, EMT-P, has created one of the most innovative and true-to-life training programs that many EMS providers will ever experience. Logan, who heads up EMS Consequence Management and Quality Improvement for the Memphis Fire Department, finds himself immersed in disaster preparedness and terrorism response daily. As part of EMS Special Operations, and as chair of the federal grant program for the Metropolitan Medical Response System (MMRS) in Shelby County, Tenn., Logan was part of a steering committee charged with developing and executing a conference for local EMS that would be funded by MMRS.
“Conferences and lectures are great, but sometimes you can PowerPoint people to death,” he says. “We are guilty of drilling our providers in an interactive setting, but often we don’t focus on educating them on the objectives of the drill. So the idea emerged to do more interactive education.” This has resulted in giving providers a more hands-on, “minds-on” approach to critical thinking and skills in the learning environment.
An Interactive Partnership
The idea that the steering committee eventually devised was to bring the Memphis community—private and public ambulance services, health departments and hospital communities—together to participate in a daylong multi-casualty incident (MCI) simulation exercise. The idea was that participants would work together in a building that would seem like it had been bombed by an improvised explosive device, or IED. Firefighters and paramedics from around Shelby County and Memphis would train together as if the simulation were a real bombing and MCI.
Logan, who has been in EMS since 1984 and with the Memphis Fire Department since 1991, says, “The Medical Education Research Institute [MERI] provides the cadavers, procedural cadaver lab, bomb simulation building and high-fidelity simulators. The MMRS community provides the instruction with subject matter experts, including EMS educators, physicians and nurses.” The day begins with a 90-minute lecture covering various topics, including MCI management, terrorism and disaster preparedness. Speakers have included bombing specialists and FBI personnel.
“We take the education that the EMTs and paramedics already have and don’t get to practice every day, and we twist it into an hour-and-a-half refresher,” says Logan. “Then we go out and use it, and we critique each other.”
Lest you think this sounds simple and fun, consider this: Participants in the event are in full turnout and wearing personal protective equipment. The true-to-life scenario includes a debris-strewn building simulated to appear as if it has been severely bombed. The environment is pitch black and filled with cold smoke. High-fidelity simulators, the most true-to-life interactive computer-operated manikins ever developed, are also placed across the room and exhibit symptoms of severe trauma.
“It’s pitch black; you can’t see your hand in front of your face,” Logan says. “We use cold smoke, artificial flames and auditory distractions, like a jackhammer and a helicopter, during the triage of the patients. We also incorporate live actors from a nursing, EMT or paramedic school as victims.” Clearly, this is no day at the beach.
The simulators talk, vomit, sweat and have pulses and blood pressures. “Students get so engaged that I’ve had to calm a couple of them down and tell them this is not the real thing,” says Logan. Once triaged, the simulators and actors are tagged for severity of injury into green, yellow, red and black and transported to the treatment group for medical care.
In the treatment division, firefighters and paramedics practice airway management, vascular access and other high-risk skills on the simulators and live actors.
“Half of the day is spent with the students doing high-risk, low-frequency procedures across the street in the cadaver lab to become more comfortable with those tools,” Logan says. “A lot of times at a conference you’ll go by a vendor’s booth and say, ‘That’s a cool toy,’ and you’ll play with it on a piece of plastic. Plastic is different than human tissue. We let students put these basic and advanced tools in their hands and use them on human cadavers, which builds confidence.”
Focus on Transport & Tracking
Most uniquely, this training is completed in an eight-hour period, which allows time for teaching, thinking, evaluating and, most importantly, correcting mistakes. “A lot of times, when we do drills for mass casualty incidents, we only have an hour-and-a-half to play together,” Logan says. “Here we are able to slow down, make mistakes, stop, take a time out or work through something.”
Logan adds, “Where we fail ourselves sometimes in EMS is that we go out and have big drills, but we set our participators up for failure because we have limited time.”
Once the simulated patients leave the treatment division, they are transported across the street to a simulated emergency department and are received by a nursing contingent. “We transport patients every day to the hospital, so we simulate that transport piece,” says Logan. “It’s a continuum of care.”
Since Hurricane Katrina, accountability in relation to transport has been given a greater emphasis. “What we learned in Katrina was accountability; we didn’t track people well,” Logan says. “Through MMRS, we have purchased electronic patient tracking software, which is used in the training. And we’ve gone to a standardized triage tag for both private and public EMS.”
Students who participate are taught how to use the electronic patient tracking system. “They follow the patient from the scene to the hospital,” Logan says.
Logan estimates the training has reached some 1,000 EMTs and paramedics. And, as a by-product of the training, professional relationships are being built across the spectrum of healthcare in Memphis.
Logan is interested in taking the training to surrounding states and, possibly, around the country.
Logan says his passion comes from his 27-year EMS background and involvement in FEMA’s urban search and rescue program. He has deployed to multiple incidents across the U.S. as a medical specialist for more than a decade.
“It comes from the things I saw at the Pentagon during 9/11, and the things I saw on the first day I assisted in medical operations in New Orleans after the levees broke,” he says. “That day, we triaged 368 people; I intubated a lady on the hood of a car. Most don’t get to experience that intensity level of a mass casualty, and that’s what I wanted to bring to this education: realism.”
Because of the sometimes extreme conditions EMS providers face in the field and because an acute need for practical and interactive aspects to training exercises exists, Logan set out to create something people could take to work and use afterward. And he has succeeded.
“We’ve got the routine stuff down—I mean everything from my toe hurts to cardiac arrest,” he says. “But you see a lot of mistakes being made, and people suffer from mistakes. And this training is where mistakes can be made.
“We are able to pull participants aside and ask, ‘Do you think you made the right decision?’ You don’t just have a drill and send them home and then have an action report later. They want to know what they did right and wrong right then, and we talk about that.”
Better Training Leads to Better Response
Logan considers himself either very unfortunate, or very blessed, to have been present at the largest man-made and largest natural disasters in our country’s history: the 9/11 attacks on the Pentagon and World Trade Center and Hurricane Katrina. Bearing witness to these events has helped him see what still needs to be done to help the EMS community better respond to events of this magnitude.
He’s confident that through trainings such as this, EMS providers will continue to be more prepared for the situations they will face in the future. And he’s more heartened by the partnerships he now sees among individuals and agencies.
“We have to rely on every EMS agency and fire department within hundreds of miles of here,” he says. “Hopefully we can get this kind of training out to a lot more people.”