Literature Review: Simulation Training With a Low-Tech Manikin

   Bredmose PP, Habig K, Davies G, et al. Scenario based outdoor simulation in prehospital trauma care using a simple manikin model. Scand J Trauma Resusc Emerg Med 18:13, Mar 15, 2010.

Abstract

   This is a description of a system of scenario-based training using simple manikins under realistic circumstances for the training of prehospital care providers. Methods--A simple intubatable manikin is used with a training version of the equipment used by the physician/paramedic prehospital care team. The scenarios are outdoors and led by senior physician facilitators. Pilots, firefighters and medical students are utilized in scenarios to enhance realism by taking up roles as bystanders, additional ambulance staff and police. These scenario participants are briefed, introduced to the scene in a realistic manner, [and then] assess, treat and deliver a hospital handover as they would in a real mission. A formal structured debriefing then takes place. Results--This method has been used for the training of all London Helicopter Emergency Medical Service (London HEMS) doctors and paramedics over the last 24 months. Informal participant feedback suggests this is a very useful teaching method in improving motor skills, critical decision-making, scene management and team interaction.

   Discussion--The teaching and maintenance of prehospital care skills is essential to an effective trauma care system. Simple manikin-based scenario training is feasible on a day-to-day basis and has the advantages of low cost [and] rapid set-up and turnaround. The scope of scenarios is limited only by the imagination of the trainers. Significant effort is made to put the participants into "the zone"--the psychological mind-set where they believe they are in a realistic setting treating a real patient. The method can be used for learning new skills, communication and leadership, as well as maintaining existing skills.

   Conclusion--This is a low-technology, low-cost alternative to high-technology simulation that may provide a useful adjunct for both induction and regular training of prehospital trauma care providers.

Comment

   Simulation training has long been used for learning new skills and maintaining proficiency. To most effectively create "psychological fidelity," the ability of trainees to suspend disbelief and perceive the scenario to be a real patient encounter, the simulation equipment and environment must mimic the real world. As technology has advanced, manikins have become increasingly capable. However, research has not shown that use of more-capable manikins results in better learning than use of simpler ones. In addition, the complexity, cost and fragility of the devices make them less suited for prehospital training.

   This study presents a shift in focus: using simple manikins, but in a more real-world setting. Simple manikins cannot talk or become diaphoretic and cyanotic. But they can be used to train a team to assess a scene; extricate a victim from a crushed truck in inclement weather while simultaneously managing the spine, airway and obtaining vascular access; transport and hand off to hospital personnel. Also, rather than setting up a single expensive resource in a fixed location, this approach allows an organization to have a number of manikins that can be used in a variety of realistic situations.

   The authors list the important components of effective simulator training. Manikins must be life-size, durable, washable and have realistic airway anatomy. Medical packs must be the same as those normally used. Teams should train together and use actors to simulate other on-scene personnel. Scenarios must be carefully planned and monitored and conclude with structured debriefings.

   This approach is particularly well suited to prehospital care. EMS systems should evaluate whether it may have a role in their primary training, team training, refresher courses, skills maintenance and/or QI programs.

   Editor's note: The full text of this journal article is available for free on the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine website. See www.sjtrem.com/content/18/1/13.

   Angelo Salvucci, Jr., MD, FACEP, is medical director for the Santa Barbara County and Ventura County (CA) EMS agencies.