Since it’s inception in 2009, the Chicago Fire Department’s (CFD) simulation training center (STC) has provided countless hours of clinical experience and training to EMS and first responder providers throughout the city of Chicago. The STC is dedicated to a five-part mission: simulation, education, research, peer sharing and performance improvement.
Since the summer of 2012, the STC has expanded its scope beyond an advanced airway course and crew skill maintenance to include a variety of additional courses. These include:
- Incident Command for Cardiac Arrest;
- Tactical Special Weapons and Tactics (SWAT) for EMTs;
- Law Enforcement Medical and Rescue Training;
- WMD and All-Hazard Incidents; and
- An internship program.
- The most expansive of these recent changes is the ICCA course, which seeks to train approximately 4,500 active members that make up the emergency responder populace in Chicago.
Incident Command for Cardiac Arrest
Across the United States, approximately 383,000 cardiac arrests occur out of the hospital. However, less than 8% of the people who suffer an out-of-hospital cardiac arrest survive.1 Therefore, there exists a need for out-of-hospital cardiac arrest management reform in Chicago and other EMS systems.
As part of the statewide Illinois HeartRescue Project launched in August 2012, the CFD instituted an Incident Command for Cardiac Arrest (ICCA) course that emphasizes a revised team-based approach to treating sudden cardiac arrest in the prehospital setting.
The primary goal of the ICCA program is to increase the percentage of successful prehospital resuscitations in the CFD EMS System, as well as increase the number of cardiac arrest patients discharged from the hospital neurologically intact.
The new approach focuses on a code commander who’s tasked with overseeing the operation of the cardiac arrest treatment and monitoring the status of all team members. This method also emphasizes the importance of early defibrillation, high-quality uninterrupted chest compressions, minimizing gaps between performing compressions, and not moving the patient prematurely.
The ICCA course was developed to be taught in two stages. The first stage consists of a mandatory 70-minute didactic lecture that covers the need for the course, highlights roles and responsibilities of emergency personnel, and stresses relevant cardiac arrest statistics and data.
The second stage utilizes the capabilities of the CFD STC to reinforce the primary tasks of the ICCA program. Small groups of on-duty emergency medical companies (both fire and EMS) get hands-on practice for CPR skills. These practice sessions utilize high-fidelity Laerdal simulators to give real-time feedback of compression depth, rate and accuracy. The data is displayed for the ambulance and engine crewmembers so they can assess and improve their technique with assistance from the instructors.
Simulating a Cardiac Arrest Call
Following the hands-on practice sessions, participants are placed into a 15—20 minute out-of-hospital cardiac arrest simulation that’s specially designed to give responders a truly lifelike experience using the new ICCA approach before they’re called upon to apply it in the field.
The scenario takes place in the open street area room, one of several mock rooms in the state-of-the-art STC. The class is monitored and recorded by the instructors in the control room, who watch as students treat advanced patient simulators with actual interventions they would use in the field, such as an automated external defibrillator LifePak 1000 or LifePak12 defibrillator/monitor and a quick response bag (QRB), which contains medication and critical life-saving equipment for IV/intraosseous (IO) access and airway management.
The student-driven scenario stresses the significance of high quality chest compressions, limiting time off of the chest, and early defibrillation. If the correct interventions aren’t performed in a timely manner, the resuscitation is unsuccessful.
The scenario starts with actual dispatch information from the instructors in the STC control room to 2—4 participants acting as an initial responding CFD first response engine company. Additional participants “arrive” as needed, increasing the manpower to a preferred CFD cardiac arrest team. These new arrivals carry out secondary code tasks, such as the establishment of IV access.
Following each simulation, a non-judgmental educational debriefing is held which provides the participants with direct feedback on the quality of their team’s chest compressions, ventilations, and overall effectiveness. In addition, the students are able to watch a video of their team as they perform the ICCA skills and engage in an open discussion on what they did well or what they could improve on.
The CFD STC has started preliminary data collection through the SafetyPAD EMS information management system to compare cardiac arrest runs prior to the ICCA course with runs handled after the launch of the class. This research focuses on comparing the amount of time CFD engine companies spend on scene, proper defibrillation technique (timing and number of shocks delivered), time spent off the chest of the patient, use of their Lifepak monitor/defibrillator, and the patient’s ultimate outcome. The data will be compiled and presented in a future paper.
Tactical SWAT for EMTs
Tactical teams must operate flawlessly in a hostile environment. Tactical EMS members, trained EMTs with an advanced scope of practice, are integrated into the individual assault teams of the Chicago Police Department (CPD) SWAT team to provide quick self-help and buddy-help to their fellow tactical team members. To ensure training of both tactical EMS and their law enforcement counterparts, the CFD partnered with the CPD to develop a high-intensity simulation. First held in December 2012 for tactical EMS team members of the CPD and FBI SWAT teams, the special 16-hour tactical course takes place over two days and includes four hours of didactic lecture, four hours of psychomotor skill training and eight hours of simulation.
The course content covers a wide range of lifesaving interventions, including the application of hemostatic agents that control severe bleeding, such as QuikClot; the proper usage of the combat application tourniquet (CAT); starting IO infusions; and needle chest decompression.
A number of high-fidelity scenarios were designed to hone the clinical skills stressed in lecture. These scenarios take place in the CFD STC and utilize advanced patient simulators that yell, cry, sweat and bleed to enhance the realism of each simulation. Scenarios vary from a fellow SWAT member who develops chest pain during an operation to a complete, complex SWAT rescue mission that involves an active shooter. This scenario places the Chicago SWAT members in a combat situation, which requires the use of training flashbangs, actual weapons with simulated ammunition, and all of the skills stressed in the lecture and hands-on/simulation training.
Law Enforcement Medical & Rescue Training
The Law Enforcement Medical and Rescue Training (LEMART) course, developed by members of the CPD. is an eight-hour course reviewing the concepts of special direct pressure bandages, application of the CAT and the use/application of QuikClot hemostatic agent. Concepts are taught through a combination of didactic lectures, hands-on skill stations, and virtual reality simulation cases. The course also has a refresher on hands-only CPR that utilizes the same Laerdal advanced patient simulators and incorporates role players to serve as bystanders or other victims in the scenarios.
WMD & All-Hazard Incidents
A special hazmat-focused course, Emergency Medical Response to Weapons of Mass Destruction (WMD) and All-Hazard Incidents was created through a joint effort with the CFD and the Northeastern Illinois Public Safety Training Academy. The eight-hour course rolled out in June 2013 and focuses on biological, chemical and radiological incidents in addition to emphasizing the importance of scene awareness and scene safety.
Consisting of didactic lectures and a facilitated group discussion that reinforces the use of appropriate personal protective equipment (PPE), the concepts of proper scene size-up using the RAIN (Recognize, Avoid, Isolate and Notify) acronym, working within the incident command structure, proper performance of triage in cold and warm zones, and how to rapidly deploy and operate decontamination at incidents.
The course expands on the material through 225 minutes of simulation divided into chemical hazard, biological hazard and radiological hazard incidents. Each scenario uses a combination of video and hands-on skill practice with the STC’s high-fidelity simulators.
The class begins with participants watching a first-person video segment that simulates their arrival onto a potential hazardous material scene. Then, a small group selected from the class enters into a scenario through the use of the STC’s mock rooms and delivers care to high-fidelity simulators. The rest of the class watches them live from the classroom on a large video monitor.
The class synthesizes the material by applying the lessons stressed in these incidents to routine calls in order to relay the concept that scene awareness is crucial to every run. Students learn taking the extra time to step back and analyze the situation prior to responding could expose hidden threats that could be lethal to both patients and themselves.
All participants in this demanding simulation course take pre- and post-tests to gauge the retention of the training.
Internship Program
The CFD STC internship program began in May 2012. This program allows college students to gain valuable experience in EMS and prehospital care and enables interns to work closely with CFD Medical Administration and Regulatory Compliance Division staff and become involved with high-fidelity simulators within the STC’s state-of-the-art facilities. In addition, interns have the opportunity to assist with organizing and running scenarios, thereby introducing them to computer and manikin simulation programs.
Interns learn how to write scenarios for the patient simulators utilizing scenario-writing software and help apply moulage to human and manikin simulators with a large array of makeup and accessories to create realistic looking injuries.
They’re also given the opportunity to go on ride alongs with CFD ambulance crews to get firsthand experience in the prehospital atmosphere and have the option to work on CFD STC research projects. This program provides a unique source of clinical and research experience for those interested in a career in the medical field.
Conclusion
The CFD operates a modern, robust simulation training center and offers courses deemed critical to highly demanding field operations. Simulation participants have found each program to be an important educational experience designed to assist them in the performance of their duties and, most importantly, keep them safe while doing so. Several of the simulation programs cross agency boundaries and enable all involved team members to work together in a cooperative and coordinated manner.
References:
1. American Heart Association. (June 2011.) CPR & sudden cardiac arrest fact sheet. Retrieved May 23, 2013, from www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/CPRFactsandStats/CPR-Statistics_UCM_307542_Article.jsp.
