Columns, Training

Simulation is the New Education Revolution

Issue 7 and Volume 41.

You and your partner have been pushing on the patient’s chest for what feels like hours, but it’s only been about 20 minutes. After two more minutes and one more shock by the AED, you once again trade positions and return to ventilating the patient. The team leader says, “Good switch, make sure you’re pushing deep enough on the chest.

Your agency has recently switched to a new airway management device and this is the first time your team has used it during a cardiac arrest. Your partner was able to place the device easily and obtain chest rise with ventilations. At the next two-minute break, the AED advises, “No shock advised. Check for pulse.” You feel a weak, rapid pulse, but the patient still isn’t breathing. Your partner continues ventilations and the team leader requests their blood pressure be taken. The patient is moved onto a stretcher and placed in the ambulance.

Hospital Course

During transport, there’s a discussion on whether it would be better to transport to the hospital or rendezvous with an ALS ambulance. Seven minutes later, you arrive at the hospital and give the receiving staff a handoff report.

At the end of the report, a voice from the back of the room interjects, “Good job you guys, let’s stop there.” It’s the training officer. He’s been monitoring the whole process, documenting times and logging the events of the arrest. The patient was a manikin, the ambulance was a simulated space and the ED staff was composed of other team members.

As the team silences the flow of oxygen, turns off the AED and begins putting the kit back together, the training officer asks, “So how did that go?”

The team leader says with a light chuckle, “Better than the last one.” And with a bit of levity, the debriefing begins.

After a lively conversation about the good things, the unclear things and things that could be done better next time, the training officer says, “OK, let’s get reset and work through another case.”

Discussion

Train like you’re gonna fight” is the educational battle cry that echoes in EMS classrooms across the country. Educators are coming to the realization (or are having their preconceived notions proven true) that scenario-based education is superior to the classroom lecture.

EMS is a team sport: Providers work together with the single goal of making the patient better. To this end, assessments are conducted, treatment plans are established and skills are performed simultaneously in an effort to relieve the patient’s symptoms and bring them back to some degree of stability.

This wonderful orchestration of prehospital patient care can’t be perfected by sitting in a classroom, watching slides and listening to the expert of the day talk about best practice. Like a sports team with a playbook full of strategically placed Xs and Os , plans in EMS must also be taken to the field and rehearsed.

The skills required for appropriate patient management can’t be mastered by reading the textbook or protocol manual. Skills need to be rehearsed again and again, then incorporated into scenarios where providers can integrate them into patient care plans.

In primary EMT and paramedic classrooms across the country, EMS instructors are increasing the amount of hands-on scenario training. Training officers are presenting continuing education (CE) in the form of scenarios rather than lectures. Workshops are being offered to help educators learn to develop scenarios better designed to teach and evaluate provider performance.

In January 2017, the National Registry of EMTs is changing the paramedic practical exam to include a scenario test. Currently, the most common method of recertification only requires that providers sit in a classroom for a number of hours, where a required topic is discussed at length. Think about the last time you ran a scenario in a CE session and then had the opportunity to discuss your performance.

Conclusion

Participating in scenarios increases critical thinking skills, helps perfect those skills, and can enhance teamwork. As an EMS provider, we should look for the opportunity to participate in scenario training. As educators or training officers, we should work to deliver content through scenarios and simulations rather than via projected images and lectures. It takes more work on everyone’s part, but in the end, it can result in better providers, patient care and patient outcomes. Plus, it can be fun!