Introduction
Resuscitation and advanced cardiac life support (ACLS) can be extremely demanding for individual rescuers and multi-rescuer teams.1 In order to achieve maximum effectiveness, high-performance resuscitation requires rescuers to be competent in performing various components of a technically-demanding workflow during stressful and time-sensitive situations.
These pressures are increased in the out-of-hospital or prehospital environment because the immediate surroundings of resuscitation vary considerably between patient encounters and there might be less control than the in-hospital environment. Resuscitation of out-of-hospital cardiac arrest, specifically, is unique because it is a high-stakes situation that occurs relatively infrequently, meaning many emergency medical services (EMS) crews do not get very many opportunities to perform real cardiac arrest management .2 Simulation has proven to be a valuable tool in improving resuscitation performance; for one, it allows teams to practice complex scenarios.3
Both sensory deprivation and sensory stimulation are gaining popularity within the medical simulation community as viable educational tools.4 We incorporated sensory deprivation and sensory stimulation into resuscitation simulation training for a handful of firefighter/paramedics from a fire department within a major metropolitan area (Video 1/Figure 1).
Figure 1. Sensory Stimulation and Deprivation as Resuscitation Training
All scenarios involved the use of a high-fidelity simulation manikin, as well as most of the normal EMS equipment utilized during normal day-to-day operations (e.g. airway bag, cardiac monitor, “first-in bag”). The simulations described were conducted in a dedicated EMS simulation training facility in a room with advanced audiovisual capabilities.
Sensory Stimulation
Sensory stimulation was achieved through the use of flashing multicolored strobe lights, extremely loud music, and artificial fog in a darkened room. Rescuers were told they were responding to a person found unresponsive at a rock music festival.
A member of the simulation team played the role of the victim’s “friend” – they initially provided a brief history about the patient to rescuers but then acted as a hindrance after all pertinent information had been provided. For instance, they would interrupt the participants and ask questions, like “what are you doing?” or “is the patient going to be ok?”. In order to be most successful, participants had to ask the friend to leave the scene. This simulated one potential distraction that may be found in an out-of-hospital resuscitation.
While being subjected to sensory stimulation, rescuers were largely unable to communicate by voice with each other and had to rely on gestures and mutually-shared trust between one another. This scenario also challenged rescuers’ abilities to perform technical skills. For instance, obtaining intraosseous access, drawing up medications, performing endotracheal intubation, and interpreting a cardiac monitor were all complicated by the darkened environment, flashing lights, and loud music.
Groups that were successful were very proficient at the specific skills needed (e.g. vascular access, interpreting a cardiac rhythm, endotracheal intubation), could make appropriate decisions in spite of the challenging environment, and had sufficient trust between participants to accomplish the necessary steps of the resuscitation.
Sensory Deprivation
Sensory deprivation was achieved through the use of a blindfold. Rescuers entered a room with an unresponsive patient lying in the center. They had to first locate the patient while blindfolded, assess them, and then initiate care based on their assessment. Participants were verbally given information as they progressed through the scenario – for instance, if participants connected the patient to a cardiac monitor, they were told the heart rhythm and vital signs.
For safety, any equipment that had the potential to injure participants (such as sharp objects) were removed prior to beginning the sensory deprivation simulation, and facilitators were in the room with participants. In this simulation, rescuers had to optimize verbal communication in order to clearly describe everything they were doing to their partners. Groups that were particularly effective organized themselves and their equipment immediately after identifying the patient: this allowed them to clearly determine which rescuer should perform what task (e.g. airway management for the person by the head) and where specific pieces of equipment will be.
Furthermore, successful groups were intimately familiar with their equipment, including where specific items are located in their “first-in bags” and how to connect a patient to their cardiac monitor.
Conclusions
All participants reported both the sensory stimulation and sensory deprivation scenarios as being good opportunities to practice various aspects of resuscitation, including teamwork, communication, and the performance of specific skills.
From a training perspective, both simulations were also good opportunities to assess how well individuals were able to communicate and delegate tasks between them and their partner. Thus, introducing sensory stimulation or deprivation may also be good methods to evaluate the effectiveness of clinical teams or add a new level of complexity to training.
Teams that are able to perform effectively in these challenging environments have the potential to perform very-effectively in the likely less-challenging circumstances they normally encounter. We report here the preliminary success of sensory stimulation/deprivation as resuscitation training techniques and encourage other rescuer teams to utilize this approach as part of their training.
Conflicts of Interest: None
Funding: None
References
- Hunziker S, Johansson AC, Tschan F, Semmer NK, Rock L, Howell MD, Marsch S. Teamwork and leadership in cardiopulmonary resuscitation. Journal of the American College of Cardiology. 2011 Jun 14;57(24):2381-8.
- Czekajlo M, Dabrowska A. In situ simulation of cardiac arrest. Disaster and Emergency Medicine Journal. 2017;2(3):116-9.
- Wayne DB, Didwania A, Feinglass J, Fudala MJ, Barsuk JH, McGaghie WC. Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case-control study. Chest. 2008 Jan 1;133(1):56-61.
- Weston-Price J, Kallappa C. Sensory deprivation and simulation to promote team working for medical students. BMJ Simulation & Technology Enhanced Learning. 2020 Nov 1;6(Suppl 1):A48-.
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