Background
Bystander CPR can double or triple a patient’s chance of surviving a cardiac arrest. Unfortunately, it is also an intervention that is often underperformed due to persistent barriers including bystander fear, lack of knowledge and stress of the incident. Mecklenburg EMS Agency (Medic) is attempting to address these major barriers by reimagining the approach to telecommunicator training, a sometimes overlooked critical link between the bystander and the patient.
Telecommunicators are the only first responders who can equip bystanders in the moment with the knowledge and tools to engage with a patient, control the call environment, provide direct instruction and coach the caller prior to EMS arrival. According to North Carolina CARES data, the two most frequently reported barriers to bystander CPR are that the caller is unable to move the patient and that the caller is too distraught to follow instructions.
Below, we will review the details of a novel style of simulation-based training that aims to improve the connection between telecommunicators and callers, and further support bystander CPR performance from the 911 call center.
Simulation-Based Training in EMS
Simulation, or the imitation of a clinical experience, is a common tool used to train and evaluate EMS personnel. It is used in EMT and Paramedic courses when acquiring certification, and is often incorporated into ongoing education, training, and evaluation at EMS agencies.
Simulations designed for telecommunicators are less regularly integrated into training and present an opportunity to expand the role this training plays in EMS response. A simulation for a telecommunicator audience should include a realistic scenario experience that replicate the call-taking experience, pose realistic barriers, and include a debrief session to review performance and best practices.
Telecommunicator simulations traditionally mirror a 911 phone call while a trainer observes to provide feedback following the scenario. However, Medic educators believed it could be beneficial to rethink the approach to telecommunicator simulations and explored new options through a series of small-scale tests and direct telecommunicator feedback.
Building on existing resources and practices mentioned above, Medic tested a new approach that incorporated video review debriefs into the simulation process. These video debriefs allowed telecommunicators to take part in a traditional style of simulation, but with the added ability to review the call both from their perspective and that of the caller.
This was accomplished by a two-part simulation training. The telecommunicator first worked their way through the simulation in their typical environment. They had access to their standard ProQA prompts and only interacted with the caller through the phone. In this case, they were responding to a caller with a family member suffering a cardiac arrest.
Afterward, when reviewing the call with their trainer, they watched a video from the side of the caller, allowing them to hear and see themselves providing instruction while simultaneously seeing how the caller carried out this instruction in a realistic environment. To achieve this, the simulation was performed simultaneously by the telecommunicator and the caller, each in isolated locations. Each side was recorded, and then the videos were merged for a side by side review during the debrief.
You can watch the full simulation here.
Feedback
Feedback from telecommunicators and process owners has been overwhelmingly positive. Telecommunicators shared that the simulation was “very similar to a real call with real resistance and hesitation.” A telecommunications trainer who accompanied her trainee shared, “the trainee definitely benefitted from it, and it was a huge step up from talking through scenarios. The simulation felt just like the real thing.”
When asked about the video debrief, participants shared the following thoughts:
“I like the video because most people who come to communications don’t come from the field so there can be a disconnect. This lets us see what callers do with our direction and serves as a good reminder to take pauses, not speed through instructions, and be able to picture what we are actually asking from their caller on the other side.”
Another participant offered:
“It helped to put me in the caller’s shoes. I think it was also good because when I was in training, we never had to listen to one of our calls until much later, and it’s always nerve wracking listening to yourself. But getting that out of the way early and on a simulated call is a good thing and helps break down the discomfort.”
One of the more veteran telecommunicators to take place in this simulation even shared about how the training prepared her in ways she couldn’t have expected.
“I tested with a scenario that I have never done before – and I always end up with a cardiac arrest. But I have never had to explain all the way through how to move the patient off the bed with sheets. In the simulation, I had to do just that, and got to practice clicking through those responses and getting comfortable with it. After the test I knew how to do it, and then two days later I had the exact situation and felt so prepared. The caller was older, the patient passed away in the bed, and she was unable to move him. I had to walk them through exactly my scenario and it was definitely such a confidence boost to have just gone through that practice run.”
Lessons Learned
The integrated simulation training provides the best of both worlds: the initial simulation replicates a realistic call-taking environment, while the debrief session provides a behind the scenes look at what a caller might be experiencing on the other side of the phone.
This training addressed the most consistent barrier to CPR – an inability to move the patient- while also incorporating elements that challenged our telecommunicators’ ability to manage the caller. These obstacles are known barriers to bystander CPR, and preparing our telecommunicators for these likely hesitations may help to promote bystander CPR rates.
Additionally, this training style could help to better connect dispatcher to their callers, provide a deeper understanding of what directions look like when carried out by a bystander, and allow telecommunicators a safe and low-risk environment to gain confidence providing bystander instruction for medical emergencies.
While the first-round telecommunicator simulation training was limited to addressing barriers to bystander CPR, it has far-reaching applications for any time-sensitive emergencies where bystander intervention is key (i.e.: choking, suspected overdose, anaphylaxis, or bleeding control). Medic looks forward to exploring how this training practice can be further incorporated to enhance pre-EMS arrival care from bystanders empowered by telecommunicators.