Columns, Training

Improving Patient Safety with Simulation: Patient Handoff, Airway Management and Bariatric Patients

Issue 12 and Volume 42.

Simulation to improve handoff, airway & bariatric patient safety

“Safety is defined and measured more by its absence than its presence.”-James T. Reason

In our last column, we discussed an EMS patient safety culture as it relates to the 10 EMS safety goals identified by the Center for Patient Safety.

In our next two articles, we’ll discuss in more detail the remaining EMS identified patient safety goals. (Table 1 provides examples of simulation activities for building a culture of patient safety into your students.)

Table 1: Simulation activities to improve patient safety

Handoff of Care

It’s estimated that handoff of care is the most dangerous point in patient care that can lead to medical errors. Vital information can easily be lost in translation or forgotten if not provided in a written format.

Due to the risk involved, adopting a standardized mechanism to handoff patients between healthcare providers is essential to improving patient safety.

Throughout healthcare, a well- accepted acronym for improving patient handoff is the acronym SBAR, which stands for situation, background, assessment and recommendations. Patient handoff is an EMS safety goal that can overlap into most EMS simulation activities.

Airway Management

EMS providers know first-hand how difficult managing an airway in the prehospital environment can be. The environment alone serves as a difficult factor adding to the complexity of the procedure. Proficiency in basic airway maneuvers is as vital as advanced techniques.

Simulation activities must include objectives beyond uncomplicated, commonly performed airway skills. It’s important to develop activities that place manikins in environments that mimic the EMS patient care environment.

Many education programs place manikins on tables or at waist height, which doesn’t provide a realistic environment for providers to achieve or maintain airway competency.

Utilizing real or simulated ambulance space is important for mental mapping related to equipment set-up during a procedure within the ambulance. Proper equipment set-up is shown to improve airway management success rates.

Objectives that require emphasis on both basic procedures and assessing for airway difficulties reinforces the importance of systematic approach, which improves provider success.

Utilizing pictures to allow individualized assessment is an easy way to modify an already existing vetted scenario. If an actual patient would be diaphoretic based on the scenario, then mimic those factors during the simulation activity to promote practicing as real to life as possible.

Recreating opportunities to perform high-risk/low-frequency procedures is important for maintained competence at all healthcare levels.

Activities should include teamwork and communication techniques especially in complex, high-acuity cases. Lastly, developing activities that promote interaction with varied level EMS providers can also be important for improving patient safety culture.

Bariatric Patients

It’s reported that 30% of adult patients are obese. EMS system culture often ridicules providers that request a lift assist. This culture is detrimental to provider safety in EMS.

Even if an agency’s culture has evolved and personnel are provided with bariatric equipment and encouraged to request assistance, some experienced providers resist the change of procedure and place themselves and their patient in an unsafe environment.

Overcoming these intrinsic hurdles brings us next to the bariatric patient assessment. Bariatric patient assessments require unbiased, non-judgmental interaction.

Anatomical changes present in bariatric patients may complicate otherwise simple skills like ECG application or repositioning for obtaining lung sounds.

Simulating the complexities of bariatric system response and care requires creative simulation design for suspension of disbelief. Recruiting bariatric standardized patients can assist in achieving a real-life patient interaction experiences and realistic evaluation of communication techniques and patient treatments.

Enhancing the use of the EMS safety goals into simulation activities is important to achieve improved EMS patient safety.


Enhancing the use of the EMS safety goals by incorporating them into simulation activities is an important way to achieve a culture of improved patient safety. Many of the patient safety goals can be integrated into a single EMS simulation activity, since they’re prevalent on most EMS patient interactions.

Although we’ve provided some ideas for sample activities in this column, remember to be creative and come up with ideas of your own; the possibilities for incorporating EMS safety goals as learning objectives for simulation activities are endless!


• Bigham BL, Buick JE, Brooks SC, et al. Patient safety in emergency medical services: A systematic review of the literature. Prehosp Emerg Care. 2012;16(1):20-35.

• EMS Forward. (2016.) Center for Patient Safety. Retrieved Oct. 28, 2017, from

Learn more from Jennifer McCarthy, Amar Patel, Andrew Spain and Timothy Whitaker in the full-day EMS Today preconference workshop, “Stimulating Simulation: A deep dive into EMS best practice of simulation techniques,” held at the new, ultra-modern MEDIC Simulation Center in Charlotte, N.C., on Feb. 20, 2018. Visit for more details and to register.