In January 2009, the Chicago Fire Department (CFD) leaped forward in their provision of EMS education by developing a state-of-the-art simulation training center (STC). Through the use of several grants (e.g., Urban Area Security Initiatives and Metropolitan Medical Response System), CFD constructed a virtual EMS simulation center containing seven mock rooms: a family room, bedroom, baby’s nursery, bathroom, the Flat Liners barroom, an alley and a large open street area. The CFD STC allows EMS providers the opportunity to train safely in a virtual reality environment—or as CFD calls it, a “combat environment.”
Construction of the STC at CFD Fire Academy South began in May 2009, and the physical plant was completed in October. CFD used an already existing structure that previously housed an exercise and storage room. In addition to the seven mock simulation rooms with their unique environmental characteristics, the STC has an attached control room. The control room houses a cutting edge audio-visual system and media point server, allowing the recording, viewing and broadcasting of simulations.
Each simulation room features a pan/tilt/zoom camera and voice-activated microphones. In August 2010, a video conferencing system was installed to broadcast live to off-site locations the interactive training being conducted in the simulation center. This enables crews and students at off-site locations to view the training, and it gives instructors the ability to interact via camera. CFD plans to broadcast using video conferencing in 2012.
In addition to video conferencing, the CFD simulation training center has e-learning capabilities, which provide CFD members with the capacity to access and complete online modules from their stations or homes. The e-learning system allows CFD to log participation and monitor educational progress through post-module evaluation questions. Once this system is finalized, administrators will be able to print a continuing education certificate after successful completion of a module. Then an electronic file will be sent to the CFD training division.
The center also created a unique, on-the-job performance improvement process. The structure was designed to permit CFD EMS instructors to replicate realistic scenarios for their prehospital providers and response partners. Providers are taken to the STC on duty and out of service for training. The center has a five-part mission:
4) Peer sharing; and
5) Performance improvement.
A classroom used for didactic training, peer sharing, research, meetings and table-top training has a SmartBoard, video conferencing equipment, video display, table-top airway simulators and airway equipment for providers to use.
The Advanced Airway Course is led by Peter Lazzara, EMT-P, veteran CFD ambulance commander and EMS instructor. With the help of two other EMS instructors, Lazzara puts a group of eight paramedics through a 1.5 hour didactic session, reviewing recent EMS airway controversies and associated literature, basic and advanced airway management techniques and CFD protocols. Capnography, tube confirmation and techniques to improve laryngoscopic view are the focus of the advanced skills session.
In addition to the didactic session, providers have an opportunity to share their attitudes, discuss current culture and barriers to success, as well as helpful strategies in airway management. The collective EMS experience in the “room” on any given day is 100–200 years.
After the didactic session, paramedics spend 1.5 hours in the simulation lab. An intubation obstacle course has been created to mimic real-life airway management challenges in a field context. One station simulates intubation in a confined space. Another station is an upright, restrained driver who can’t be extricated, and a third simulates a patient suspended in the prone position 2.5" above ground.
In addition to real-life patient scenarios, the environment is designed to mimic EMS field work. A dark, smoke-filled barroom with loud music is the setting for one station, while another simulates reduced visibility with darkness and a strobe light. Training emphasizes basic airway skills, but it also gives providers repetitive, hands-on practice for advanced skills.
The value of realistic simulation is multifold. Although crews can go through the motions on a classroom tabletop, dark, loud, smoke-filled, distracting environments with simulators in real-world contexts gives them a more realistic environment and an accessible alternative to the human intubation experience on cadavers or in the operating room. CFD has more than 700 single-role paramedics and more than 500 cross-trained firefighter/paramedics, so the simulation lab is a versatile surrogate for skill maintenance.
Today, paramedic intubation and airway management have become areas ripe for research. CFD and EMS physicians from the University of Chicago are closely looking at prehospital intubation in Chicago. Rather than focusing solely on patient outcome, the ongoing Institutional Review Board-approved Chicago Paramedic Airway Study (CPAS) examines difficult and unsuccessful prehospital intubations. Developing a prehospital airway registry allows for better analysis of the airway characteristics and techniques associated with success. CPAS also assesses paramedic perceptions pre- and post-airway simulation training.
In the next year, simulation classes and modules will include an improvised explosive device detonation, incident command for cardiac arrest and a variety of specialized courses covering obstetrics and pediatrics. In addition, CFD will use the center for EMTs and paramedics for which a knowledge gap has been identified, as well as for new hires.
Firefighter/EMTs, crossed-trained firefighter/paramedics and single-role ambulance paramedics will rotate through didactic and peer sharing sessions followed by simulation scenarios. The courses will assign specific roles and responsibilities to each CFD member, and concurrent research data gathering and reviews of relevant literature will be integrated into the modules.
CFD is also working on several multidisciplinary training modules and table-top exercises with response partners for disaster and terrorist incidents.
The CFD STC is an exciting performance improvement initiative that has already become a valued addition to education and training in Chicago’s EMS landscape. And in the coming year, CPAS will help inform the national dialogue on prehospital airway management. JEMS
This article originally appeared in June 2011 JEMS as “Simulation Station: Chicago Fire Department takes training to a new level.”