The role of simulation training in the education of healthcare providers continues to grow alongside increased emphasis on competency-based benchmarks.
Simulation training has widely been accepted as a beneficial teaching strategy since it provides a safe learning environment where students can experientially learn and increase their confidence, knowledge, leadership, teamwork and communication skills.1–3 It also allows for learning opportunities across disciplines (e.g., nursing and paramedicine).
An interdisciplinary simulation training exercise places EMTs and paramedics on the frontlines of healthcare and disaster responses in coordinated efforts with other first responders and in-hospital providers.2 Benefits of this approach include breaking down the “us vs. them” mentality, increasing patient safety and decreasing medical errors, and better preparing students for their real-world functions on healthcare teams.2,4
The author of a national study of paramedic and nursing students’ readiness for interprofessional learning (IPL) said, “If universities fail to incorporate IPL and promote collaboration within paramedic curricula they perpetrate disservice not only to the students but also the community at large.”4
Last year, the paramedic program at Creighton University in Omaha, Neb., organized their annual mass casualty incident (MCI) training for soon-to-graduate paramedic students, which included active roles for accelerated nursing students from Creighton University, an Air Methods helicopter paramedic and nurse transport team, the state of Nebraska EMS medical director and two emergency medicine residents. This article describes the experiences of students and serves as one example of how EMS programs can engage in interdisciplinary simulation training.
For some paramedic students, this was the first taste of what an MCI is like.
Gas & Smoke
This training exercise was hosted by the City of Bellevue Nebraska Fire Department and held at their burn tower and training center, and is supported by Papillion (Neb.) Fire Department. A group of paramedic students was assigned for initial response to a scene where a demonstration and protest was occurring. Initial dispatch reported several calls for a smell of gas in the area with utilities en route. Upon arrival, the first responding team found smoke coming from the ground level of the burn tower.
The scene quickly developed into a small explosion involving 30 patients with a variety of traumatic injuries and a few experiencing a medical emergency. From there the initial response team requested additional services, some of which experienced delays in their response. Ambulances were used to transport patients from the the burn tower, to the the training center, which was transformed to an ED where nursing students and emergency residents waited to receive the field report, transfer of care, and provide assessment and treatment.
One of the main goals of the drill was to make it as real as possible, including a medical helicopter landing on scene. The students were pushed to think quickly to assess and treat each patient.
Following the scenario, paramedic and nursing student leaders were tasked with providing a group reflection on the learning experience.
Paramedic Students Reflect
None of the students knew what the incident was going to be, or what sort of patients were going to be presented. According to one paramedic student, “I liked not knowing what the scenario was going to be or what incident happened because it made it more real and made us think on our toes. Also, having real actors added the extra adrenalin and real-life complexity to the event.”
As responders, you don’t know what the situation is going to be until you get on scene and see what the damage is and how many patients are present. First responders have to be careful about not only the patients’ safety, but also their own.
Another paramedic student stated, “I liked having a large number of volunteers with a few curve balls incorporated into the scenario such as the lawyer and the patient that kept walking back into the scene. I also appreciated being one of the first crews to respond. It really added to the gravity of the scenario and made me realize how daunting and intimidating of a task it can be.”
This MCI training proved to be beneficial and serve as a
simple example of the benefits of interdisciplinary
training between paramedic and nursing students.
One paramedic student who’s also a career firefighter who has experienced real-life MCIs reflected on the similarities and differences of the drill: “Practicing an MCI helps with muscle memory. If you do something enough, you can do it without thinking about it. You get to go through the motions and critically think about it in a more relaxed setting.”
Another student stated, “An MCI is hectic, and communication is a must to accomplish the given task. Luckily … MCIs are relatively uncommon. The primary difference between a drill and the real thing is having to do a real assessment on an actual patient. The patient will be exhibiting real signs and symptoms instead of acting them out and having a sheet of paper with vitals written on them. Along with having a real patient in front of you, the adrenaline and awe of a mass casualty or similar disaster puts your mind in a different place entirely.”
The similarities and differences are seen throughout the drill, but knowing how to handle each situation that is thrown at you, is the way to practice for success.
As a whole, most of the paramedic students found the drill to be a success, preparing them to better respond to an MCI. For some, this was the first taste of what an MCI really feels like: hectic, scary and life-threatening. But, with the practice of triaging, treating and transporting patients, and evaluating our response, they were able to reflect on how to be better paramedics.
As one student remarked, “It did a great job preparing me for a real-world MCI. I can study from a textbook all day but it’s completely different when it has to be applied. The drill showed me new ways to work as a team, how to use limited resources, communicate with people of various roles, handle a large number of patients, and talk to patients in tragic and hectic scenarios.”
The Nursing Perspective
Many BSN programs, including Creighton’s, are built around developing generalist providers who can then branch out into specialized positions, such as emergency medicine—an environment they often don’t have the opportunity to explore. For the accelerated nursing students, participating in this MCI drill allowed for a rare, firsthand experience of emergency medicine.
Like the paramedic students, a general consensus among the nursing students was that they didn’t know what to expect going into this drill, but they found it allowed them the experience to become familiar with triage, employ trauma surveying of patients, and utilize critical thinking skills as well as understand the different roles EMS and hospital personnel can take in an emergent situation.
Lack of exposure to emergency medicine and the personnel that are involved has also created gaps in understanding the role of EMS. Before the MCI drill, many of the nursing students were unaware of the scope of practice that EMS operates under. The experience allowed them insight to the impact that EMS has on care management in the field and hospital environment, and emphasized how EMS and nursing providers must work as one team to provide care to critically ill patients.
Participating in this MCI allowed for the nursing students to see the care that EMS provides before patients are brought to the hospital as well as how that care is bridged into the hospital. It gave nursing students a foundation to create a unified team that includes EMS, and helped them to understand that both roles share the commitment to provide safe and effective care to all patients.
Paramedic students transfer a patient to the scenario’s
ED, where nursing students take over patient care.
Following the drill, a formal debriefing took place. Based on the reflections of both student groups, educators felt this MCI training experience was received well and was beneficial to participants’ paramedic or nursing education and training as both groups of students increased their awareness of one another’s roles at an MCI and recognize that healthcare is a cooperative, interdisciplinary profession.
The outcomes of the drill support the findings of a recent study, which discussed the impact of simulated interprofessional education among nursing and paramedic students. The researchers’ data suggested a correlation between how active a role the student had in the simulation—the more active the role, the greater the increase in the student’s attitude toward interprofessional education and training, as well as higher confidence
Organizers of this annual interdisciplinary MCI training drill are excited about the results and are already looking forward to future training opportunities, including practical ways to incorporate students from other health sciences in an effort to build additional bridges between disciplines.
As Eric Ernest, MD, EMS medical director for the state of Nebraska and associate medical director for Creighton EMS, explains, “The MCI drill is a phenomenal training opportunity not only for our paramedic students, but as an interdisciplinary drill for our other healthcare practitioners. While never truly replicating a real disaster, this drill allowed some of our students and physicians in training to experience some of the intricacies and stressors of a real-life disaster. Given the incidents that have happened around the world lately, this training becomes all the more timely and important. I would hope that we could expand this training in the future to include more types of healthcare providers to better prepare everyone for when the real disaster comes.”
Support for interdisciplinary approaches in healthcare education continues to grow. The nature and role of EMS and nursing support interdisciplinary approaches in education and training. From the reflections of students participating in Creighton University’s annual MCI drill, both groups of students broke down professional barriers and increased their understanding of the role each group plays in providing patient care, strengthening the link between out-of-hospital and in-hospital emergency care.
1. Furseth PA, Taylor B, Kim SC. Impact of interprofessional education among nursing and paramedic students. Nurse Educ. 2016;41(2):75–79.
2. Leggio WJ, D’Alessandro KJ. Support for interdisciplinary approaches in emergency medical services education. CJIL. 2015;1(1):60–65.
3. Gough S, Hellaby M, Jones N, et al. A review of undergraduate interprofessional simulation-based education (IPSE). Collegian. 2012;19(3):153–170.
4. Williams B, Webb V. A national study of paramedic and nursing students’ readiness for interprofessional learning (IPL): Results from nine universities. Nurse Education Today. 2015;35(9):e31–e39.