Training

Patient Care Competitions Offer a Unique EMS Learning Experience

Issue 7 and Volume 41.

There’s a constant pursuit to improve the skills, knowledge and abilities of EMS providers to meet the many challenges associated with assessing and treating injured or ill patients. Providers can opt to read journal articles, participate in continuing education courses, complete online training programs or participate in a number of other educational offerings.

One of the top methods for improving the ability of EMT and paramedic personnel is to participate in simulated patient scenarios that challenge the providers to assess and treat a patient-either a live actor or a patient simulator-with a medical or traumatic condition.

The use of simulated patients to help educate EMS providers in both the military and civilian settings has been shown to be very effective.1-3 The concept for this form of training and quality enhancement uses all the elements of an actual patient. There’s information to be gleaned from the actor or simulator to develop the medical history, and there are clinical findings to help demonstrate how the patient should be treated that can be adjusted based on interventions given by the care providers.

In an effort to meld together an effective form of education while simultaneously providing a measure of competition and entertainment, the basic and advanced life support competitions came into being. In these competitions the caregivers (i.e., competitors) are faced with a variety of situations accompanied by varied patient presentations. In this article, the JEMS Games Advanced Clinical Competition will be used as a point of departure, though the educational benefit of any competition applies with equal validity.

Competition scenarios can range from a basic motor vehicle crash to a more elaborate scenario such as a collaborated suicide. What each has in common is the ability to gather many patient presentations into one cohesive scenario. This allows the competition designer to mold the patient presentations to the scenario and to the needs of the agency or competitors. One scenario can cover multiple medical and traumatic conditions, which allows for assessment of abilities on a broad spectrum.

A competition can be designed to determine who should win or developed to assess the EMS providers’ abilities to handle certain types of patients. Irrespective of the approach taken, there’s a significant benefit to the competitors who prepare for the simulated scenario.

EMS competition simulation
High-fidelity simulation manikins allow for full assessment and interventions like endotracheal intubation. Photo Glen E. Ellman

Simulation

The use of simulation to enhance skills isn’t new. Perhaps the best example of the use of simulation to prepare for action comes from the military, which has been using simulation for centuries during basic military training (i.e., boot camp) to help prepare men and women for the rigors of operating on the battlefield.4-7 This form of training is also used to prepare soldiers for specific types of battles.

Born out of the world of military simulation is the advent of war games. These types of games take advantage of the mental power of the participants in employing various strategies to move toward victory, either for play or for real situations. These games range from the basic game of Battleship to the more elaborate use of topographic maps and models that military officers use to strategize specific types of confrontations.

How can this concept be used in the civilian world for application to EMS providers? First, simulation can be used to prepare students for individual patient scenarios they’re likely to face in the field. It’s simply not enough to ask students to read assigned textbook material, learn skills in lab and clinical settings, and discuss patient scenarios. Students need to be immersed in scenarios that challenge them to coalesce all the knowledge, skills and abilities they developed and place them all into practice.

For example, one student, working as a simulated patient, can portray the signs and symptoms of an acute myocardial infarction. Students can then approach the simulated patient to establish a history, perform an exam, render any necessary treatments and document the event.

This scenario can be further enhanced by using advanced simulation technology, such as a simulated patient monitor that allows judges to display a variety of cardiac rhythms, oxygen saturation (SpO2) or end-tidal carbon dioxide (EtCO2) readings that react realistically to the competitors’ interventions.

The same scenario can also be accomplished by the use of a simulator (i.e., high-fidelity manikin) that allows for full assessment and interventions, such as insertion of IV catheters, endotracheal intubation, intraosseous needle placement, and a host of other invasive interventions.

Second, simulation training can be used to develop or enhance the skills of the EMS provider who has completed initial training and is actively working in the field. Simulations can be used to test the provider’s ability to care for certain types of patients, assess clinical proficiencies, address complicated patient presentations or be used for a variety of other reasons. The approach remains the same: Immerse the field provider in a situation that requires them to use all of their knowledge, skills and abilities to provide appropriate care and treatment. Upon completion of the simulation, the assessors can discuss positive and negative aspects of all aspects of the simulated case.

Third, simulation training can be used in a manner akin to the war games used by the military. In this vein (pun intended), a team of providers is placed in a competition environment that challenges them to manage all aspects of the scene, assess and care for one or more patients, and otherwise demonstrate their ability to handle situations in a competitive environment.

Competitions can be designed by local EMS agencies to encourage learning, or be designed by colleges, universities, professional associations or other entities to allow for more elaborate designs and attract multiple competitors from the region, state, country or around the world.

EMS competition MCI
Some competitions thrust the team into a mass casualty environment that challenges them to manage all aspects of the scene. Photo Glen E. Ellman

EMS Competitions

One of the more challenging tests of EMS providers’ ability to handle complex patient presentations in a simulated environment is the EMS competition. These range from a local competition involving a few teams to an international competition with agencies from around the world.

However simple or elaborate, there are certain elements that are inherent in all EMS competitions. There must be a staff to develop the administrative aspects of the scenario. Competition rules and regulations have to be created, and an overall scenario developed in which to present the patients. There must be assigned reference material to provide a guide as to the medical standards to be used in the competition. Simulated patients are then developed and scoring assigned to each aspect of assessment and management. In addition, there are logistical needs that must be coordinated, such as ordering supplies, preparing paper copies, coordinating schedules for judges, and arranging for a facility to host the competition.

Once these needs are addressed, the competition is prepared. Judges are briefed on their respective roles, which typically involve providing patient feedback and scoring of individual elements of assessment and intervention. Manikins or actors are moulaged and otherwise readied for competition. Simulated patient monitors are programmed and readied. Any elements of set design are addressed to immerse the competitors in a simulated environment to enhance realism. In addition, there’s typically a team check-in process where competitors sign in to have their EMS kits assessed for compliance with the rules and regulations.

The competition day is a culmination of the collective efforts of the competition staff and judges. Everything that’s been designed and prepared is put into practice. The first competing team is brought to the scenario area and provided an overview. This marks the last step before the team engages in competition.

Once the official time starts, the competing team enters the scenario. The first point of their scoring can be overall scene management, use of body substance isolation, calling for additional units as needed and ensuring scene safety. Competitors then begin the more particularized goals of managing each and every patient. These individual patient presentations can range from a medical emergency to a traumatic event or any combination thereof.

Competition Benefits

The value of an EMS competition, like the value of war games, goes beyond a simple venue for competing for a top spot. Each of the competitors has the opportunity to improve knowledge, skill and ability in the preparation for the competition. Because most competitions go far beyond a basic cardiac or stroke patient, the competitors must seek to learn more nuanced clinical presentations. Savvy competitors will use the reference material assigned to the competition to further study assessment and care parameters from both a generalized and particularized focus.

In general, competitors preparing for a competition would review assessment and care parameters that would apply to a wide patient spectrum. This approach would include review of basic and advanced interventions. For example, reviewing CPR guidelines would be appropriate to prepare for simulated patients in cardiac arrest. Reviewing standard approaches to assessment is another way that competitors prepare in a general sense. This aspect would include studying the elements of the initial assessment; focused history and physical exam; rapid trauma assessment; rapid medical assessment; detailed physical exam; and ongoing assessment. The same is true for review of interventions like IV access, endotracheal intubation, use of traction splints, pleural decompression and a number of additional treatments.

The focus on particularized knowledge draws the competitors’ attention to certain patient presentations that competitions are likely to use to separate competing teams. Patient scenarios that are used in competitions include an endless array of possibilities but very often can be narrowed into probabilities. Competitors can prepare-and thus advance their knowledge base-by reviewing unique patient presentations. Competitions can feature challenging patient encounters, such as calcium channel blocker overdoses; supraglottic edema from inhalation of hot gases; breech birth; and patients with unique cardiac conditions like Wolf-Parkinson-White syndrome. If providers can successfully assess and manage these types of patients in a fast-paced competition environment, they can handle actual patients with typical clinical findings.

Conclusion

Although there are many ways for prehospital caregivers to sharpen their knowledge, hone their skills and develop their abilities, training that involves simulation offers one of the best methods for improvement. Taken one step further, simulation within a competition environment provides a mechanism for improving all aspects of field care while simultaneously offering a fun, competitive environment.

References

1. Eppich WJ, Adler MD, McGaghie WC. Emergency and critical care pediatrics: Use of medical simulation for training in acute pediatric emergencies. Curr Opin Pediatr. 2006;18(3):266-271.

2. Alinier G, Hunt B, Gordon R. Effectiveness of intermediate‐fidelity simulation training technology in undergraduate nursing education. J Adv Nurs. 2006;54(3):359-369.

3. Steadman RH, Coates WC, Huang YM. Simulation-based training is superior to problem-based learning for the acquisition of critical assessment and management skills. Crit Care Med. 2006;34(1):151-157.

4. Livermore WR: The American kriegsspiel: A game for practicing the art of war upon a topographical map. Houghton & Co.: Boston, 1882.

5. von Verdy du Vernois J: Beitrag zum Kriegsspiel. Ernst Siegfried Mittler & Sohn: Berlin, 1876.

6. Wells HG: Little wars: A game for boys from twelve years of age to one hundred and fifty and for that more intelligent sort of girls who like boys’ games and books. F. Palmer: London, 1913.

7. Jane FT: How to play the “Naval War Game”: With a complete set of the latest rules, full instructions, and some examples of “wars” that have actually been played. S. Low, Marston & Co.: London, 1912.


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Compete in the 2017 JEMS Games

EMS providers from across the U.S. and around the world are invited to compete in the annual JEMS Games Advanced Clinical Competition at the 2017 EMS Today Conference and Exposition in Salt Lake City, Utah. The preliminary competition will be conducted on Wednesday, Feb. 22, 2017, with the top three teams competing in the final competition on Friday night, Feb. 24, 2017.

The goal of the JEMS Games is to present a fun, challenging and educational experience for EMS personnel that results in participants being better prepared for the challenges they encounter in the field.The preliminary competition tests a team’s ability to complete assigned tasks and provide high-quality patient care at a rapid, but efficient, pace.

The final competition is a 20-minute, scenario-based event that tests each finalist team’s ability to manage multiple patients with varying illnesses or injuries in front of a large audience of their peers.

The final scenario is unknown to the teams and the audience, creating an element of surprise that tests the team’s ability to size up a scene as well as locate and triage patients.

Prove that you’ve got what it takes to win by putting together a team and register to compete in the JEMS Games. The first 10 teams to register to compete will receive free Gold Passes to attend EMS Today. Don’t miss out on this exciting opportunity, go to www.emstoday.com/jems-games to register today!

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